Should tax money be spent for research on pornography in Bangladesh? How about on sex worker organisations’ efforts to legalise sex work? Do humanitarians have a right to a sexual life? While there is widespread global support for some aspects of sexual health, such as HIV prevention or ending sexual violence against women and girls in war zones, many other sexual health issues are far more controversial. The theme of this year’s World Sexual Health Day on Thursday is exploring what sexual health actually is, and what it means to all of us.

The World Association for Sexual Health and the World Health Organisation’s definition of sexual health is:

“Sexual health is a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. 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. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”

Clearly, sexual health is about much more than HIV, sexually transmitted infections, maternal mortality and other health problems that can count on broad public support. For that matter, these uncontested issues can only be solved by addressing some of the thorny and controversial aspects of sexual health. Take sex education for teenagers. Unmarried teenagers are often excluded from receiving information and sexual health services because, according to unrealistic and prudish social norms, they are not supposed to be sexually active.

This leads young men to turn to the only other easily available source of information about sex: pornography. Unfortunately, pornography is also a key source of misinformation on sex, often depicting sexual activity as entirely oriented towards fulfilling male sexual desire, with little attention given to pleasurable or safe sexual experiences for women.

Unsurprisingly, relying on pornography as a major source of sexual education for men does not produce very positive sexual health outcomes. And denying unmarried teenage women access to reliable sex education in schools contributes to high maternal mortality rates and high infant malnutrition rates. Moreover, even married men and women, whose sexual activities are socially condoned, often lack the basic conditions for sexual health.

The lack of political interest in improving comprehensive sexual health is a major reason why poor countries are failing to significantly reduce maternal mortality, one of the millennium development goals.

Globally, an estimated 222 million women lack access to modern methods of family planning. In some of the least developed countries, up to a quarter of women report an unmet need for family planning. Some of these unmet family planning needs can be addressed by increasing access to contraceptives. But the provision of any contraceptive technology has to address women’s health concerns, including the concerns they might have about how it will affect their sexual relationships. If couples do not want to use condoms because they decrease sensation, or resist using an intrauterine device because their countries have no trained healthcare staff to help insert it properly, we need to take these concerns seriously, rather than dismissing them as ignorant or irresponsible.

Some people don’t get access to sexual health education or services because society doesn’t think of them as sexually active. Services aimed at widows and disabled people often fail to take their sexual activity into account. Widows who do engage in sexual activity may be silenced by fear of religious ostracism. Poor people, including migrants and street children, may be housed in shelters where sexual activity is forbidden or treated as a crime. For others, unorthodox sexual activities put them outside the pale of socially approved sexual health services, and make them more vulnerable to poverty.

When the Institute of Development Studies reviewed the social science literature on sexuality and poverty, it found abundant evidence that lesbian, gay, bisexual and transgender (LGBT) people and sex workers suffer from stigma, material exclusion, marginalisation, lack of access to social institutions, and lack of relevant knowledge. Both sex workers and LGBT people experience extreme violence – often at the hands of authorities – and challenges to exercise civil and political rights. In many countries (South Africa, India, Vietnam, and the Philippines, to name a few on a long list), governments allocate benefits to heterosexual nuclear families, excluding same-sex couples.

Sex is a social and personal activity, deeply bound up in culture, politics and family life. Common sense dictates that promoting sexual health requires addressing much more than narrow medical needs. Yet, as a recent WHO report in the Lancet found, global programmes have tended to exclusively develop narrow maternal health and HIV “silos”, instead of promoting a comprehensive sexual and reproductive health agenda.

Reducing HIV and maternal mortality depends on universal access to sexual and reproductive healthcare, including family planning, abortion, pap smears and treatment for reproductive tract infections. And bringing in the entire population means agreeing to respect sexual diversity as part of the guarantee of universal human rights. The medical goals of sexual health may be politically non-controversial, but achieving those goals will require us to also deal with the controversial aspects of sexual life.

• Pauline Oosterhoff is a research fellow at the Institute of Development Studies