The Irish Study of Sexual Health and Relationships Main Report

SEX and sexuality are core dimensions of the human experience and an important determinant of well-being. An individual’s sexual behaviour and sexual health cannot be separated from their social and cultural context. This is brought out in the World Health Organisation’s (WHO) definition of sexual health. It is concerned not just with the absence of disease or dysfunction but with a broad definition of health: “Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.” Nonetheless, sexual behaviour can have serious consequences for physical health. These have been the subject of growing concern: Rates of sexually transmitted infections have increased by over 250% in Ireland since the mid-1990s.2 HIV notifications have increased by 243% between 1998 and 2003. Research by the Crisis Pregnancy Agency also shows that around a quarter of women who have been pregnant have experienced a ‘crisis’ pregnancy, a figure which rises to over half of all women under 26 who have been pregnant. These worrying developments demand a coordinated policy response, yet in Ireland this response has been undermined by a lack of detailed information on sexual partnerships, practices and use of contraception and protection, and the manner in which these are related to sexual attitudes, knowledge and beliefs. Research on sex in Ireland has been mainly confined to the study of sexual attitudes. Representative sources of data on sexual behaviours include: • a limited module on sexual behaviours in the 1994 International Social Survey Project • an analysis of contraceptive behaviour in the ICCP Survey • an analysis of general sexual activity, contraception and condom use using the 1998 and 2002 Slán surveys The availability or lack of representative and detailed data has an impact on the policy response. The Irish Study of Sexual Health and Relationships (ISSHR) was designed to fill the need for data. This report is one of four that detail the findings of the study. This report provides a general overview of the main findings from the ISSHR Survey. ISSHR Sub-Report 1: ‘Learning About Sex and First Sexual Experiences’ provides more detailed findings on how individuals learn about sex and on their first sexual experiences. ISSHR Sub-Report 2: ‘Sexual Health Challenges and Related Service Provision’ provides more in-depth analyses of sexual health challenges such as STIs and crisis pregnancy as well as examining associated service use. ISSHR Sub-Report 3: ‘Contemporary Sexual Knowledge, Attitudes and Behaviours in Ireland’ provides a detailed examination of contemporary Irish sexual knowledge and attitudes, and the manner in which these are related to behaviours. The ISSHR project and accompanying reports emerged from a series of developments over a number of years. In almost all countries where knowledge, attitude and behaviour (KAB) surveys have been carried out, public-health concerns have provided the impetus and legitimation for these. To a certain extent this has been true for Ireland. However, the ISSHR project, overall, emerged from a broader set of concerns and interests, such as: Chapter 1: Introducing the Irish Study of Sexual Health and Relationships • the development and findings of sexual knowledge, attitude and behaviour surveys (KABS) in other countries over the last two decades • the deliberations and recommendations of the National AIDS Strategy Committee (NASC) • a scoping study for an Irish KAB carried out in 2003 • the establishment, mandate and interests of the Crisis Pregnancy Agency in October 2001 These different influences together led to the commissioning in December 2003 of a national KAB survey for Ireland. These influences will be examined in more detail in the second section of this chapter. The chapter’s third section examines the importance of the Irish context for understanding the results of the ISSHR survey. Sexual knowledge, attitudes and behaviours can only be understood within the history and culture of an Ireland that has changed radically in recent decades. The fourth section examines the issue of socio-economic differences in health and their role in shaping sexual knowledge, attitudes and behaviours. The fifth section briefly discusses Irish legislation on sexual issues and, more importantly, how this has changed in recent decades. The sixth and last section outlines the structure of the rest of the report and briefly summarises the issues examined in the next 11 chapters.