The Middle East/North Africa region is diverse in many respects, including, among others, the level of development (United Nations Development Program [UNDP], 2013), legal codes and secular versus religious state leadership. Health disparities are enormous, as indicated by maternal mortality ratios, which range from 7 in Qatar to 200 in Yemen (World Health Organization [WHO], United Nations Children’s Fund [UNICEF], United Nations Population Fund [UNFPA], & The World Bank, 2012).Despite this diversity, the region faces common challenges in securing sexual and reproductive health and rights (SRHR). These challenges include gender inequality; lack of sexuality education; social taboos and restrictions on women’s sexual autonomy, pre-marital and extramarital sexual activity, sexual orientation and gender identity; and harmful traditional practices, such as early and forced marriages, honour crimes and female genital mutilation, all of which jeopardise women’s and girls’ health and violate their human rights (Amado, 2005; Aoyama, 2001).In the 20 years since the International Conference on Population and Development (ICPD), social movements across the region, especially those led by women, youth and lesbian, gay, bisexual, transgender, queer (LGBTQ) groups, have been claiming sexual autonomy and sexual rights at national, regional and international levels. Feminist movements have secured legal reforms that support gender equality in civil codes in Morocco, Jordan and Egypt, and in civil and penal codes in Turkey (Ilkkaracan, 2009). The number of, and networking among, LGBTQ organisations and communities have noticeably increased.At the same time, sexuality and gender have become subjects of intense political and social struggles in the region, with conflicting implications for SRHR. Mobilisation by the Islamic religious right, which started in the 1980s and has intensified since 2001, has narrowed the space for progressive reforms in laws and policies, including in regard to sexuality. Moreover, the ‘Muslims vs. the West’ discourse, which has taken hold in all Muslim societies, encourages religious right movements to assert that sexual autonomy and rights, including many ICPD commitments, are ‘Western’ values imposed on ‘Muslim culture’.Threats to gender equality include government actions to restrict or ban legal abortion in Tunisia and Turkey. Despite the prevention of formal bans by feminist movements and the public in practice significant restrictions on access have resulted. Public financing for safe abortion has been reduced and it appears that doctors and medical institutions more frequently refuse to provide abortion on the basis of conscience, although such refusal is illegal in both countries. Another concern is the increasingly moralistic tone and content of governmental positions, especially regarding youth, in Tunisia, Turkey and Egypt. An example is the recent move of Turkish Prime Minister Erdoğan to outlaw co-ed dormitories at state universities and even to extend this crackdown to off-campus housing shared by male and female students, which was blocked by a storm of public protest (Arango, 2013).Such short-term moves must not, however, be understood as the predominant impact of the Arab Spring on gender, sexuality and human rights. The implications for gender equality and SRHR of the so-called ‘Arab Spring’ are complex and should be analysed with a long-term vision. Much analysis in the West seems instead to be short sighted, particularly in concluding that the Arab Spring only generated backlash against gender equality. Although the political gains by the Islamists in the short term do significantly threaten the human rights of women, the Arab Spring processes also produced positive changes.The process opened new political spaces for women and many other social movements, shattered stereotypes and taboos and empowered large segments of the population including women, youth and LGBTQ to become the main drivers for political as well as social change. Women especially have played leading roles in political and other public actions, engendering the rapid and historic changes sweeping the region (Al-Ali, 2012).Hundreds of thousands of women participated in demonstrations, an action that even in itself broke barriers. In Egypt, the opposition’s use of sexual harassment and violence to prevent women’s participation in demonstrations led to increased public awareness, and a radical politicisation and cultural transformation of ‘sexual harassment’. As an activist from the region reports, before the violence, sexual harassment was understood as ‘an inherent element of Arab culture’, but is now recognised ‘as a political tool used by men to curtail women’s right to participate in public spaces’ (L. Darwich, personal communication, November 10, 2013).The future of SRHR in the region depends on both domestic and international factors. The shattering of taboos on gender equality and sexuality, the mobilisation of women, youth and LGBTQ, and the push from the bottom for democracy have opened spaces for new discourses and movements on SRHR that will continue, even though religious conservatives currently seem to be the ‘winners’ in the short term. International politics and policies towards the region will have significant impact, for good or for ill. External actors, both governments and international agencies, need to understand the centrality of gender equality, including SRHR, to the future of democratisation in the region, and make it a significant priority of foreign policy and long-term investments.