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Table of Contents

Introduction.

Demographics of the group.

Analysis of current situation.

Need for improvement.

Social, cultural and political factors that cause the negligence.

Recommendations.

Conclusion.

References.

Introduction to Sexual and Reproductive Health Inequalities

Looking after the sexual and reproductive health of individuals is a human right that is essential to human development and achieving the Millennium Development Goals (Kangas et. al. 2015). Sexual and reproductive rights are important for all individuals in order to understand the needs and functioning of the human body and gaining access to safe and effective methods of contraception, family planning information and other such facilities (Kangas et. al. 2015). Sexual and reproductive health is also important from a human health point of view, where inadequate information can lead to dire consequences. Inadequate sexual and reproductive health centers in a particular area can lead to not only infant and maternal deaths but also various infections, diseases and other casualties. Sexual health is not merely about reproduction but also about sexual well-being of an individual (WHO 2020).

According to WHO 2020, various inequalities exist amongst various social groups regarding access to safe sexual and reproductive help. This flaw in the service is especially present amongst the rich and the poor. The correlation in between poverty and poor reproductive health is well established (WHO 2020). It has also been found that women living in low income countries are at a greater risk of such infections and sexual diseases as compared to the other demographics (WHO 2020). Another demographic that is under the high risk of sexual and reproductive issues is the older generation, despite what the general opinion is. This project is aimed at highlighting the sexual and reproductive health inequalities regarding such senior citizens, finding out the reasons for such inequalities and listing out recommendations for an improvement in the current situations.

Demographics of The Group

The senior citizens are defined as individuals who are aged 65 or above (The World Bank, 2019). According to reports, 9% of the total population of the world consists of senior citizens (The World Bank 2019). Specific to Australia, 16% of Australia’s total population consists of persons who are of the age 65 or above (The World Bank, 2019). Out of these statistics, over 50% of the population is female (AIHW 2018). The life expectancy of individuals in Australia has grown too in the last decades by around 7 years (AIHW 2018). Studies have also shown that the number of older persons in the world is expected to increase in the coming years due to the rising life expectancy. However, the senior citizens are one of the most neglected groups when talking about sexual and reproductive health (Aboderin 2014). Contrary to the stereotype regarding the elderly, almost 64% men and women over the age 65 are sexually active (Home 2018). This social group is often excluded and under-valued when talking about sexual and reproductive issues when in fact they are under a lot of danger from the same. Many issues, especially STIs are excessively common in the elderly.

Analysis of Current Situation

According to Aboderin (2014), the ICPD identified the older generation as one of the four key population groups that are marginalized when talking about sexual and reproductive health and rights. The conference stated that the post-reproductive and post-menopausal ages are often overlooked by researchers, politicians and other such groups (Aboderin 2014). The sexual and reproductive issues that are faced by the older generation are distinct compared to the ones faced by other individuals and thus often don’t gather a lot of attention. However, issues have been raised in the past few years regarding the sexual and reproductive health of the senior citizens and a need for equality amongst all individuals has been conveyed (Aboderin 2014).

Reasons for these current situations may be found in widespread assumptions, which associate older age with “asexuality”, as well as taboos around older adults’ sexual lives (Lusti-Narasimhan and Beard 2013). Often, it is assumed that the older generation does not have any sexual or reproductive needs and issues. This is especially harmful for the health of older women who have many more health issues related to their reproductive system as compared to older men. According to Scaunich (2014), Sexually Transmitted Infections (STIs) are increasing amongst women over the age 50 in Australia. It has been found that women over the age 50 are less likely to engage in protected sexual activities and thus are more likely to contract such diseases (Scaunich 2014). Women also undergo physiological changes after they attain old age which also contributes to their need for a good sexual and reproductive health facility which is unfortunately very uncommon in most places.

A few doctors in Australia believe that the taboo that older people do not engage in sexual activities should be broken and such older people should be engaged in talks about their sexual activities more often in order to understand the issues that they face (Lyons 2018). A doctor points out that stereotypes against older people engaging in sexual activities exist not only in the society but in the older individuals and the health professionals who treat them as well (Lyons 2018). The Doctors don’t initiate sexual conversations as they believe the patient will start them if required and on the other hand the older patients refrain from talking about their sexual lives as they are embarrassed and the notion of the elderly engaging in sexual activities is considered a taboo by many (Lyons, 2018).

In short, in current times the sexual and reproductive health of the elderly is almost completely going unnoticed due to various factors like stereotypes, insufficient information available, shyness and other such factors. As a result of these inadequacies, the number of sexual issues and STIs is on the rise. In Australia itself the number of STIs has increased by over 50% in the last few years (Lyons 2018). It is believed that there is a need to educate the masses and make the doctors take a better interest in the patient’s sexual life without feeling uncomfortable. Taboos need to be broken and health policies need to be established in order to create better situations regarding the sexual and reproductive health of the elderly.

Need for Improvement

There is a need for people’s sexual and reproductive health to be in the state of complete well-being. What this essentially implies is that individuals should have a safe and hygienic sex life and reproductive system that is properly maintained and taken care of (UNFPA 2020). It should be noted that there is special need for improvement in the sexual and reproductive health facilities related to the elderly for several reasons:

  • The number of elderly individuals in the world is most likely to increase over the years (Banke-Thomas et. al. 2020) and thus it is essential to be ready to take care of their needs. With the rising number of senior citizens in the world with rising life expectancy, it is important to look into the sexual health aspects of their lives. Aging has a significant impact on the health of individuals (Banke-Thomas et. al. 2020) and it is essential to acknowledge such changes and treat them accordingly.
  • There is a need for improvement in the sexual and reproductive health of the elderly due to the current situations regarding them. Sexual and reproductive health of the elders continues to remain a taboo (Banke-Thomas et. al. 2020) and many societies neglect their need for needs regarding the same. From health professionals to researchers, most individuals are oblivious of the fact that a major part of the demographic engages in sexual activities and thus needs attention regarding the same.
  • Elderly women, especially, face many issues regarding sexual health. Post-menopause, there is a sharp decline in the estrogen and progesterone levels which often lead to reduced libido, irritability and lack of energy. Women, after menopause, stop using protection in some cases due to the correlation in between the use of protection and conceiving a child. What most women don’t remember is that protection also offers a safe-guard from sexually transmitted infections (Lusti-Narasimhan and Beard, 2013). This reduced use of sexual protection and led to increased number of cased of STIs and HIV in the elderly (Banke-Thomas et. al. 2020).
  • In many cases, the doctors are not comfortable discussing the elderly people’s sexual lives (Banke-Thomas et. al. 2020). Such doctors are not given proper training as to how the sexual issues of the elderly need to be addressed and often come across as stereotypical, prejudiced and discriminatory against older people (Banke-Thomas et. al. 2020). These doctors need to go through special training in order to learn the proper approach that needs to be taken with the older patients. Thus there exists a need for improvement in the doctors.
  • There also exists a need for improvement as many elderly individuals are uncomfortable discussing their sexual life with doctors in the fear of facing embarrassment. Thus, there is a need to normalize the discussion of the individual’s sex life without feeling shy or embarrassed.

Social, Cultural and Political Factors that Cause the Negligence

There are various factors that have contributed to the inequalities amongst the elderly individuals when talking about sexual and reproductive health. Some of these factors include:

  1. Stereotypes: One of the major reason why the sexual and reproductive health of the senior citizens is ignored is due to the beliefs and stereotypes that surround them (Dhingra et. al. 2016). By a major part of the population, the elderly are considered sexually inactive or asexual and thus, their sexual life and issues often go unnoticed (Dhingra et. al. 2016). People often forget to consider the changes that individuals go through after middle age and the kind of attention their body and reproductive parts require. These stereotypes have created a bubble around the elderly and they often find it difficult to come out of that bubble. The stereotypes have also caused the negligence in understanding the needs of the elderly which has amounted to an increased level of misconceptions and misunderstandings. Gott, Hinchliff and Galena (2004) had found that doctor’ beliefs about sexual behaviours their older patients were based on stereotypes of aging and sexuality, rather than experience with patients. These stereotypes have made it difficult for the elderly to talk openly about their sexual life and activities in front of people as they are considered a “taboo”.
  2. Negligence from the government: The authorities of various countries have failed to acknowledge the sexual and reproductive needs of the elderly individuals that have caused a failure to have proper policies and regulations regarding them (Ports et. al. 2015). Such issues have gone unnoticed in most countries. It is failure on the side of the government that they have failed to understand the needs of the elderly and accordingly ensure that they get an effective sexual and reproductive health service. While attention has been given to the sexual health of young and middle-aged women, the same amount of importance is not given to the elderly women.
  3. Lack of education: The older adults of a given population are more likely to have less or limited knowledge about various sexually transmitted infections and HIV, and are less likely to engage in protected sexual activities, which makes them particularly susceptible to such infections (Ports et. al. 2015). This lack of education stems from not only the missing government policies but also due to the lack of communication amongst the elderly and the healthcare professionals. It is essential to remember that while talking about sexual health, communication is key (Mayo Clinic 2017). It is important to understand the exact symptoms and situations before commenting on the possible solutions to problems. Educating the elderly about the risks of unprotected sexual activities and normalizing the concept of the elderly engaging in sexual activities is essential in order to reshape the current situations.

Recommendations on Sexual and Reproductive Health Inequalities

Proper planned steps need to be taken in order to raise awareness about the presence of sexual and reproductive issues in the elderly. Some of the basic steps that can be taken are:

  1. More awareness about STIs: Not only amongst the health professionals and the senior citizens, but amongst every person in the society. Everyone needs to be aware of the various problems related to the sexual and reproductive health of people of all age. Like the presence of sex education, there is also the need for proper sexual health and reproductive health education of human beings that should include but not be limited to the elderly. This will help break various stereotypes that surround the elderly and help normalize sexual activities amongst them. Educating the masses about a specific issue is step one towards bringing a change in the current situation.
  2. Policies regarding the elderly sexual and reproductive health: There is a need to establish certain policies regarding the sexual and reproductive health amongst the elderly. It is important to remember that most of these individuals survive on pension (Amaglobeli and Gaspar 2020), and thus the health facilities have to be affordable and easily available. In some countries where the policies already exist but are not very helpful, proper analysis needs to be to highlight where the policy lacks and accordingly changes should be made. The policies should be simple and easy to avail.
  3. Training for doctors: Training the doctors is essential in the process of improving the sexual and reproductive health of the senior citizens. Ageism exists amongst various sections of the society (Ageing Equally 2019) and doctors are becoming increasingly uncomfortable discussing intimate details with their senior patients (Gugliucci et. al. 2020). One reason for this is the stereotypes that various health officials have towards such sexual activities and another reason is the lack of training. Doctors are not provided with proper education about how this sensitive topic is supposed to be brought up and discussed with the elderly (Gugliucci et. al. 2020). Many doctors find it difficult to discuss such details with their patients and this issue needs to be addressed. A proper training that teaches health professionals the correct approach to discuss their patients’ sex life and reproductive parts should be established in all training curriculums. The patients should be made comfortable and such details should be discussed in a safe and professional environment.

Conclusion on Sexual and Reproductive Health Inequalities

Along with proper education and awareness about the sexual health and reproductive health of the elderly along with highlighting the various risks that exist to their health, the problem of inequality should be effectively solved. In the coming years, one can hope that these issues get resolved and the sexual lives of the senior citizens get the attention it needs. This will not only promote a healthier sex life amongst such individuals but also help massively reduce the cases of STIs amongst them. It is established that the topics of sex and intimacy are often times controversial or misunderstood in our society. However, with the help of these recommendations and others, the problem can be resolved and changes can be brought in the society.

References for Sexual and Reproductive Health Inequalities

Aboderin, I. 2014. Sexual and reproductive health and rights of older men and women: addressing a policy blind spot. Reproductive Health Matters, vol. 22 no. 44, pp. 185–190.

Ageing Equal. 2019. Ageism and sexuality. [Online]. Available at https://ageing-equal.org/ageism-and-sexuality/ [Accessed on 28/08/2020]

AIHW. 2018. Senior Citizens in Australia. [Online]. Available at https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/demographics-of-older-australians [Accessed on 28/08/2020]

Amaglobeli, D., & Gaspar, V. 2020. The Impact of Aging Worldwide on Pensions and Public Policy. [Online]. Available at https://www.imf.org/external/pubs/ft/fandd/2020/03/impact-of-aging-on-pensions-and-public-policy-gaspar.htm [Accessed on 28/08/2020]

De Sousa, A., Dhingra, I., & Sonavane, S. 2016. Sexuality in older adults: Clinical and psychosocial dilemmas. Journal of Geriatric Mental Health, vol. 3 no. 2, pp. 131.

Gott, M., Hinchliff, S., & Galena, E. 2004. General practitioner attitudes to discussing sexual health issues with older people. Social Science & Medicine, vol. 58 no. 11, pp. 2093–2103.

Gugliucci, M., & Weaver, S. 2020. Defining Moments: Sexuality and Care of Older Adults. [Online]. Available at https://www.aginglifecarejournal.org/defining-moments-sexuality-and-care-of-older-adults/ [Accessed on 28/08/2020]

Home. 2018. Senior Sexuality: Common Sexual Problems Among Older Adults. [Online]. Available at https://www.kendalathome.org/blog/senior-sexuality-common-sexual-problems-among-older-adults [Accessed on 28/08/2020]

Kangas, A., Haider, H., Fraser, E., & Browne, E. 2015. Sexual and reproductive health and rights. [Online]. Available at https://gsdrc.org/topic-guides/gender/sexual-and-reproductive-health-and-rights/#:%7E:text=Further%20resources-,Introduction,of%20the%20Millennium%20Development%20Goals.&text=SRH%20accounts%20for%20at%20least,14%20per%20cent%20for%20men. [Accessed on 28/08/2020]

Lusti-Narasimhan, M., & Beard, J. R. 2013. Sexual health in older women. Bulletin of the World Health Organization, vol. 91 no. 9, pp. 707–709.

Lyons, A. 2018. Talking sexual health with older patients. [Online]. Available at https://www1.racgp.org.au/newsgp/professional/talking-sexual-health-with-older-patients [Accessed on 28/08/2020]

Mayo Clinic. 2017. Sexual health and aging: Keep the passion alive. [Online]. Available at https://www.mayoclinic.org/healthy-lifestyle/sexual-health/in-depth/sexual-health/art-20046698 [Accessed on 28/08/2020]

Ports, K. A., Barnack‐Tavlaris, J. L., Syme, M. L., Perera, R. A., & Lafata, J. E. 2015. Sexual Health Discussions with Older Adult Patients During Periodic Health Exams. The Journal of Sexual Medicine, vol. 11 no. 4, pp. 901–908.

The World Bank. 2019. Population ages 65 and above, male (% of male population) - Australia | Data. [Online]. Available at https://data.worldbank.org/indicator/SP.POP.65UP.MA.ZS?locations=AU [Accessed on 28/08/2020]

UNFPA. 2020. Sexual & reproductive health | UNFPA - United Nations Population Fund. [Online]. Available at https://www.unfpa.org/sexual-reproductive-health#:%7E:text=Good%20sexual%20and%20reproductive%20health,how%20often%20to%20do%20so. [Accessed on 28/08/2020]

WHO. 2020. Social determinants of sexual and reproductive health. [Online]. Available at https://www.who.int/social_determinants/tools/9789241599528_eng.pdf?ua=1 [Accessed on 28/08/2020]

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