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Sexual Health: More Than Infection or Pregnancy Prevention -- May 2002

Issues that tend not to be discussed by health providers and their clients during medical consultations include sexuality, infidelity as a cause of sexually transmitted infections (STIs), and intimate partner violence. Yet, better dialogue between reproductive health and family planning providers and clients about such matters may improve the quality of health care, says FHI researcher Dr. Patricia Bailey in the current issue of Network, an international quarterly health bulletin published by Family Health International (FHI).

What is Sexual Health? Sexual health is, according to the World Health Organization (WHO), "the integration of the physical, emotional, intellectual, and social aspects of sexual being in ways that are enriching and that enhance personality, communication, and love."

"The goal of such discussions would be to foster optimal sexual health, an aim that encompasses much more than just the prevention of sexually transmitted infections or unplanned pregnancies," says Dr. Bailey, whose work has included research on how contraception affects men's and women's quality of life.

Besides establishing open and respectful communication about the circumstances of clients' lives, providers can optimize their clients' sexual health by taking into account various factors that strongly influence reproductive health decisions. These include a woman's ability to work and earn an income that she can control; religious prohibitions; expectations that women prove their fertility; relationships with friends and family members; and freedom of movement. "Providers should not forget that many women are living in a context where they are not making unilateral decisions about their reproductive health," stresses Dr. Bailey.

Expectations about what it means to be a man or a woman, which are a basic part of most children's socialization, can also profoundly affect sexual health. Expectations that females be submissive and males be powerful can restrict access to health information, hinder communication, and encourage risky behavior among both women and men. Ultimately, how children are socialized can increase vulnerability to violence, sexual exploitation, unplanned pregnancy, unsafe abortion, and STIs, including HIV. As a result, some experts believe that interventions that encourage at-risk youth to analyze and change their attitudes and sexual behaviors are essential to promoting sexual health. Although many such interventions to change attitudes and behaviors that threaten sexual health are remarkably similar in their approaches, fairly new and have not been well evaluated.

Meanwhile, many men and women fail to protect themselves against unplanned pregnancy and STIs, or to optimize their sexual health, in part because they find it difficult, if not impossible, to discuss with their partners subjects related to sexuality. Tools to improve partner communication have been used in limited settings and have not been thoroughly evaluated. Furthermore, merely talking about reproductive health does not ensure that couples will make permanent behavioral changes that protect against reproductive health dangers. Finally, in some cultural settings, increased partner communication about sexuality may lead to marital discord, suspicions of infidelity, and even intimate partner violence. But efforts by health educators, providers, and program planners to help couples talk about sexuality and share responsibility for their reproductive health decisions can produce potentially life-saving changes in behavior. In fact, helping couples communicate about sex is increasingly viewed as essential to HIV/AIDS prevention strategies.

Increasing contraception reduces abortion

The current issue of Network also clarifies the complex relationship between contraception and induced abortion. It explains that recent studies offer strong evidence of a widely assumed but difficult-to-demonstrate benefit of reproductive health services: that increasing the use of effective contraception leads to declines in induced abortion rates. The results of such studies can help dispel misconceptions about the relationship between family planning and abortion. They can also help policy-makers, program managers, and providers identify ways to improve reproductive health services. Demonstrating that increased contraceptive use leads to fewer abortions is particularly important in countries where unsafe abortion poses a serious threat to women's health and survival.

FHI is a nonprofit research organization based in the United States that seeks to improve reproductive health worldwide, with an emphasis on developing countries. Network is provided free to family planning providers and other health professionals worldwide.

For more information, please contact:

Kim Best, Managing Editor, 919-544-7040