Advancing the "sexual" in sexual and reproductive health and rights: a global health, gender equality and human rights imperative

• Published in: Bulletin of the World Health Organization Vol. 102; no. 1; pp. 77 - 78
• Main Authors: Ghebreyesus, Tedros Adhanom, Allotey, Pascale, Narasimhan, Manjulaa
• Format: Journal Article
• Language: English
• Published: Switzerland World Health Organization 01.01.2024
• Subjects: Aggression; Biomedicine; Breast cancer; Cancer; Cervical cancer; Cervix; Cisgender; Clinical outcomes; Coercion; Discrimination; Disease transmission; Domestic violence; Dyspareunia; Economic development; Educational systems; Ejaculation; Emotions; Endometriosis; Equal rights; Erectile dysfunction; Ethnic identity; Gender; Gender aspects; Gender Equity; Gender identity; Gender-affirming care; Global Health; Health behavior; Health care; Health care access; Health education; Health research; Health risks; Health services; Heterosexuality; HIV; Human dignity; Human immunodeficiency virus; Human Rights; Humans; Infections; Infertility; Internet; Interpersonal relations; Intimate partner violence; Lineage; Maternal mortality; Men; Menopause; Menstruation; Mental health services; Mothers; Ovarian cancer; Physiological effects; Populations; Post-menopause; Prostate cancer; Public health; Quality of care; Quality of life; Race; Reproductive Health; Reproductive rights; Reproductive system; Risk behavior; Risk taking; Sexual Behavior; Sexual coercion; Sexual health; Sexuality; Sexually transmitted diseases; Social exclusion; STD; Stigma; Support networks; Support systems; Sustainable development; Testicular cancer; Transgender persons; Violence; Well being; Women; Women's Rights; Womens health
• DOI: 10.2471/BLT.23.291227
• ISSN: 0042-9686

As one aspect of population health, the global interest in women's health has focused largely on maternal health and has implicitly ignored other aspects of women's sexual and reproductive health and well-being. Despite this focus, maternal mortality remains unacceptably high,1 reflecting an indictment of our health systems, with insufficient access to services, uneven quality of care and an over-stretched health workforce. However, women's health extends beyond motherhood, and across their lives the issues stemming from physiological, psychological, or societal factors significantly affect their well-being and quality of life. Often overlooked are sexual health needs of women including menstruation, endometriosis, vulvodynia, dyspareunia and peri- to post-menopause, as conditions that are often normalized to womanhood. Sexual health needs of men are also often overlooked, including infertility, premature ejaculation, impotence, and psychosexual concerns. Furthermore, millions are affected by sexually transmitted infections, including human immunodeficiency virus (HIV), reproductive tract infections and cancers of the reproductive system of women (cervical, breast, uterine and ovarian cancers) and men (prostate and testicular cancers). Defining the potential challenges and health risks at every life stage allows for proactive health-care interventions, education and support systems that promote positive sexual health outcomes throughout a person's life.Sexual health is fundamental to the overall health and well-being of all people, to the dignity of the individual and to the social and economic development of communities and countries.2 Sexual health of women and girls, and gender-diverse individuals is politicized. Violations of human rights in the context of sexual health are embedded in hierarchical structures of gender, generation, lineage, race, class and caste, in which more powerful or privileged people control the bodies and emotions of the less powerful. People with diverse sexual orientations and gender identities often face stigma and discrimination, and, in some countries, are subjected to extreme violence and are criminalized. Social exclusion of gender-diverse populations reduces their access to sexual and reproductive health care. There is a lack of evidence and capacity to address specific sexual health needs, and fear of discriminatory treatment by health and care workers confound this problem of access. There is a general paucity of research on the sexual health of transgender individuals, especially concerning sexual coercion, sexual and intimate partner violence, relationship quality, sexual risk behaviours and structural barriers to sexual health care access. Further research is also required to address important aspects of gender-affirming care. The focus on predominantly cisgender and heterosexual populations also means that evidence and guidance around key biomedical and health services, as well as health outcomes, are lacking.