SRHR2017 showed differences in sexual and reproductive health and rights between different groups in the population. The answers to almost all questions in the survey differed between women and men, and the greatest gender differences were seen for:
- sexual harassment and sexual violence
- experiences of payment in exchange for sex
- pornography use
- several different experiences in people’s sex lives
This reflects different gender conditions regarding sexual and reproductive health. Further, the results show greater vulnerability among women, younger people, non-heterosexuals, and trans people and to a certain degree among people with lower income and education.
A majority of the population have good sexual health, which of course is a positive result. At the same time, sexuality and people’s sex lives differ, sometimes a lot, between women and men. For example, women more often experience low sex drive because of fatigue and stress compared to men. Why men less often feel free to say no to sex needs to be studied further. There are strong norms in our society regarding sex and sexuality, and gender roles, norms regarding femininity and masculinity, and norms regarding heterosexuality affect to what extent people feel free to live their lives as they see best.
Sexual harassment, assault, and sexual violence and how these affect our health is an important public health issue. The prevalence and the consequences do not just affect the victimized individual; they are also a marker for how equal a society is.
Based on the results of SRHR2017, there appears to be a need for more discussions and analyses on sexuality regarding support, advice, and education. For young people we have youth clinics and maternity health care centers where issues related to sex also can be discussed – but that mainly target women – and there are few places where older people can turn to receive help regarding their sex life and sexuality. There is a need to systematically monitor and evaluate these preventive institutions, especially youth clinics, also because of the need of men for support, advice, and care related to their sexuality. We need to emphasize the reproductive rights and health of men and discuss men’s rights to reproductive health, the path to having children, their use of contraceptives, treatment for sexually transmitted diseases, and general sexual health.
In SRHR2017, we see that women and men of all ages use digital arenas for sexual purposes. Young people are more active online, and differences between the sexes are small among young people. UMO.se is an online youth clinic and a good example of how to handle sexuality issues in way that reaches many and with high quality.
Schools are important arenas for improving gender equality and equity regarding health, and the sex education in schools constitutes an important part of SRHR. Sex education in schools and school health care are to provide information to all students about structural perspectives, like legislation and norms, and individual perspectives, such as the physical body, sexual health, relationships, and sexuality. Studies show that students receive more information on sexual health, pregnancy, and contraceptive use than about gender equality, LGBT perspectives, and relationships even though sex education has been subjected to improvements such as integration into other subjects. The improvement work with sex education is supported by a quality assessment from the School Inspection, improvements from the School Authority, and international guidelines regarding sex education from UNESCO and WHO Europe.
SRHR in Sweden – how to proceed
Sweden has a unique opportunity to reach gender-equal sexual and reproductive health and rights based on Swedish legislation, UN conventions, and established policy documents. Sweden has a strong political consensus, which is also reflected in Agenda 2030.
Sexuality is a determinant of health, and the interplay between structural, socioeconomic, demographic, and biological factors influences sexual health. Sexuality and sexual health are dependent on many other aspects of health and lifestyle factors, such as mental health and the use of alcohol and drugs.
In conclusion, our results confirm our prior understanding of SRHR, namely that social prerequisites are crucial for people’s freedom and sense of control over their sexuality and reproduction and to have good sexual, reproductive, mental, and general health. Gender differences exist due to structures, norms, and expectations on both the individual level and societal level, and this creates patterns that affect people’s sex life, communication, relationships, and family life in relation to health.
An important public health issue is sexual harassment, assault, and sexual violence and how this negatively affects health. Harassment, assault, and sexual violence have to stop.
We need further knowledge on differences due to gender, socioeconomic status, and sexual identity in order to improve gender equality and equity. The conditions for and the rights to sexual health need to be monitored and analyzed.
SRHR is coordinated on a national level by The Public Health Agency of Sweden, which works to improve knowledge and national cooperation. In the monitoring of the sustainable development goals, the Swedish gender equality policy, and the strategy to end men’s violence against women, the SRHR issues and specific items from this material are essential. The knowledge generated by this study is a starting point for further public health improvements within the field of SRHR in Sweden.