How Do You Talk About Sex in Different Cultures?

In the late 1990s, I worked in Guatemala among the Mayan Indians. The Mayans are a closed society, very suspicious of outsiders. I thought, if ever there were a culture where it would be difficult to talk about sex, this would be it. But we had amazing focus groups with Mayan women. Female university students—themselves Mayan, speaking the local language and wearing traditional dress—led separate groups of younger girls and older women. We were surprised at how openly they answered questions like, Does your husband force you to have sex? Or, Is sex a burden or is it pleasurable?

I learned that even where it was "taboo to talk about sex," there are ways to get information. People are more willing to tell an interviewer (a perfect stranger) about their sex life than to tell the person next door. But there's no gold standard for determining if people are telling the truth. You still can get culturally desirable responses. Males tend to overreport sexual activity. And in study after study, only about 2 percent of women report having extramarital relations. I just smile about the predictable 2 percent.

In many countries, men and women do not easily talk with each other about sex. Our communication programs encourage them to talk about condom use or family planning. In countries where the status of women is low, some women fear physical violence if they bring up issues related to sex, like condom use. We work with the whole community and include men in the conversation so it's not the women who come home one day and say, "Here's what you should do."

The bottom line is that until you do something about the status of women, you will not solve the world's reproductive health problems.