PUBLIC health is a term referring to the health of the population as a whole, and pornography is the depiction or portrayal of sexual behaviour for the purpose of sexually arousing or satisfying a person.

A recent article in the United States quoted flight attendants who said they could not believe the number of persons they witnessed watching pornography on aeroplanes. It was often a source of complaints from other passengers, which airline personnel would prefer not to have to address.

In many countries, people can watch pornography on their cellphones and computers, even in front of children and other people, and various international studies have put pornography consumption rates at between 50 to 99 per cent among men, and 30 to 86 per cent among women.

‘Porn’

The fact is that ‘porn’ (as pornography is referred to in some countries) is now big business in many countries of the world, particularly in the United States where a lot of its contents are produced. The companies making porn are currently making fortunes, and online pornography was able to dislodge and replace the videotape industry once it was able to come into homes.

Research has shown that pornography is one of the most common reasons for people to be online. All kinds of people can access it, including children, adolescents, adults of various ages, and even people with pronounced psychological problems. As much as one in every 25 adults are affected by compulsive sexual behaviour, which involves an obsession with sexual thoughts, feelings or behaviour which they are unable to control. This has led some people to regard pornography as constituting a major public health problem that requires attention. Others, however, have viewed the matter as connected to freedom of speech or simply something that people can choose to access online to entertain themselves.

Possible abuse

The reality, however, is that many people sometimes get into trouble through their use or abuse of pornography. Some people lose relationships, some lose marriages, while others become reclusive and spend an inordinate amount of time watching pornography online. Further, some people cannot seem to find any way to break loose from what may have become a deeply engrained habit.

Pornography triggers brain activity in individuals with compulsive sexual behaviour which is similar to that triggered by drugs in the brain of drug addicts. This triggering, however, does not necessarily mean that pornography itself is addictive.

The matter will require, in part, some type of response from the health care system. There is also the concern that what people see in pornography may lead to behaviours that their partners or spouses may not wish to engage in.

To increase its appeal, the producers of pornography often depict scenes from the fringes of sexuality, since that is where the greater viewership lies. Sex in the straight-forward missionary position is not as visually appealing as those in positions on the fringes. However, some of these may invoke public morality concerns regarding what is acceptable and respectful.

On the other hand, the challenge exists in how to address the desire for sex which porn seeks to satisfy and which, apparently, it is succeeding phenomenally in doing so, if its huge viewership is a measure of this.

Ethical balancing

Ethics involves evaluating possible consequences, the means to each end, and balancing the risks and benefits. In this regard, however, it is not readily clear what to do about pornography.

If watched in private and kept away from minors, then it is difficult to argue that the State should have an interest in people viewing pornography. For many individuals, pornography can be entertaining and fun to watch. It may also serve as an adjunct to people’s sex lives.

However, we will need further research to help inform us on any possible medium- and long-term ramifications of pornography. Important aspects for assessment include how and when pornography is a part of someone’s sex life as opposed to actually ‘overtaking’ it, or dominating it, or encouraging behaviours that are not healthy or good for people.

A public health issue

Some people are concerned that pornography promotes abuse of women and children by depicting rape and abuse as acceptable acts. Defenders of pornography say it can enhance their sex lives, provide a safe recreational outlet, and perhaps even reduce the incidence of sexual assault.

After pornography was legalised in Denmark in 1969, researchers reported a corresponding decline in sexual aggression.

Pornography becomes a public health issue when it becomes associated with drug use, abuse or drug addiction, or the use of guns and similar nefarious matters. At that stage, it would require public health strategies of harm or risk reduction, or using an addiction model to help break people’s habits or any irresponsible sexual behaviours.

Considerations of rights and individual freedoms, however, would inhibit society’s censoring pornography that appears on the Internet. Despite all this, however, we must be cognisant that there are people who are more vulnerable to the lure of the pornographic industry, and so medicine and health care must have an interest and role to play in this matter.

Dr Derrick Aarons MD, PhD, is a consultant bioethicist /family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA.)