Power In Sexual Relationships

An opening dialogue among reproductive health professionals
POWER
IN SEXUAL RELATIONSHIPS

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iii
Prefacev
Acknowledgmentsvii
Power in Sexual Relationships: What Is the Evidence?l
Field-Based Efforts: Service Deliveryl4
Field-Based Efforts: Communityl9
Field-Based Efforts: Socialization26
Comments from the Community of
Donors and Implementing Agencies3l
Looking to the Future: Working Groups43
Closing Remarks48
Appendix: Meeting Participants5l
CONTENTS

For most of its history, the population
and public health field skirted issues of
sexuality and avoided acknowledging the
role of differential power in sexual rela-
tionships between men and women.
Silence on these matters was excused
before the HIV/AIDS epidemic by be-
liefs that these relationships were “pri-
vate,” that acts between partners were
fully voluntary, that people would be ret-
icent to discuss their sexual behavior and
health, and finally, that even if interven-
tion were considered desirable on public
health or other grounds, bringing about
changes in sexual relationships would be
too difficult.
The
l994Cairo International Con-
ference on Population and Development
and the
l995Beijing Women’s Conference
publicly ended the silence by focusing
attention on how gender influences sexu-
al relations and reproductive health deci-
sionmaking. Participants at the Beijing
Conference adopted a resolution con-
demning sexual coercion. Sponsored by
women from both modern and tradition-
al cultures, the resolution served as an open
declaration that much sexual activity for
many women was neither safe, nor volun-
tary, nor, dare it be voiced, pleasurable.
Women and women’s health advocates
have not been the only ones concerned
about communication, equality, and
power in sexual relationships. Public
health and social development profession-
als and many men began to voice concerns
that male gender roles were also limiting
men’s lives—leading to unequal and riskysexual relationships for them—and fos-
tering many negative outcomes for socie-
ty, such as high rates of sexually transmit-
ted infections and sexual violence.
While the role of power in sexual rela-
tionships has in recent years been acknowl-
edged, this understanding has largely lacked
practical expression in the reproductive
health field. The discussions summarized
in the following report indicate that gen-
der-based power inequalities hinder com-
munication between partners, limit the
ability of individuals and couples to talk
about or achieve desired child spacing and
family size goals, limit effective use of
reproductive health services, undercut
men’s and women’s attainment of sexual
health and pleasure, and increase substan-
tially their vulnerability to HIV/AIDS
and other sexually transmitted infections.
International efforts to reduce the
impact of AIDS have increasingly high-
lighted unequal power in sexual relation-
ships as a vital factor in the spreading epi-
demic, especially among adolescents and
young adults. In some parts of the world
where the epidemic is in full swing, the
ratio between female and male infection
rates among those aged
l5–24is 8to l.
As Paul Delay said in the course of this
meeting, HIV has become “essentially a
girls’ epidemic driven by male behavior.”
This report summarizes the proceed-
ings of a meeting, co-sponsored by the
Population Council and USAID’s Inter-
agency Gender Working Group’s Men
and Reproductive Health Subcommittee,
that responded to an increasing ground-
v
PREFACE

vi
swell of interest. Many organizations in
attendance believed it was imperative to
open a dialogue on power in sexual rela-
tionships, indeed on sexuality itself, to
affirm what we know and urge a continu-
ing learning process fed by diagnostic
research and carefully observed experi-
mental programs.
The participation at this meeting was
eclectic by design: reproductive health pro-
fessionals concerned with this subject mat-
ter have long felt that they need the advice
and perspective of those with a much more
in-depth knowledge of sexuality per se—
their own perspective is too confined to
conventional views. Further, we sought the
counsel of those with a sociological per-
spective on how boys and girls and men and
women construct their sexual identities.
Finally, we cannot move the debate much
further without improved measurement
tools—some drawn from distant fields—to
define and view meaningful dimensions of
power in sexual relationships and document
the ability of interventions to change them.
This meeting was a call to action.
Among the
l4lpeople who attended, there
was a unified sense that inequality in sex-
ual relationships is a vital issue in public
health and social