Major socio-economic changes took place in Estonia immediately after the country regained its independence from Soviet occupation in 1991, including the creation of democratic political institutions, changes from a planned to a market economy, health care reforms and changes in the school curricula. In 1996 new school curricula were introduced including sexuality education lessons, which were integrated in a compulsory subject called Human and Civil Studies (renamed as Human Studies in 2002). The Human Studies curriculum is based on the principle of social skills education. Part of the curriculum deals with building general attitudes and skills, and the other part is explicitly sexuality related. Simultaneously, youth counselling services addressing reproductive and sexual health matters were set up resulting in 20 counselling centres offering individual counselling and health education for schoolchildren by 2010.
Teenage fertility rates and abortion rates started to decrease immediately after sexuality education, contraceptives and youth-friendly services became available. The abortion rate among 15-19 year-olds declined by 61% and the teenage fertility rate by 59% between 1992-2009. The annual number of registered new HIV cases among 15-19-year-olds declined from 560 in 2001 to just 25 in 2009, a 95% drop.