Researchers at Columbia University argue that global sexual health programs have failed to adequately address pleasure, desire and community-defined well-being, instead imposing frameworks developed in wealthy nations onto the Global South.
Sexual health interventions have historically flowed from the Global North to the Global South, with researchers and donors setting priorities and defining success. Yet major challenges persist. More than 374 million new cases of sexually transmitted infections occur yearly. Over 1 billion people live with sexually transmitted infections worldwide. An estimated 225 million women who wish to avoid pregnancy do not use effective contraception.
In a recent commentary, the Columbia team examined how colonial histories, unequal funding and research hierarchies shape where knowledge is produced and whose knowledge counts as legitimate. They draw on examples from Māori communities, Somalia and West Africa to show how Global South and Indigenous traditions offer different understandings of bodies, sexuality and well-being.
Researcher Ngāhuia Murphy draws on Māori cosmologies to portray menstruation and women's reproduction as sacred and life-giving, challenging colonial narratives that frame them as shameful. Somali oral poetry traditions serve as knowledge sources about health and bodies. Nigeria's Yoruba knowledge traditions understand knowledge as experienced through senses and reason.
The researchers recommend that global sexual health move beyond exporting interventions. Instead, researchers and funders should work with communities to co-create approaches that value local knowledge, cultural traditions, pleasure and well-being. They call for measuring success beyond disease prevention to include joy, safety, intimacy, autonomy and belonging. They also advocate shifting funding and decision-making power toward Global South institutions and recognizing those communities as architects of innovation.