The sexuality connection in reproductive health

Abstract

Sexuality and power relations based on gender are relevant to researchers, policymakers, and service providers in the reproductive health field, because they underlie virtually all of the behaviors and conditions that their programs address. Yet, a review of conventional treatments in the demographic and family planning literature reveals that, when they consider these topics at all, researchers typically adopt narrow definitions of sexual behavior and focus almost exclusively on risks of pregnancy and disease. This article proposes an analytic framework as a guide to researchers and family planning providers. It relates four dimensions of sexuality to reproductive health outcomes and concludes that family planning policies and programs should address a broader spectrum of sexual behaviors and meanings, consider questions of sexual enjoyment as well as risk, and confront ideologies of male entitlement that threaten women's sexual and reproductive rights and health.

PIP: The aim of this article was to identify some impact connections between sexuality, gender, and reproductive health for helping family planning professionals. A review was provided of sexuality and gender in conventional family planning literature. A theoretical framework was provided for sexuality and gender, which drew from a review of sexual behavior in sub-Saharan Africa on behavioral and objective, psychological and cultural, and subjective dimensions. Sexual partnerships were differentiated from sexual acts, sexual meanings, and sexual drives and enjoyment. The relevance for family planning workers was that adoption of a "sanitized version of sexuality that treats intercourse as an emotionally neutral "act" interfered with the need to learn about their clients' sexual and reproductive concerns. This information can be obtained through intake questionnaires, physical examinations, contraceptive counseling, and clinic-based group discussions. Clients could be asked about their partners attitudes toward and practices of contraception, and cooperation in practicing contraception and disease prevention. Examinations and routine questioning can reveal signs of physical and sexual abuse, reproductive tract infections, and damage from genital mutilation, vaginal medication, or other practices. Group discussions might address topics on transmission of AIDS and reproductive tract infections, infertility, contraceptive preferences and beliefs, fecundity cycles for females, misconceptions about menopause and menstruation, causes of unwanted pregnancy and abortion, and male responsibility for birth control and child rearing. Community teach-ins can work to dispel misinformation; videos can focus on specific topics such as multiple sexual partners. Research activity might include not only standard questionnaires, but also analysis of print media or daily diaries of sexual and contraceptive activity. What is important to understand is the number, duration, and social identities of a person's sexual partnerships and the person's ability to protect oneself. Population policies need to be adjusted to accommodate equal rights policies on legal, social, and economic goals, such as gender equality, sexual choice, male entitlement, or sexual enjoyment.