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Developing sexual health programmes: A framework for action

Dr Sarah Hawkes (UCL Institute for Global Health) was one of the authors of a new WHO publication setting out a framework for programmes to improve sexual health, Developing sexual health programmes: A framework for action. The framework draws on extensive research to translate evidence on sexual health patterns and outcomes into recommendations for improving sexual health.

The new framework provides definitions of sexual health and related concepts such as sexuality; as well as identifying challenges and opportunities in addressing sexual health and defining strategies that countries and regions might adopt in order to promote sexual health according to their specific contexts. It is intended to assist anyone working to improve sexual health outcomes by providing information and support for both broadbased and targeted community education initiatives.

Dr Hawkes said: ”“This WHO publication is important as it outlines the building blocks for achieving good sexual health for all. However, programmes require more than evidence-based guidelines; we also need the political will to put evidence into practice and thereby ensure that every person has the right to a safe sexual life which is free from discrimination and violence, and respects the rights of others.”

Background on sexual health

Sexual health (which includes the rights of all persons to have the knowledge and opportunity to pursue a safe and pleasurable sexual life) is fundamental to physical and emotional health and well-being as well as to the social and economic development of communities and countries. In the world’s poorest countries, unsafe sex is calculated to be the second most important risk factor for overall levels of morbidity and mortality.

Outcomes of unsafe sex include unplanned pregnancies and infections – it is estimated that on an annual basis, 120 million couples do not have their needs for contraception met, over 400 million people are newly infected with sexually transmitted infections, and a further 2.5 million became infected with HIV. Much of the burden of unsafe sex falls on women, and particularly women in poor countries and poor communities – women suffer the consequences of unintended or unplanned pregnancies, and have higher rates of complications from sexually transmitted infections (including cancers and infertility), than men.

However, despite the high burden associated with sexual ill-health, and the availability of known-to-be-effective interventions, achieving a goal of good sexual health remains a significant challenge for many men and women across the world.

The framework

The WHO framework is important because it contextualizes an internationally agreed set of ideas concerning what constitutes sexual health and what factors influence sexual health, and discusses how the concept of sexual health can best be promoted in health programmes. In order to ensure that everyone attains the highest possible level of sexual health, the framework emphasizes the need for governments to promote healthy sexuality throughout the individual’s lifespan and to offer sexual health services that are appropriate, affordable, accessible and of good quality, to all persons and without stigma or discrimination on the basis of sex, race, ethnicity, age, lifestyle, income, sexual orientation or gender expression.

The framework follows a meeting convened by WHO in 2002 to explore sexual and reproductive health and how programmes to promote sexual health could be improved. It recognises that the ability of men and women to achieve sexual health and wellbeing depends on access to information about sexuality; knowledge about risks and vulnerability to adverse consequences; access to sexual health care; and an environment that affirms and promotes sexual health. It points to the importance of programming for sexual health across the five domains of laws, policies and human rights; education; society and culture; economics; and health.