{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:19:25Z","timestamp":1787656765218,"version":"build-2736575974"},"reference-count":35,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Pleasure Project","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"The Case for Her","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Vitol","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2026,7,12]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pleasure is a key reason why people have sex. Yet many sexual and reproductive health (SRH) programmes do not consider the fundamental role of pleasure, focusing primarily on the prevention of pregnancy and sexually transmitted infections. Moreover, there is limited policy-ready evidence on pleasure-based sexual and reproductive healthcare (PBSRH), including implementation guidance, costs, impacts and return on investment at scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted semi-structured interviews with nine PBSRH providers to characterise the incremental activities required to implement PBSRH relative to conventional SRH. Using activity-based costing, we estimated the costs of integrating pleasure principles into existing SRH programmes for 15\u201324-year-olds in 99 low- and middle-income countries (LMICs) over 2026\u20132035. We focused on a narrow behavioural pathway - increased condom use - and projected its effects on (1) Unintended pregnancies, abortions, maternal and child mortality using methods consistent with Guttmacher\u2019s\n                      <jats:italic>Adding it Up<\/jats:italic>\n                      approach and (2) HIV outcomes using the Goals-Spectrum application. We undertook a prospective, societal benefit-cost analysis to estimate global, regional and country-level return on investment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighteen incremental activities are commonly undertaken when integrating pleasure into SRH programmes. The estimated incremental cost of these activities for 15\u201324 year olds in LMICs is $1.6\u2009billion (95%\u2009CI $1.1 to $2.2) over 10 years. This is expected to lead to 30.7\u2009million (95%\u2009CI 17.8 to 41.1)\u2009additional years of condom use, averting 4.3\u2009million pregnancies (95%\u2009CI 2.1 to 6.7)\u2009and 2.1\u2009million abortions (95%\u2009CI 1.1 to 3.4). PBSRH integration would avert 92\u2009318 deaths by 2050 (95% CI 47\u2009965 to 139\u2009835), ~80% relating to women and children. The expected return on investment is $22.9 (95% CI $13.8 to $37.6) in benefits per $1 of incremental cost. The largest benefits and returns are in Sub-Saharan Africa and Latin America and the Caribbean.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PBSRH is a cost-effective and high-return intervention to support global SRHR and HIV\/AIDS goals for young people in LMICs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2026-024479","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:25:14Z","timestamp":1787653514000},"page":"e024479","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Scaling pleasure-based sexual and reproductive health: an impact and economic modelling study in 99 low- and middle-income countries"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8704-6225","authenticated-orcid":false,"given":"Brad","family":"Wong","sequence":"first","affiliation":[{"name":"Mettalytics, Federal, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ophelia","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Independent Researcher, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1764-2122","authenticated-orcid":false,"given":"Bryce","family":"Everett","sequence":"additional","affiliation":[{"name":"Mettalytics, Federal, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"De Meyer","sequence":"additional","affiliation":[{"name":"The Pleasure Project, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9348-0116","authenticated-orcid":false,"given":"Katie","family":"Newby","sequence":"additional","affiliation":[{"name":"University of Hertfordshire, Hatfield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beyonce","family":"Karungi","sequence":"additional","affiliation":[{"name":"Transgender Equality Uganda, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatmah","family":"Suleyman","sequence":"additional","affiliation":[{"name":"Young & Alive Initiative, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sesilia","family":"Shirima","sequence":"additional","affiliation":[{"name":"Young & Alive Initiative, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4606-4274","authenticated-orcid":false,"given":"Elo\u00efse","family":"Cowan","sequence":"additional","affiliation":[{"name":"DKT International, Washington, DC, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Precious Chima","family":"Nwaogbo","sequence":"additional","affiliation":[{"name":"DKT International, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6024-4830","authenticated-orcid":false,"given":"Laura","family":"Ramos Tom\u00e1s","sequence":"additional","affiliation":[{"name":"TabuTabu, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina","family":"Page","sequence":"additional","affiliation":[{"name":"MSI Reproductive Choices, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamolefe","family":"Petlane","sequence":"additional","affiliation":[{"name":"Sesotho Media and Development, Maseru, Lesotho"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Philpott","sequence":"additional","affiliation":[{"name":"The Pleasure Project, Dorset, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"2026082503250631000_11.8.e024479.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30293-9"},{"key":"2026082503250631000_11.8.e024479.2","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1080\/19317611.2021.1965690","article-title":"How to Navigate a Blindspot: Pleasure in Sexual and Reproductive Health and Rights Programming and Research","volume":"33","author":"Philpott","year":"2021","journal-title":"Int J Sex Health"},{"key":"2026082503250631000_11.8.e024479.3","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18052555","article-title":"Sex Education in the Spotlight: What Is Working? 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Adding it up: investing in sexual and reproductive health 2019. 2020."},{"key":"2026082503250631000_11.8.e024479.16","first-page":"277","article-title":"Sexuality Education Goes Viral: What We Know About Online Sexual Health Information","volume":"10","author":"Holstrom","year":"2015","journal-title":"Am J Sex Educ"},{"key":"2026082503250631000_11.8.e024479.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)01724-6"},{"key":"2026082503250631000_11.8.e024479.18","article-title":"School-based interventions for improving contraceptive use in adolescents","volume":"2016","author":"Lopez","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2026082503250631000_11.8.e024479.19","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.094268"},{"key":"2026082503250631000_11.8.e024479.20","doi-asserted-by":"publisher","DOI":"10.1016\/J.GLOENVCHA.2016.05.009"},{"key":"2026082503250631000_11.8.e024479.21","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czz127"},{"key":"2026082503250631000_11.8.e024479.22","unstructured":"Global HIV Prevention Coalition . Condom needs estimation tool | GPC. 2023. Available: https:\/\/hivpreventioncoalition.unaids.org\/en\/resources\/condom-needs-estimation-tool-user-guide [Accessed 28 Nov 2025]."},{"key":"2026082503250631000_11.8.e024479.23","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0258(20001130)19:22<3127::AID-SIM784>3.0.CO;2-M"},{"key":"2026082503250631000_11.8.e024479.24","unstructured":"UN Population Division . World population prospects. Available: https:\/\/population.un.org\/dataportal\/home"},{"key":"2026082503250631000_11.8.e024479.25","unstructured":"Darroch JE . Adding it up: investing in contraception and maternal and newborn health, 2017\u2014estimation methodology. Guttmacher Institute; 2018."},{"key":"2026082503250631000_11.8.e024479.26","unstructured":"Monea E , Thomas A . The public cost of pregnancy. 2011."},{"key":"2026082503250631000_11.8.e024479.27","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1016\/S2214-109X(13)70179-7","article-title":"Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries","volume":"2","author":"Nove","year":"2014","journal-title":"Lancet Glob Health"},{"key":"2026082503250631000_11.8.e024479.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-007681","article-title":"Effect of adolescent pregnancy on child mortality in 46 countries","volume":"7","author":"Noori","year":"2022","journal-title":"BMJ Glob Health"},{"key":"2026082503250631000_11.8.e024479.29","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1017\/bca.2024.10","article-title":"Lessons from Applying Value of Statistical Life and Alternate Methods to Benefit\u2013Cost Analysis to Inform Development Spending","volume":"15","author":"Redfern","year":"2024","journal-title":"J Benefit Cost Anal"},{"key":"2026082503250631000_11.8.e024479.30","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1017\/bca.2019.10","article-title":"Valuing Children\u2019s Fatality Risk Reductions","volume":"10","author":"Robinson","year":"2019","journal-title":"J Benefit Cost Anal"},{"key":"2026082503250631000_11.8.e024479.31","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1017\/bca.2018.26","article-title":"Valuing Mortality Risk Reductions in Global Benefit-Cost Analysis","volume":"10","author":"Robinson","year":"2019","journal-title":"J Benefit Cost Anal"},{"key":"2026082503250631000_11.8.e024479.32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/bca.2023.32","article-title":"Save 4.2 Million Lives and Generate $1.1 Trillion in Economic Benefits for Only $41 Billion: Introduction to the Special Issue on the Most Efficient Policies for the Sustainable Development Goals","volume":"14","author":"Lomborg","year":"2023","journal-title":"J Benefit Cost Anal"},{"key":"2026082503250631000_11.8.e024479.33","article-title":"The cost-effectiveness of sexual and reproductive health and rights interventions in low- and middle-income countries: a scoping review","volume":"29","author":"Kaiser","year":"2021","journal-title":"Sex Reprod Health Matters"},{"key":"2026082503250631000_11.8.e024479.34","unstructured":"WAS . Declaration on sexual pleasure | the world association for sexual health (WAS). 2019. Available: https:\/\/www.worldsexualhealth.net\/was-declaration-on-sexual-pleasure [Accessed 18 Apr 2025]."},{"key":"2026082503250631000_11.8.e024479.35","doi-asserted-by":"crossref","unstructured":"Stenberg K , Sweeny K , Axelson H , et al . Returns on investment in the continuum of care for reproductive, maternal, newborn, and child health. In: Black RE , Laxminarayan R , Temmerman M , et al ., eds. Reproductive, maternal, newborn, and child health: disease control priorities, third edition (volume 2). Washington (DC): The International Bank for Reconstruction and Development \/ The World Bank, 2016. 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