Title: Reproductive Health and Health Sector Reform Turin, December 2001 Reproductive Health: from concept to action
1Reproductive Health and Health Sector
ReformTurin, December 2001Reproductive
Healthfrom concept to action
2Plan of the session
- The genesis of reproductive health
- Definitions of reproductive health
- Whats in and whats out?
3Why 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
41994 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
5What 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
6How 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
7Not just deaths
- Mortality
- HIV/AIDS
- pregnancy-related
- syphilis
- perinatal
- suicide/violence
- Morbidity
- HIV/AIDS
- pregnancy-related
- STIs
- perinatal
- gynaecological
- contraceptive
- psychological
8What 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)
10What 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
11Conditions 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
12RH 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
13HIV/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
14Each 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
15Maternal mortality 1995 estimates
Maternal deaths per 100,000 live births
Source WHO/UNICEF/UNFPA
16Contribution of maternal and perinatal conditions
to the global burden of disease, 1999
contribution to global burden of disease
17Reproductive 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
18What 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?
19Unsafe 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
20Proportion 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
21Age distribution of sex workers in Myanmar
22HIV 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.
23What is reproductive health?
A set of health conditions
An approach
A constellation of services
24Conclusions
- 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