Should we abolish ‘Sexual and Reproductive Health’?

By Ezio De Nucci

 

Should we abolish ‘Sexual and Reproductive Health (SRH)? This provocative question might sound odd, especially after the US Supreme Court scrapped the federal right to abortion. Surely, we need more focus on ‘sexual and reproductive health’, not less!

But actually, the issue is not as simple, especially after distinguishing between the need for better ‘sexual and reproductive health’ and better ‘sexual health’ and better ‘reproductive health’. Yes, it’s a conceptual question – but one that is existential to the field and the work we do.

Should we still conceptualize sexual health and reproductive health together? Isn’t that problematic, especially if one of the field’s foundational goals was (and still is) to emancipate sex from reproduction and – increasingly – also reproduction from sex? Is a single unified field at all compatible with this emancipatory project?

There are at least four complex questions at stake here:

  1. Is it even possible to conceptualize sexual health and reproductive health separately? Are the concepts too closely interconnected?
  2. Is emancipation of “sexual” and “reproductive” health compatible with conceptualizing the two together?
  3. Is emancipating sex from reproduction an essential goal for researchers within the field?
  4. and finally there is the symmetrical – but independent – question of whether the same goes for emancipating reproduction from sex, because one could easily defending the former (emancipating sex from reproduction) without thereby embracing – let alone defending – the latter (emancipating reproduction from sex), even though the opposite might be more difficult.

Too Close To Call?

The rest of this short commentary is an attempt at answering these questions. Let us begin with the idea that sexual health and reproductive health are too close to be able to keep them separate.

This first claim is empirically dubious, because even if some condition affects both one’s sexual health and also one’s reproductive health – say for example Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, which is a congenital lack of uterus – that does not mean that we cannot distinguish between the way one’s reproductive health is affected by MRKH and the way one’s sexual health is affected – or not affected, in fact, if for example in the case of MRKH we think of sexuality more broadly than just penetrative practices. So that MRKH’s might impact sexual health less than reproductive health, depending on the sexuality of the patient.

Still, healthcare professionals within SRH might point to medical advantages to keeping ‘sexual health’ and ‘reproductive health’ intertwined; but the point of the MRKH example is to show that this is unnecessary and therefore we must weigh potential medical benefits against the political and symbolic cost of keeping sexual health and reproductive health in terms of lack of progress on emancipation.

So it is possible, in principle, to distinguish between sexual health and reproductive health even for conditions that affect both – and many conditions will only affect one. And once this point has been driven home, it is methodologically important beyond sex and reproduction, as it for example also allows us to distinguish the way a condition might affect one’s reproductive health from the way it affects non-reproductive health, think of endometriosis, which gets more attention for its reproductive consequences rather than more general negative health effects.

We can move on to the next question, whether emancipation requires us to keep sexual health and reproductive health separate. The point is simple: a crucial milestone of the sexual revolution was and is to emancipate sex from reproduction, through innovation such as the pill and other contraceptives, but also through social change, like de-stigmatizing particular sexual practices, like same-sex sexual relationships.

Here we need to distinguish between healthcare respecting this emancipatory trajectory and healthcare promoting this emancipatory trajectory – but neither seems compatible with continuing to think of sexual health together with reproductive health.

It could be objected that exactly abortion represents a counterexample to keeping reproductive health separate from sexual health for the sake of emancipation, because lack of access to abortion services is a lack of reproductive health which directly affects our sexual health by limiting our sexual options, choices and freedom.

This is indeed an important point, but one that should rather be understood in terms of rights, not health: so that lack of access to abortion services restricts both one’s reproductive rights and one’s sexual rights, because both reproductive choices and sexual choices are unfairly constrained. And in fact, it is important not to reduce rights-issues to health-issues: medicalizing rights misrepresents their essentially normative character. So far, we have argued that continuing to conceptualize sexual health and reproductive health together does not do justice to the project of emancipating sexuality from reproduction, which we consider foundational to the field formerly known as SRH.

All that’s left to do now is to distinguish emancipating sex from reproduction on the one hand from emancipating reproduction from sex, because it might be legitimate to think that the latter is not as important to the field as the former.

The idea of emancipating reproduction from sex is that, through innovation and social change, we have developed ways of reproducing that do not depend on sex, like adoption and so-called ARTs (reproductive technologies) and that we should value these alternatives because they broaden and democratize access to parenthood.

While it is very difficult to come up with any sensible arguments against emancipating sex from reproduction (this side of MAGA, anyway), there are some genuine concerns with emancipating reproduction from sex, like the idea that in the end reproductive technologies might end up replicating problematic patriarchal structures such as biological parenthood, and that biological parenthood is itself not compatible with an emancipatory project because it contributes to keeping women down (think of the concept of normative motherhood, for example).

It is therefore important to distinguish between these two symmetric but independent emancipatory projects: the former is foundational to the field – and if you still don’t believe in the urgency of sexual emancipation, you should really go and do something else. The latter is much more complex, and a timely reminder that the patriarchy is very good at finding ways to infiltrate and sabotage social change: widening and diversifying access to parenthood might ultimately be counterproductive, if it ends up entrenching biological parenthood as the reproductive gold standard.

In conclusion, here we have argued against a unified SRH field by pointing out some of the costs endured, in terms of slowing progress on emancipation, by failing to keep our sexual health distinct from our reproductive health.

 


 

About the Author

Ezio Di Nucci is a philosophy professor at the University of Copenhagen, with special responsibilities in bioethics.

Competing interests: None declared 

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