Dr. Parveen Kumar
Health as defined by World Health Organization is a, ‘state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Reproductive health on the other hand implies a state of complete physical, mental and social well-being in all matters relating to the reproductive system. It means that people are enjoying a satisfied and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so. Reproductive health is a lifetime concern for both men and women, from infancy to old age. Evidence shows that reproductive health in any of these life stages has a profound effect on one’s health in later years of his/her life. A good reproductive health is important for general health and well being of both the sexes and is central to their ability to make choices and decisions about their lives, including when or whether to consider having children.
Of the two sexes; unfortunately, it is the woman who seem to suffer disproportionately from reproductive health issues. This is despite the fact that sound reproductive health of women is integral to the vision that every child is needed, every birth is safe, every young person is free from HIV, and every girl and woman is treated with dignity. Implicit in this vision is the idea that women will be able to exercise their rights to information on and access to safe, affordable and acceptable methods of fertility regulation as well as quality health care services. Young people are extremely vulnerable, often facing barriers to sexual and reproductive health information and care. They are the most to be affected as in case of the Human Immune Virus (HIV) infections. Every year millions of girls face unintended pregnancies, exposing them to risks during childbirth or unsafe abortions and interfering with their ability to go to school. As women bear children, and also often bear the responsibility for nurturing them, sexual and reproductive health and rights issues cannot be separated from gender equality. Cumulatively, the denial of these rights exacerbates poverty and gender inequality. This is seen most acutely in developing countries, where reproductive health problems are a leading cause of ill health and death for women and girls of childbearing age. Impoverished women suffer disproportionately from unintended pregnancies, unsafe abortion, maternal death and disability, sexually transmitted infections (STIs), gender-based violence, and other related problems.
ISSUES IN WOMEN REPRODUCTIVE HEALTH:
In women different life stages are associated with their reproductive health including menstruation, fertility, cervical-screening, contraception, pregnancy, sexually transmissible infections, chronic health problems (such as endometriosis and polycystic ovary syndrome) and menopause. Poor women, especially in developing countries, suffer from unintended and unplanned pregnancies, maternal death and disability, gender based violence and other problems related to their reproductive system and sexual behavior. A 2019 report by the Family Planning Association (FPA) of India reveals that 14 per cent of pregnancies amongst women aged below 20 are unplanned. It posits further that over 34 per cent of adolescent married girls admitted to being physically, emotionally or sexually assaulted. Fifty per cent of maternal deaths among girls from 15-19 years of age occur due to unsafe abortion practices. Another report by Guttmacher institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights in the United States; regarding the status of women of reproductive age (15–49 years) in India revealed that 49 million women in India have an unmet need for contraception; 51% of women giving birth make fewer than antenatal care visits; about 40% of women do not receive a postnatal care check up within 24 hours of delivery and another 14 million women do not receive treatment for one of the four major curable STIs. The Guttmacher study also concluded that if all the women wanting to avoid pregnancy were to use modern contraceptives; all pregnancy related and new born care needs were met and all women in need received treatment for major curable Sexually Transmitted Infections STIs viz Chlamydia, Gonorrhea, Syphilis and Trichomoniasis; there would annually be 16 million fewer unintended pregnancies, 10 million fewer unsafe pregnancies, 14,000 lower maternal deaths and 403,000 fewer new borne deaths and 3 million fewer cases of celvic inflammatory disease from untreated STIs. If the monetary costs involved in providing all women and new borns in India with contraception, pregnancy related and new borne care and STI treatment, it would cost only $ 5.41 per capita annually which is relatively vey low as compared with average cost of $ 10.60 per capita in other low and middle income countries.
STRATEGIES FOR GOOD REPRODUCTIVE HEALTH:
Every individual has the right to make their own choices about their reproductive health and to maintain it; people need access to accurate information about various facets of reproductive health. At the same time the married women need safe, effective, affordable and acceptable contraception method of their choice. They must be informed and empowered to protect themselves from sexually transmitted infections and when they decide to have children, women must have access to services that can help them have a fit pregnancy, safe delivery and healthy baby. When reproductive health needs are not met, individuals are deprived of the right to make crucial choices about their own bodies and futures, with a cascading impact on their families’ welfare and future generations.
The foremost emphasis thus should be on improving access to quality reproductive health services and such services should be provided by the same gender. Maternal death and disability can be reduced dramatically if every woman has access to health services throughout her lifecycle, especially during pregnancy and childbirth. The highest priority needs to be given to ensure women’s reach to skilled birth attendants at the time of giving birth and that woman who develop life-threatening complications during pregnancy; childbirth or post partum can immediately access treatment at adequately-equipped facilities. Government has also now engaged ASHA workers as front line health activists at the village level to take care of all such needs of pregnant women. Ensuring timely transportation to health care centers and enabling prompt treatment on arrival can also give good results. A balanced diet rich in all the nutrients can help build the immune system of the girls at the reproductive age so as to resist the infections naturally. Family Planning is another important factor which can drastically reduce the number of unwanted and closely spaced births. This can be done by providing access to quality contraceptive services. Moreover, a set of emerging issues, such as infertility, reproductive cancers, morbidities such as prolapse and gender based violence, need to be studied and can also be addressed simply by awareness. In addition, programmes also need to focus on preventing and treating reproductive tract and sexually transmitted infections and meeting unmet reproductive health needs of underserved groups, such as adolescents and people living with HIV/AIDS with special reference to information, counseling and services. Safe sex practices are also very important for the sexual and reproductive health of sexually active women of all ages. It also involves a respectful and positive approach towards sexual relationships. Services such as human papilloma virus vaccination, cervical screening tests and screening for sexually transmissible infections are also essential.
In 1951, India became the world’s first nation to launch a family planning programme. The National Population Policy was formulated in the year 2000 affirming the government’s commitment to promote voluntary and informed choice, and continuation of the target-free approach in family planning service delivery. The National Rural Health Mission (NRHM) launched in 2005 aims to revamp the public healthcare delivery system and seeks to provide accessible, affordable and quality healthcare to rural population. A national level Reproductive and Child Health Programme II (RCH II) introduced in 2005 focuses on addressing reproductive health needs of the population through evidence-based technical intervention through wide range of service delivery network. Conditional Cash Transfer schemes like Janani Suraksha Yojana (for promoting institutional deliveries) have also been introduced to help address economic barriers for access to services. The Accredited Social Health Activists (ASHA) have also strengthened the human resources at grassroots levels.
At the global level, the United Nations Population Fund, formerly the United Nations Fund for Population Activities (UNFPA) is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA works with a range of partners to promote reproductive health in India. It pools a significant proportion of its country programme resources in the Reproductive and Child Health II (RCH-II) programme, aimed at reducing maternal mortality, child mortality, as well as provision of range of quality contraceptive services. Adolescent reproductive health is important focus of UNFPA’s work. UNFPA also works to prevent and address STIs, which take an enormous toll around the world. More than a million people acquire an STI every single day. Without diagnosis and treatment, some STIs, such as HIV or syphilis, can be fatal. STIs can also cause pregnancy-related complications, including stillbirth, congenital infections, sepsis and neonatal death. UNFPA supports demand led interventions largely through civil society partners. These Interventions focus on empowering community-based organizations and village-based health/sanitation committees to monitor service provision and articulate community perspectives on access and quality of reproductive health services.
Reproductive health concerns cut across many socio–economic aspects. The health sector alone cannot resolve them. Addressing this issue needs a holistic approach. This requires the services of a variety of sectors that include health, education, social welfare and even the transport systems which are required to ensure that the health care is accessible. These must be strengthened. Most of the problems and their costly consequences can be averted if reproductive health is routinely addressed within the context of primary health care as a first line of prevention and care. Besides strengthening health systems, it is also necessary to build trust among the communities they serve by taking into account the social, cultural, economic and gender dimensions too.
(The author is a Scientist at SKUAST-K; can be reached at [email protected])
Dr. Parveen Kumar