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Inequality is bad for sexual health

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HealthWiki > Health Actions for Women > Chapter 4: Sexuality and Sexual Health > Inequality is bad for sexual health


Chapter 3 of this book discusses the idea that there are different gender roles for people with female bodies and people with male bodies. In almost all places, male gender roles are considered more important than female gender roles. So, men generally have dominant roles. And this usually means that in relationships between men and women — including sexual relationships — men have more power and more resources. This inequality between women and men is a root cause of many of the health problems discussed in this book, and health problems related to sexuality are no exception.

Sexual rights and responsibilities

A woman’s most basic gender role is her reproductive role — the expectation that she will have at least one child. In many societies, this role comes with many sexual responsibilities and few sexual rights. For example:

a tired-looking woman breastfeeding a baby while 3 older children cling to her.
a man standing with arms folded while a woman with a child holds out her hand to him.
Women are responsible for giving birth and taking care of their children, but they may not have the right to decide when to have children or not to have children. Women work very hard to keep the family going (cooking, cleaning, caring for children) but they are not paid for their work. They depend on men for income, so they might feel they have no choice but to do what their partner wants.
a man lying on top of a woman in bed.
Women are responsible for pleasing their partners, but they may not have the right to choose when and how to have sex for their own comfort, pleasure, and satisfaction.
a woman holding a condom while a man stands with his arm around her.
a woman trying to push away a man who is on top of her.
Women are responsible for asking men to use condoms to prevent STIs, but they may not have the right to refuse sex if the men refuse condoms. Women are responsible for keeping a respectable reputation, but they often have little power to defend themselves from sexual harassment or forced sex.


One of the most harmful beliefs about women and sexual health is the idea that women are responsible for most sexual health problems. Women are often blamed for STIs, infertility (being unable to have children), and impotence (when a man wants to have sex but his penis does not get hard). These problems can have many different causes, and it is unfair to always blame women or make a woman feel ashamed when she or her partner has a sexual health problem.

Improving sexual health requires changing harmful gender roles so all women can experience their sexuality without shame, fear of violence, or needing to use sex to support themselves and their families. Making these changes is a long process. One way to begin is by meeting to reflect and talk about these issues with women in our communities.

HAW Ch4 Page 93-3.png

Women are more confident and able to communicate with their partners about sex when they do not have to hide their sexuality. If women are expected to be ashamed of knowing about sex or enjoying sex, it will be difficult — and sometimes dangerous — for them to suggest safer or more pleasurable ways of having sex to prevent STIs or unintended pregnancy.

The activity below can help a group of women think about ways gender roles in their community influence sexual relationships between women and men.

ActivityWhat is sex for a man? What is sex for a woman?

Discussing men’s and women’s expectations about sex is a good way to see how gender roles influence sexual relationships.

  1. Ask the group to think about what men and women are expected to do in sexual relationships. How are they expected to behave? Give them a few minutes to think about their own relationships and those of other people they know.
  2. Discuss the different expectations for men and women. For example:
    • Are women expected to have sex only to have children? Are expectations different for men? If so, what are they?
    • Do men and women get the chance to talk openly about sex? If so, with whom do they speak?
    • Are men’s and women’s pleasure both important? Are men ashamed of feeling desire or pleasure? Are women?
    • Can a woman decide what she and her partner do when they have sex?
    • How do the sexual expectations of a young woman change when she gets married? How do they change for a young man?
    • What do people think if a man has more than one sexual partner? What if a woman does?


    Ask how young men and women learn these expectations. How do parents, other familiy members, friends, teachers, religious leaders, or the media play a role? How have these expectations changed from the time of your grandparents?

  3. a discussion leader speaking to a group of women.
    How are men and women expected to learn about sex? Do they learn differently?

  4. To conclude, ask each person to say one thing they wish they could change about the different expectations women and men have about sex.


Activities that question sexuality can make people uncomfortable and leave them feeling vulnerable. Find ways of closing your meetings that strengthen the connections among the participants. It can be as simple as asking everyone to say something they appreciate about the person next to them.

2 women speaking to each other.
I like how you listen so closely when people talk.
I was glad you shared about what happened between you and your husband. I thought I was the only one who had that problem.

Stories and role plays to discuss sexual health

There are many reasons why some women do not have safe and satisfying sexual relationships. You can use a story or role play to discuss problems with sexuality and sexual health, possible causes, and how things could be different. Here is a sample story:

Sex and the unhappy bride

When Emma turned 17, she and her boyfriend Roberto got married. Emma had sex for the first time on her wedding night. Roberto had been very respectful and never pressured her to do more than kiss while they were courting. She was grateful that he wanted her to be a virgin when they married. Now, after 3 months of marriage, Emma and Roberto have sex every day, but Emma does not enjoy it at all.

Emma and Roberto standing next to their bed.


Roberto works at a banana plantation, and Emma stays home alone every day. Her family does not live nearby, so she does the house chores alone. She must take care of the animals, collect water, gather wood, wash the clothes, walk to the market, and cook. She is so tired at night that she wishes she could just fall asleep in Roberto’s arms. Roberto works hard too, but he always wants to have sex when they go to bed, and Emma cannot tell him how she feels.

Before the wedding, Emma’s older sisters told her it was her duty as a wife to please her husband in bed, but they did not explain what "pleasing him" meant. Emma loves Roberto and wants more than anything else to please him, but everything he does when they are in bed makes her feel ashamed and uncomfortable. She hopes to get pregnant soon, but she is also afraid that after she is pregnant Roberto will go out and have sex with other women.

ActivityChanging stories, changing lives

Discussing someone else’s story is usually easier than discussing our own relationships, especially our sexual experiences. This activity will work best with a group of only women. You can do step 1 with the whole group, or divide the women into smaller groups with 2 to 4 women in each group.

For this activity you can use Emma’s story, Sex and the unhappy bride, or give the group other situations where a woman might experience a difficulty in a sexual relationship. For example:

  • A young woman who just started having sex thinks she is pregnant. She is afraid to tell either her boyfriend or her family.
  • A woman suspects that her husband has sex with other women. She worries he might have HIV or another STI. She wants to ask him to use a condom when they have sex but is afraid he will be angry.
  • A woman has a partner she loves, but she has never had an orgasm when they have sex.

  1. Have the group or groups prepare and present their problem to the others either as a role play or by telling it as a story. (See instructions on role plays.)
  2. After each story or role play, discuss how the situation affects the woman’s sexuality and sexual health. For example, how does this situation affect:
    • the woman’s health? What health problems does she have now? What health problems might happen later?
    • the woman’s sexual experience or pleasure?
    • the woman’s feelings about her life and her future?
    • the woman’s relationship with her partner? How does it affect her relationships with her family, neighbors, schoolmates, or co-workers?
  3. 1 woman speaking to 3 others.
    Why is it difficult for the woman to talk with her partner about this problem?
  4. Also talk about why this situation is happening. What are some of the causes? Are gender expectations for women or men contributing to this problem? Who has more control over decisions in the relationship?
  5. To conclude, ask each person to say one thing they wish they could change about the different expectations women and men have about sex. After discussing the stories or role plays, ask the groups to think of ways each situation could be healthier for the woman. For example, what could be different in Emma’s life? Make a list of possible changes and improvements.
  6. Discuss with the group the lists of changes or improvements that would give the woman more power in her relationship. You might ask:
    • Are these changes that you could make in your own life? In your children’s lives? Why or why not?
    • How can we make these changes in our families and community? What would you need, or what would our group need, to make these changes happen?
    • Some changes might require organizing things differently. For example, maybe your community needs more opportunities for sex education.