Concept Of Reproductive Health Research Articles

(210) Breastfeeding: The Blind Spot in Sexuality Education, is it a Gender Bias?

Abstract Introduction Sexuality is fundamental to people's well-being and involves all dimensions of existence: cognitive, emotional, physical and cultural dimensions. Media show conflicting and confusing informations and pictures about sexuality and sexuality education is more necessary than ever to provide accurate knowledge, to rule out false beliefs, to promote gender equality and to eradicate gender-based violence. The concept of sexual health was developed in 1974 and, 20 years later, the Cairo Conference enhanced it with the concept of reproductive health. Is gender equality possible in reproductive health? Gaps seem to persist, especially in sexuality education: the word breastfeeding seems to be absent from sexuality education programms. Objective `-Etablish an inventory of official recommendations and programs about sexuality education, in France, and at the international level -Review especially reproductive health education programs in France -In order to introduce in these programs the question of breastfeeding, physiological function of the breast, and raise awareness of lactational amenorrhea as an economical and ecological method of contraception, according to World Health Organization (WHO) recommendations - In order to teach about breastfeeding in the "International technical guidance on sexuality education" developed by UNESCO Methods Literature review with the key words breastfeeding in sex education for the last five years on PubMed and Google Scholar Study of the 139 pages of the "International technical guidance on sexuality education" developed by UNESCO Study of 26 official french texts about sex education since 11/1992 to 12/2022, Code de l'Education, legal texts, decrees and ciculars in France Results Breastfeeding and lactational amenorrhea as birthcontrol are missing in all the sex education programs examined in France and in the 139 pages of the"International technical guidance on sexuality education" developed by UNESCO No relevant study is found about breastfeeding and lactational amenorrhea birth control in sex education for the last five years on PubMed and Google Scholar These results confirm breastfeeding as the blind spot in sex education and raise the question of gender equality in reproductive health especially in reproductive health education: why ignore this singularity of the female body, while children can see breastfeeding persons, especially in their family? What to think of a person breastfeeding in a public place? What to think of a person who breastfeeds a child over the age of two? What to feel in front of the emission of milk that can occur during female orgasm? What about family ties of two children of different couples, breastfed by the same woman? Conclusions Breastfeeding is a strong WHO recommendation, support measures for breastfeeding women are already numerous in many countries. But when is the decision to breastfeed taken? Persons are most often confronted with breastfeeding when they are already pregnant, lacking time to make a really wanted choice, possibly under pressure from people around them, feeling guilty about the sometimes restrictive reality of breastfeeding. The aim of this work is to build a gender egalitarian sex education, considering all aspects of sexual and reproductive health, including breastfeeding. Disclosure No.

Development and psychometric properties of the Reproductive Health Assessment in Systemic Lupus Erythematosus: Mixed-Methods study.

Systemic lupus erythematosus (SLE) with a high morbidity rate (7% in general and 325/100.000 in reproductive period) was known as "the mother of autoimmune diseases." But healthcare providers hadn't reliable scales to measure the effectiveness of interventions to improve reproductive health. Women with systemic lupus erythematosus (SLE) express concern about a significant gap in their reproductive and sexual health during medical care due to the lack of a specific scale to measure this concept. This study developed psychometrically specific scale to evaluate this concept in Iranian women. The study utilized a sequential-exploratory mixed-methods design, wherein the concept of reproductive health was clarified during the qualitative phase using conventional content analysis (inductive-deductive) to create a pool of RHASLE (Reproductive Health Assessment in SLE) items. During the psychometric process, the face, content, and construct validities of the RHASLE were checked with 650 individuals (320 using exploratory factor analysis [EFA] and 330 using confirmatory factor analysis [CFA]) through interviews and completion of the questionnaire. Convergent and divergent validities were then checked, and the reliability was assessed through stability and internal consistency. Finally, the measurement error, responsiveness, and interpretability of the scale were evaluated and confirmed. The study's findings revealed that the RHASLE consisted of 5 factors (33 items): physical-psychological disorder (13 items), relaxing feeling (6 items), spirituality (3 items), high-risk pregnancies (5 items), and sexual satisfaction (6 items). These factors explained a total of 99.97% of the variance in the concept of reproductive health. Confirmatory factor analysis confirmed the good model fit, and its validity and reliability were deemed acceptable. The RHASLE consisted of 27 items with high internal consistency, stability, responsiveness, and interpretability. That was able to get approval of Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Based on the results, RHASLE is a valid and reliable multidimensional scale that encompasses various aspects of reproductive health (physical, sexual, psychological, social, and spiritual).

A degree That Includes Vocational Education Textbooks of the Higher Basic Level in Jordan for Reproductive Health Concepts: دَرَجة تَضمُّن كُتب التّربية المِهَنيّة للمَرْحَلةِ الأسَاسيَّة العُليا في الأُرْدنِّ لمفاهيمِ الصّحة الإنْجَابيةِ

This study aimed to reveal the degree of inclusion of reproductive health concepts in the vocational education subject for the higher basic stage in Jordan, by analyzing the content of these books, the tool represented in building a list of reproductive health concepts that included (18) domains and (42) concepts that were applied to a sample of four vocational education books. The reliability coefficient of the tool was (92.2%).And the study adopted the descriptive- analytical approach. The results of the study revealed that the vocational education book for the tenth grade was the most inclusive of reproductive health concepts, with a percentage of (46.2%) of the total repetitions in four books, and this percentage falls within a high degree of inclusion. The vocational education book for the ninth grade came in the second rank with a rate of (23.5%), and this value is considered as a low degree of inclusion. In the third rank was the vocational education book for the seventh grade at a rate of (17.9%) which is considered a low degree of inclusion also. While the vocational education book for the eighth grade came in the fourth and last, with a rate of (12.4%), which is considered a low degree of inclusion too. As the number of reproductive health, concepts found in the vocational education books for the high basic stage reached 19 concepts, while the four vocational education books together did not include the remaining 23 concepts of reproductive health. It came in the following domains: marriage, genetic diseases, pregnancy, abortion, childbirth, breastfeeding, sexually transmitted diseases, and diseases related to the male and female reproductive system. The study recommended including the concepts of reproductive health included in the vocational education books in low percentages or those not mentioned in the vocational education books for the high basic stage.

Female Adolescents Knowledge Regarding Reproductive Health

Background: Adolescence as the period of human growth and development that occurs after childhood from 10 to 19 years of age. The physical and psychological wellbeing is vital for knowledge of this group considering their health.. Method: The study was conducted among girls aged 16_20 years in female secondary school in AL_Hilla city. Collected about 141 samples so we collected these samples to educate and increase of awareness of reproductive health. We use a developed and wellconstructed questionnaire, the data collected by the methods of selfadministered technique. We used accurate details to know the percentage of adolescent girls on the concept of reproductive health and discuss the concept of puberty with their parents, teachers, sisters or brothers as well as knowledge of diseases related to the reproductive system. Result: Sixtyeight percent have low knowledge about the concept of reproductive health. This means that they are risky factors to have reproductive diseases such as UTI or STD for the lack of awareness of how to take care and maintain of themselves and all of that because their lack of education and knowledge about the reproductive health and this constitutes a negative impact on the concept of reproductive health.

Islamic Guidance And Counseling Concept For Family Life Readiness Among High School Teenagers

<p align="center"><em>This article explains the concept of Islamic guidance and counselling to help high school students build readiness for marriage and having family life. Marriage and family life readiness is one of aspects in Competency Standards of Independence (SKK) that must be achieved by students at high school level.This concept is similar to the phases and tasks of adolescent development which begin to enter the early adult development phase. The researchers did not find any particularly studies that discuss the concept of Islamic guidance and counseling to help marriage readiness and family life for high school students. Despite the fact that the theme is important to be discussed for further elucidation,the problems eventuates among adolescents, such as premarital sex. The research is conducted by library research method. To support information requirements, researchers also conduct document observations and in-depth interviews with marriage counselor in Religious Affairs Office (KUA), high school principals, as well as high school guidance counselor and school counselor. The concept of guidance and counselling answers the need and solutions to the problems of adults at the high school level. This also helps to understand family life responsibilities and functions, the concept of reproductive health, what appropriate sexual behaviour is, family norms and relationships between family members.</em></p>

Assessing sexual and reproductive health dimensions tools in women with type 1 diabetes mellitus with regard to Consensus-based Standards for the selection of health status Measurement Instruments checklist.

A valid tool is of paramount importance in determining women's sexual and reproductive health status, meeting their health needs, and recognizing the effectiveness of some interventions. This review study aimed to assess sexual and reproductive health dimensions tools in women with type 1 diabetes mellitus with regard to Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist. In this review study, in addition to Iranian databases (MagIran, Sid, Irandoc), non-Iranian databases (PubMed, Scopus, Embase, and Web of Science) and Google Scholar search engine were considered. The mentioned databases were searched for articles in English and Persian published within 2000–2019, using the search strategy for each database and Boolean operators along with appropriate keywords according to the MESH term. Articles with nonresearcher-made tools measuring the sexual and reproductive health concepts and dimensions were included in the present study. Afterward, the psychometric properties of the tools were assessed according to the COSMIN checklist. In the selected articles, there were 14 psychometrically valid tools to be assessed from 151 articles containing the sexual and reproductive health dimensions; among which, seven tools were evaluated with regard to COSMIN. None of the tools also had all the features noted in COSMIN. Moreover, all the concerned scales were not interpretable and accountable; however, a majority of them had internal consistency and construct validity. In this study, there was no valid and specific tool for measuring sexual-reproductive health status in this population group. Therefore, it is necessary to develop a valid tool according to the dimensions and needs of specific reproductive health in type 1 diabetes.

Konsep Kesehatan Reproduksi Perempuan dalam al-Qur’an

The purpose of this study is to find out the verses of the Qur'an related to women's reproductive health, as well as the contextual interpretation of the commentators, so that it can be seen that the Qur'an is concerned with the reproductive health of women. The concept of reproductive health of women according to the Koran consists of six concepts, namely: Menstruation (Menstruation), sex and sexuality, pregnancy, childbirth, breastfeeding, and child care. All of these concepts are taken from the explanation of the Qur'an and so in the contextual interpretation of the commentators. The results of this study conclude that the commentators have a broad understanding relating to the science of reproductive health of women. Like menstruation, about menstrual blood described in the Surah Al-Baqarah verse: 222. Then the concept of the prohibition of adultery in Islam contained in Surah al-Isro 'verse: 32. Pregnancy, verses of the Qur'an that explain about pregnancy very much, among them, Al-Qur'an Surat Al-Mukminun verses 12-14. Childbirth, Al-Qur'an explains the verse about childbirth contained in the Surah Al-Ahqaf verse 15. Breastfeeding, Breastfeeding is also a function of reproduction. Verses that explain about breastfeeding include Surah Al-Baqarat verse 233. And caring for children, as Allah SWT says in the Qur'an is related to the care of children Lukman verse verse: 13.

Reproductive Health: Morals, Margins and Rights

AbstractReproductive interventions and technologies have the capacity to generate profound societal unease and to provoke hostile reactions underpinned by various moral concerns. This paper shows that this position currently goes relatively unchecked by the European Court of Human Rights, which allows the margin of appreciation and consensus doctrines significantly to limit the scope of reproductive rights under the right to respect for private and family life under Article 8. This occurs both in relation to the interest in avoiding reproduction at stake in abortion, and that in achieving it at stake in medically assisted reproduction. The paper demonstrates significant flaws in the Court's framing and deployment of these doctrines in its reproductive jurisprudence. It argues that, as regards existing and upcoming reproductive interventions and technologies, the Court should attend to the concept of reproductive health, long recognised in international conventions and policy materials.

Strategy of effectiveness in the modern concept of reproductive health

The modern concept of reproductive health is based not only on the search for optimal methods of treatment of diseases, preservation of planned pregnancy, prevention of maternal and child morbidity and mortality, but, first of all, on preventive correction of pathological conditions. These problems were examined on the 17th World Congress of the International Academy of Human Reproduction which took place on March 15–18, 2017 in Rome. In particular, the section “Current Problems in Reproductive Surgery” examined the problems of diagnosing pathological conditions before surgery, as well as issues of effective prevention of the disease recurrence. Within the framework of the section the associate professor of the Department of Perinatology, Obstetrics and Gynecology of the Kharkov Medical Academy of Postgraduate Education V.V. Bobritskaya presented the report “Management of patients after surgical treatment for ovarian neoplasia.”The report described the results of data-analysis of the management of 140 patients after surgical treatment for benign ovarian tumors. A retrospective study of these results was presented: using combined oral contraceptives (COCs), combination of COCs and the metabolic oncoprotect drug Epigalin, as well as the results of the isolated use of Epigalin in the rehabilitation period (6–12 months). The aim of the study was to optimize the methods of preventing relapses of neoplastic processes in operated women of reproductive age.Among the observed patients, the best results were reported in the group receiving co-therapy COCs + Epigaline – no recurrence of ovarian neoplasia. In group I (COCs only) 1 case of the endometrioid cyst recurrence was observed, in group III (Epigalin only) – 1 case of the cyst of the yellow body recurrence. The expected maximum number of relapses (6) was observed in a group of women who did not take the recommended drugs during the rehabilitation period for various reasons.According to conclusion of the study authors, a combination of COCs with a low dose of 20 μg ethinyl estradiol and 150 μg desogestrel with 90 mg epigallocatechin-3-gallate and 400 mg indole-3-carbinol (Epigalin) can be considered as one of the optimal methods for preventing of ovarian neoplasia recurrence, and therapy of dyshormonal conditions. Preventative treatment must be performed in the postoperative period.

Public Policies, Nursing Role and Health Programs Against Gender Violence. Comparative Study Spain - Brazil

Abstract Introduction: Gender violence is a serious public health problem and human rights, both in the Brazilian and Spanish society, so that public policies of these countries have the responsibility to eradicate this problem. Objective: To compare policies on gender violence between Spain and Brazil as well as their influence on nursing care to the abused women. Results: public policies that both countries have made since the 70s until today, under the influence of the International Conferences of the United Nations, notably from Beijing are exposed. Among the policies developed in these countries currently stands in Spain Organic Law 1/2004 and Brazil Maria da Penha Law. Public policies are translated in both countries in specific programs on women's health, who have also evolved since the 70s, from contemplating women exclusively in their gravid-puerperal cycle glimpsing in their overall health throughout the life cycle. These programs provide care to women in situations of gender violence through action protocols that emphasize the importance of identifying the problem in primary care, multidisciplinary actions among health professionals and coordination of the various institutions of protection of women to violence. Conclusions: As a consequence of global conferences and conventions on women and human rights, there have been policies in Spain and Brazil focused on gender equality and prevention of violence against women that have resulted in significant advances for the whole society, but they have not yet reached their goals. Women Health Programs start considering women as a subject of citizenship and rights. This evolution occurs in Spain after the influence of international conventions and conferences. However, Brazil is pioneering programs to include comprehensive women's health and reproductive health concepts, even before gouging importance internationally. These programs include violence against women as a field of action from the performance of health professionals in general and nursing in particular, establishing different protocols.

СВИНЕЦЬ ТА КАДМІЙ ЯК ЧИННИКИ РИЗИКУ РОЗВИТКУ ГЕСТАЦІЙНИХ УСКЛАДНЕНЬ

Introduction. Considering intensive chemical environmental pollution, health care is one of the priority problems in modern medicine. Nowadays, heavy metals, particularly lead and cadmium, which are classifi ed as global environmental pollutants, adversely affect public health. Even low concentrations of these metals and their compounds can accumulate and result in decrease of adaptive body reserves. Under such conditions, generative function is among the least protected and most susceptible ones. In this regard, the concept of reproductive health as a sensitive indicator of ecological problem was stated. The aim of this study was to evaluate lead and cadmium levels in women’s blood in uncomplicated and complicated pregnancy and to assess the signifi cance of their infl uence on the gestational process. Materials and methods. Investigation of lead and cadmium content in the blood of 42 women with uncomplicated pregnancy and 50 women with gestation complicated by anemia (44.0 %) and threatened abortion (56.0 %) was carried out. Determination of metals was evaluated by inversion voltammetry method. Results. An average concentration of lead in the blood of women with uncomplicated gestation corresponds to generally accepted levels. However, in 11.9 % of pregnant women, metal content was detected within 0.2 to 0.4 mg/l, which is rated as “carriage” and in 4.8 % of women, lead concentrations slightly exceeded the upper level of acceptable content (> 0.4 mg/l). Comparing the results with the data of the Center for Disease Control, physiologically acceptable level of lead (0.1 mg/l) was determined in 57.1 % of women with uncomplicated gestation. Exceeding of this level was detected in 42.9 % of pregnant women, which can cause hypertension in adults and leads to lower IQ, hearing, and growth in children. It is disturbing to determine the lead level above 0.45 mg/l in 11.1 % of women, which is too high and without timely medical aid is dangerous for children’s health. The average level of lead in complicated pregnancy was defi ned as “alertness” (0,2-0,4 мг/л) and was 2.4 times higher than in women with uncomplicated course of gestation. The highest concentration of metal was recorded in the blood of women with threatened miscarriage, which was by 154.0 % higher than in uncomplicated pregnancy. At the same time, lead level in women with anemia exceeded the index in physiological gestation by 95.2 %. In comparison with the data of the Center for Disease Control (USA), physiologically acceptable level of lead was determined only in 12.0 % of women with complicated gestation. In 88.0 % of women (in anemia – 86.3 %, threatened abortion – 89.2 %), exceeding of the maximal physiologically acceptable level is observed. Among them, in 63.6 % cases lead concentrations ranged within 0.2-0.44 mg/l, which is regarded as being high for children and “alarming” for adults. Potentially harmful level of lead was observed in 25.0 % of women. The level of cadmium in the blood of the women with physiological pregnancy corresponded to the known options for an average person (< 0.013 mg/l) and was slightly higher than recommended by the American Conference of Governmental Industrial Hygienists (0.005 mg/l). If compared with the approximate reference level of cadmium in the adults’ blood, cadmium content was determined within 0.005-0.01 mg/l in 33.4 % of women with uncomplicated gestation, which is estimated as the level of “alertness”, and potentially harmful levels were found in 9.5 % of cases (> 0,01 мг/л). The average level of cadmium during complicated pregnancy exceeded acceptable level 3 times and 2.8 times the index in uncomplicated gestation. In 44.0 % of women, cadmium was determined in “alert” range, potentially harmful level was found in 40.0 %. The highest content of cadmium was recorded in threatened miscarriage which exceeded the index in physiological gestation 3.2 times. However, pregnant women with anemia had 2.4 times higher cadmium level than healthy ones. Conclusions. Nowadays in ecological conditions with increased levels of abiotic substances, it is reasonable to implement detection of lead and cadmium contents into practical health care, especially in early gestation, as risk factors for development of gestational complications, which in its turn can protect the health of women and newborns.

Infertility in Sub-Saharan Africa: A Woman’s Issue for How Long? A Qualitative Review of Literature

Infertility or childlessness is a major reproductive health issue for females as well as males respectively. Many couples suffer from infertility worldwide and in Sub-Saharan Africa, which has a cultural preference for high fertility; women shoulder the highest infertility consequences. The objective of this review was therefore to explore socially acceptable and culturally effective reproductive health strategies for the social management of infertility in sub-Sahara Africa. Different databases were searched to source articles on infertility in Sub-Saharan Africa. The databases included Medline, Pubmed and Fudan University library. Google scholar was also utilized to get additional relevant articles. Titles and abstracts of the articles searched were critically evaluated for relevance based on the inclusion criteria. Final extraction of the articles was done by getting only those studies that met the inclusion criteria. Twenty articles were identified and five were included in this review. The findings reveal three main themes: perception, health seeking behavior and the social impact of infertility. In many Sub-Saharan Africa societies, there is negative perception of infertility problem as such those affected do not seek medical attention early. There is also a disproportionate social impact of infertility on women in the region. In Sub-Saharan Africa, high value is placed on children and those who are infertile are greatly stigmatized. In such a setting, the concept of reproductive health should include policies which could make it possible for couples and the whole society aware of the reality of infertility as a reproductive health problem and seek medical attention early.

Perception regarding reproductive health among adolescents of rural Sindh, Pakistan

Adolescence, the second decade of life, is a period in which an individual undergoes major physical and psychological changes. Adolescence is a period when health problems that have serious immediate consequences can occur or when problem behaviours that could have serious adverse effects on health in the future are initiated. This study examines the knowledge and perception regarding reproductive health and opinion toward reproductive health education among adolescents of rural Sindh, Pakistan. Study was conducted in 2008- 2009 on a total number of 369 adolescent males (209) and females (160) studying in colleges of Kambar Shadadkot, rural Sindh. This descriptive study using cluster sampling technique was conducted in randomly selected eight intermediate colleges of boys and girls. After informed consent and ensuring confidentiality, an anonymous quantitative questionnaire was completed to ascertain the knowledge of adolescents. Main outcome measures were adolescent’s knowledge of reproductive health concepts, pregnancy and contraceptive methods and knowledge in relation to sexually transmitted diseases (STDs) and HIV/AIDS. Analysis of data revealed that a sizable proportion of adolescents had low knowledge regarding reproductive health issues and had misconception regarding reproductive physiology, STDs and condoms. Teacher was the focal source of information and 63% male and 43 % female respondents desired a need for RH education. More than half of participants had no knowledge on STDs and HIV/AIDS and its spread and a small percentage had awareness regarding contraceptive methods, about condom use and its protective coverage against STD’s and pregnancy. Strong efforts are needed to augment awareness among rural adolescents and education could serve the purpose. Gender-based ethnically amenable sex education curriculum should be introduced in educational institutions.South East Asia J Public Health | Jan-June 2012 | Vol 2 Issue 1 | 39-45 DOI: http://dx.doi.org/10.3329/seajph.v2i1.15264

The Silent Epidemic of Reproductive Morbidity Among Ever Married Women (15–49 Years) in an Urban Area of Delhi

Concept of reproductive health has long been discussed and need to focus on reproductive morbidity as a measure of reproductive health has evolved. There is poor reproductive health with neglect of women's own health. Compounded with socio-cultural factors, the result is poor treatment seeking and hence poor quality of life. This community based study was conducted to find out the magnitude, type of reproductive morbidity and treatment seeking behavior for the same. Cross sectional study was conducted in Palam Village among married women aged 15-49years. 750 women were interviewed by visiting every fifth house through systematic random sampling. Symptomatic women were referred for gynecological examination and investigations. The overall prevalence of Reproductive Morbidity was found to be 46.3%: Gynaecological morbidity in 31.3% subjects, obstetric morbidity in 43.4% of the eligible women and contraceptive induced morbidity in 11.2% of the ever contraceptive users with 5% reporting more than one symptom. Problem perception and treatment compliance was poor for subjects with gynecological morbidity as compared with contraceptive and obstetric morbidity respectively. High self-reported obstetric morbidity was observed with good treatment seeking behavior as compared to poor treatment seeking behavior in women with gynaecological morbidity. Contraceptive morbidity was reported by fewer subjects but treatment seeking was good. There is a need to understand the pattern of reporting and health seeking behavior among women suffering from reproductive morbidity. The large magnitude of reproductive morbidity warrants attention and hints the poor quality of MCH care delivered to women.

Progress and prospects in reproductive health in the Asian and Pacific region

In regards to the demographic-oriented indicators traditionally used to measure the progress made by population programmes, the Asian and Pacific region is viewed as a much heralded success. The current total fertility rate (TFR) of the region is 2.3 and the annual population growth rate is just 1.1 (ESCAP, 2005). There has also been progress in indicators that reflect the more inclusive concept of reproductive health based on supporting individuals to achieve their reproductive health goals. The quality of reproductive health care and services has improved, and reproductive rights, rather than demographic targets, now underlie most reproductive health programmes in the region.

Women's Perceptions of Reproductive Health in Three Communities around Beirut, Lebanon

The aim of this study was to elicit definitions of the concept of reproductive health among women in three communities around Beirut, Lebanon, as part of the reproductive health component of a larger Urban Health Study. The communities were characterised by poverty, rural-urban mobility and heterogeneous refugee and migrant populations. A random sample of 1,869 women of reproductive age completed a questionnaire, of whom a sub-sample of 201 women were randomly selected. The women's understanding of good reproductive health included three major themes, which were expressed differently in the three communities. Their understanding included good physical and mental health, and underscored the need for activities promoting health. Their ability to reproduce and raise children, practise family planning and birth spacing, and go through pregnancy and motherhood safely were central to their reproductive duties and their social status. Finally, they saw reproductive health within the context of economic status, good marital relations and strength to cope with their lives. These findings point to the need to situate interventions in the life course of women, their health and that of their husbands and families; the importance of reproduction not only from a health services point of view, but also as regards women's roles and responsibilities within marriage and their families; and taking account of the harsh socio-economic conditions in their communities.

Reproductive health: some data and reflections

Respect for human rights goes beyond the concept of reproductive health. The right to a responsible, satisfactory and safe sex life and the right to choose the number of children means that we must also concern ourselves with such concepts as fertility, unwanted pregnancy and assisted reproduction. Spain has one of the lowest birth rates in the world, with 1.24 children per woman. Data from a recent national survey showed that 7.2% of Spanish women are at risk for an unwanted pregnancy, either due to failure to use contraceptive measures or to use of poorly efficient measures. The abortion ratio, which has been increasing since 1992, was about 7 per 1000 women in 2001. On the other hand, although more and more couples are consulting with problems of sterility, the public health services do not appear to be covering their requirements.

Human Rights Dynamics of Abortion Law Reform

The legal approach to abortion is evolving from criminal prohibition towards accommodation as a life-preserving and health-preserving option, particularly in light of data on maternal mortality and morbidity. Modern momentum for liberalization comes from international adoption of the concept of reproductive health, and wider recognition that the resort to safe and dignified healthcare is a major human right. Respect for women's reproductive self-determination legitimizes abortion as a choice when family planning services have failed, been inaccessible, or been denied by rape. Recognition of women's rights of equal citizenship with men requires that their choices for self-determination be legally respected, not criminalized.

The implementation of reproductive health programs: experiences, achievements and challenges

As a fundamental element of population strategies for international development, reproductive health has received much recognition since the International Conference on Population and Development held in Cairo in 1994. Nevertheless, much remains to be done to improve the understanding of the concept of reproductive health, support reproductive rights, operationalize reproductive healthcare within basic health services and promote a more conducive social, cultural and economic environment, especially for women and girls, to enable the attainment of reproductive health. Collaboration between governments and non-governmental organizations will be crucial and obstetrician-gynecologists have a unique role, through service provision, review of regulatory frameworks, education and advocacy, for the promotion of reproductive health.

Integrated approach to women’s health

The objective of this study was to demonstrate the importance of the practical application of the concept of reproductive health in São Paulo, Brazil, from 1991 to 1998 at the Pérola Byington Hospital with a new model of Primary Health Care (PHC) in which 2000 women/day, separated into two groups and over 45 years, was attended by nurses trained to detect the most frequently occurring gynecological problems supervised by doctors, who finalized the visit of each patient. The results demonstrated the advantages and viability of this strategy and also the bad health conditions of the women. Based on the high incidence of different kind of diseases detected, programs were set up for the diagnosis and treatment of gynecological cancer, STD, AIDS, hypertension, diabetes, etc. The results of two of these control programs, cervical cancer and breast cancer, demonstrated a significant increase in the diagnosis of early lesions. An economic study demonstrated an obvious and significant impact of this model not only in saving lives, but also in decreasing financial expenses in health.