Elsevier

The Lancet

Volume 368, Issue 9547, 4–10 November 2006, Pages 1595-1607
The Lancet

Series
Sexual and reproductive health: a matter of life and death

https://doi.org/10.1016/S0140-6736(06)69478-6Get rights and content

Summary

Despite the call for universal access to reproductive health at the 4th International Conference on Population and Development in Cairo in 1994, sexual and reproductive health was omitted from the Millennium Development Goals and remains neglected (panel 1). Unsafe sex is the second most important risk factor for disability and death in the world's poorest communities and the ninth most important in developed countries. Cheap effective interventions are available to prevent unintended pregnancy, provide safe abortions, help women safely through pregnancy and child birth, and prevent and treat sexually transmitted infections. Yet every year, more than 120 million couples have an unmet need for contraception, 80 million women have unintended pregnancies (45 million of which end in abortion), more than half a million women die from complications associated with pregnancy, childbirth, and the postpartum period, and 340 million people acquire new gonorrhoea, syphilis, chlamydia, or trichomonas infections. Sexual and reproductive ill-health mostly affects women and adolescents. Women are disempowered in much of the developing world and adolescents, arguably, are disempowered everywhere. Sexual and reproductive health services are absent or of poor quality and underused in many countries because discussion of issues such as sexual intercourse and sexuality make people feel uncomfortable. The increasing influence of conservative political, religious, and cultural forces around the world threatens to undermine progress made since 1994, and arguably provides the best example of the detrimental intrusion of politics into public health.

Section snippets

Antenatal, perinatal, postpartum, and newborn care

Despite some accomplishments, maternal mortality rates in many countries have remained more or less static in the past 15 years, and more than half a million maternal deaths take place each year. Yet, in the 21st century, no excuses can be made for so many women dying in pregnancy and childbirth. The burden of maternal morbidity and mortality shows one of the largest differentials between rich and poor countries.20 WHO's systematic review of maternal mortality and morbidity points to some

Unsafe abortion

Many governments have concerns about rising rates of unintended pregnancy and induced abortion, perhaps especially in developed countries. Although a concern, at least abortion is safe in such places. However, in many countries, access to safe abortion is restricted and, in some of those, unsafe abortion causes more than 30% of maternal deaths. All but 3% of 19 million unsafe abortions estimated to take place every year happen in developing countries (figure 2).14 The estimated 68 000 deaths

Reproductive tract infections and morbidities

After pregnancy-related causes, sexually transmitted infections are the second most important cause of healthy life lost in women. In 1990 the World Bank estimated that sexually transmitted infections (excluding HIV), accounted for 8.9% of all disease burden in women aged 15–45 years, and 1·5% in similarly aged men.30 In the same year, the Global Burden of Disease and Injury report31 estimated that 18·6 million disability-adjusted life years (DALYs) were lost from syphilis, gonorrhoea, and

Family planning

Investment in family planning services, together with the development of modern methods of contraception in the second half of the 20th century led to a striking increase in contraceptive use in many countries.50 In the 1960s fewer than 10% of married women were using contraception, in 2003 the proportion was 60%. In 2003 the total fertility rate—the total number of children a woman would have by the end of her reproductive life if she met the prevailing age-specific fertility rates from age 15

Violence against women and girls

Violence against women is an important contributor to ill-health of women, especially to their sexual and reproductive health. Such violence is a human rights abuse and a consequence (and a cause) of gender inequality.1 The most common and better documented types of violence (physical, sexual, and emotional), are intimate-partner violence (domestic violence) and sexual violence (rape, sexual coercion, and child sexual abuse). Abuse by an intimate partner is widespread and happens in both

Sexual and reproductive health and men

Much of sexual and reproductive health affects women, and men tend to be seen only as the perpetrators of acts leading to ill-health. However, men are also subject to sexual and reproductive ill-health; they also aquire sexually transmitted infections, including HIV. Male factors account for at least a third of couples attending for infertility treatment, and some young men are victims of non-consensual sex and of intimate partner violence.80 Men who have sex with men, including those who do

Why is sexual and reproductive health neglected?

Despite the obvious fact that sexual and reproductive illhealth is a major cause of morbidity and mortality, with the exception of HIV and AIDS, the subject has failed to capture broad support from the donor community. Some argue that the notion of reproductive health that was promoted in Cairo was too idealistic, that by emphasising issues such as empowerment of women and reproductive rights rather than the provision of services and “by asking too much, it ended up getting too little”.85

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  • Introduction

  • de Sanjose S, Diaz M, Castellsague X, Vimbert R, Tous S, Frayle H, Bosch FX. World-wide cervical HPV prevalence among...

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