Sexual health and the link to gender equality
The Universal Declaration of Human Rights states that everyone has the right to life, liberty and security of person. But in many countries, women and girls are not in full control of their lives, their liberty, nor their bodies. In too many countries—currently more than 150—there are laws that discriminate in some form against women. From Female Genital Mutilation (FGM) to child marriage; from a lack of access to contraception to a lack of education on the risks of becoming infected with HIV, legislation and common practice place restrictions on what women and girls can learn and become. In conflict ridden countries where rape is used as a tactic of war, in refugee camps or in transit where displaced families are vulnerable to exploitation or trafficking, or in the inner cities where girls have learned to fear taking public transport or walking in unlit streets, the basic human rights of women are being compromised or ignored. Without “security of person,” patterns of inequality between women and men are enforced and repeated, locking women into cycles of poverty, diminished experience, and lost opportunity.
The effort to achieve sexual and reproductive rights connects to many key areas of equality and development. These rights are recognized in international normative frameworks, including the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW), the Programme of Action of the International Conference on Population and Development (ICPD), and the Beijing Platform for Action. Yet only 32 percent of countries enforce laws that set out to provide full and comprehensive sexual and reproductive health services and rights, and in some countries rights are being curtailed. The voice of civil society must speak up for the needs of women and girls everywhere.
When women are in control of their bodies, they can make health decisions that are critical to their wellbeing and that of their communities and societies. When women are better informed about HIV and sexually transmitted infections, they are better able to protect themselves. When women have access to family planning, they can avoid childbirth complications and exert more control over their lives. These choices, coupled with freedom from violence and harassment, feed into women’s ability to engage in community politics, start their own businesses, or enroll in higher education.
We know that women in particular face widespread social, cultural, political, and structural threats to their sexual health and well-being. Women’s sexual health is often controlled by patriarchal societies. Without the option to make critical choices about their bodies, women’s prosperity, well-being, and potential in society are restricted and gender inequality is therefore perpetuated. Advancing women’s full and total control over their own sexual health is therefore vital for reaching substantive gender equality. Sexual health – or the absence of some of the most egregious manifestations of sexual ill health - is also an indicator of progress in achieving that equality.
The 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs) adopted by the governments of the world in 2015, recognizes that gender equality is necessary to accomplish their aims. For example, the fifth sustainable development goal on gender equality and women’s empowerment contains a specific target to “Ensure universal access to sexual and reproductive health and reproductive rights.”
Currently, UN Women works with governments, civil society, and the private sector to break the remaining barriers to women’s sexual and reproductive rights, and to create actions together that ensure all women have the ability to thrive. Underpinned throughout by key gender equality targets and a promise “to leave no one behind,” the SDGs are the United Nations’ roadmap to a better and more sustainable world for all people.
Young women at risk
Adolescent girls and young women aged 15-24 are the generation for whom Agenda 2030 holds the biggest potential gains.
This is a critical time for young women to be empowered; currently more than half the world’s population is under 30, and that figure is projected to rise to 75 percent over the next decade. The world today is home to 1.1 billion girls under age 18. In order to preserve the health and human rights of this growing population and unlock the potential of a “demographic dividend” for increased economic growth, young women must be healthy, well educated, and capable of being productive.
Yet this not currently the case, nor are the circumstances sufficiently in place to make it so. Adolescent girls and young women disproportionately experience unplanned pregnancy and pregnancy complications that put them at risk for unsafe abortion or childbirth and interfere with their right to education and, ultimately, their economic empowerment. For these adolescent girls, comprehensive sex education in schools can be just as essential as access to confidential counselling and affordable contraception in health centers. Reaching girls with information to prevent STIs before they become sexually active increases their use of reproductive health services and their attendance in school and participation in income-generating activities.
One way to support this is through sports programs for young women that foster leadership and independence while promoting active health consciousness. During the 2016 Olympic Games in Rio de Janeiro, UN Women partnered with the International Olympic Committee to support “One Win Leads to Another,” a community-based sport program for adolescent girls in Brazil, which helps them overcome barriers and emphasizes their right to live without violence and discrimination.
Sexual Health and HIV/AIDS
The dynamics of the HIV epidemic, which currently affects an estimated 17.8 million women, are closely linked with gender inequality. Issues vary across communities and countries, but power imbalances, harmful social norms, violence, and marginalization affect women, men, girls, boys, and transgender people across the world, limiting their ability to prevent HIV infection and mitigate its impact. Education, income, ethnicity and race further complicate the picture, for which UN Women proposes four primary pathways to transform gender relations.
Gender inequality plays a strong role in almost every aspect of the risk factors affecting young women. For example, one of the epidemic drivers for this age group is older adult men infecting younger women, who lack the ability or knowledge to negotiate safer sex.
Where there is poverty, social dynamics that give men strong dominance, low rates of education for girls and high rates of violence against them, frequent forced sex, and insufficient access to health services, this toxic combination has fostered alarming rates of new infections among women in an age group that should be the hope of the future. Young women ages 15-24 comprise 60 percent of all young people living with HIV. UNAIDS data from seven longitudinal studies across Eastern and Southern Africa show that nearly all of the new infections (91 percent) in Southern Africa occurred among people aged 15-19. Every week in 2015, some 7,500 young women aged 15–24 years around the world acquired HIV.
In addition to scaling up efforts to address power in relationships and increasing knowledge and information, women need access to preventive care such as pre-exposure prophylaxis (PrEP), sexual and reproductive health care, and targeted testing strategies. Reaching the 2020 target for prevention of HIV infections in young people will require a 74 percent reduction in new infections among young women.
UN Women’s work on HIV and AIDS is rooted in gender equality and human rights perspectives. We know that the single most important strategy in responding to the HIV epidemic is empowering women and guaranteeing their rights. This enables them to protect themselves from infection, overcome stigmatization, and gain greater access to treatment and care. UN Women has accordingly decided to cosponsor the UNAIDS family, and Chair the UNAIDS ‘Committee of Cosponsoring Organizations’.
Work with governments, civil society, women’s organizations, and human rights groups is important to build strong pillars of prevention, and ensure that national strategies and programs specifically address the needs of young women. This will require deeper efforts to support collection, analysis, and dissemination of sex- and age-disaggregated data so that we better understand young women’s dual vulnerability to discrimination—as women and as young people—and the unequal social norms, legal frameworks, and customary laws that may inhibit their ability to access health and education services.
Violence and harmful practices
HIV and other sexually transmitted diseases continue to require significant attention by governments and others. However, another problem of pandemic proportions affects women’s sexual health: sexual violence. Violence against women is a fundamental violation of human rights, resulting in both short and long-term physical, sexual, and mental consequences.
Estimates show that up to 70 percent of women have experienced physical and/or sexual violence from an intimate partner in their lifetime, and 120 million girls worldwide have experienced forced intercourse or other sexual acts at some point in their lives. The most common perpetrators of sexual violence against women are current or former husbands, partners, or boyfriends.
Violence against women and girls prevents them from fully participating in society. This has a cost for the women themselves and for their communities. It also has quantifiable financial costs, such as increased health care bills, legal expenses, and losses in productivity, which influence the overall development of a nation.
Violence against women directly affects their access to services and poses serious challenges to sexual negotiations, including the use of condoms. For example, women who face violence from intimate partners are less likely to use contraception and are up to 50 percent more likely to have an unintended pregnancy. Women in abusive relationships are 2.7 times more likely to seek an abortion. Women who have been physically or sexually abused by their partners are 1.5 times more likely to acquire HIV in some regions compared to women who have not experienced this type of violence.
Violence against women also directly affects the chances a woman will seek and be able to access health services. Every day, approximately 830 women die from preventable pregnancy and childbirth related cases. Moreover, 8 percent of maternal deaths are attributable to unsafe abortions and, globally, 225 million women have an unmet need for family planning.
Violence against women and girls also includes harmful practices such as early, forced, and child marriage. It is very difficult for child brides to negotiate safe sex—if they even know what it is—and they are especially vulnerable to early pregnancy, HIV, and other sexually transmitted infections. Worldwide, over 700 million women alive today were married before the age of 18. Of those women, one in three were married before they turned 15.
It is hard, but not impossible to change cultural practices. In Malawi, one in two girls are married before 18. But in 2015, through consistent advocacy efforts by UN Women and its partners, Malawi’s Senior Chief Inkosi Kachindamoto annulled 330 customary marriages and passed a new law that raises the legal age of marriage to 18 years-old. In February 2017, Malawi’s parliament went a step further, unanimously adopting a constitutional amendment raising the minimum age of marriage from 15 to 18 years for girls and boys. This removed a legal loophole that allowed parents to provide consent for their children’s marriage between the ages of 15 to 18.
Photo Credit: AP Images
The high rates of obstetric problems and maternal death among the same communities that practice early marriage and FGM are no coincidence. At least 200 million women and girls today have undergone Female Genital Mutilation (FGM) in 30 countries. Of these women and girls, 44 million are under the age of 15. The high rates of gender inequality, low educational attainment for girls, poor health, and cyclical grinding poverty in those same communities are no coincidence either. These issues are all linked, and they ensure that those girls have domestic responsibilities and academic deficiencies that condemn them to a future with very short horizons. With those limitations come multiple and repeating missed opportunities in personal wellbeing, social growth, economic diversity and community resilience.
Rapid population growth in countries where FGM occurs has resulted in an increase in the absolute numbers of girls affected to date by the current norms and heightened urgency to break those negative cycles. This is especially important in the light of sharpened focus on the employment of women and youth as a major driver and catalyst of poverty eradication and inclusive development.
Developing national action plans to prevent violence against women, and strengthening institutions to advocate ending violence, child marriage, and FGM are all critical actions to end violence and harmful practices. However, the prevention of violence by addressing its structural causes is also critical. For instance, working with young people to understand healthy relationships and gender equality can help prevent future violence. Evidence shows that comprehensive sexuality and HIV education programs that address issues of masculinity and femininity, gender inequality in society, unequal power in relationships, and young women’s empowerment are likely to result in lower rates of sexually transmitted infections.
The United Nations Security Council recognizes sexual violence as both a tactic of war and terrorism. Sexual violence, including rape, sexual slavery, and forced marriage, has been documented as being deliberately used against adolescent girls. Sexual violence is also used as a form of persecution; violent extremist groups are sophisticated in the methods they use to subjugate and abuse women in areas under their control. They exploit women as prizes to reward fighters and then publicize these crimes on social media to attract new recruits. Women are used as part of the systems of punishment and reward through which terrorist and violent extremist groups consolidate their power. The United Nations Security Council has recognized that efforts to protect and empower women and to combat conflict-related sexual violence are explicitly linked to conflict-resolution and counter-terrorism strategies. Extremist groups are targeting women’s and rights and are using gendered norms and stereotypes in the recruitment of both men and women. Promoting and protecting women’s rights is therefore key to preventing the spread of radicalization that leads to extremist violence.
Addressing women’s sexual health can have a ripple effect across the entire 2030 Agenda. Young people must be meaningfully engaged in all levels of decision-making and leadership roles. This includes the creation of culturally appropriate and safe spaces where young women can articulate their needs and concerns on an on-going basis, and where young men can redefine the concept of masculinity.
Although UN Women’s work focuses on sexual and reproductive health and rights for women, men also have an important responsibility to take up this fight and gain the freedoms that come from greater gender equality. Since its launch in 2014, UN Women’s HeforShe movement has received over 1.3 million commitments from men and boys around the world who have signed up to challenge social norms around gender stereotypes and identity, participate in political platforms, and advocate for issues such as education, equal pay, and healthcare. It encourages young men to become agents of change and to stand with women to take action against gender inequalities.
Youth representation is vital; UN Women needs institutional frameworks in place so that young people’s voices are heard in inter-governmental declarations and agreed language. At UN Women we have a strong framework and policy for youth, and in March 2017 we are hosting the second annual Youth Forum at the Commission on the Status of Women.
UN Women also recently partnered with the International Planned Parenthood Federation (IPPF) to empower and engage young women in the HIV response. More than 1,000 adolescent girls and young women are leaders and advocates of HIV prevention and sexual and reproductive health and rights in Malawi, Uganda and Kenya, learning how to conduct digital, social, and print media outreach on HIV prevention and sexual and reproductive health. These young leaders have engaged in local, national, and global-level HIV processes that helped them to raise their priorities with community leaders, teachers and decision-makers. We know that these kinds of innovative partnerships, including those that engage with non-traditional constituencies, are key to achieving the 2030 Agenda.
Localizing the SDGs and ensuring that no one is left behind also requires a strong focus on tackling accumulating vulnerabilities, like socio-economic status, geographical location, education, ethnicity, or disability. All of these intersecting aspects also contribute to health inequalities.
Bodily autonomy and decision-making over sexual health are central to achieving gender equality and women’s empowerment, so that women and girls can achieve their potential and thrive. They reflect women’s indivisible and interdependent human rights, and they require immediate and committed attention at all levels.
Everyone has the right to life, liberty and security of person; yet millions do not experience those rights. In the 2030 Agenda we have committed to a universality of attention, where no one is left behind, and those that are living in the greatest poverty and inequality are those who are brought forward first. A crucial step in changing the lives of those currently furthest behind is the removal of persistent structural barriers to gender equality so that the girls growing up now have a chance to flourish in a world of greater peace, security, and hope.