Empowering marginalized voices for sexual health equity

Sexual health is essential to our overall well-being and influences our physical, emotional, and social lives. World Sexual Health Day 2024 highlighted the theme of “Positive Relationships,” emphasizing the importance of respectful and safe sexual experiences for all individuals. However, as we embrace this ideal, we must confront the harsh realities faced by marginalized and vulnerable groups, such as immigrants, refugees and individuals living in low- and middle-income countries (LMICs). For many, sexual health is a distant dream, hindered by systemic barriers and societal inequities. It’s time to shine a light on these issues, speak openly about the challenges and work collectively to advance gender and sexual health equity through meaningful policy changes, innovative practices and focused research. 

Sexual health challenges among marginalized groups 

Sexual health is a fundamental human right, yet for many marginalized populations, it remains compromised by discrimination, violence, and lack of access to essential services. These challenges are particularly pronounced among immigrants, refugees, and those from LMICs, who face systemic inequalities based on race, gender, socioeconomic status and geographic location. For adolescents from refugee and migrant backgrounds, these barriers increase the risk of unintended pregnancies, sexually transmitted infections (STIs) and sexual violence. Reproductive injustice highlights the systemic challenges that hinder these groups from accessing essential sexual and reproductive health (SRH) services and making informed decisions about their reproductive lives. These systemic barriers compromise individual well-being and perpetuate broader societal inequalities that hinder global development and social justice. 

The importance of open dialogue on sexual health 

For too long, discussions around sexual health have been silenced by cultural taboos, fear, and misinformation. Open dialogue is essential for dismantling the stigma around sexual health, which has historically been silenced by cultural taboos and misinformation. Silence breeds stigma: conversation cultivates change. Without these conversations, we cannot address the root causes of sexual health disparities or create environments where all individuals can experience positive and respectful sexual relationships. 

Normalizing discussions about sexual health reduces stigma and fosters a culture of understanding. When we speak openly about sexual health, we not only lift the veil of ignorance but also weave a tapestry of understanding that binds us together. Education and awareness are critical tools in dismantling these barriers, enabling individuals to advocate for their rights and make informed choices about their sexual and reproductive health. This is particularly important for adolescents and young people, who often lack access to SRH education despite being at a critical developmental stage. By creating safe spaces for young people to learn about and discuss sexual health, we empower them to make informed decisions and advocate for their rights.

Informed choices are the seeds of empowerment.

Advancing gender and sexual health equity 

To advance gender and sexual health equity among marginalized groups, particularly adolescents and those in LMICs, we must adopt a multifaceted approach: 

1. Policies must be inclusive and responsive to the needs of all populations, particularly those historically marginalized. Comprehensive SRH services, including contraception, safe abortion, and STI prevention and treatment, must be accessible to all. Equity is the bridge that turns access into opportunity. Policies should also address social determinants of health, such as education, economic stability, and safe environments, which significantly impact sexual health outcomes. 
2. Practice innovation: Health care providers and organizations must deliver culturally competent care that respects diverse backgrounds and experiences. This includes offering services in multiple languages, providing training for health care workers on the needs of immigrants and refugees and developing outreach programs to engage these communities directly. Access to care is the first step toward dignity. 
3. Targeted research: Research focusing on the sexual health of marginalized groups, particularly in LMICs, is urgently needed. Such research should explore unique challenges, identify effective interventions, and generate evidence to inform policy and practice. Importantly, this research should be participatory, involving the communities being studied to ensure their voices are heard and their needs addressed. 

A call to action 

As we move forward, let us commit not just to celebrating the progress we’ve made, but to being active participants in the ongoing fight for sexual health equity. Together, we can build a world where every person, regardless of their background, can experience sexual health in its fullest sense. Creating inclusive policies and advancing research on sexual health disparities is crucial for addressing the systemic challenges faced by these communities. By fostering open dialogue, implementing fair policies and conducting inclusive research, we can pave the way for a world where everyone enjoys the right to safe, respectful and pleasurable sexual experiences. This is not just a matter of health. It is a matter of justice. Justice in sexual health is a fundamental human right and achieving equity requires collective efforts in policy reform, practice innovation and participatory research. Justice in health is the heartbeat of a fair society. 

Are we truly creating a world where every person, regardless of their background, can experience sexual health in its fullest sense?

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Learn more with these resources:

• Understanding the sexual and reproductive health needs of immigrant adolescents in Canada: A qualitative study, Meherali, S., Louie-Poon, S., Idrees, S., Kauser, S., Scott, S., Salami, B., … & Mangat, A. 
• Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission, Starrs, A. M., Ezeh, A. C., Barker, G., Basu, A., Bertrand, J. T., Blum, R., … & Ashford, L. S.
• Forbidden conversations: A comprehensive exploration of taboos in sexual and reproductive health, Nor Faiza Mohd. Tohit and Mainul Haque 
• Unpacking 5 truths about equality in sexual and reproductive health and rights today, United Nations Population Fund
• World sexual health day,World Health Organization (WHO)
• Sexual health and its linkages to reproductive health: An operational approach, World Health Organization (WHO)

By Amber Hussain, Amyna Ismail Rehmani and Salima Meherali