Reproductive Health ( Sociology Optional)

Introduction

  • Sexual and reproductive health was given an international consensus definition at the International Conference on Population and Development (ICPD) in 1994. 
  • At its core is promotion of reproductive health, voluntary and safe sexual and reproductive choices for individuals and couples, including decisions on family size and timing of marriage.
  • Sexuality and reproduction are vital aspects of personal identity and are fundamental to human well being fulfilling relationship within diverse cultural contexts.

Definition

  • Reproductive health is a state of complete physical mental and social well-being. and not merely the absence of reproductive disease or infirmity.
  • The International Conference on Population and Development Programme of Action states that reproductive health implies that people are able to have a satisfying and safe sex life and that they "have the capability to reproduce and the freedom to decide if, when and how often to do so. Reproductive health includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases."

Thinkers’ and Organisational views

  • As per United Nations Conference of Population and Development sexual and reproductive health mean that “people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.”
  • This includes being informed of and having access to “safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services.”

The importance of reproductive health

  • The Reproductive health is a crucial part of general health and a central feature of human development. It is a reflection of health during childhood, and crucial during adolescence and adulthood, sets the stage for health beyond the reproductive years for both women and men, and affects the health of the next generation.
  • The health of the new born is largely a function of the mother's health and nutrition status and of her access to health care.
  • Reproductive health is a universal concern. Although most reproductive health problems arise during the reproductive years. In old age general health continues to reflect earlier reproductive life events.
  • Men too have reproductive health concerns and needs though their general health is affected by reproductive health to a lesser extent than is the case for women.
  • Failure to deal with reproductive health problems at any stage in life sets the scene for later health and development problems.
  • The highest attainable level of health is not only a fundamental human right for all, it is also a social and economic imperative because human energy and creativity are the driving forces of development. Such energy and creativity cannot be generated by sick, tired people, and consequently a healthy and active, population becomes a prerequisite of social and economic development.
  • Reproductive health must be understood in the context of relationships. fulfilment and risk; the opportunity to have a desired child or alternatively, to avoid unwanted or unsafe pregnancy.
  • Reproductive health contributes enormously to physical and psychosocial comfort and closeness, and to personal and social maturation. Poor reproductive health is frequently associated with disease, abuse, exploitation, unwanted pregnancy, and death.
  • The most significant achievement of the Cairo (1994) Conference was to place people firmly at the centre of development efforts, as protagonists in their own reproductive health and lives rather than as objects of external interventions.
  • The aim of interventions is to enhance reproductive health and promote reproductive rights rather than population policies and fertility control.

Factors influencing reproductive health

  • Reproductive health is affected by, the people's lives, including their economic circumstances, education, employment living conditions and family environment, social and gender relationships, and the traditional and legal structures within which they live.
  • Sexual and reproductive behaviours are governed by complex biological, cultural and psychosocial factors. Therefore, the attainment of reproductive health is not limited to interventions by the health sector alone.
  • The status of girls and women in society, and how they are treated or mistreated, is a crucial determinant of their reproductive health.
  • Educational opportunities for girls and women powerfully affect their status and the control they have over their own lives and their health and fertility.

Important socio-cultural factors influencing reproductive health include:

  • gender-related issues such as patrilineal, patrilocal family systems; a strong matriarchal heritage; domestic violence; and oppressive values of society
  • traditional values, norms and beliefs, such as perceptions of femininity, sex taboos, the value placed on female virginity, the fear of losing “face”, and a belief in fate and karma
  • impacts of the transitional process: socio-cultural transition from rural to urban environments
  • positive and negative influences of social networks in risk behaviours
  • social segregation: both geographical and social or cultural segregation
  • sex education in school: current programmes fail to equip students with the knowledge and skills necessary to engage in safe sexual behaviour and other coping skills

Situation in India

There are several reproductive health concerns in India which need to addressed in order to improve reproductive health status of people. some of the major concerns are:

  • High unwanted fertility: As per the National Family Health Survey III - 2005-2006 (NFHS-III), nearly 21% pregnancies are either unwanted or mistimed.
  • High maternal mortality: India’s maternal mortality ratio is unacceptably high at 230 per 100,000 live births (2008) as per UN estimates.  Nearly 63,000 Indian women, accounting for almost 18 per cent of estimated global maternal deaths, die every year due to causes related to pregnancy and childbirth. 
  • Sexually Transmitted Infections/Reproductive Tract Infections: In a nation-wide community-based study, prevalence was nearly 6% in the 15-50 years age group.

Measures

Identification:

  • Criteria for Identification of priority problems should include not only importance - prevalence, severity, public concern, government commitment, impact on family, community and development - but also the feasibility of addressing them - known interventions, cost-effectiveness, availability of financing, human resources and adequate equipment and supplies.

Human resources building

  • Heath care providers will have to collaborate with others, including NGOs, women’s health advocates and young people.
  • Managerial and administrative changes will also be needed because integrated services can Impose, at least initially, greater burdens on already over-stretched staff and require attention to planning and logistics in order to ensure availability and continuity of services.
  • Training for reproductive health workers will need to focus on improving both technical and interpersonal skills.

Monitoring and evaluation

  • Monitoring and evaluation of reproductive health takes place at two levels - the country and the global level Globally.
  • WHO is working on additional indicators for global monitoring in reproductive health, including indicators on incidence and prevalence of sexually transmitted diseases, quality of family planning services, access to and quality of maternal health services, prevalence of female genital mutilation and prevalence and nature of obstetric and gynaecological morbidities.

Government and social initiatives

In 1951, India became the world’s first nation to launch a family planning programme. 

Decades later, when the International Conference on Population and Development (Cairo, 1994) prompted a paradigm shift in population programmes, with the advocacy of client-centered and quality-oriented reproductive health approaches, India formulated appropriate policy and programmatic responses:

  1. The National Population Policy was formulated in the year 2000. It affirms the government’s commitment to promote voluntary and informed choice, and continuation of the target-free approach in family planning service delivery.
  2. The National Rural Health Mission (NRHM) was launched in 2005. It  aims to revamp  the public healthcare delivery system and  seeks to provide accessible, affordable and quality healthcare  to rural population
  3. A national level Reproductive and Child Health Programme II (RCH II) was introduced in 2005 and focuses on addressing reproductive health needs of the population through evidence-based technical intervention through wide range of service delivery network. There is implicit emphasis on addressing the equity dimension in coverage, while maintaining focus on quality.
  4. Conditional Cash Transfer schemes like Janani Suraksha Yojana (for promoting institutional deliveries) were introduced to help address economic barriers for access to services.

Reproductive and Child Health (RCH) Programme

  1. It seeks to integrate services for the prevention and management of unwanted pregnancy, promotion of safe motherhood and child survival, and the prevention and management of RTI's and STIs.

Various indicators of Reproductive health

Use of contraceptives

  • There are some improvements in overall indicators such as contraceptive prevalence rates and the magnitude of unmet need for contraception.
  • However, underlying issues including limited contraceptive choice, poor quality of services, restricted access, gender inequalities and lack of male involvement continue to plague the programme.

Maternal Health and Pregnancy-related Care

  • Maternal mortality and morbidity vary considerably across the country but remain in most states, unacceptably high and largely preventable.
  • A variety of factors contribute to these high rates of morbidity such as women's powerlessness in the decision-making process and a traditional reluctance to seek timely and skilled pregnancy-related care.

Induced Abortion

  • The vast majority of women continue to seek and receive abortion services from unqualified providers.
  • As a result, many women die or suffer serious life-threatening complications. In the Indian context where the preference for sons is particularly strong the practice of second-trimester sex-selective abortions is becoming widespread.

Infertility

  • Government policies in India have largely-ignored the issue of infertility.
  • In patriarchal settings such as India where a woman's identity is determined by her ability to bear children, particularly sons; infertility can have far-reaching consequences.
  • The availability of new technologies, such as A'RTs, offers hope to infertile couples, but there is growing concern about its misuse, particularly in the absence of adequate information, and appropriate regulation.

Reproductive Tract and Sexually Transmitted Infections

  • The prevention and control of RTIs and STIs, including HIV, have become a national priority.
  • Although it is difficult to precisely estimate the prevalence of RTIs/STIs in India, evidence suggests that a large number of people are getting infected annually.

Young People's Sexual and Reproductive Health

  • An increasing number of young people are experiencing risky or unwanted sexual activity resulting in adverse reproductive health outcomes.
  • Contextual factors such as poverty, gender imbalances and lack of education or livelihood opportunities exacerbate their vulnerability. These are compounded by factors at the family, community and facility level.
  • Much of their knowledge of sexual and reproductive health is, superficial and lack of communication with parents and other trusted adults keeps young people ill informed.
  • Young people are a heterogeneous group whose situation, vulnerabilities, strengths and needs vary greatly, and policies and programmes will have to address these diverse needs through a multi-sectoral approach.

Domestic Violence

  • Violence against women is both a human rights issue as well as a public health concern as it impacts women's reproductive, sexual and mental health.
  • Studies suggest that domestic violence is pervasive and deeply rooted in social norms.
  • Women's lack of control over economic resources offers those facing violence few realistic options and a limited course of action.