Researchers from Columbia University and global south partners argue that sexual health initiatives must shift from top-down models to co-created approaches that value local knowledge, pleasure, and cultural traditions, citing examples from Māori, Somali, and Yoruba communities. A 2026 meeting hosted by Spain and South Africa, supported by the Partnership for Maternal, Newborn and Child Health (PMNCH), highlighted how 80% of 67 countries are downscaling SRHR programming, particularly for adolescents and maternal health, amid shrinking official development assistance (ODA).
Global sexual health efforts have long been dominated by frameworks developed in the global north, prioritizing disease prevention over community-defined notions of pleasure and wellbeing. A 2026 commentary led by Columbia University researchers highlights how this approach overlooks the expertise of global south communities, who are often treated as recipients of interventions rather than innovators of solutions. The authors note that in Haiti, sexual exploitation and abuse of women by UN peacekeepers persisted amid major gaps in accountability, leaving survivors without justice.
Critique of Top-Down Models
The authors, including Madison Moore, MPH, and Laura Gemmell-Sinnott, PhD, argue that decades of investment in sexual health programs have failed to address persistent challenges like 374 million new sexually transmitted infections annually and 225 million women without access to effective contraception. A 2026 analysis by Africa/B-Empire Magazine emphasized that over one billion people live with STIs, while 225 million women remain underserved, highlighting the need to center local knowledge.
Community-Led Solutions
The researchers advocate for sexual health programs co-created with communities, emphasizing that success should be measured beyond disease prevention to include joy, safety, and autonomy. They point to examples where local knowledge has informed global strategies. A PMNCH case study highlighted how a federated country used consolidated national purchasing to secure better prices for SRHR commodities, ensuring consistent service delivery.