Sexual and Reproductive Health and Rights for All!

A ground-breaking new definition of Sexual and Reproductive Health and Rights (SRHR) will help LGBTI people access sexual and reproductive health information and services. The report from The Lancet and Guttmacher Institute Commission on Sexual and Reproductive Health and Rights affirms that achieving sexual and reproductive health relies on people being able to realize their sexual and reproductive rights.

Importantly the new definition includes people’s right to freely define their own sexuality, including sexual orientation and gender identity and expression. The Commissioners also stress the importance of people being able to have access over their lifetimes to the information, resources, services and support necessary to achieve this without discrimination, coercion, exploitation or violence.

The report acknowledges that people with diverse sexual orientations, gender identities and expression, and sex characteristics, including lesbian, gay, bisexual, trans and intersex (LGBTI) people, have been neglected in efforts to advance sexual and reproductive health and this has held back progress among wider populations. Exclusion has been due, in part, to pervasive stigma and discrimination of LGBTI people, including among health workers.

These negative attitudes are emboldened by state sponsored homophobia and transphobia which criminalise same sex sexuality of men in 72 countries and of women in 45 countries and control gender expression and deny self-determination of gender identity. The report notes that fear of disclosure of sexuality or gender identity to health service providers greatly inhibits LGBTI people’s ability to receive the correct information and health care they need. This also means that fewer LGBTI people can access reproductive health commodities that they need to protect themselves and their partners from health risks, particularly as young adults.

Efforts to address the disproportionate burden of HIV among gay, bisexual and other men who have sex with men (MSM) and, to a lesser extent, transwomen have demonstrated that it is possible to reach LGBTI people provision of in sexual health services. Nevertheless, inclusion of these populations is often contested within national HIV responses. In some cases a backlash has occurred such as in Tanzania where the Ministry of Health has withdrawn provision of condoms and lubricant, arrested service providers and threatened to deregister organisations serving MSM and other LGBTI people. Tanzania’s government has effectively banned these essential health commodities and services because of the erroneous belief that they promote homosexuality.

Beyond what we know about HIV there is a dearth of data on the SRHR status of LGBTI people in low and middle income countries. OutRight calls for more investment in building the evidence base on the SRHR needs of LGBTI people.

OutRight’s paper Agenda 2030 for LGBTI Health and Well-being released last year during the UN High Level Political Forum on Sustainable Development concurs with how the Commissioners have framed the SRHR needs of LGBTI people which include:

  • contraceptive counselling and services;
  • reproductive health screenings;
  • access to safer sex technologies;
  • counselling for sexually transmitted infection (STI) risk prevention;
  • STI treatment;
  • pregnancy related services;
  • partner violence and sexual violence;
  • counselling on fertility options;
  • and hormone therapy.

OutRight hopes that this new definition will result in meeting the SRHR needs of more LGBTI people. OutRight recommends that UN member states ensure that access to sexual and reproductive health care is truly universal by:

  • repealing punitive laws, policies, and practices that criminalize consensual same-sex behavior and self-
  • determination of gender identity;
  • prohibiting non-consensual medical procedures, including intersex genital mutilation, forced sterilization, and anal examinations;
  • collecting the number of services that address the sexual and reproductive health (SRH) needs of LGBTI people nationally;
  • measuring access to reproductive health commodities relevant to LGBTI sexual and reproductive health: condoms, lubricants, dental dams, latex gloves and finger cots; documenting inclusion of LGBTI topics in comprehensive sexuality education;
  • and ensuring SRH care providers commit to non-discrimination and respect for human rights in provision of SRH information and services.

OutRight congratulates the Guttmacher Institute and all the Commissioners for ensuring that a holistic approach to understanding the SRHR needs of LGBTI people has been highlighted in their important work.