cultural variation in sexual norms and practices and in the social meaning of healthy sexuality. We identify three different aspects of sexuality over which individual control is possible and on which there would be varying levels of agreement with regard to autonomy:

  1. control in the sense of protection from sexually related violence or coercion, including rape and sexual exploitation of children. This aspect of sexuality is the one most likely to find consensus across cultures.

  2. control over sexual relations within a stable union, in particular the right to refuse sexual relations, whether physically safe or ''unsafe" (that is, likely to lead to infection or to an unwanted pregnancy). The right of women to refuse sexual relations is now more openly discussed and is also being officially acknowledged, at least in principle; the Fourth World Conference on Women in Beijing in 1995 endorsed this right in its Platform of Action.

  3. control over access to sexual relations, that is, the right to seek sexual relationships. This aspect of sexuality has the least agreement across cultures, and we do not make policy recommendations in this area.

Not only do these three kinds of control vary across and, at times, within cultures, they can also vary during a person's life. Norms, behavior, and their implications for reproductive health can also change over time.

In this chapter we first examine sociocultural variations in these three aspects of healthy sexuality. We then look at two special problems in healthy sexuality, sexual violence and female genital mutilation. The role of public policy and interventions to promote reproductive health is discussed in the last section. We emphasize cross-cultural variations in norms and institutions and highlight the major changes in sexual behavior that are occurring.

CULTURAL CONTEXT OF SEXUALITY

Volition in sexual relations can have distinct meanings, defined as conditions under which women would have an acknowledged right to refuse sexual relations:

  • when there is the possibility of exposure to an unwanted pregnancy,

  • when there is the possibility of exposure to an infection, especially of the reproductive tract, and

  • when the sexual relationship in general or at any particular time is unwanted for other reasons (including physical tiredness).



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