Power In Sexual Relationships | Page 3

family planning literature, which
focuses on heterosexual unions; howev-
er, she also drew insights from work in
other aspects of reproductive health,
including HIV/AIDS. Below are some
highlights.
Thinking about power
Blanc highlighted a distinction between
“power to” (the ability to act) and
“power over” (the ability to assert wish-
es and goals even in the face of opposi-
tion from another). She argued that
what is important for purposes of
examining the role of power in sexual
relationships is not the absolute power
of either member of a couple, but the
comparative influence of members rela-
tive to each other. She added that gen-
der inequities operate within the con-
text of other types of power imbal-
ances—such as those based on race,
wealth, or age—and interact with them.
What are the consequences of
unequal power?
Characteristics at the individual, couple,
family, and community level influence
both the balance of power and the extent
to which individuals have access to and
use reproductive health services. Gender-
based power relations can have a direct
effect on the ability of partners to
acquire information, to make decisions,and to take action related to their repro-
ductive health, safety, and well-being.
Reproductive decisionmaking
The relationship between reproductive
decisionmaking and gender-based
power is complex. Often, a woman and
her partner may not agree on the desir-
ability of pregnancy or the use of con-
traception. In spite of much research,
however, the evidence regarding whose
opinion carries more weight in repro-
ductive decisionmaking cannot be gen-
eralized across settings, and even within
the same setting the evidence has not
always been consistent.
Studies have shown that although the
majority of men say they approve of
family planning in the abstract, their
own partner’s use of contraception
often raises concerns and resistance.
Concerns expressed by men include fear
that they will lose their role as head of
the family, that their partners will
become promiscuous or adulterous, and
that they will be ridiculed by other
members of the community. While
men are often the primary decision-
makers in family planning, they may
leave the implementation of their deci-
sions to their partners. This attitude is
reinforced by services that tend to be
geared exclusively toward women.
Women who perceive that their hus-
bands will not support the decision to
use contraception may use a method
surreptitiously. Openly using contra-
ception in defiance of a partner’s real or
perceived wishes is difficult for many
women, especially those who are eco-
2

nomically dependent on their partners
and those whose partners can threaten
them with separation, divorce, or vio-
lence. However, surreptitious use has its
costs as well: going against a husband’s
will is viewed as uncharacteristic of
being a good wife, fear of being found
out is a constant burden, and seeking
medical help for problems or side
effects is awkward.
Use of reproductive health services
Power differentials directly influence
women’s access to and utilization of
reproductive health services. One of the
most concrete ways this occurs is through
men’s control of their wives’ financial
resources or mobility. This does not nec-
essarilymean that men purposely deny
women health care. Instead, their igno-
rance about women’s reproductive health
may lead them to have incorrect assump-
tions and make uninformed decisions.
Men’s sexual health and pleasure
Unequal power relations can have a
detrimental influence on men’s sexual
health as well. The limited information
that is available on this topic suggests
that both physical and psychosexual
problems are common among men. Yet
men’s concerns about appearing power-
ful and in control can discourage them
from discussing sexual health problems
with their partners or others, including
service providers.
Gender-based violence
Gender-based violence has a multitude
of negative effects on women’s repro-
ductive and sexual health. In addition tothe immediate injury, the damage to
women’s physical and mental well-being
can include depression, anxiety, gyne-
cological problems, and pregnancy
complications (including fetal loss).
Sexual violence may result in unwanted
pregnancy and sexually transmitted
infections (STIs). Even fear of abuse
may inhibit women from refusing
unwanted sex or from raising the issue
of contraception or condom use, leav-
ing many women and girls at risk of
unwanted pregnancy and STIs.
Vulnerability to HIV/AIDS and
sexually transmitted infections
Quantitative studies have demonstrated
that increased power among women is
often associated with increased condom
use. However, because women are often
expected to be ignorant and passive
about sexual matters, it is difficult for
them to be informed about risk reduc-
tion strategies. Even among women and
girls who are informed, unequal power
reduces their ability to negotiate disease
protection, to express their concerns
about sexual fidelity, and to say no to
sex. Economic dependence on men fur-
ther reinforces their vulnerability: it
increases the likelihood that they will
submit to unsafe sex as an insurance
policy against abandonment or in
exchange for money or favors. In cul-
tures where virginity is highly valued,
young women may be coerced by older
men into having sex, or may turn to
practices such as anal sex that preserve
their virginity but place them at
increased risk for STIs.
3

Norms about masculinity and its
association with power, self-reliance,
and risk-taking also contribute to men’s
vulnerability to HIV/AIDS. Multiple
sexual relationships for men are con-
doned, or at least not condemned, in
many societies. This leads some men to
pursue many partners, including com-
mercial sex workers, in spite of being
aware of the risks. In addition, the
expectation that men will be self-reliant
discourages them from seeking informa-
tion about sex or protection from dis-
ease, and encourages the denial of risk.
What have interventions that address
power demonstrated?
In addition to what we have learned
from research that addresses partner-
ship issues (i.e.,