Key websites

Socio-cultural factors

Social taboos

Issues around sex and sexuality are taboo in many cultures, and perceived stigma and embarrassment can lead to a reluctance to discuss and address sexual health issues. Taboos are even more pronounced for people who do not conform to socially accepted norms of behaviour such as adolescents who have sex before marriage and men who have sex with men (MSM). Unmarried adolescent girls are routinely denied or have limited access to SRH services even though they are vulnerable to violence and sexual abuse, and the consequences of early sexual experiences including unwanted pregnancy, STIs and unsafe abortions. In West Africa, some donors are apprehensive to fund research and support the service needs of MSM for fear that these activities might fuel anger in some communities and restrict progress made on less sensitive reproductive health programmes.

Gender roles

Gender norms in many societies tend to make men macho, women passive, and marginalise transgender people – making all of them vulnerable in different ways to SRH problems, and inhibiting access to services. For example, men may associate masculinity with taking risks in their sexual relations which expose them to HIV and STIs, and may be reluctant or too embarrassed to seek out appropriate health information and care (these are often focussed on women).

Women who are financially, materially or socially dependent on men may have limited power to exercise control in relationships, such as negotiating the use of condoms during sex. Social expectations about how women should behave can place women in subordinate roles and increase their risk of being sexually assaulted, contracting STIs and having unwanted pregnancies, and also limit their access to SRH services. In Zanzibar, unmarried women are denied contraceptives from health professionals, while in Botswana and Senegal married women are restricted from using contraceptives without the permission of their husbands. In many societies, women’s health concerns are often considered less important than those of men and children, and household responsibilities can prevent them from spending time visiting a clinic.

Religious conservatism

Religious fundamentalisms expressed through policy and funding decisions undermine progress towards achieving universal access to SRH services. Conservative Christian attitudes towards sexuality in the United States have led to government funding restrictions on services for sex workers, and the promotion of narrow sex education programmes for young people which focus only on abstinence as a means of STI prevention. These policies limit access to and information about contraceptives and safe abortions, and neglect the complexities and realities of peoples’ lives, for example the prevalence of rape (including marital rape) and sexual coercion of unmarried girls. Similarly, the Vatican’s stance against contraception has compromised the promotion of condoms for STI/HIV prevention, and "pro-life" movements linked to both have hampered efforts to reduce unsafe abortions, for instance by blocking access to emergency contraception.

Conversely, some religious groups have taken action to improve access to SRH services and information. Catholics for a Free Choice advocate the use of condoms (www.condoms4life.org); and Christian Aid has adopted an approach to HIV prevention which promotes safer practices, available medications, voluntary counselling and testing, and empowerment as an alternative to abstinence strategies.