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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