"Sexual and reproductive health is fundamental to the social and economic development of communities and nations, and a key component of an equitable society".

"Sexual health and reproductive health overlap and, in addition to supporting normal physiological functions such as pregnancy and childbirth, aim to reduce adverse outcomes of sexual activity and reproduction. They are also about enabling people of all ages, including adolescents and those older than the reproductive years, to have safe and satisfying sexual relationships by tackling obstacles such as gender discrimination, inequalities in access to health services, restrictive laws, sexual coercion, exploitation, and gender-based violence." [1]

As presented so clearly in the special Lancet series on sexual and reproductive health in November/December 2006 [1], ensuring the sexual and reproductive health of the Australian population is essential for the wellbeing of the nation. As well as their overall importance, at least three aspects of sexual and reproductive health are among the key policy issues for present Australian governments: maintaining and increasing the birth rate; reducing the abortion rate; and preventing and controlling Chlamydia infections.

Yet sexual and reproductive health, as a broad and interrelated set of health outcomes, has been the subject of relatively little public health examination. Despite calls for a national sexual health strategy [2], and the existence of the National Indigenous Australians Sexual Health Strategy [3], the National HIV/AIDS Strategy [4] and the National Sexually Transmitted Infection (STI) Strategy [5], the area lacks a comprehensive policy framework. Thus, for example, safe sex practices and contraceptive practices are inextricably linked yet the competing policy imperatives are rarely identified. There are currently no data to demonstrate whether, for example, promoting condom use to adolescents for HIV/STI prevention may have unintended effects such as discouraging the use of more effective contraceptive methods.

Analysis of general practice activity in 2005–06 indicated that one in 15 GP consultations concerned sexual and reproductive health. As a percentage of total reasons for encounters, sexual and reproductive health matters comprised 6.5%. In comparison, cardiovascular reasons comprised 7.2% and digestive reasons 6.6% of total reasons for consultation. [6]

STIs are common in Australia and are responsible for a significant amount of long-term morbidity. Chlamydia, for example, is now the most common notifiable infection in Australia with 43,681 notifications in 2006 and is a significant cause of infertility at a time when Australia's population growth is at its lowest. [5]

There have been five major longitudinal studies in the US that have begun to map similar territory. They are: the Wisconsin Longitudinal Study (WLS) [7], The Health and Retirement Survey (HRS) [8], The National Survey of Families and Households (NSFH) [9], American Changing Lives (ACL) [10] and Changing Lives of Older Couples (CLOC) [11]. Of these only WLS and HRS are ongoing.

Table 1 indicates the significant gaps in information emanating from such studies and compares them with the Australian Longitudinal Study of Health and Relationships (ALSHR).

Table 1 Sexual and reproductive health data from longitudinal studies Full size table

There are other longitudinal studies, but all have focused either on adolescents (National Longitudinal Study of Adolescent Health (USA), Christchurch Health and Development Study (NZ), National Adolescent Males and Youth Risk Behavior Survey (USA), National Longitudinal Surveys of Youth '79 and '97 (USA); or only on women (Australian Women's Health Study, Melbourne Women's Midlife Health Study, Iowa Women's Health Study (USA), Reproductive Risk Factors for Incontinence Study at Kaiser (USA). Men are seriously under-studied and the complex relational elements of sexual and reproductive health decisions and outcomes are barely touched upon.

The overall aim of ALSHR is to document the natural history of the sexual and reproductive health of the Australian adult population.