The world continues to face significant challenges in providing adequate sexual and reproductive health services to all people. Despite medical advances, millions still lack access to basic care, leading to preventable suffering and death. Recent major reports have highlighted these gaps and emphasised the urgent need for action.
The Current Global Situation
Sexual and reproductive health issues affect billions of people worldwide. These problems don’t just impact individuals – they affect entire communities and economies.
Each year, approximately 25 million unsafe abortions take place around the world. These procedures put women at serious risk and contribute to about 5-13% of all maternal deaths globally.
The situation with sexually transmitted infections (STIs) is equally concerning:
- Over 350 million people annually need treatment for one of the four curable STIs.
- Nearly 2 million people become newly infected with HIV each year.
- Many infections go undiagnosed due to lack of testing.
- Recent WHO reports show syphilis cases increasing by over 1 million, reaching 8 million cases.
Almost all 4.3 billion people of reproductive age worldwide will experience inadequate sexual and reproductive health services at some point in their lives.
Impact on Vulnerable Populations
The burden of poor sexual health is not shared equally. Those who are already marginalised face even greater challenges.
Women and Girls
Women and girls often bear the heaviest burden of inadequate sexual health services. When they lack access to contraception, they face higher risks of unintended pregnancies.
Untreated STIs can lead to serious complications for women, including:
- Infertility.
- Pelvic inflammatory disease.
- Ectopic pregnancies.
- Chronic pelvic pain.
- Increased risk of HIV acquisition.
In many regions, young women aged 15-24 are twice as likely to be living with HIV as men in the same age group.
Marginalised Communities
People who are perceived as having socially unacceptable sexual practices or characteristics often suffer from both marginalisation and stigma. This includes:
- People living with HIV.
- Unmarried sexually active adolescents.
- Sex workers.
- Migrants.
- Transgender and intersex individuals.
- Those engaging in same-sex sexual behaviour.
- People with disabilities.
Social exclusion reduces access to sexual and reproductive health care for these populations. In some countries, these groups face legal barriers to accessing services.
Key Areas of Concern
Unsafe Abortions
Unsafe abortions remain a major public health concern. When carried out according to WHO guidelines, abortion is a simple and safe health intervention. However, only half of all abortions take place under such conditions.
Tragically, unsafe abortions cause around 39,000 deaths globally each year, with:
- Over 60% in Africa.
- 30% in Asia.
- Most deaths occurring in lower-income countries and among vulnerable populations.
- Millions more suffering from complications and disabilities.
The risk of death from an unsafe abortion is highest in Africa, where the case fatality rate is 520 deaths per 100,000 unsafe abortions.
Sexually Transmitted Infections
STIs continue to pose significant public health challenges. The WHO reports that global HIV, viral hepatitis, and sexually transmitted infections cause approximately 2.5 million deaths annually.
Recent statistics indicate a concerning rise in STIs, particularly syphilis:
- In 2022, WHO Member States aimed to reduce annual adult syphilis infections from 7.1 million to 0.71 million by 2030.
- Instead, new syphilis cases increased by over 1 million, reaching 8 million.
- The most significant increases occurred in the Americas and African regions.
- Gonorrhea is showing increasing resistance to antibiotics.
Untreated STIs can lead to serious long-term health problems including infertility, certain cancers, and increased vulnerability to HIV infection.
Contraception Challenges
Limited access to contraception puts women at risk for unintended pregnancies. While progress has been made, many still lack access to modern contraceptive methods.
The proportion of women using modern contraceptive methods increased from 467 million in 1990 to 874 million in 2022. However, more than 200 million women in developing regions still want to avoid pregnancy but are not using modern contraception.
Barriers to contraception access include:
- Cost.
- Limited availability.
- Poor quality of available services.
- Gender-based barriers.
- Restrictive laws and policies.
- Cultural or religious opposition.
Human Rights Framework
Sexual and reproductive health is increasingly recognized as a fundamental human right. International organizations emphasize that sexual health is intrinsic to overall health and essential for thriving individuals, families, and societies.
Rights-Based Approach
Sexual and reproductive health rights are interdependent with other human rights, including:
- The right to life.
- The right to be free from torture.
- The right to health.
- The right to privacy.
- The right to education.
- The right to substantive equality.
- The prohibition of discrimination.
These rights are directly linked with equitable and sustainable development and the attainment of the Sustainable Development Goals.
Legal Obligations of States
States have obligations to respect, protect, and fulfil rights related to sexual and reproductive health. This includes:
- Ensuring sexual and reproductive health services are available in adequate numbers and equitably distributed.
- Making services accessible physically and economically.
- Providing services without discrimination.
- Ensuring services are of good quality.
- Respecting individual autonomy in decision-making.
Failure to fulfil these obligations often result in violations of sexual and reproductive health and rights.
Recent Progress and Initiatives
Despite the challenges, there have been some positive developments in addressing global sexual health issues.
WHO Guidelines and Recommendations
In March 2022, WHO released new guidelines on abortion care to protect the health of women and girls and help prevent unsafe abortions. These guidelines include:
- Recommendations for simple interventions at the primary care level
- Task-sharing by a wider range of health workers.
- Ensuring access to medical abortion pills.
- Making accurate information available to all who need it.
- Recommendations for using telemedicine where appropriate.
These guidelines aim to ensure quality abortion care is available and accessible to all who need it.
Advances in HIV and STI Prevention
Progress is being made in expanding STIs, HIV, and hepatitis services:
- The number of people acquiring HIV has fallen by 38% since 2010.
- Global HIV treatment coverage reached 76%, with 93% of people receiving treatment achieving suppressed viral loads.
- As of March 2022, 60% of WHO Member States have included the HPV vaccine in their routine immunization schedules.
- Pre-exposure prophylaxis (PrEP) for HIV prevention is becoming more widely available.
New technologies like self-testing for HIV and STIs are helping to reach more people with testing services.
Maternal Health Improvements
WHO has validated 19 countries for eliminating mother-to-child transmission of HIV and/or syphilis. This reflects investments in testing and treatment coverage for these diseases among pregnant women.
Maternal mortality has decreased by 34% since 2000, though progress has been uneven across regions.
Challenges to Progress
Despite some advances, significant barriers to improving global sexual health remain.
Policy and Legal Challenges
Restrictive laws and policies continue to limit access to sexual and reproductive health services in many countries. Evidence shows that restricting access to abortions does not reduce the number of abortions that take place. In fact:
- In countries where abortion is most restricted, only 1 in 4 abortions is safe.
- In countries where the procedure is broadly legal, nearly 9 in 10 abortions are safe.
- Criminalization of certain sexual behaviours can prevent people from seeking needed health services.
Many countries still require parental or spousal consent for accessing certain sexual and reproductive health services.
Social and Cultural Challenges
Violations of women’s sexual and reproductive health and rights are often due to deeply engrained beliefs and societal values pertaining to women’s sexuality. These can manifest as:
- Denial of access to services that only women require.
- Poor quality services.
- Requiring third-party authorization for women’s access to services.
- Forced procedures without women’s consent.
- Harmful practices like female genital mutilation and early marriage.
- Stigma and discrimination against certain groups.
Stigma around sexual health issues prevents many people from seeking the care they need.
Economic Challenges
Economic factors also limit access to sexual and reproductive health services. In developing regions:
- More than 30 million women do not give birth in a health facility each year.
- More than 45 million have inadequate or no antenatal care.
- Out-of-pocket costs for services can be prohibitive.
- Lack of transportation to health facilities creates barriers.
The COVID-19 pandemic has worsened these economic barriers and disrupted sexual and reproductive health services in many countries.
The Way Forward
Addressing global sexual health challenges requires a comprehensive approach that includes policy changes, increased resources, and community engagement.
Policy Recommendations
International organisations recommend several key actions:
- Ensure that sexual and reproductive health is integrated into national health policies and plans.
- Review and align existing laws with human rights international laws and commitments.
- Include comprehensive sexual and reproductive health services within national health benefit packages.
- Ensure priority-setting processes are guided by principles of equity, rights, and gender equality.
- Promote the active participation and leadership of women and girls at all levels.
Policy changes should be evidence-based and centred on human rights principles.
Expanding Access to Services
Improving access to sexual and reproductive health services is critical. This includes:
- Expanding the availability of medication abortion pills and trained support.
- Investing in family planning services and contraception access.
- Eliminating unsafe abortion.
- Combating sexually transmitted infections.
- Promoting sexual health education.
- Ensuring services are youth-friendly and accessible to adolescents.
Digital health technologies offer promising opportunities to expand access to information and services.
Education and Awareness
Comprehensive sexuality education is essential for empowering people to exercise their rights. Studies in several European countries have shown that long-term national sexuality education programs have led to a reduction in teenage pregnancies and abortions.
Education efforts should:
- Start early and continue throughout life.
- Be scientifically accurate.
- Be culturally appropriate.
- Take a positive approach to sexuality.
- Address gender inequality.
- Build decision-making and communication skills.
Conclusion
The global burden of unmet sexual and reproductive health needs remains substantial. Millions suffer from preventable conditions and lack access to basic services. However, with continued commitment to a rights-based approach, expanded access to services, and increased education, progress is possible.
Sexual health is not just a health issue – it’s a fundamental human right. When people lack bodily autonomy, control over their fertility, and the freedom to experience safe, consensual relationships, the consequences are dire for individuals and communities alike. Addressing these challenges is essential for achieving gender equality, empowering individuals, and building healthier societies.
