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- Giuseppe Benagiano
- Training Course in Reproductive Health/
Sexual Health Research
- Geneva 2006
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- Health is defined in the
Constitution of the World Health Organization as «A state of complete
physical, mental and social well-being and not merely the absence of
disease or infirmity». In t=
he
context of this positive definition, reproductive health is not mere=
ly
the absence of disease or disorders of the reproductive process.
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- Rather it is a state of
physical, functional and psychological well being within the domain =
of
the reproductive processes, functions and system at all stages in li=
fe.
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- Reproductive health there=
fore
implies that people are able to have a responsible, satisfying and s=
afe
sex life and that they have the ability to reproduce and the freedom=
to
decide if, when and how often to do so.
Implicit in this last condition are the right of men and wome=
n to
be informed of, and to have access to, safe, effective, affordable a=
nd
acceptable methods of fertility regulation of their choice, and the
right of access to appropriate health-care services that will enable
women to go safely through pregnancy and childbirth and provide coup=
les
with the best chance of having a healthy infant.
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- concept internalised by most countries
- new policies and programmes defined (e.g., India’s target-free
reproductive and child health programme)
- new partnerships formed (e.g., greater NGO participation; public/pri=
vate
partnerships)
- new evidence collected (e.g., burden of disease due to reproductive
ill-health; best practices; gender-based violence)
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The post-Cairo
years:
The negative side=
div>
- patchy implementation of holistic and
integrated programmes
- uncoordinated, fragmented approaches by multiple players
- failure to scale up from projects to sustainable programmes
- weak health systems (health sector reform)
- relative neglect by new development instruments (SWAps, PRSPs, Global
Fund, etc.)
- “competition” from other issues
- politicisation of “reproductive health” and “reproductive rights”
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- «If a woman has a difficu=
lt
delivery, a tradition cloth is tied between two sticks and we carry =
her
7 km to the health center. =
You
know how long it takes to walk like that? There is nobody who can help her=
e…»
- Togo, Voices of t=
he
Poor
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- Women represent a disproportionate share of the poor.
- Women in the poorest compared to the wealthiest households have much
higher fertility rates and far fewer safe deliveries.
- Women in poorest compared to wealthiest households have gaps greater=
in
skilled delivery than other services.
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- Lack of mobility, decision-making power, and income constrain women’s
health service use.
- Prohibitions against women seeking care from male providers are also=
a
serious constraint.
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- Improving women’s health and nutrition
- Equity
- Productivity
- Widespread benefits,
- especially to children
- Cost-effective allo=
cation
- of health resources=
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- Women’s Health Status
- Individual behaviour and psychological factors
- Biology
- Social, economic and cultural influences
- Health and nutrition services
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- Recent conventions and tr=
eaties
recognize women’s right to:
- Reproductive choice
- Pregnancy-related care
- Freedom from violence
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- Pregnancy-related complications
- Higher risk per exposure of contracting STDs, including HIV/AIDS
- Special nutritional requirements, e.g. iron
- Gynecological cancers
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- Women have higher death and disability from depression, domestic
violence, and sexual abuse, compared to the main causes of men’s
burden of disease which are injuries and substance abuse.
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- Infancy and childhood (0-9 years)
- Sex selective abortion
- Genital mutilation
- Discriminatory nutrition
- Discriminatory health care
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- Why Mom? Why did you let them do this to me?
- These words continue to haunt me.
- It’s now four years after the operation and my children continue to
suffer from its effects. Ho=
w long
must I live with the pain that society imposed on me and my children=
?
- a mother bears w=
itness
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- About 2 million girls undergo female genital mutilation each year.=
li>
- At least 90% of women have undergone the operation in Djibouti, Egyp=
t,
Mali, Eritrea, Sierra Leone, and Somalia.
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- Adolescence (10-19 years)
- Early childbearing
- Abortion
- STDS and AIDS
- Undernutrition and micronutrient deficiency
- Rising trend in substance abuse
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- Early Teenage Pregnancy
- + Low weight and height in teens
- Small adult women
- Low birth-weigh=
t baby
-
Child growth failure
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- Young women aged 15-25 are most at risk.
- Social norms make it difficult for women to insist on mutual fidelit=
y or
condom use.
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- Women who become suddenly=
poor
through the loss of a male partner are frequently forced into
prostitution to earn a living. In
fact HIV/AIDS is largely seen as a woman’s illness.
- South Africa, Voic=
es of
the Poor
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- Women now represent 43% of all adults living with HIV/AIDS.
- In Africa, more women than men are living with HIV.
- Physiologically, men are four times more likely to transmit the viru=
s to
women than women to men.
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- Reproductive years (15-44 years)
- Unplanned pregnancy
- STDs and AIDS
- Pregnancy complications
- Malnutrition, especially iron deficiency
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- When a meal is served in a
house, the men eat first then women eat if something is left.
- Pakistan, Reproductive Health Matters
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- One-third of all under-five mortality occurs during the first month =
of
life
- 20% of babies have low birth weight
- Pregnancies spaced less than two years apart result in double the in=
fant
deaths than longer intervals.
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- Almost certain newborn death
- Two million children orphaned annually
- Increased probability of older children dying, especially daughters<=
/li>
- Increased probability of children’s absenteeism from school
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- Men rape within the marriage. Men believe that paying dowry means bu=
ying
the wife, so they use her anyhow at all times. But no one talks about it.
- Voices of the Poor<=
/li>
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- Childhood sexual abuse Greater likelihood of teen pregnancy
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- Fatal Outcomes
- Homicide
- Suicide
- Maternal deaths
- AIDS-related deaths
- Non-Fatal Outcomes
- Unwanted pregnancy
- Chronic pain syndrome
- Injury
- Depression
- Alcohol/Drug Use
- STDs/HIV
- Irritable bowel movement
- Gynecological disorders
- Low birth weight
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- Postreproductive years (45+ years)
- Cardiovascular diseases
- Gynecological cancers
- Osteoporosis
- Osteoarthritis
- Diabetes
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- Lifetime Health Problems
- Gender-based violence
- Certain occupational and environmental health hazards
- Depression
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- Sexual abuse during childhood increases the likelihood of mental
depression in later life.
- Repeated reproductive tract infections can lead to infertility.
- Girls fed inadequately during childhood may have stunted growth, lea=
ding
to higher risks of childbirth complications.
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- Bridge gap between health facility and household
- Reach beyond clinic or hosp=
ital
with information and serv=
ices
- Participate in dialogue with
community on problems and issues
- Conduct audits of women’s d=
eaths
which look beyond clinical causes
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- Use influence beyond the health sector
- Lobby for legislation and its enforcement to curb harmful practices such as:
- Domestic violence, child marriage and gender bias
- Urge government to increase education and employment opportunities f=
or
women
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- Address social and cultural factors affecting women’s use of health
services
- Educate and involve family
decision-makers, especially husbands
- Take into account constrai=
nts on
transport, money and time
- Ensure adequate numbers of
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female health providers
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- Promote women’s right to essential services
- Prevention and management of unwanted pregnancies
- Safe pregnancy and delivery services
- Prevention and management of STDs and gynecological cancers
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- Promote essential interventions f=
or
behavior change and positive health practices
- Safe sex
- Adequate nutrition
- Quality of care, including privacy and informed choice
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- Elimination of harmful practices
- Young marriage and childbearing
- Domestic violence, rape and female genital mutilation
- Trafficking of girls and forced prostitution
- Overuse/abuse of medical technologies, such as C-section, episiotom=
y
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