There is a mass of evidence supporting the belief that adolescents are sexually active but do not use contraception, or do not use it effectively. There are a number of factors which may account for this:

(1) a belief in spontaneous behaviour; (2) lack of acceptance of their sexuality by themselves and by others, especially their parents and their teachers; (3) inadequate sex education; (4) inhibitions about obtaining contraception and actual difficulties encountered.

These headings are very arbitrary since all these factors are inter-related and it is difficult to know where to start.

A recent report by the Brook Advisory Centres, refers to the fact that in girls under 20, the numbers of illegitimate births and abortions have not shown any decline in the period 1966–77. It is also estimated that half the 40,000 teenage brides who marry each year are pregnant when they do so. It seems appropriate therefore, at this time, to look at the social and emotional factors that contribute to this situation.

For those interested in the patterns of adolescent fertility there is a lesson to be learned from the story about the Emperor's new clothes (Andersen, 1913). The problems, or lack of them, present themselves as starkly as the Emperor's, yet there is a tendency not to face the fact that in certain societies adolescent sexuality can create problems. The vast majority of parents, health personnel and policy makers seem to prefer to ignore what can be readily perceived. Conversely, in many areas of the world, there may be a tendency to announce the existence of problems which do not exist.

In the past 20 years at least 54 countries have passed legislation setting or raising the minimum age at marriage. How successful this legislation will be is questionable, especially when it runs counter to prevailing social and cultural institutions and beliefs, but it does reflect the growing international concern with delaying marriage. The deleterious consequences of early marriage are most evident in high birth rates and low status of women, both of which prevent poor countries from developing. Concern for postponing marriage has evolved from the larger objectives of stemming population growth and of guaranteeing women their basic rights. To raise the standard of health and education of the mother thus improves the welfare of the family.

In my professional work I could not escape the realization that a major part of human suffering arose out of ignorance of simple facts, unquestioning acceptance of tradition, and unhealthy social pressures. This realization made me plunge into the stormy waters of human sexuality and sex education of young people in particular. To them I gained personal access, as well as access through mass media. The response I received from our target population was most gratifying. The bulk of the material I now present was derived from some of the responses.

The population of African countries, typical of developing countries, is characterized by the large proportion of children and young people. An almost perfect pyramid illustrates the age distribution of Ghana's population (Text-fig. 1).

Projections of future population point to a further rise in the proportion of children (0–15 years of age) from the present 45% to 47–49% by the year 1980. The children of today will be the parents of tomorrow and for the adolescents the statement can be taken literally; the study of adolescents and their sexual and fertility problems, therefore, needs urgent attention. Especially in black Africa, these problems cannot be studied in isolation from the traditional, cultural and socio-economic environment. Indeed much of the psychosexual trauma of this group is closely interwoven with their complex backgrounds.