Socioeconomics and Erotic Inequity: A Theoretical Overview and Narrative Review of Associations Between Poverty, Socioeconomic Conditions, and Sexual Wellbeing

Socioeconomics and Erotic Inequity: A Theoretical Overview and Narrative Review of Associations Between Poverty, Socioeconomic Conditions, and Sexual Wellbeing. Jenny A. Higgins,Madison Lands,Mfonobong Ufot &Sara I. McClelland. The Journal of Sex Research, Mar 18 2022. https://doi.org/10.1080/00224499.2022.2044990

Abstract: Sexual health includes positive aspects of sexuality and the possibility of having pleasurable sexual experiences. However, few researchers examine how socioeconomic conditions shape sexual wellbeing. This paper presents the concept of “erotic equity,” which refers to how social and structural systems enable, or fail to enable, positive aspects of sexuality. In part one, we use this concept to consider potential pathways through which socioeconomic conditions, especially poverty, may shape sexuality. Part two builds from this theoretical framework to review the empirical literature that documents associations between socioeconomics and sexual wellbeing. This narrative review process located 47 studies from more than 22 countries. Forty-four studies indicated that individuals who reported more constrained socioeconomic conditions, primarily along the lines of income, education, and occupation, also reported poorer indicators of sexual wellbeing, especially satisfaction and overall functioning. Most studies used unidimensional measures of socioeconomic status, treating them as individual-level control variables; few documented socioeconomics as structural pathways through which erotic inequities may arise. Based on these limitations, in part three we make calls for the integration of socioeconomic conditions into sexuality researchers’ paradigms of multi-level influences on sexuality.

Discussion and Recommendations

Strong but Contextually Limited Associations Between Socioeconomic Conditions and Sexual Wellbeing

In this paper, we established theoretical and conceptual pathways through which socioeconomic conditions, including poverty, may shape people’s experience of their sexual wellbeing. We then built upon this foundation to closely examine the empirical literature documenting economics and sexual wellbeing. In this narrative review of empirical research, we found overwhelmingly that poorer economic conditions were positively associated with lower levels of sexual wellbeing. By drawing out secondary or buried findings within these studies, we helped establish an evidence base for relationships between economics and erotic inequity. In sum, connections between economic conditions and sexual wellbeing are not just a likely hypothesis but an empirically documented phenomenon at the individual level. Moreover, these relationships were consistent across high and low-income countries, although studies did not allow for much relative comparison across cultural settings. However, these findings were usually stripped of the contexts, both material and nonmaterial, in which poverty causes these relationships.

Indeed, we encountered a critical discrepancy between our conceptual framework and the literature included in the empirical review. Exceedingly few of the 47 articles documented or commented on socioeconomic status as a series of structures through which these inequities arise. The articles largely treated socioeconomic status as a single-domain (e.g., income), individual-level independent variable. They also tended to use unidimensional, often Western-developed indicators of sexual wellbeing, such as FSFI scores.1 We encourage future researchers to take more complex, multi-domain approaches to measuring sexual wellbeing and the economic conditions that impact it. Along similar lines, while dozens of articles in this review report on associations between socioeconomic and sexuality measures, few considered or documented the pathways through which these disparities originated and developed. Nor did most research document the local contexts from which their findings emerged. These absences leave us with few tools for how to address inequities or how to measure, assess, and document relationships between poverty and sexual wellbeing that account for the complexities above. These absences may also perpetuate the notion that sexual experiences are cultural or personal, not structural (see McClelland, 2010 for discussion).

An Agenda for Future Research on Poverty and Erotic Inequity

To at least some extent, more qualitative and mixed-methods research could assist with understanding these pathways. For example, Muhanguzi’s (2015) focus groups with women living in poverty in Uganda documented their reports of heavy workload and fatigue and their own understanding of how these conditions undermined sexual wellbeing and importantly, offer ideas for intervention beyond the woman herself. This study also documented ways in which poor women had sexual agency within the constraints of poverty, highlighting positive aspects of these women’s sexual experiences versus portraying them in a solely negative light. While less directly about poverty, McDaid et al. (2019) used in-depth interviews to shed light on how economically deprived Scottish men and women come to equate sexual health merely with STI and pregnancy prevention versus positive aspects of sexual wellbeing (McDaid et al., 2019). They illustrated starkly different gendered pathways through which men and women develop expectations regarding sexual respect and freedom from violence. Such qualitative studies can help locate findings in the local cultural contexts in which sexual experiences, both physical and psychological, unfold.

High-quality longitudinal studies could also shed light on how sexual inequities develop and evolve over time. For example, in an article included in this review, Cheng and colleagues (2014) analyzed several waves of data among young 6,416 young women in the U.S. National Longitudinal Study of Adolescent Health. These data suggest that socioeconomics can shape sexual wellbeing during adolescence, but also that sexual wellbeing at younger ages may influence later-life income and education, highlighting the potential for bidirectional and multidirectional relationships over the life course.

While most articles in this review understandably focused on individual level measures, sexuality is a dyadic, familial, and social process. Those studies that did measure partner and family-level variables often found associations with sexual wellbeing, underscoring the importance of intimate relationships and family environments in shaping sexual trajectories. One of the few ecological studies (Cranney, 2017) linked population-level sexual satisfaction average scores to economic development and per capita income.

Along similar lines, we would suggest more studies of how communities, nations, and even histories of colonization shape relationships between socioeconomic and sexual wellbeing. For example, research on sexual wellbeing could be improved by integrating more anthropological approaches to examine the contexts of poverty and economic conditions in which people live their lives, including their sexual lives. Structural and institutional-level ideas could balance the enormous focus in sexuality research on behavior-based, identity-based, and individual-level research. Inspiring examples of the former can be found in the social science literature regarding power, culture, structure, and HIV/AIDS (Dworkin & Ehrhardt, 2007; Farmer et al., 1993; Gómez & Marín, 1996; Pulerwitz et al., 2002). For example, anthropologist public health scholars have examined how systems of globalization, oppression, law, homophobia, and sexism are far more useful in understanding and addressing HIV/AIDS transmission than sociodemographic indicators alone (Farmer et al., 2019; Hirsch et al., 2002; Parker, 2001). Further, comparative scholarship across multiple geographic settings could help highlight some of the sociocultural and structural factors at play in driving erotic inequities. Sexual wellbeing is a neglected but important part of public health, and there is value in documenting the socioeconomic policies of nation states in relation to all aspects of wellbeing, including sexual wellbeing.

Future research would also benefit greatly from more intersectional approaches. We as sexuality researchers must consider socioeconomic status in relationship to race and ethnicity, gender, sexual identity, nation, and other inequities with strong influences on sexual bodies. In an example of one potential intersection, social privilege and power operate in such a way that people from privileged groups (e.g., white, straight, cisgender, male U.S. citizens) receive higher income on average than members of structurally oppressed groups. We chose deliberately to examine one axis of inequality here given its absence in prior research, but multilevel studies will be important. At the same time, we caution that interaction terms alone will not accurately capture the lived experiences of communities who experience multiple oppressions, as explored fully in the scholarship of Lisa Bowleg and others (Bowleg, 2008).

Finally and relatedly, like any sexuality research, this field of study must both include and focus on more diverse samples in terms of gender identity, sexual identity, and racial identity. The literature we included in our narrative review overwhelmingly drew from white, cisgender, heterosexual populations. This sample homogeneity perpetuates invisibility of, and injustice to, structurally disadvantaged people and communities. It also significantly limited the scope of what we might learn about pathways to sexual wellbeing – a limitation highlighted in other reviews (Boydell et al., 2021). Trans and gender-diverse people, people of color, and queer people often face heightened rates of discrimination and as a result, economic vulnerability (Carpenter et al., 2020). Initiatives must focus on institutional violence based on gender identity, sexual orientation, and race, including violence in schools, juvenile homes and prisons, and seek ways to make these institutions more accountable.

Limitations

A primary limitation of any methodical review of the literature is that we may have missed articles using our search terms, even with attempts to reach out to colleagues in the sexuality field for additional titles not captured through our systematic search process. Fortunately, the narrative review approach does not demand the same degree of exactitude as a meta-analysis, but rather is designed to provide a more conceptual overview of the literature on an emerging topic. Given the overwhelming consistency of our findings (e.g., more than 90% of articles documenting the same direction of association), we have confidence in the more general conclusions we drew from our analyses, despite the likelihood of at least some overlooked publications. As we described above, another limitation of this paper is the disjuncture between the theoretical pathways in part one and the narrative review results in part two. Synthesizing these two very different bodies of literature was challenging. Despite this, we humbly remain committed to our overall project of both theoretically and empirically building the concept of erotic equity and its connections with socioeconomic conditions, especially poverty.