Sexual and Reproductive Health Rights: A (Heterosexual Cis-)Woman’s Burden?

By Jessica Schwarz

Women’s Rights Team

Global Human Rights Defence

Introduction

According to the Office of the United Nations High Commissioner for Human Rights (UNHCR), “sexual and reproductive health are integral elements of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” (OHCHR, 2003). Moreover, sexual and reproductive health (SRH) as a whole are related to multiple other human rights, such as the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education and the prohibition of discrimination (OHCHR, n. d.). SRH rights should not be limited to just family planning in terms of abortion, but include issues like infertility, surrogacy, sexual transmitted infections (STIs) and diseases, domestic gender-based violence, and harmful traditional practices such as female genital mutilation.

The reproductive system, its function and dysfunction, as well as its associated diseases, is central to women’s health. The Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women have also stated that women’s right to health includes their sexual and reproductive health (CESCR, 2016 and CEDAW, 1979). Each year, many women die of preventable causes related to maternity, from birth-related complications and deaths to dangerous and illegal abortion procedures, indicating that there is further to go in advancing SRH rights. Moreover, women’s bodies remain at the heart of culture wars, especially those surrounding abortion and bodily autonomy. This shows that the legalisation of a right does not mean its universal enforcement, as there remains an inequality in ability to enjoy SRH rights depending on economic status, age, location, ethnicity, and gender identity. SRH rights are not just a crucial part of healthcare, but are also essential to achieving gender equality and promoting women’s rights as they allow women to make autonomous decisions about their own bodies, health, fertility, sexuality and thus their lives. SRH rights imply that people have the ability to reproduce, regulate fertility and practice, as well as enjoy, sexual relationships. However, SRH rights are often seen as the domain of women and girls’ health and well-being, for sound biological reasons of course, but this ends up excluding others from the discussions surrounding sexual and reproductive health.

Achieving sexual and reproductive freedom is a human right; however, SRH rights almost exclusively discuss cis-gendered women as if men or non-cis women do not also have sexual and reproductive health needs. Regarding certain aspects of reproductive health, especially in heterosexual partnerships, the responsibility is shared by both men and women; however, the burden, for both biological and social reasons, is on the women. Maternity, in this sense, is both a privilege and burden for (cis)women. But SRH rights include both reproduction and safe sexuality, neither of which is exclusive to cis women.

The Heterosexual Cis Woman Perspective

Despite women being at the centre of discussions surrounding SRH rights, they were often considered as a means in reproduction and fertility control. Contraception meant to empower women has historically been used by governments and others to control women. While women benefited from the process, they were not at the centre of the process, despite having more at stake in fertility control than anyone else. While SRH rights have advanced greatly for women, with women being able to take control of their bodies and sexualities through the large variety of contraceptive methods available, what is often not discussed is how women suffer disproportionately from their reproductive role. Contraception and abortions, in the rare cases women are granted them, come with not insignificant physical and mental costs. Various birth control methods have side effects such as bleeding, headaches, nausea, weight gain, mood swings, changes in menstruation, decreased sex drive, depression, severe pain and more. The long term effects of contraception on women’s health and bodies are still being studied. Even the morning after pill entails days long side effects. Abortion procedures also come with mental and physical consequences and other complications. Of course, there are many positive side effects to contraceptives and birth control methods, but alongside the positives are often periods of adjustments, changes to the body, and other risks. SRH is closely related with the right to the highest attainable standard of physical and mental health, but what is not discussed is how contraception sometimes negatively impacts women’s physical and mental health. This is especially relevant as the development of contraceptives was not always concerned with women’s health. Even during pregnancy and childbirth, women’s desires are not always heard despite being at the centre of pregnancy; in extreme cases, obstetric violence can occur.     

All of this points to the burden placed on women, their bodies and minds, in relation to SRH rights. Women suffer disproportionately from their reproductive role as the available methods have potential health hazards. Certainly, this is not to complain of or negatively frame SRH rights in general, but to highlight the burden placed on women, especially in heterosexual partnerships, when in reality, we all, regardless of gender, have sexual and reproductive rights and needs.

The Male Perspective     

Historically, sexual and reproductive health has been mostly concerned with women and population control. In general, when discussing health, men are considered the standard, in terms of research and policy, but it is the opposite with SRH. Cis-female-oriented contraception ignores men’s need for sexual and reproductive health needs, which include the need for contraception, the prevention and treatment of STIs and the human immunodeficiency virus (HIV), sexual dysfunction, and male cancer. These needs are often unmet due to a lack of service availability and information, poor health-seeking behaviour, unfriendly health facilities towards men or a general lack of options for men, specifically regarding contraception. Aside from abstinence, the current options for male contraception are condoms, spermicides in the form of gels, creams, foams, films or suppositories to be inserted into a vagina (which once again involve women and their bodies), vasectomy, non-vaginal ejaculation in the form of withdrawal and outercourse, with varying degrees of effectiveness in preventing pregnancy. This pales in comparison to the oral pills, transdermal patches, injections, implants, vaginal rings, intrauterine devices (IUDs), sponges and cervical caps available to women as contraception. Men, too, have sex lives and often want easier means of contraception. Birth control and contraception are issues for all parties involved, not just the women or uterus-bearer. Various alternative forms of male contraception aimed at either reducing sperm count or preventing sperm reduction are being developed, from testosterone or hormonal combination injections, hormonal contraception gel, a male hormonal pill, a reversible chemical vasectomy, an intra-vas device, to a birth control vaccine. Hormonal options are more likely to cause side effects like low libido, erectile dysfunction and weight gain. In the past, attempts at creating male birth control have failed due to complaints of such side effects—side effects that women have been dealing with for decades (Gorvett, 2023). When the male contraception options are available in the market, men need to be a part of the conversation regarding contraception and the responsibility of pregnancy prevention should be divided between both men and women in heterosexual relationships.     

As men do not usually share the responsibility of SRH in heterosexual relationships, leaving it instead to women, gender inequality is exacerbated, especially as their limited participation in SRH is a result of gender inequality and patriarchal understandings of gender and control over bodies. With the emergence of the acquired immunodeficiency syndrome (AIDS) and increased prevalence of STIs, male participation and responsibility in condom use has become more important. However, men who adhere to harmful masculine norms such as risk-taking, dominance, and toughness are more likely to have negative attitudes towards condom use, thereby increasing their chances of contracting STIs, and they are also less likely to seek healthcare compared to women. while having more sexual partners, thereby increasing the chances of STI contraction. Sexual violence against men and boys is also an issue falling under SRH. As such, men and boys’ SRH needs must be recognised and improved, from more comprehensive sex education, to access to contraception and services treating STIs and HIV, as well as the development of more male contraceptive options, to issues regarding fertility, parenting, male cancers, and sexual dysfunction later on in men’s lives.

More must be done to engage men as partners in regards to SRH due to the relational nature of our lives and partnerships—a person’s SRH choices affect others. What is often not talked about is how unintended pregnancies negatively impact men’s mental and physical health, schooling and education, as well as men’s caregiving abilities. Thus, SRH rights impact more than one party. As such, we can and should expand SRH rights of men while still prioritising and championing the same for women all over the world. SRH are crucial to achieving gender equality and increasing men’s SRH rights is an essential part of greater equality given its benefits to both partners and children.

The LGBTQ+ Community’s Perspective

     With regards to the LGBTQ+ community, the Office of the United Nations High Commissioner for Human Rights reports that members of the LGBTQ+ community are “disproportionately represented in the ranks of the poor, people experiencing homelessness, and those without health care” (OHCHR, 2020). Historically, health care for LGBTQ+ individuals has focused on HIV/AIDS among men who have sex with men. However, this does not represent the different SRH needs of LGBTQ+ individuals. Members of the LGBTQ+ community experience major disparities in healthcare, let alone sexual and reproductive health, as a result of discrimination and barriers in the health care system. For example, even among ciswomen, lesbian and bisexual women’s SRH needs are less adequately handled (Munson and Cook, 2016), despite them having higher risks of STIs, unwanted pregnancies and sexual violence (Ward, Dahlhamer, Galinsky & Joestl, 2013). Given that members of the LGBTQ+ community are more at risk of having an STI and being infected than heterosexual individuals (Boehmer, Miao, Linkletter & Clark, 2012) and are more exposed to sexual violence than other groups (Dunbar, 2006), it is essential they receive adequate sexual health care.     

Moreover, as the LGBTQ+ community is not a monolithic entity, they have diverse needs, ranging from STI and HIV testing and treatment, services related to reproductive cancers, support for intimate partner and sexual violence, family planning and abortion care, fertility preservation and assisted reproductive technologies, as well as gender-affirming services. All of this falls under SRH, thereby requiring tailored approaches to different individuals and their SRH needs. The heteronormative and cis-normative assumptions about the sexual and reproductive health needs of LGBTQ+ individuals need to go. Many LGBTQ+ people, including lesbian and bisexual women, transgender men, two-spirit, intersex, nonbinary, and gender non-conforming individuals, can get pregnant, use birth control, have abortions, carry pregnancies, and become parents. Clearly, reproductive health is not solely a ‘women’s issue’. Assisted reproductive technologies such as egg and sperm donors, IVF, and surrogacy should also be made accessible to those who want or require them. Transgender and gender-diverse individuals also require contraceptive services suited to their needs. Additionally, transgender individuals remain at risk for health issues due to their previous gender, such as transgender women who might be at risk for prostate cancer or transgender men who require screening for breast and/or cervical cancer (Cahill and Makadon, 2014). Unfortunately, homophobic and transphobic attitudes and a lack of knowledge regarding the SRH needs of LGBTQ+ individuals remain prevalent in health     care, thus hindering the SRH rights of the LGBTQ+ community. Everyone deserves equal, respectful, and safe health     care, and it is vital to the health of individuals and society that we receive it.

Conclusion

The realisation of SRH rights is essential for human wellbeing, as sexuality and reproduction are parts of our human experience. As such, we must challenge the notion that SRH rights are solely a heterosexual cis woman’s issue, and engage men and members of the LGBTQ+ community. SRH rights are some of the most vulnerable human rights and more must be done to ensure their realisation for all genders. We must view sexual and reproductive health from an intersectional lens and raise awareness in sex and health education programmes and health care services and beyond. As mentioned throughout this article, SRH rights guarantee everyone the right to self-determination in matters regarding sexuality, pleasure, reproduction, safe sex and services preventing and treating STIs, sexual dysfunction, reproductive system cancers, and other reproductive health services. These SRH rights are all things everyone needs in different and varying forms. Thus, sexual and reproductive need to be for everyone.

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