Concept Of Reproductive Health Research Articles

Effects of Globalization on the Efforts to Decriminalize Abortion in Mexico

The concept of reproductive health has been incorporated in Mexican population and development policy since the ICPD, but access to reproductive health services remains unequal, demographic goals persist, and financial commitment is waning. Gloria Elena Bernal, Sharon Bissell and Ana Cortes look at how NGOs are working to develop new ways to ensure access to safe abortions for qualifying cases and advocate the review of punitive laws, building on civic interest and international accords.

Quality of Family Planning Services: Lessons from Concurrent Evaluation

The concept of reproductive health received global recognition in the International Conference of Population and Development (ICPD) at Cairo in 1994. A reproductive health approach means: people have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and child birth safely; the outcome of preg nancy is successful in terms of maternal and infant survival and wellbeing; and couples are able to have sexual relations free of the fear of pregnancy and of contracting disease. In 1995, after the Cairo conference, the Government of Rajasthan took the initiative to translate the concept of reproductive health into policies and programmes. The innovative interventions, one in Bundi district with UNFPA support, and the other in the two districts of Tonk and Dausa under the Vikalp project were imple mented, abolishing the method-specific targets. Later, in April 1996, the government abolished the targets in all districts and introduced micro district level planning in which the emphasis was laid not on numbers but on the quality of care. In the light of a target-free approach, the quality of family planning services in Rajasthan has been examined by using data from Concurrent Evaluation of Reproductive and Child Health Services. The quality framework evolved by Bruce (1990) was adopted to evaluate the total quality of care of family planning services. Nearly 86 per cent of couples were informed about three spacing methods, namely, condoms, oral pills, IUD and sterilis ation. Less than three-fifths of the users mentioned the method of their own choice. Nearly half of the couples were not informed about the side effects and risks of the methods at the time of adoption. About one-third of the female health workers did not have correct knowledge of IUD insertion. About 79 per cent women were visited by health workers three months prior to the survey. The present study concludes that there

Reproductive and sexual health and safe motherhood in the developing world

The aim of this paper is to discuss the main hurdles and possible solutions concerning reproductive and sexual health and safe motherhood in the developing countries.In response to the changing global situation, a broader new concept of reproductive health has emerged. The Programme of Action of The International Conference on Population and Development (ICPD) emphasizes and highlights various aspects of reproductive health. No population in the world has met the goals of the ICPD. The problems are particularly acute in developing countries: between 20 and 40% of births are unwanted or wrongly timed, posing hardships for families and jeopardizing the health of a million women and children. An estimated 50 million induced abortions are performed each year, with some 20 million of these performed under unsafe conditions or by untrained providers. Almost 600 000 women die every year due to pregnancy-related causes, 99% of them in developing countries. Approximately 7.6 million infant deaths occur during the perinatal period each year. There are more than 333 million new cases of curable sexually transmitted diseases world-wide each year. Nearly 22 million people are estimated to be infected with the human immunodeficiency virus, of whom 14 million are in sub-Saharan Africa, with rapidly increasing numbers of infected persons in South and South-East Asia. When compared to the developed world, these figures are staggering because of barriers operating at different levels and preventing women from receiving care that is timely and of good quality. United efforts of obstetricians, pediatricians, sociologists, and different governmental and non-governmental organizations are required to achieve our targets.

The Cultural Context of Reproductive Health: Implications for Monitoring the Cairo Agenda

When the 1994 International Conference on Population and Development adopted a reproductive health approach it became necessary to develop and adopt new indicators of progress. While former program experience has been used to further this task less attention has been paid to the underlying conceptual framework or to reconciliation of the goals of 1) developing a universal set of indicators and 2) responding to local conditions. The concept of reproductive health was developed through coalition-building but is nevertheless a cultural construct. Thus challenges to the development of indicators include 1) defining reproductive health and its scope 2) translating concepts into languages that have no equivalents 3) incorporating a gender perspective in settings where even women may seek other goals before seeking empowerment 4) setting appropriate priorities and 5) resolving discrepancies between womens perceptions and expressions of needs and biomedical assessments of their health. It is useful therefore to consider reproductive health indicators as existing on an continuum with quantifiable measures on one end and new indicators on the other to measure socioeconomic conditions changes in awareness satisfaction or well-being and empowerment. These latter measurements must be flexible enough to respond to specific cultural contexts. The very interdisciplinary nature of the current conceptualization of reproductive health will demand development of multidisciplinary interventions.

IAMANEH and the new concept of reproductive health

Prof. Hubbert De Watteville, first Secretary General and founder of the International Federation of Gynecologists and Obstetricians (FIGO), created the International Association for Maternal and Neonatal Health (IAMANEH) in 1977, after realizing that the improvements in maternal and neonatal health observed in developed countries were not benefiting the so-called Third World. The purpose of IAMANEH was to stimulate local associations to take initiatives to improve the health of the women and their children. Lack of attention to women's own health has been characteristic of the emphasis on antenatal care to protect the newborn or family planning to reduce demographic growth, with little attention to the needs of women themselves. The evolution to the more comprehensive concepts of reproductive health has been slow and moved by a few visionaries in the Obstetrics and Gynecology establishment and by the women's rights movement. Currently, the concept has been accepted at world conferences, such as those of Cairo (1994) and Beijing (1995). Brazil officially incorporated an even wider concept of Comprehensive Women's Health Care, originated at the State University of Campinas and formally adopted by the Federal Government in 1984. It was placed in practice in the state of São Paulo between 1987 and 1990, showing important improvements in the quantity and quality of services provided to women.

Viagra: A focus on sexual health

The concept of reproductive health implies that individuals and couples have the right to a satisfying safe sexual life. The drug Viagra has the potential to be as liberating to men as the Pill was to women 30 years ago. Viagra distribution offers an excellent opportunity for family planning associations to attract men to their programs and expand education around male sexuality. The availability of Viagra raises complex ethical issues however related to whether a drug that increases sexual enjoyment should be covered by medical insurance. Insurance coverage for people without physical problems who want to use the drug for enhancement of sexual pleasure does not seem justified. Without insurance coverage Viagra will remain a remedy available only to those who can afford its high price.

Reproductive health/family planning and the health of infants, girls and women.

The 1994 International Conference on Population and Development developed international consensus amongst health providers, policy makers, and group representing the whole of civil society regarding the concept of reproductive health and its definition. In line with this definition, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. Reproductive health care saves lives and prevents significant levels of morbidity through family planning programmes, antenatal, delivery and post-natal services, prevention and management programmes for reproductive tract infections (including sexually transmitted diseases and HIV/AIDS), prevention of abortion and management of its complications, cancers of the reproductive system, and harmful practices that impact on reproductive function. Reproductive health care needs are evident at all stages of the life cycle and account for a greater proportion of disability adjusted life years (DALYS) in girls and women than in boys and men. Reproductive health protects infant health by enabling birth spacing and birth limitation to be practiced through family planning. The prevention and early detection of reproductive tract infections, including sexually transmitted diseases and HIV, through the integration of preventive measures in family planning service delivery not only improves the quality of care provided but is also directly responsible for improvement in survival and health of infants. Addressing harmful practices such as son preference, sex selection, sexual violence and female genital mutilation complements the positive impact of planned and spaced children through family planning services on infant mortality and the reproductive health of young girls and women. They are also in addition to prenatal, delivery and postnatal services, positive determinants of low maternal mortality and morbidity and are integral to the promotion of reproductive health in women of child bearing age. Reproductive tract infections, including sexually transmitted diseases and HIV contribute to significant level of ill-health in women of reproductive age and continue to pose a threat through the menopause which in turn brings with it increasing risk of cancers of the reproductive system.

From reproductive health to sexual rights achievements and future challenges

This paper aims to map recent changes in discourse on sexuality and reproduction and identify new conceptual perspectives on gender and sexuality. First, it examines the etymology of recently legitimised concepts-reproductive rights, sexual health, and sexual rights-which are related to, but separate from, the concept of reproductive health. Second, it considers the status and meaning ofthese terms vis-à-vis an agenda for social transformation. Lastly, it focuses on new conceptualisations of gender and sexuality and analyses whether it is possible to distinguish between these two concepts.

Preserving the pot and water: A traditional concept of reproductive health in a Yoruba community, Nigeria

Within the background of the outcome of the 1994 Cairo Conference, this paper describes a traditional conceptualization of prenatal care in a Nigerian community and draws their implication for effective delivery of reproductive health services in the area. The data used were from qualitative interviews during 2 field trips to the community in 1988–1989 and 1991. The finding of the study highlights a local metaphor that likened the risks of pregnancy and child birth to a group of women that trekked to a local brook to fetch water with their earthen pots: some fell, broke their pots; some missed steps and spilt their water but kept their pots, and others returned without any mishap. The first group represented cases of maternal mortality; the second group were cases of miscarriage, still-births or infant deaths, and the third group represented successful outcomes for both pregnancy and the resultant baby. Various steps that were traditionally taken to ensure that the mother neither lost her pot nor spilled her water are described. The implications of these findings for policy and research are discussed in the paper.

The Cairo Conference: Achievements and Canadian Contributions

A significant achievement of the International Conference on Population and Development (ICPD) was the considerable work of consciousness-raising about population and its relationship to other key issues. ICPD participants reached a consensus on a 99-page document with only a few countries having reservations about only parts of the document. 90% of the text had been agreed upon before ICPD but the texts sections on abortion were worked out during the conference thus the issue of abortion received much press coverage. The document stresses in almost every chapter the interrelationships of underdevelopment poverty environmental degradation low status and lack of education among women and inadequate reproductive and other health services including family planning. It called for the approach to population and development to be fully integrated. ICPD did not discuss population control but the need to address the interrelated factors that if pursued comprehensively will likely result in lower fertility. The text dedicates a whole chapter to international migration. Nongovernmental organizations played a key role in the text. The biggest accomplishment of ICPD was the implicit assumption that women when informed and having the needed services will tend to make sound and enlightened choices about their fertility that benefit themselves their family and society in general. Canadians contributed in a meaningful way to ICPD. Canada had a representative in seven of eight special groups charged to thrash out tough issues. Canadians were largely responsible for guiding consensus on qualitys being as important as quantity in family planning programs. They were active in promoting agreement on the concept of reproductive health. Canada is involved in the UN Population Commission the agency overseeing follow-up to ICPD. Canadian demographers have formed a Contact Group on Population and Development to facilitate their involvement in population and development activities.

Reproductive health: A global perspective: Presidential address

Reproductive health is the ability 1) to regulate and control fertility (family planning and infertility) 2) for all women to have a safe pregnancy and childbirth and 3) for the newborn to experience a healthy infancy and freedom from sexually transmitted diseases (STDs). Modern medicine which increased life expectancy and reduced the death rate and an increase in births have resulted in rapid global population growth. Urbanization in developing countries adds to the burden of rapid population growth. In the 1970s social scientists and governments confronted rapid population growth by focusing on family planning but by the 1980s they learned that contraceptive technology alone did not slow population growth. Thus they integrated maternal and child health with family planning and focused on maternal and child health. In 1987 various groups formed the Safe Motherhood Initiative to reduce maternal mortality. The Initiative incorporates adequate primary health care and family planning comprehensive prenatal care help of trained delivery personnel for all women in childbirth and effective access to maternity hospital services for women with high-risk pregnancies and for women in dire emergencies. Many of the problem of and obvious solutions to maternal mortality are social or cultural (e.g. lack of transportation). Family planning programs strive to prevent unwanted pregnancies help achieve birth spacing and help couples limit family size so as to reduce maternal mortality. Infertility is highest in those areas of the world where fertility is also highest (e.g. sub-Saharan Africa) due to the high incidence of STDs which cause infertility. Further HIV infection is also highest in these same areas. Improved education and condom use prevent the spread of both STDs and HIV. Womens status must be raised worldwide so the comprehensive reproductive health programs can succeed. All the worlds obstetrician-gynecologists should actively promote improvement of womens status and support the concept of reproductive health.