Talking about Sexuality in Family Planning

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Talking about sexuality in family planning

In most family planning clinics around the world, providers and clients talk to each other, but they rarely mention sex. Although people use contraception to prevent pregnancy, and pregnancy is the result of sexual behavior, that fact is rarely acknowledged in clinics. This is due in part to discomfort witha nd lack of knowledge about sexuality.

In addition, several factors have helped create a service climate, both domestically and abroad, in which sexuality is notably absent. These include:

Whatever the cultural context, these factors are barriers to delivering high-quality family planning services. The consequences of this missed opportunity are profound.

A narrow view

For many years, contraceptive education and services have been delivered primarily in programs that focus on women and their role as mothers. The specialized mission of these programs has led many of them to hold a narrow view of the needs of women and of family planning clients in general. Traditionally, providers have viewed the family planning client as a heterosexual female in a monogamous relationship with a heterosexual male who, with her, shares decision-making about contraceptive issues. This profile is often the exception rather than the norm.

A demographic imperative

In some countries, reducing population growth has been the foundation for family planning programs. Demographically driven goals often fail to take into account individual interest and reasons for using contraception.

This pressure has worked against a larger understanding of family planning clients, including their sexual concerns. When target systems treat women and men as "acceptors," quality of care takes a backseat to the achievement of numerical goals.

A clinical approach

With the development of "modern" family planning methods, contraception has become increasingly medicalized. Providers are often doctors and nurses who tend to emphasize the medical aspects of contraception over the personal.

By talking with the client about the clinical aspects of the method, including potential side effects, many providers feel that they have done a comprehensive job without the need to delve into discussions of sexuality.

Preconceptions about relationships

Providers may make assumptions about the dynamics or the decision-making power within a relationship that create a false picture of shared responsibility between partners or that may cause providers to overlook the signs of sexual and other violence.

Decision making may not be shared; in fact, in heterosexual relationships, men are much more likely to have the ability to determine when, where, and how sexual activity takes place.

Women's risks may run the gamut from a partner's spoken disapproval about a contraceptive method (or its side effects) to violence.

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