Researchers at Columbia University say global sexual health has spent decades shipping programs from wealthy countries to the rest of the world while rarely asking communities what sexual wellbeing means to them, according to The Conversation. They write that pleasure, desire and community-defined wellbeing barely register in how success gets measured.
The authors are sexual and reproductive health researchers at Columbia, and the piece is a commentary, not a clinical study.
Their case starts with some blunt numbers. Every year there are more than 374 million new cases of four major sexually transmitted infections, they write, and more than one billion people worldwide are living with an STI. An estimated 225 million women who want to avoid pregnancy still aren't using effective contraception. Despite decades of investment, the authors say, those numbers should make us ask whether the dominant frameworks work as well as many assume.
The authors say that when programs are built around externally defined priorities, success tends to be measured only through things like HIV incidence or contraceptive uptake. That overlooks pleasure, intimacy, bodily autonomy and wellbeing. In some settings, they argue, the narrow focus has also sidelined sexual violence and local priorities in favor of donor agendas. They point to Haiti, where sexual exploitation and abuse of women by UN peacekeepers persisted amid major gaps in accountability and legal recourse.
The research itself skews the same way. In one systematic review of 33 pleasure-inclusive interventions, 25 were conducted in the United States, and very few took place in global south settings, the authors write.
The alternative they offer draws on knowledge traditions that standard public health tools don't capture. Researcher Ngāhuia Murphy draws on Māori cosmologies to challenge colonial narratives that cast menstruation as shameful or impure, describing it instead as sacred and life-giving, they write. Feminist author Minna Salami argues for what she calls “sensuous knowledge,” which is grounded in relationships, lived experience and the body. Somali oral poetry and Nigeria's Yoruba knowledge traditions, they say, also treat bodies and wellbeing as something understood through the senses as well as reason.
The authors say none of this means abandoning science. Surveys, clinical trials and epidemiological data remain indispensable, they write, but they aren't the only ways of understanding sexuality. Their recommendations include putting global south communities at the center of decision-making, measuring success beyond disease prevention to include joy, safety, intimacy and autonomy, and shifting funding and decision-making power toward global south institutions and locally designed models of care.
Their closing line is the sharpest one in the piece. “The future of global sexual health must depend less on teaching the global south and more on learning from it,” they write.