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Reproductive Health and Health Sector Reform Turin, December 2001 Reproductive Health: from concept to action

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Fertility declines worldwide; retreat from target-driven ... Gonorrhoea. Cancers. Breast. Cervical. Uterine. Ovarian. Prostate. HIV/AIDs. Maternal Conditions ... – PowerPoint PPT presentation

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Title: Reproductive Health and Health Sector Reform Turin, December 2001 Reproductive Health: from concept to action


1
Reproductive Health and Health Sector
ReformTurin, December 2001Reproductive
Healthfrom concept to action
2
Plan of the session
  • The genesis of reproductive health
  • Definitions of reproductive health
  • Whats in and whats out?

3
Why reproductive health?
  • Fertility declines worldwide retreat from
    target-driven family planning
  • HIV/AIDS pandemic focuses attention on sexual
    behaviour
  • Needs of women not only as mothers
  • Young people, vulnerable groups
  • Health more than the absence of death and disease

4
1994 ICPD, Cairo
  • Rights-based approach to social and development
    issues including health
  • Attention to womens health and gender issues
  • Social and economic determinants of ill-health
  • Concept of reproductive health

5
What is reproductive health?
  • ... a state of complete physical, mental and
    social well-being and not merely the absence of
    disease or infirmity, in all matters relating to
    the reproductive system and to its functions and
    processes ...
  • ICPD Programme of Action, Cairo, 1994

6
How do we know we have achieved reproductive
health?
  • If we cannot define it,
  • we cannot measure it
  • If we cannot measure it,
  • we cannot change it.
  • But measuring reproductive health is a challenge

7
Not just deaths
  • Mortality
  • HIV/AIDS
  • pregnancy-related
  • syphilis
  • perinatal
  • suicide/violence
  • Morbidity
  • HIV/AIDS
  • pregnancy-related
  • STIs
  • perinatal
  • gynaecological
  • contraceptive
  • psychological

8
What do we mean by morbidity?
  • Impairment the physical or mental condition
  • Disability the effect of this condition
  • Handicap the social consequences of the
    disability

9
(No Transcript)
10
What is so special about RH?
  • Cumulative morbidity
  • Co-morbidity
  • Multiple conditions in one woman
  • Missing ICD-9 or ICD-10 codes for FGM,
    miscarriages
  • Contraceptive morbidity missed
  • Social consequences outweigh medical

11
Conditions exacerbated by sex pregnancy
Conditions associated with reproductive organs
and system

Reproductive Health
Maternal mortality Obs/gyn morbidity Contraceptive
morbidity Infertility STDs/AIDS
Social aspects of sex reproduction
12
RH Conditions Sequelae included in 2000 GBD
  • Syphilis
  • Chlamydia
  • Gonorrhoea
  • Cancers
  • Breast
  • Cervical
  • Uterine
  • Ovarian
  • Prostate
  • HIV/AIDs
  • Maternal Conditions
  • Maternal haemorrhage
  • Maternal sepsis
  • Hypertensive disorders
  • Obstructive labour
  • Abortion
  • ?incontinence
  • ?c-section

13
HIV/AIDS estimates Children and adults End-2001
global
  • People living with HIV/AIDS 40 million
  • New HIV infections in 2001 5 million
  • adults 4.2million
  • women 2 million
  • children lt15 years .8 million
  • HIV/AIDS deaths in 2001 3 million
  • AIDS orphans living 14 million

14
Each year 11 of adults acquire STDs
Yearly infection rate per 100 adults
East Asia Pacific
N Africa M East
W Europe
N America
Australasia
E Europe C Asia
L America Carib
S SE Asia
Sub-Saharan Africa
Global average
Source WHO 1995
15
Maternal mortality 1995 estimates
Maternal deaths per 100,000 live births
Source WHO/UNICEF/UNFPA
16
Contribution of maternal and perinatal conditions
to the global burden of disease, 1999
contribution to global burden of disease
17
Reproductive ill health neglected in GBD 2000
  • Indirect obstetric conditions
  • Gynaecological morbidity
  • Contraceptive morbidity
  • Psychological morbidity
  • Infertility
  • FGM
  • Violence
  • Stillbirths
  • Interlinkages between HIV STDs
  • Menopause
  • Menstrual problems
  • Psychosexual dysfunction

18
What else do we need to know?
  • Knowing the dimensions of the burden of
    reproductive ill-health is important but
    insufficient
  • What proportion of the burden is due to exposure
    to specific risk factors?
  • What proportion of the burden can be alleviated
    by reducing risks?
  • How can risk factors be modified?

19
Unsafe sex - a key risk factor for poor
reproductive health
  • Unsafe sex leads to HIV/AIDS, STIs, unwanted
    pregnancy, sexual violence
  • More than 99 of HIV infections in Africa
    attributable to unsafe sex
  • 3.3 million deaths (6 of total) attributable to
    unsafe sex in 2000

20
Proportion of young women aged 1524 who have
heard of AIDS and have sufficient knowledge to
protect themselves
93
97
13
4
97
3
84
94
70
72
91
93
94
90
99
59
14
90
33
37
15
43
5
5
16
27
16
4
26
96
2
16
23
59
81
17
5
18
Have heard of AIDS Have sufficient knowledge to
protect themselves
Source UNICEF/MICS Measure DHS, 1999-2001
21
Age distribution of sex workers in Myanmar
22
HIV prevalence in pregnant women by age, South
Africa, 19912001
Percent
35.0
2029
30.0
25.0
lt 20
20.0
15.0
30
10.0
5.0
0.0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Source Dept. of Health, Republic of South
Africa. Summary Report National HIV and Syphilis
Sero-Prevalence. Survey of Women Attending
Public Antenatal Clinics in South Africa, 2001.
23
What is reproductive health?
A set of health conditions
An approach
A constellation of services
24
Conclusions
  • Need to define reproductive health in a
    measurable way
  • Measuring burden of disease is the first step in
    measuring avoidable burden
  • Which risk factors can be modified?
  • Boundary problems for RH have to be faced
    resolved
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