Doctors for Life International is concerned about some proposed amendments to the Sexual Offences Act. These are namely:

a) The lowering of the age of consent to homosexual activity from 19 to 16 years.

b) The allowance of sexual experimentation for children between the ages of 12 and 16 years, provided that the difference in age between the two children is not more than 3 years.

c) The position of homosexual offences in contrast with heterosexual offences.

Much research has been done in recent years concerning how people make health care decisions. Some of this research has been done in children, and some are particularly related to health care decisions made by children in relation to sexual activity. This research is very relevant to the formation of any law that will regulate sexual, including homosexual activity in children.

It is important to realise that the increased pressure for "adolescent rights to health care decision-making" has been limited to the area of sexual activity. Parental involvement has always been an integral part of the legal protection of minors; therefore, to justify the elimination of such involvement should be well substantiated with medical and sociological research. Some activists have systematically attempted to justify such changes on the shaky grounds that adolescents have the intellectual and cognitive ability to make such decisions on their own[i]. Recent research casts considerable doubt on these premises. The majority of international developmental psychologists consider adolescents to be developmentally unable to make decisions where abstract reasoning is required, as will be seen from the review of research findings below.

1. The Cognitive Ability of Children to Make Sexual Decisions

The proposed amendments envision children making decisions concerning their sexual health without the knowledge of their parents or guardians.

A child's ability to make rational choices depends on his or her level of cognitive development, and this is not related physiologically or anatomically to the maturation of the reproductive processes. The nervous system does not mature as early as the gonads (one of the masses of generative tissue giving rise to either an ovary or a testis) and psychology shows us that mature, adult reasoning is a late feature[ii]. Formal operational thought is the method of thinking that allows abstract thought and problem solving. Research has shown that this type of thinking commences at an age of 18 years and over, not 12 years as previously thought[iii].

It has been shown scientifically that adolescents do not function like adults and cannot be expected to always make logical decisions. Given a wide range of choices about sexual lifestyles, the adolescent will not choose one on a rational basis[iv]. This research also leads to the conclusion that adolescents are not sufficiently cognitively developed to allow logical decision-making or to use formal operational thought regarding sexual activity[v]. Adolescents have not fully reached the stage of operative thinking[vi]. At this stage (of operative thinking) people are able to imagine the future in such a way as to be able to foresee what might happen far ahead in time as a result of the present situation, and in such a way as to be able to take action based on these potential future situations.

Formal operational thought is obviously needed when considering the risks and benefits of a particular course of action. If someone is not sufficiently cognitively developed to think in a formal operative way, he is not sufficiently cognitively developed to give fully informed consent to a procedure. Adolescents have been shown scientifically to be deficient in:

a) imagining risks and future consequences,
b) appreciating the need for independent professional opinions in certain situations,
c) recognising the potential vested interests of health care professionals in providing certain information[vii].

Individuals capable of formal operative reasoning sometimes reason on a formal level, sometimes on a concrete level, sometimes on an affective level, and sometimes not at all. To complicate matters, adolescents who do employ formal thought may do so effectively in one area, but clumsily in another[viii]. The teen years are the transition between the juvenile incompetencies of childhood and the full responsibilities of adulthood. It is a time when adolescents mature and gain experience.

There are several characteristics of teenage thought that result in deficient reasoning abilities, and so a difficulty in predicting outcomes. Sixteen-year-olds consider themselves to be unique, living by different rules, and facing different probabilities and consequences from others. This results in a failure to infer probable outcomes, contributes to adolescent mortality, unemployment, drug abuse, sexually transmitted infections including HIV/AIDS, and pregnancy. Adolescents believe that they are unlikely to suffer from the negative consequences of their actions, and hence take risks that others would not[ix].

Teenage girls engage in emotional reasoning; they employ affective logic. For them, what they feel to be right is true. They tend not to employ deductive reasoning (to work from a certain premise towards a logical conclusion) or inductive reasoning (the ability to derive a general principle from observed particular instances)[x].

The adolescent believes be/she is invulnerable, and that the laws of probability does not apply to 'me'. When the individual is emotionally charged, this belief becomes even stronger, and is amplified even more when narcissistic gratification is on the line. Coupled with this is the belief that negative consequences will not accrue from sexual activity. His or her activity will not result in AIDS, sexually transmitted infection or pregnancy. Adolescents believe themselves immune to natural consequences[xi].

The ability to present an argument, to impartially analyse the data on which it is based, and to consistently draw accurate inferences from the data is a late-adolescent, young-adult phenomenon. It is seen only sparingly during the earlier years of adolescence[xii].

Just as the two-year-old cannot understand explanations that fall outside his or her personal experience, so too a teenager is unable to process information that lies outside his or her personal experience. When given material to learn, teenagers tend to memorise it, but cannot internalise it or apply it to other content areas. They also, like the two-year-old, believe they understand more than they do. They are not aware of their limitations and make judgements that are inappropriate.

Unfortunately, if the adolescent believes that he/she has enough information to become sexually active the errors that can result may be devastating to him/her. The major difference between a two-year-old and an adolescent in this case is that the adolescent can make bigger mistakes.

During adolescence the final shift to formal operations, the 'adult' type of thinking, begins. In the United States of America the majority of adolescents are concrete operational thinkers; they are not able to think and reason abstractly and accurately predict the likely consequences of their actions. There is a poor understanding of cause and effect. If an event occurs which was not planned, the adolescent thinker does not take responsibility for the outcome. It was simply an accident for which there is no direct decision and therefore, no responsibility. With adult thinkers, if an unplanned outcome does occur, they are prepared to take responsibility for it because they can evaluate the effectiveness of their own planning process. Just because they failed to anticipate something does not mean that they did not cause it to happen[xiii].

Thus an adolescent who is involved in sexual activity will not be able to conceptualise the effects of such sexual activity. It is outside of his/her experience, and as a rule adolescent thinkers cannot think in abstract terms. What they can conceptualise are their sexual feelings, and the feeling of gratification they give. Based on the above, and that an adolescent reasons according to feelings, it is unlikely for them to make the right decisions even if they are warned of the risks involved.

The teenager faced with an unwanted or unplanned pregnancy illustrates this point: If the concrete operating adolescent becomes pregnant the decision made will be the quick, immediate solution, which is an abortion. The concrete thinker cannot think into the future possibilities of bearing a child (which to her is outside of her experience) in abstract terms. She will also act according to how she feels at the time, using affective reasoning. She may feel her parents will 'kill' her if they find out, and because she feels this, it will be true to her. These are characteristics of adolescent thinking. They think like this just because they are not yet adult thinkers, or because, even if they are able to use formal operational thought, they are so emotionally charged at the time of an unplanned pregnancy that they characteristically revert to adolescent thinking.

Valid consent to sexual activity involves an exercise of choice, which in itself is dependent on information about the options available and the risks and benefits attendant on each one.

In order to make the right choices the adolescent must be able to anticipate long-term effects and weigh the cause and effect of these options. This is exactly the ability that is lacking in most high school students. In one study only 40% of the students in the senior year of high school considered long-term consequences in solving problems.

Biological and medical science indicates that children, presented with a range of options, will not be able to make an adult decision because they are unable to weigh up abstract concepts, the ~what if's" of the situation [xv][xvi].

Studies that have been done on the ability of children to make their own health care decisions compared younger adolescents (12-14 years old) with older adolescents (18-21 years old). The studies showed that adolescents between 16 and 21 years of age function in the same way as the younger adolescents. That is, they were equally incomp`etent. This is not surprising to developmental psychologists and probably to most parents[xvii]. It does not seem logical to remove the increment of wisdom, experience and skill that one would expect parents to provide.

In conclusion it is evident from these studies that young people up to the age of 21 are limited in a number of important ways in making their own decisions. The most noticeable is that they have a poor ability to use long4erm planning in making decisions, to recognise possible risks of intervention, and to use rational reasons for these decisions. There is no evidence to indicate that decisions regarding sexual activity, be it heterosexual or homosexual activity, suddenly allows adolescents to marshal extraordinary abilities[xviii].

2. Sexual practices of homosexuality and the health risks involved

Doctors For Life International is of the opinion that the proposed amendments to the Sexual Offences Act do not take into account some important facts about the sexual practices of homosexuality and the health risks involved.

Unlike heterosexual sexual practices, anal sex is a fairly standard component of sexual practices of homosexual nature. Anal sex contains various health hazards that vaginal sex does not contain, even in the case of adults:

1) Whereas the mucosa of the vaginal wall has several layers of squamous epithelium the anal mucosa only has one such layer. The multiple layers
of the vaginal mucosa protect against penetration of the mucosa by pathogens. Because of the anus only having one layer of epithelium, small tears in the mucosa are caused by anal intercourse. Furthermore, semen contains enzymes, which also erode the mucosa and decreases the barrier effect of the mucosa. The anus ultimately becomes a mixing bowl for semen and stools (with all the myriads of germs that are commonly found in stools). That, combined with the single layer mucosa, the tears in the mucosa, as well as the corrosive effect of enzymes in the semen makes the most common form of sexual activity amongst homosexuals, more dangerous than ordinary vaginal sex - even f no major injuries are inflicted.

2) It is further a fact that repetitive receptive anal intercourse, cause incompetence of the anal sphincter muscles leading to incontinence of
stools. This danger is amplified in the case of receptive anal sex in younger people because the sphincter is smaller and penetrative sex does more damage.

Numerous research documents have shown that other non-physiological, hazardous sexual practices are common amongst homosexuals. As a result, a relatively large proportion of homosexual men ingest faeces in the pnocess. Practices like fisting, where the whole fist is pushed up the anus and various other forms of deviant sexual behaviour are also more common than amongst the heterosexual community.

Added to this, are the psychological effects of the homosexual lifestyle. Various studies have shown that depression, suicide and other psychological conditions are more common amongst the homosexual community than the heterosexual community.

Thus, the decision of a child to get involved in homosexual activities has greater health implications in contrast to heterosexual activities and are consequently of greater gravity in general. This should be seen in the context of the inability of children to make cognitive decisions as described in section 1 of this document.


Based on the empirical scientific data provided, Doctors For Life International urges the Department of Justice and Constitutional Development not to lower the age of consent to homosexual activities from 19 to 16; nor should the proposed amendments allow sexual experimentation between the ages of 12 and 16. The proposed amendments should not promote any sexual activity with or between adolescents, as seen in the light of the above-mentioned medical, sociological and psychological research.

Taking the latest medical research into account, Doctors For Life International believes that the Department should ensure that the best interests of South Africa and it people are protected and not violated.


[I] Franz W The Impact of Abortion on Adolescents. Are They Vulnerable to Misuse by the Abortion lndustry?--ln "Window on the Future," David Andrusko (ed.),