The five core aspects of reproductive
and sexual health are; improving antenatal, perinatal, postpartum and newborn
care; providing high-quality services for family planning, including
infertility services; eliminating unsafe abortion; combating sexually
transmitted infections including HIV, reproductive tract infections, cervical
cancer and other gynaecological morbidities; and promoting sexual health.
Because of the close links between the different aspects of reproductive and
sexual health, interventions in one area are likely to have a positive impact
on the others. It is critical for countries to strengthen existing services and
use them as entry points for new interventions, looking for maximum synergy.
The most countries, the major entry
point will be antenatal, childbirth and postpartum services, which form the
backbone of primary health care. Central to reducing maternal morbidity and
mortality, and perinatal mortality, are the attendance at every birth of
skilled health personnel and comprehensive emergency obstetric care to deal
with complications. Provision of these services requires effective referral
systems for communication and transport between service points. Maternal health
services offer a key opportunity to reach women with family planning. They are
also an excellent means through which to offer women prevention, counseling,
testing and treatment for HIV infection and for preventing HIV
transmission during pregnancy and
birth and through breastfeeding. Indeed, it is only through these services that
these interventions can be adequately
provided. These points are further
elaborated in the WHO strategy for making pregnancy safer.
As a preventable cause of maternal
mortality and morbidity, unsafe abortion must be dealt with as part of the
Millennium Development Goal on improving maternal health and other
international development goals and targets. Several urgent actions are needed,
including strengthening family planning services to prevent unintended
pregnancies, and, to the extent allowed by law, ensuring that services are
available and accessible. Also to the extent allowed by law, provision of safe
abortion services requires training health-service providers in modern
techniques and equipping them with appropriate drugs and supplies, all of which
should be available for gynawcological and obstetric care; providing social and
other support to women with unintended pregnancies; and, to the extent allowed
by law, providing abortion services at primary health care level. For those
women who suffer complications of unsafe abortion, prompt and humane treatment
through post-abortion care must be available.
The success of family planning
services in most countries of the world is evidenced by the great increase in
contraceptive use in developing countries over the past two to three decades.
These programmes are an essential part of services to reduce maternal and
perinatal morbidity and mortality because they enable women to postpone, space
and limit pregnancies. As these services are directly concerned with the
outcomes of sexual relationships,
they also have great potential for
leading the way in promoting sexual health and efforts to prevent sexually
transmitted infections and HIV transmission.
Sexually transmitted infections are
being diagnosed and treated by pharmacists, drug sellers and traditional
healers, often ineffectively. Various attempts have been made to reach women by
integrating sexually transmitted infections management into existing maternal
and child health and/or family planning services, but with limited success.
Nonetheless, experience shows that intergration of sexually transmitted
infection prevention into family planning services, especially through
counseling and discussion of sexuality and partner relationships, has increased
the use of services and improved quality of care. These approaches can be built
on and improved in order to expand coverage and outreach to men, youth and
other groups not previously the focus of family planning. In addition,
presumptive treatment in groups at high risk and comprehensive, community-based
programmes to control sexually transmitted infections could greatly contribute
to the reduction of HIV transmission rates.
Additional gains from strengthening
reproductive health services are numerous. They include attention to violence
against women, which is now being tackled in various country settings with, for
instance, provision of emergency contraception, abortion (to the extent allowed
by law) if requested, treatment of sexually transmitted infections and
post-exposure pro-phylaxis for HIV infections after rape, screening and
treatment of cervical cancer, prevention of primary and secondary infertility,
and treatment of gynaecological conditions. Well-desinged and effectively
delivered reproductive and sexual health services, especially those involving
community participation, can also
contribute to improved user-provider relations, men’s participation, and women’s
empowerment to make reproductive choices.
All reproductive and sexual health
services have a key role to play in providing information and counseling in
promoting sexual health.
Appropriate information can also
contributed to better communication between partners and healthier sexual
decision-making, including abstinence and condom use.
Actions
WHO proposes the following key action
areas for countries, and is committed to supporting Members States in building
and strengthening their capacity to improve reproductive and sexual health.
Each country needs to identify problems, set priorities and formulate
strategies for accelerated action through consultative processes involving all
stakeholders. Five overarching activities are strengthening health systems
capacity, improving information for priority setting, mobilizing political
will, creating supportive legislative and regulatory framework, and
strengthening monitoring evaluation and accountability.
·
Strengthening
health systems capacity
·
Improving
information for priority setting
·
Mobilizing
political will
·
Creating
supportive legislative and regulatory frameworks
·
Strengthening
monitoring, evaluation and accountability
·
WHO’s
commitment to attaining global reproductive health goals
Millennium Development Goals
Goal 1. Eradicate extreme poverty and hunger
Goal 2. Achieve universal primary education
Goal 3. Promote gender equality and empower women
Goal 4. Reduce child mortality
Goal 5. Improve maternal health
Goal 6. Combat HIV/AIDS, malaria and other diseases
Goal 7. Ensure environmental sustainability
Goal 8. Develop a global partnership for development
“ Expand access to sexual and
reproductive health services, including family planning and contraceptive
information and services, and close funding gaps for supplies and logistics.”
“Focus on women’s and girls’ health
(including reproductive health) and education outcomes, access to economic and
political opportunities, right to control assets and freedom from violence.”
“Universal access to reproductive health
services by 2015 through the primary health system, ensuring the same of
progress or faster amongst the poor and other marginalized groups.”