Arquivo de etiquetas: Saúde Reprodutiva

Maternal and Child Health IV

The Sexual and Reproductive Health Agenda

Maternal health shall be always a core health priority in any nation. It shall always be part and parcel of the universal health coverage, whatever the model. Indeed, MDG V also had a sub-target which espoused ensuring universal access to reproductive health as its horizon. And we still have to achieve this. Maternal mortality is an indicator of how well health systems are functioning. In well-functioning health systems, maternal mortality is extremely low, as low as less 20. Negligible.

443 And in ensuring universal coverage for mothers and women would require access to quality reproductive health services, but not just that, it would also require financial protection without which this access is not possible without impoverishment. When we move toward examining challenges post-2015, then one of the bottlenecks is the problem of poor quality and poor access to data, in the context of maternal health. Only 11 of the 75 countries have information, good enough information on maternal health indicators. And 85% of the global population lives in areas where cause of death data, as basic as the cause of death data are of poor quality and therefore one of the endeavors as we move towards post-2015 framework says, to set up maternal morbidity indicator frameworks and capacity worldwide. And such an initiative has been launched by the World Health Organization. We must remember that maternal mortality, the death of a woman related, occurring as a result of, or a complication of pregnancy is just the tip of the iceberg. For every maternal death, there are 20 to 30 other women, other pregnant women who experience acute or chronic morbidity. And this emanates from a near death that they just managed to avert. Or, non-severe obstetric complication, but can be very devastating, such as uterine prolapse or a fistulae. So we move from reduction in mortality, that’s one aspect, but we also have to take care of this part of obstetric morbidity and the near misses that continue to occur in a very large number of women, even now. sexual and reproductive health continues to need greater attention in the development agenda.451It’s a fundamental pillar of core development of a nation and a society. Unsafe sex is among the top ten causes of disability and death globally. It’s a key toward bad outcomes. And addressing this is the pathway to overall better health, overall sustainable health and sustainable communities. More than 120 million couples continue to have unmet need for contraception. More than 120 million couples. And even today 80 million pregnancies are unintended each year on the globe. This has to be addressed. We’re still far away from an optimum reproductive health scenario in the world today.

452Our efforts to intensify this and in particular to address the younger women, the adolescent girls and women and mothers in marginalized societies. Poor households, poor communities, rural or urban, has to be an important endeavor even in the post-2015 scenario. Family planning promotion has the potential to reduce poverty and hunger and avert almost a third of all maternal deaths, because the number of pregnancies comes down, the mother is able to cope with pregnancies much better. And also family planning can reduce childhood deaths by 10%. Women’s health cannot be optimally addressed without addressing the social determinants such as the status of women in the society and the level of their empowerment, education, and connectivity with the environmental sustainability. In the post-2015 frameworks an important priority for women’s health shall be addressing the problem of unsafe abortions. Each year there are 19 to 20 million unsafe abortions in the world. Almost all of them take place in countries that are low or middle income. And they are particularly so in countries with restrictive, conservative abortion laws. Very disturbingly each year there are 40,000 deaths of adolescent girls and women each year in the world who do unsafe abortions. We have the overarching picture of the abortion laws. The green color depicts liberal abortion laws where the choice is offered to the woman, to under…undertake an abortion.

453The red colors indicate those countries where the abortion laws are restricted and there are conditionalities to undergo abortion. In the second map that how appears on the screen, you would see that areas where there are restrictive abortion laws the burden of unsafe abortions is high. Thus, in Latin America and in sub-Saharan Africa, where the laws related to abortion are restrictive, conservative, the prevalence of unsafe abortions is very high. The take is that if you wish to curb unsafe abortions, the abortion laws should be liberal and pro-choice as far the women and the girls are concerned. I’d like to move toward the unfinished agenda of sexually transmitted illnesses in the context of post-2015 priorities. The STI, the sexually transmitted illnesses are the second most common cause of healthy lives lost in women after the pregnancy resolves. Our focus has been on gonorrhea, chlamydia, syphilis and trichomonas and it remains a challenge.

454HIV is also a sexually transmitted illness and it could be put here as a part of STIs. But we also have human papillomavirus infection, herpes simplex virus infection, hepatitis B infections. And somewhat less troublesome, problems such as scabies and pubic lice that need to be addressed. You will see that the Americas in the developed parts of the world have a huge challenge of sexually transmitted illnesses. So that’s one major area is the Americas, then Asian countries are the other major hub of STIs. And this needs to be put on the high priority agenda in the post-2015 scenario. STIs have a huge impact on not only women, but also on the fetus and the child. STIs cause premature delivery, newborn deaths, birth defects, infections in children. They are contributing toward infertility in women. And they also of course are associated very importantly with rejection of the women by the families and disempowerment. STIs must be addressed optimally and among all women in the world as we move on. Then we look at other challenges in women’s health post-2015. One problem stands out very clearly and that is the issue of violence against women. Not fully understood, often hidden, but we now know from large studies and one particular one done by WHO that the prevalence of violence against women, often by the intimate partner, the husband or the partner is extremely high. Non-sexual as well as sexual violence.Sexual abuse before the age of 15 is quite significantly prevalent across nations. Across societies. At times, transactional sex is common in some regions. And pays for education among the girls. Women who experience violence lose their sexual and reproductive choices because they are forced. They lose their rights. Intimate partner violence is common cause of unintended pregnancies. And this happens in the confines of the home. Thus there are multifarious impacts of this…this problem, affecting a large number of women in the world today. And this must be addressed as a health problem, this must be addressed as a social problem. One form of violence against women is the practice of female genital mutilation, which occurs as a traditional practice in some parts of the world, particularly Africa and some Asian countries.

455Female mutilation, female circumcision has no medical benefit or value. This is an unacceptable practice. There are problems related to psychological trauma and the impact it has in future reproductive live. But there are also acute problems such as infections and hemorrhage, which can potentially kill the woman. And there is also likelihood of chronic morbidity, obstetric problems, fistulae, which can ruin the life of, of the girl, of the woman. Female genital mutilation has to be curbed in the post-2015 frameworks. If required there has to be laws against this depraving practice and if required, there has to be a major social movement to, to address this menace. We must also remember that women’s health is not just about reproductive health or pregnancy or maternal health, there is also a huge importance of mental health in the context of healthy women, healthy mothers. Suicides are among top causes of deaths in peri-natal period in the developed world. And this would happen increasingly so in developing countries as we move toward better, so-called better care. Often the conversation around the mental health is focused on post-natal depression and that’s fortunately getting new attention. But other psychiatric illnesses in peri-natal period also need to be paid attention to. So peri-natal mental health is an important emerging agenda for the global community to address. Other priorities that await focus, are the breast cancer and cervical cancer. And infertility in its own right, not only are we concerned about excess fertility, but we are also concerned about women’s choice and the families or the couple’s choice to have children. And infertility is equally devastating to individuals and families. So this is waiting attention and this should be a priority in the post-2015 agenda. My key messages in this lecture are the following. First, we have made progress in regard to reduction in maternal mortality. And we are proud of it, even though we would miss the MDG V but the, the progress made is remarkable. Maternal mortality has declined by 50% since 1990 and this is the effect of the MDG initiative. Although the current burden, as we have stated earlier is unacceptable and we need to take care of this unfinished agenda, we must always remember that 99% of all maternal deaths are really in the developing countries. It’s the agenda of the poor. It’s the agenda of the developing nations and emerging economies. Maternal health is at the heart of development agenda and it’s at the heart of our quest toward universal health coverage. As we move beyond 2015, we have to take care of the unfinished task of averting all preventable maternal deaths. But we also need to focus clearly on the near misses and the obstetric morbidity that may not result in mortality. We have a huge unfinished reproductive health agenda, huge unmet family planning and need has to be addressed. Unsafe abortions have to be tackled. These are needless deaths and needless morbidity and needless risk to the women. Sexually transmitted illnesses have to be a focus for us to eliminate them, bring them down to a negligible level in years to come. The new agendas on the table are violence against women, peri-natal mental health, and other conditions such as cancer and infertility that affect women and mothers of the world.