Network: Sexual Health

Sexuality, gender socialization, partner communication, social relationships, and cultural norms all influence sexual health, defined by the World Health Organization as "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 current issue of Network seeks to increase awareness of these important and often overlooked dynamics, and to help readers identify social and programmatic barriers to optimal sexual health. A special package of articles in the issue also clarifies the complex relationship between contraception and induced abortion, citing evidence that increased use of effective contraception leads to declines in induced abortion rates.

In this issue Discussing Sexuality Fosters Sexual Health 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. This article explores how better dialogue between reproductive health and family planning providers and their clients may improve the quality of health care. That sexuality counseling can be successfully integrated into services at family planning clinics is discussed in Training Providers to Talk about Sex, and the impact of cultural and social factors on reproductive health decisions of women throughout the world is described in Life Circumstances Influence Decisions. Gender Stereotypes Compromise Sexual Health Expectations about what it means to be a man or a woman, which are a basic part of most children's socialization, can also greatly affect sexual health. This article describes how such gender stereotypes can increase vulnerability to violence, sexual exploitation, unplanned pregnancy, unsafe abortion, and STIs, including HIV. Contradictory Messages Put Young Women at Risk presents qualitative research indicating that many young women in Rwanda are so constrained by contradictory messages about purity, submission, and love that they cannot say "yes" or "no" to sex. Because of the profound influence of gender stereotypes, 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. Many such interventions are fairly new and have not been well-evaluated. But they are remarkably similar in their approaches, as described in Youth Programs Challenge Stereotypes. When Partners Talk, Behavior May Change 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. (Communication about Family Planning depicts graphically the percentage of women in various countries who discuss family planning with their husbands.) But research described in this article suggests that facilitating communication between husbands and wives helps these couples agree upon and meet their reproductive goals. (In Traditional Method Use, Communication Sometimes Linked, some women report a preference for traditional methods because they feel that their effective use demonstrates marital cooperation and communication.) Helping couples communicate about sex is increasingly viewed as essential to HIV/AIDS prevention strategies. Dialogue Tool Promotes Open, Honest Discussion discusses the use and evaluation in India of a tool developed by FHI to help men and women at risk for HIV infection communicate openly with each other about issues affecting their sexual health. Meanwhile, offering HIV voluntary counseling and testing services to couples has been found to help HIV-positive clients share their status with partners, as described in Counseling of Couples Facilitates HIV Disclosure. Increasing Contraception Reduces Abortion This article clarifies the complex relationship between contraception and induced abortion. It explains that recent studies offer strong evidence of a widely supposed but difficult-to-demonstrate benefit of reproductive health services: that increasing the use of effective contraception leads to declines in induced abortion rates. (This relationship -- as observed in Shanghai, China, and in Hungary -- is graphically depicted in Relationship between IUD Use and Abortion Rate in Shanghai and in Abortion Trends in Hungary.) Demonstrating that increased contraceptive use leads to fewer abortions is particularly important in settings where unsafe abortion poses a serious threat to women's health and survival, as depicted graphically in Global and Regional Mortality Due to Unsafe Abortion (1995-2000). Evidence that easy access to high-quality family planning services kept induced abortion rates from rising in one area of Matlab, Bangladesh, despite the increasing likelihood that unintended pregnancies among women there would end in abortion, is discussed in High-Quality Services Keep Down Abortion. How the relatively recent availability of contraceptives in the former Soviet Union has affected induced abortion rates there is described in A Culture of Abortion?, which is accompanied by the illustrative graph Contraception and Abortion Trends in Kazakhstan, 1991-1998.

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