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Your Environment. Your Health.
Reproductive health, what is niehs doing, further reading, introduction.
Reproductive health refers to the condition of male and female reproductive systems during all life stages. These systems are made of organs and hormone-producing glands, including the pituitary gland in the brain. Ovaries in females and testicles in males are reproductive organs, or gonads, that maintain health of their respective systems. They also function as glands because they produce and release hormones.
Reproductive disorders affect millions of Americans each year.
The following clinical trials are currently recruiting:
- Demystifying a Girl’s First Period
- Environmental Causes of Infertility
- Inherited Reproductive Disorders Study
Female disorders include:
- Early or delayed puberty.
- Endometriosis, a condition where the tissue that normally lines the inside of the womb, known as the endometrium, grows outside of it.
- Inadequate breastmilk supply.
- Infertility or reduced fertility (difficulty getting pregnant).
- Menstrual problems including heavy or irregular bleeding.
- Polycystic ovary syndrome, ovaries produce more male hormones than normal.
- Problems during pregnancy.
- Uterine fibroids, noncancerous growths in a woman’s uterus or womb.
Male disorders include:
- Impotence or erectile dysfunction.
- Low sperm count.
Scientists believe environmental factors likely play a role in some reproductive disorders. Research shows exposure to environmental factors could affect reproductive health in the following ways:
- Exposure to lead is linked to reduced fertility in both men and women. 1
- Mercury exposure has been linked to issues of the nervous system like memory, attention, and fine motor skills. 2
- Exposure to diethylstilbestrol (DES), a drug once prescribed to women during pregnancy, can lead to increased risks in their daughters of cancer, infertility, and pregnancy complications. 3
- Exposure to endocrine-disrupting compounds , chemicals that interfere with the body’s hormones, may contribute to problems with puberty, fertility, and pregnancy. 4
NIEHS conducts and funds research to understand environmental factors that may affect human reproductive health.
Heat exposure during pregnancy – NIEHS-funded researchers studied more than 400,000 pregnancies and found that both long- and short-term maternal heat exposures during pregnancy are associated with increased risk of severe maternal morbidity . The Centers for Disease Control and Prevention lists 21 different indicators of this medical condition that unexpectedly occurs after labor and delivery. The prevalence of severe maternal morbidity has continued to increase in the U.S. despite improvements in improvements in prenatal care coverage and quality.
Heavy lifting or shift work and decreased fertility – Two occupational factors for women – lifting heavy loads or working non-daytime schedules – are associated with fewer eggs in their ovaries, which could indicate decreased fertility. 5
Chemical exposure and assisted reproductive technology – Exposure to high levels of flame retardants 6 and plasticizers 7 may have a negative impact on the outcomes of in vitro fertilization (IVF), a technology used to help people get pregnant. The researchers found that women with higher levels of these chemicals in their urine had lower levels of ovary cells necessary for reproduction, and fewer successful pregnancies and live births.
Soy formula and menstrual pain – Girls who were fed soy formula as infants are more likely to develop heavy menstrual bleeding 8 , severe menstrual pain 9 , endometriosis 10 , and larger fibroids 11 later in life.
Vitamin D and uterine fibroids – Women with adequate levels of vitamin D are less likely to develop uterine fibroids than those with inadequate levels. 12
Uterine cancer – Women who used chemical hair-straightening products were at higher risk for uterine cancer compared to women who did not report using these products, according to research from The Sister Study that included more than 33,000 women. The researchers found that women who reported frequent use of hair-straightening products, defined as more than four times in the previous year, were more than twice as likely to go on to develop uterine cancer compared to those who did not use the products. Uterine cancer is relatively rare and accounts for about 3% of all new cancer cases. But it is the most common cancer of the female reproductive system.
Sperm quality – A comprehensive study, which included systematic review and meta-analysis, found sufficient evidence of an association between higher insecticide exposure—organophosphates and methyl carbamates—and lower sperm concentration in adult males. People can be exposed to insecticides through residential, occupational, and recreational sources.
NIEHS-supported researchers found prenatal exposure to air pollution (PM2.5) may shorten the distance between the anus and genitals, or the anogenital distance. Anogenital distance is a way to gauge reproductive health related to hormone levels, such as testosterone. Shorter anogenital lengths in newborn males are an indicator of lower testosterone activity in the womb, which may have implications for fertility and semen quality in adults.
NIEHS Research Efforts
- Calorie Restriction, Environment, and Fitness: Reproductive Effects Evaluation (CaREFREE) – A study, conducted at NIEHS, that investigates how nutrition, fitness, and environmental factors affect women’s menstrual cycles.
- Environment and Reproductive Health (EARTH) Study – Conducted by grantees in Massachusetts, analyzes the effects of environmental contaminants on male and female fertility and pregnancy outcomes.
- LifeCodes – A pregnancy cohort, led by Brigham and Women's Hospital in Boston, providing samples and data from more than 5,000 pregnancies for research projects such as investigating the association between environmental exposures and spontaneous preterm birth. It is one of the nation’s largest pregnancy cohorts and specimen banks.
- Pregnancy And Childhood Epigenetics (PACE) – A consortium of researchers at NIEHS, and around the world, that studies how environmental exposures in early life affect pregnancy outcomes and child health.
- Reproductive System Disorders – NIEHS supports research that is developing a fuller understanding of the relationship between exposures and risk of reproductive health problems. For example, grantees are studying the effects of arsenic exposure on birth outcomes; ties between dioxin exposure and endometriosis; and the role endocrine disruptors might play in sperm chromosomal abnormalities.
- Study of Environment, Lifestyle, and Fibroids (SELF) – A study conducted at NIEHS that uses ultrasound screening to identify risk factors for uterine fibroid development in African-American women.
Stories from the Environmental Factor (NIEHS newsletter)
- Early-life Exposures, Assisted Reproductive Technologies Can Alter Gene Expression, Says Falk Lecturer (November 2023)
- Risk for Female Reproductive Cancer May Increase After Early-life Exposure to Endocrine-disrupting Substances (November 2023)
- Exposures Affect Men’s Biological Clocks, Too (June 2023)
- Scientific Excellence, Mentorship Go Hand in Hand for NIEHS Researcher (June 2023)
- Anne Marie Jukic wins NIH Bench-to-Bedside award (January 2021)
- Early embryos develop successfully through molecule called tankyrase (June 2020)
- Humphrey Yao elected to board of Society for the Study of Reproduction (May 2021)
- On the road again: NIEHS shines at the Endocrine Society’s annual conference (July 2022)
- Researchers Identify Cells Involved in Development of Genitalia (July 2021)
- Preterm Birth, Prolonged Labor Influenced by Progesterone Balance (April 2021)
- Replacement Chemicals May Put Pregnancies at Risk (February 2020)
- Pregnancy Hypertension Risk Increased by Traffic-related Air Pollution (January 2020)
Cosmetics and Hair Dye
Environment and Health A to Z
Reproductive Health in Females and Males
- Preterm Birth More Likely With Exposure to Phthalates (July 11, 2022)
- Common Reproductive Health Concerns for Women – Information and educational materials for women and health care providers provided by the U.S. Centers for Disease Control and Prevention (CDC).
- Journal of Women's Health Maternal Morbidity and Mortality – In the U.S., women are more likely to die from complications related to pregnancy or childbirth than in peer nations, and many health inequities are present among those who die. This special issue offers a research road map to help end this public health crisis. It showcases the work of NIH including NIEHS, other federal agencies, and the scientific community.
- Polycystic Ovary/Ovarian Syndrome – The NIH Office of Research on Women’s Health published an informational booklet on PCOS, an endocrine disease affecting millions of women that is often missed during medical examination.
Related Health Topics
- Bisphenol A (BPA)
- Cosmetics and Personal Care Products
- Endocrine Disruptors
- Women's Health
- Karen Clay, Margarita Portnykh, Edson Severnini. Toxic Truth: Lead and Fertility. 2019. NBER Working Paper No. 24607. [Accessed online 25 June 2019] [ Available Karen Clay, Margarita Portnykh, Edson Severnini. Toxic Truth: Lead and Fertility. 2019. NBER Working Paper No. 24607. [Accessed online 25 June 2019] ]
- U.S. Environmental Protection Agency (EPA). 2019. Health Effects of Exposures to Mercury. [Accessed June 25, 2019] [ Available U.S. Environmental Protection Agency (EPA). 2019. Health Effects of Exposures to Mercury. [Accessed June 25, 2019] ]
- American Cancer Society. 2019. DES Exposure: Questions and Answers. [Accessed June 25, 2019] [ Available American Cancer Society. 2019. DES Exposure: Questions and Answers. [Accessed June 25, 2019] ]
- Endocrine Society. Impact of Endocrine-disrupting Chemicals on Reproductive Systems. [Accessed June 25, 2019] [ Available Endocrine Society. Impact of Endocrine-disrupting Chemicals on Reproductive Systems. [Accessed June 25, 2019] ]
- Mínguez-Alarcon L, Souter I, Williams PL, Ford JB, Hauser R, Chavarro JE, Gaskins AJ; Earth Study Team. 2017. Occupational Factors and Markers of Ovarian Reserve and Response Among Women at a Fertility Centre. Occup Environ Med 74(6):426-431. [ Abstract Mínguez-Alarcon L, Souter I, Williams PL, Ford JB, Hauser R, Chavarro JE, Gaskins AJ; Earth Study Team. 2017. Occupational Factors and Markers of Ovarian Reserve and Response Among Women at a Fertility Centre. Occup Environ Med 74(6):426-431. ]
- Carignan CC, Mínguez-Alarcon L, Butt CM, Williams PL, Meeker JD, Stapleton HM, Toth TL, Ford JB, Hauser R, EARTH Study Team. 2017. Urinary Concentrations of Organophosphate Flame Retardant Metabolites and Pregnancy Outcomes among Women Undergoing in Vitro Fertilization. Environ Health Perspect 125(8):087018. [ Abstract Carignan CC, Mínguez-Alarcon L, Butt CM, Williams PL, Meeker JD, Stapleton HM, Toth TL, Ford JB, Hauser R, EARTH Study Team. 2017. Urinary Concentrations of Organophosphate Flame Retardant Metabolites and Pregnancy Outcomes among Women Undergoing in Vitro Fertilization. Environ Health Perspect 125(8):087018. ]
- Hauser R, Gaskins AJ, Souter I, Smith KW, Dodge LE, Ehrlich S, Meeker JD, Calafat AM, Williams PL; Earth Study Team. 2016. Urinary Phthalate Metabolite Concentrations and Reproductive Outcomes among Women Undergoing in Vitro Fertilization: Results from the EARTH Study. Environ Health Perspect 124(6):831–839. [ Abstract Hauser R, Gaskins AJ, Souter I, Smith KW, Dodge LE, Ehrlich S, Meeker JD, Calafat AM, Williams PL; Earth Study Team. 2016. Urinary Phthalate Metabolite Concentrations and Reproductive Outcomes among Women Undergoing in Vitro Fertilization: Results from the EARTH Study. Environ Health Perspect 124(6):831–839. ]
- Upson K, Harmon QE, Laughlin-Tommaso SK, Umbach DM, Baird DD. 2016. Soy-based Infant Formula Feeding and Heavy Menstrual Bleeding Among Young African American Women. Epidemiology 27(5):716-25. [ Abstract Upson K, Harmon QE, Laughlin-Tommaso SK, Umbach DM, Baird DD. 2016. Soy-based Infant Formula Feeding and Heavy Menstrual Bleeding Among Young African American Women. Epidemiology 27(5):716-25. ]
- Upson K, Adgent MA, Wegienka G, Baird DD. 2019. Soy-based Infant Formula Feeding and Menstrual Pain in a Cohort of Women Aged 23-35 Years. Hum Reprod 34(1):148-154. [ Abstract Upson K, Adgent MA, Wegienka G, Baird DD. 2019. Soy-based Infant Formula Feeding and Menstrual Pain in a Cohort of Women Aged 23-35 Years. Hum Reprod 34(1):148-154. ]
- Upson K, Sathyanarayana S, Scholes D, Holt V. 2015. Early-life Factors and Endometriosis Risk. Fertil Steril 104(4):964-9761. [ Abstract Upson K, Sathyanarayana S, Scholes D, Holt V. 2015. Early-life Factors and Endometriosis Risk. Fertil Steril 104(4):964-9761. ]
- Upson K, Harmon QE, Baird DD. 2016. Soy-Based Infant Formula Feeding and Ultrasound-Detected Uterine Fibroids Among Young African-American Women With No Prior Clinical Diagnosis of Fibroids. Environ Health Perspect. 124(6):769-75. [ Abstract Upson K, Harmon QE, Baird DD. 2016. Soy-Based Infant Formula Feeding and Ultrasound-Detected Uterine Fibroids Among Young African-American Women With No Prior Clinical Diagnosis of Fibroids. Environ Health Perspect. 124(6):769-75. ]
- Baird DD, Hill MC, Schectman JM, Hollis BW. 2013. Vitamin D and the Risk of Uterine Fibroids. Epidemiology. 24(3):447-453. [ Abstract Baird DD, Hill MC, Schectman JM, Hollis BW. 2013. Vitamin D and the Risk of Uterine Fibroids. Epidemiology. 24(3):447-453. ]
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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions (1997)
Chapter: 1: introduction, introduction.
In 1994 representatives of nearly 180 countries at the International Conference on Population and Development (ICPD) adopted a Programme of Action, a crucial section of which included a definition of reproductive health (United Nations, 1994):
Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its processes. Reproductive health therefore 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. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for the regulation of fertility which are not against the law, and the right of access to appropriate health-care services that enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. … It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counseling and care related to reproduction and sexually transmitted diseases.
Linking fertility regulation to other positive goals of reproductive health was seen as a call for change in the focus of population policy and for commitment of resources to meet previously neglected health needs. The Programme of Action entails both expansion and reform of health
services, as well as action by sectors other than health to create the supportive environment for improvements in reproductive health. Implementing the Programme of Action will require improvements in the quality and range of existing services, as well as basic and applied research on new services. It will also require information on the magnitude of reproductive health problems, the effectiveness and feasibility of alternate actions to overcome the problems, and the resources needed to do so.
To aid in this process, the U.S. Agency for International Development, the Andrew W. Mellon Foundation, and the William and Flora Hewlett Foundation asked the Committee on Population of the National Research Council to: (1) assess the magnitude and severity of reproductive health problems in developing countries, (2) assess the likely costs and effectiveness of interventions to improve reproductive health, and (3) recommend priorities for programs and research. To carry out this task, the Research Council formed the Panel on Reproductive Health in Developing Countries.
THE PANEL'S FRAMEWORK
To organize our research and presentation, the panel adopted the ICPD's vision of reproductive health:
Every sex act should be free of coercion and infection.
Every pregnancy should be intended.
Every birth should be healthy.
This vision is also consonant with other widely used definitions of reproductive health (see Fathalla, 1988; Germain and Antrobus, 1989).
No population in the world has attained the state of health described by the ICPD definition quoted above nor fully realized the vision adopted by the panel. By stating the goals positively, rather than in terms of reduction in morbidity, mortality, and other forms of suffering, we emphasize health and a broad focus. We consider social and behavioral change and policy changes, as well as programs targeted directly against particular causes of illness and death. Improving reproductive health involves social and cultural influences and the behavior of individuals and their families, at least as much as delivery of services by public and private agencies to their clients.
This report should be useful for those who design reproductive health programs in developing countries, set priorities for funding them, and conduct or fund research to improve programs. The geographic focus of this report is primarily the low- and middle-income countries of Asia, the Pacific islands, Africa, Latin America, and the Caribbean basin. However,
many of the conclusions and recommendations are also relevant to the formerly socialist countries in transition to market economies and to high-income countries.
Reproductive health overlaps with, but is not the same as, women's health. Reproductive health includes the health of men; reproductive rights include men's rights. However, the programmatic discussion in the following chapters deals more with women than with men, for several reasons. For example, sexually transmitted diseases are more often recognized and treated among men than among women, and the challenge for policy is to design services that reach women effectively and appropriately. Sexual violence and circumcision are more serious threats to health for women than for men. Abortion, pregnancy care, and safe delivery all have more direct effect on women's health than on men's, although men's views and behavior affect these aspects of reproductive health. Most problems and interventions we discuss below cannot simply be classified as women's health or men's health. Prevention of sexual coercion, condom use for prevention of sexually transmitted diseases (STDs), prevention of infertility, provision of contraceptive methods, and communication of information for health promotion are all measures to improve the sexual and reproductive health of both women and men. And pregnancy and delivery care, education in general, and sexuality education can improve the health and development of all children.
Many of the barriers to achieving reproductive health in developing countries described in this report exist in developed countries as well, but the problems are particularly acute in the developing countries.
Nearly 90 percent of all the births in the world occur in developing countries—115 million births per year. These 115 million births are the outcomes of about 180 million pregnancies. A significant proportion of these births—about one-fifth—are unintended. An estimated 50 million induced abortions are performed each year, with some 20 million of these performed in unsafe circumstances or by untrained providers. There are estimated to be more than 333 million new cases of curable sexually transmitted diseases worldwide each year. Partly as a result of these infections, an unknown, but in some countries tragically high, number of couples cannot have the children they want. Almost 600,000 women each year die from pregnancy-related causes (complications of pregnancy, delivery, puerperium, or abortion), 99 percent of them in developing countries. About 1 in 48 women in developing countries dies from these causes, compared with only about 1 in 1,800 women in developed countries.
Some 7.6 million infants die in the perinatal period each year. Far larger numbers of women and their children survive the reproductive process but with disabilities that may profoundly affect their lives. The imprecision of such estimates, and the lack of any statistics for some of the problems discussed in this report, are due in part to the lack of past attention to research and measurement of these problems.
Gaps in knowledge of the extent of problems are also due to inadequate health services at crucial stages of reproduction. Millions of women do not receive adequate delivery care. Their deaths, the vast majority of which are preventable, are due to lack of contact with health care providers, or late contact, or inadequate action after contact. Millions of women and men do not have the knowledge about, or access to, family planning and safe abortion that would help them make and implement informed choices about fertility. Millions of people lack knowledge about, or access to, services that would help them avoid infections that can permanently affect their health, including their fertility.
One immediate challenge for reproductive health is the sheer growth in the size of the populations to be served. Even in countries in which declines in fertility have begun, there will still be rapid increases in the number of women aged 15-49 and in the number of young people during the next few years.
The challenge is particularly daunting for countries with poorly developed family planning services—those with very low prevalence of modern contraception. All of these countries are projected to have increases of 50 percent from 1995 to 2010 in their population of women aged 15-49; see Table 1-1 . (The population of men in these high-fertility years, not shown in Table 1-1 , will also increase by almost exactly the same proportions as the population of women.) Just to continue present inadequate levels of services would require very rapid growth in absolute terms; to expand and improve the quality and range of services will require both increased resources and skilled management.
In countries in which health and family planning services are better established (again, the proxy measure is the contraceptive prevalence rate), less effort will be required to match the expected growth rate of the populations to be served. In Colombia, for example, the number of adult women will increase by less than one-fourth over the 15-year span, and the number of young people by one-tenth. In Thailand, the number of young people will actually decrease. This does not mean that Colombia and Thailand do not need resources and policy attention for reproductive health: The epidemic of AIDS and other STDs, the need to improve quality of other reproductive health programs, and the need to reach previously underserved populations present major challenges. However, these
TABLE 1-1 Projected Increases in Number of Women Aged 15-49, Number of Persons Aged 15-24, and Percentage of Population Living in Cities, Selected Countries, 1995-2010
tasks can be undertaken against a background of relatively stable population growth.
Rapid urbanization is the other demographic change that is affecting the populations that are the focus of this report. In all the countries shown in Table 1-1 , the urban population is growing much more rapidly than the rural population, due to migration, natural increase, and the reclassification of growing towns as cities. In some ways the increasing concentration of populations should make the provision of high-quality reproductive health services easier, particularly for services such as clinical contraception and safe delivery care, which have always been hard to deliver among dispersed populations. But many programs will have to adapt models of community-based services that were developed for largely rural societies for urban populations.
SCOPE OF THE REPORT
The panel's work builds in many ways on the report of the Committee on Population's Working Group on Health Effects of Contraception and Reproduction (National Research Council, 1989), which strengthened the scientific understanding of associations of fertility patterns and family planning with infant and maternal health.
Like the former working group, the panel attaches particular significance to the view that reproductive health concerns the entire life-cycle. Some reproductive health problems have their origins in insufficient investment in nutrition, health care, and education early in childhood and adolescence. Gender inequities in these investments by parents and society at large have long-lasting, harmful effects. Some reproductive health problems have consequences for women's health during and after menopause. Reproductive health is thus not confined to what are considered the "reproductive years."
The panel neither adopted nor rejected the framework of reproductive rights that guided much of the discussion before and during the ICPD, nor did we adopt the approach of defining rights to health care, education, or other basic needs. 1 The human rights approach can be very important as a way to define international agreement and hold governments accountable for their actions or inactions. But our aim is more modest: given considerable agreement about the goals, as shown by the willingness of nearly 180 governments to sign the ICPD Programme of Action, what can we say about practical next steps that can be taken within 5-10 years to bring all countries closer to the goals? Though we do not define a single minimum package of reproductive health interventions, we argue that there are steps that can be taken in all settings, even where rights to health care, and many other rights, are realized only very imperfectly.
Several topics implied by a broad definition of reproductive or sexual health are not encompassed in the framework used by the panel. These include problems of sexual dysfunction (except insofar as these would be improved by measures against coercion and infection or by increased confidence in control over fertility) and cancers of the reproductive organs (except for some consideration of STD prevention and treatment as a cost-effective measure for prevention of cervical cancer). Many diseases and conditions prevalent in developing countries, such as malaria, are
aggravated by pregnancy: we include as reproductive health those programs that help prevent pregnancy but not those that disrupt malaria transmission. The framework we use does not include actions to improve child survival after the first week of life, though many of the interventions we discuss (improved pregnancy and delivery care and child spacing and fertility limitation) would have positive effects on child health.
For practical purposes, the panel concentrated on health problems for which causes, consequences, and effective remedies are linked programmatically. We recognize that in drawing limits around our subject we risk neglecting some useful linkages. The boundaries around our topics should be considered permeable membranes, not rigid walls.
The next four chapters of this report follow the sequence suggested by our organizing framework, dealing with healthy sexuality ( Chapter 2 ), infection-free sex ( Chapter 3 ), intended pregnancies and births ( Chapter 4 ), and healthy pregnancy and delivery ( Chapter 5 ). Each chapter discusses both the magnitude of problems and what is known about the effectiveness of interventions. The next two chapters deal with themes that link the interventions: program design and delivery ( Chapter 6 ) and costs and financing ( Chapter 7 ).
A recurring theme in this report is the need for more research. Although enough is already known to move programs and policies in more effective directions, continued organizational learning and adaptation is still needed. This need spans the spectrum from development of new diagnostic tools, pharmaceuticals, and contraceptives to field trials, survey measurement of reproductive morbidities and risk behaviors, operations research, and cost-effectiveness analysis of interventions. The panel finds good reason to believe that the investment in this research will pay off in terms of improved quality of life, especially for the people who are now the least well served.
Sexually transmitted diseases, unintended pregnancies, infertility, and other reproductive problems are a growing concern around the world, especially in developing countries. Reproductive Health in Developing Countries describes the magnitude of these problems and what is known about the effectiveness of interventions in the following areas:
- Infection-free sex. Immediate priorities for combating sexually transmitted and reproductive tract diseases are identified.
- Intended pregnancies and births. The panel reports on the state of family planning and ways to provide services.
- Healthy pregnancy and delivery. The book explores the myths and substantive socio-economic problems that underlie maternal deaths.
- Healthy sexuality. Such issues as sexual violence and the practice of female genital mutilation are discussed in terms of the cultural contexts in which they occur.
Addressing the design and delivery of reproductive health services, this volume presents lessons learned from past programs and offers principles for deciding how to spend limited available funds.
Reproductive Health in Developing Countries will be of special interest to policymakers, health care professionals, and researchers working on reproductive issues in the developing world.
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- Sexual & reproductive health
Good sexual and reproductive health is a state of complete physical, mental and social well-being in all matters relating to the reproductive system. It implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. To maintain one’s sexual and reproductive health, people need access to accurate information and the 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 skilled health care providers and services that can help them have a fit pregnancy, safe birth and healthy baby. Every individual has the right to make their own choices about their sexual and reproductive health. UNFPA, together with a wide range of partners, works toward the goal of universal access to sexual and reproductive health and rights, including family planning.
Reproductive health and development
Key concerns, a life cycle approach, unfpa’s work.
UNFPA works to ensure sexual and reproductive health and rights remain at the very centre of development. The International Conference on Population and Development draws a clear connection between reproductive health, human rights and sustainable development. When sexual and 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. And because 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 sexual and 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 problems related to pregnancy and childbirth.
Young people are also extremely vulnerable, often facing barriers to sexual and reproductive health information and care. Young people are disproportionately affected by HIV , for example, and 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. Adolescent sexual and reproductive health is therefore another 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. STIs like human papillomavirus (HPV) can lead to pelvic inflammatory disease, infertility and cervical cancer, a major killer of women.
Sexual and reproductive health is a lifetime concern for both women and men, from infancy to old age. Evidence shows that reproductive health in any of these life stages has a profound effect on one's health later in life. UNFPA supports programmes tailored to what people face at different times in their lives, including comprehensive sexuality education , family planning , pre-conception care, antenatal and safe delivery care , post-natal care, services to prevent sexually transmitted infections (including HIV ), and services facilitating preventive screening, early diagnosis and treatment of reproductive health illnesses including breast and cervical cancer.
To support sexual and reproductive health throughout the life cycle, services across a variety of sectors must be strengthened, from health, including the health workforce, to education systems to even transport systems, which are required to ensure health care is accessible. And all efforts to support sexual and reproductive health service delivery rely on skilled health care providers who can provide timely, high-quality and respectful care that is also affordable and accessible, functional health infrastructure, integration with other services and the availability of essential health supplies such as contraceptives, life-saving medicines and basic medical equipment.
UNFPA's work on improving sexual and reproductive health is a key effort towards achieving Sustainable Development Goal 3, which calls for good health and well-being. It also advances Goal 5, which calls for gender equality, as well as many of the other goals included in the 2030 Agenda.
UNFPA works with governments, other UN agencies, civil society and donors to develop comprehensive efforts to ensure universal access to sexual and reproductive health care. UNFPA advocates for integrating the delivery of these services into primary health care, so it is as accessible as possible. This means, for instance, that a woman could address her family planning, antenatal care, HIV testing and general health needs all in one place.
UNFPA is also working with governments and communities to strengthen health systems, including supporting the implementation of reproductive health programmes, improving the quality of reproductive health care and strengthening human resources . UNFPA also works to make sure reproductive health commodities are available where needed, and that a functioning logistics system is in place. The Maternal Health Thematic Fund and UNFPA Supplies are just two examples of UNFPA’s work in strengthening health systems and quality services.
While strengthening national systems, UNFPA also puts special emphasis on increasing access for disadvantaged groups , including young people, the urban poor, rural communities, indigenous populations and women and girls with disabilities.
Updated 04 April 2022
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- Biology Article
- Reproductive Health Problems Strategies
Reproductive Health - Problems and Strategies
Table of Contents
What is Reproductive Health?
Objectives of reproductive health, reproductive health problems, strategies to improve reproductive health, what is amniocentesis test.
“Reproductive health refers to the complete physical, mental and social well-being and not simply the absence of a disease in an individual capable of reproducing.”
As per the WHO (World Health Organization), reproductive health can be defined as the total well-being and proper functioning of reproductive organs in all phases of reproduction. This includes a complete state of mental, physical, and social well-being.
There are a number of programs which are directed toward maintaining reproductive health. These programs include both small ads and a few entertainment shows telecasted on the television for promoting safe sexual habits and awareness about various sexually transmitted diseases (STDs) . All these efforts by the government and NGOs aim at achieving a reproductively healthy society.
Let us understand more in detail about the reproductive health followed by its problems and its strategies.
Following are the major objectives of reproductive health:
- To make quality maternal and reproductive health services accessible to the people living in rural areas.
- To enhance the prevention of diseases that might affect maternal health.
- To broaden the institutional and human resource capacities of local governments, health centres, communities, and men and women involved in reproductive health.
Also Read: Importance of Reproductive Health
The common problems or concerns associated with reproductive health are:
- Sexually Transmitted Diseases
- Ill health of both mother and her baby
- Early marriages before attaining puberty
- An increased mortality rate of both mothers and Infants
Listed below are a few strategies followed to improve reproductive health:
- The introduction of sex education is one of the steps taken by the government which aims to create awareness among adolescents about safe sexual practices.
- As adolescents become eligible to reproduce, it is essential to inform them about the consequences of unsafe sexual practices and early pregnancy. It is achieved by the implementation of the ‘National Adolescent Education Program’ at various schools from classes 9th to 12th.
- People in the marriageable group are educated all about infertility, birth control methods, pregnancy, post-childbirth care of the baby and mother, etc. It is also essential to provide proper medical facilities to deal with obstacles like infertility and other reproductive difficulties.
- There are a few evil practices related to reproduction that still plague our society. Female infanticide is one such example. In order to prevent this crime, a legal ban has been put on Amniocentesis Test.
The amniocentesis test is mainly used for the determination of the sex of the unborn baby by analyzing the chromosomal content of the amniotic fluid surrounding the fetus. This test can also be used for the early detection of chromosomal abnormalities.
All these efforts being put forward to achieve a reproductively healthy society would be worthless if we do not cooperate. Thus, with the cooperation of the society, government and other NGOs, a reproductively healthy society can be achieved.
Also Read: Amniocentesis
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Definition and components of reproductive health? Demographic trends and fertility determinants Family planning Impact of reproductive patterns on child health Impact of reproductive patterns on women health Mechanisms to reduce morbidity and mortality
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- 1. REPRODUCTIVE HEALTH By: Adam F. Izzeldin; BPEH, MPH, PhD candidate. Department of International Health, TMDU
- 2. Contents Contents Definition and components of reproductive health? Demographic trends and fertility determinants Family planning Impact of reproductive patterns on child health Impact of reproductive patterns on women health Mechanisms to reduce morbidity and mortality.
- 3. What is reproductive health? Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies 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. (WHO)
- 4. Components of reproductive health • Family-planning counseling, information, education, communication and services; • Education and services for prenatal care, safe delivery, and post-natal care, especially breast-feeding, infant and women's health care; • Prevention and appropriate treatment of infertility; abortion; sexually transmitted diseases; and reproductive tract infections • information, education and counselling, as appropriate, on human sexuality, reproductive health and responsible parenthood.
- 5. Reproductive health links • Reproductive health tied to policy concerns about population growth as well as health. • International Conference on Population and Development in Cairo 1994 focused on population while two previous international conferences emphasized on family planning. • In 2000 , the United Nation Millennium declaration was adopted as a commitment; however, goal 5 is to improve maternal health (by reducing maternal mortality three quarters).
- 6. Demographic trends and fertility determinants • World population reached 1 billion just after 1800. • But it took less 125 years to add the second billion in 1930. • In 1960 the world passed the third billion. • Within 40 years ahead the population doubled to be 6 billions in 2000. • In year 2010 the world population reached 7 bilion. • The majority of this expansion has taken place in developing countries. • The encouraging news is that the rate of growth is declining since 1960.
- 7. World population growth Source: United nation population division
- 8. Population size by continent, 1950-2100
- 9. The world population growth rate 2010
- 10. The process of fertility Sterility Marriage Effective reproductive span Birth of woman Marriage dissolution Menarche Start of marriage B1 Postpartum amenorrhea B2 B2 Time to conception Resumption of menses B3 B last Time to conception conception Fetal loss End of exposure to risk pregnancy conception B3 Death of woman
- 11. Deliberate control of fertility 1. Reducing the effective reproductive span through postponement of marriage or interrupted marriage or by sterilization that ends reproductive capacity early. 2. Using contraception, which increases the time to conception. 3. Abortion, which increases the time added to birth interval by pregnancies that do not lead to live birth
- 12. The effect on fertility of the proximate determinants: Bongaart’s Indices • The index of postpartum infecundity: The proportion of potential fertility, TF, when the average of postpartum period of the population of interest is taken into account. • The index of abortion: The proportion of TF, after postpartum first taken into account. • The index of contraception: The proportion of TF, after the effect of postpartum infecundity and induced abortion taken into account. • The index of marriage: The proportion of TF, after the first three factors are considered. TFR= TF
- 13. Family planning • The rationale is to reduce unintended fertility because of its negative health and welfare consequences and because it has been recognized as a human right . • Over the last 50 years, the dissemination of modern ideas bout small families was adopted. • In part, due to lack of availability , accessibility, and effective contraceptive, the gap between observed and desired fertility is grew, leading to in turn to an increase to unintended fertility. • According to WHO, in 2005 out of 211 million pregnancies, 87 million women became pregnant unintentionally.
- 14. Family planning methods Region Sterilization Pill IUD Condom Total Female Male 21.0 4.0 7.0 15.0 5.0 61.0 Africa 2.0 0.1 7.0 5.0 1.0 26.0 Asia 25.0 4.0 5.0 18.0 4.0 64.0 Latin America 31.0 2.0 13.0 8.0 4.0 70.0 Oceania 12.0 9.0 21.0 2.0 9.0 59.0 Japan 3.0 0.6 0.8 1.5 43.0 56.0 Europe 4.0 2.0 16.0 15.0 10.0 67.0 Northern America 23.0 14.0 15.0 1.0 13.0 76.0 New Zealand 14.0 19.3 20.5 3.3 11.0 74.0 World Low and middle income countries Industrialized region
- 15. Barriers for family planning • The economic cost of access to services, including transportation and supplies. • The social cost, including traditional constrains, and women movement. • Psychic cost of contraceptive use in a society that offer little support for small family. • The health cost of side effects, whiter subjective or objective, from contraceptive use.
- 16. Consequences of unintended pregnancy • Abortion: represents 20% of all pregnancies (WHO estimates 20 million unsafe abortion annually accounts from 13% of maternal deaths) • Poor infant health with high morbidity and mortality. • Lower investment in human capital (allocation f resources for education and health).
- 17. Organization of family planning program • Focus on commitment to achieve program objectives and access to adequate resources. • Placing the family planning program under a national supervisory council or by establishing a separate ministry. • Collecting data on indicators such as contraceptive prevalence, proportion of unwanted births, maternal morbidity and mortality, pregnancy complications and their management, and actual fertility level.
- 18. Intervention levels of family planning Health center community menstrual regulation or vacuum aspiration abortion Information, education, and communication Surgical contraception/ post abortion counseling and contraception Community-based distribution counseling and treatment of contraceptive side effects Social marketing of condoms and pills Health post Counseling/ screening for contraception Counseling/ referral for menstrual regulation or abortion Inject able contraceptive/ IUD/ counseling and treatment of contraceptive side effects Family planning District Hospital Surgical contraception Abortion through 20 weeks post abortion counseling and contraception
- 19. Strategies of Bangladesh Family planning Diagram Strategy 1 Improving coverage and quality of services ( 5 miles clinics, free of charge sterilization, home service) Strategy 2 Awareness and motivation ( mass media, focused programs) Strategy 3 Fostering villagebased and household services (outreach) Strategy 4 Community development and demand creation (improving status of women through other program such as micro-credit and education).
- 20. Impact of reproductive patterns on child health Reproductive pattern Mechanism through which child health affected First born child Higher frequency of death (parents less experienced in child care, poor intrauterine growth) Higher-order children Cumulative maternal injuries “maternal depletion syndrome” leads to poor intrauterine growth. Large families Competition for limited resources (disproportionate girls) Child born to very young mother Inadequate development of reproductive system causes maternal risks, and inexperience in prenatal care and delivery Child born to older mother Greater risk of birth trauma and genetic abnormality Short interbirth intervals Inadequate maternal recovery (depletion);similar-age siblings competition; termination of breastfeeding; low-birth, infections Unwantedness Conscious or unconscious neglect; child born in stressful situation Maternal death or illness Early termination of breastfeeding; no maternal care; disease may be passed to child Contraceptive use Hormonal contraception may interrupt braestfeeding
- 21. Maternal health • Pregnancy is one of major health risks for women in in low-and middleincome countries. • Nearly 536,000 women die worldwide each year due to pregnancy related causes, and the vast majority (99%) of these deaths in low- and middleincome countries. • Although these numbers are alarming,230 million pregnancies and approximately 118 million births occur annually in the world in safe reproduction.
- 22. Confusion in definitions of maternal deaths • Definition for Maternal deaths which defined as deaths of woman while pregnant or up to 42 days post delivery from any cause accept accidents. (undercount deaths up to 90 days). • Maternal risk measurements are conceptually distinct. 1.Maternal mortality ratio: the number of maternal deaths to the number of pregnancies (LB) 2.Maternal mortality rate: the number of maternal deaths divided by the number of women of reproductive age (15 – 49 years old) 3. Life time risk: chance of dying from pregnancy related cause.
- 23. Maternal mortality risks • In sub-Saharan Africa and South Asia, maternal mortality ratio of 800 maternal deaths per 100,000 live births have been reported. • The disparity between low- and middle-income and high-income countries is much greater for maternal mortality ( 20 times higher risk of maternal death per pregnancy) than infant mortality ( 10 time s higher risk of infant death per pregnancy). • Life-time risk of maternal mortality vary from 1/75 in low- and middle-income countries to 1/7,300 in highincome countries. • Maternal mortality ratios are 50 times higher (450 death/100,000 LB in low- and middle-income countries vs. 9 deaths/100,000 LB in high-income countries )
- 24. Total Fertility Rate, Maternal Mortality Ratios, and Lifetime Risk of Maternal Death by region,2005. source: Population Reference Bureau (2008) Region Total Fertility Maternal Maternal Deaths Rate (Birth per Mortality Ratio woman) (Deaths per Lifetime Risk Death per year 100,000 LB) World 2.6 400 1 in 92 536,000 Industrialized countries 1.7 9 1 in 7,300 960 Low- and middle-income 2.7 450 1 in 75 533,000 Africa 4.8 820 1 in 26 276,000 Asia 2.3 330 1 in 120 241,000 Latin America and Caribbean 2.3 130 1 in 290 15,000
- 25. Direct and indirect causes of maternal mortality and morbidity • Direct: related to pregnancy or postpartum periods (hemorrhage 25%, sepsis 15%, eclampsia 12%, complications of unsafe abortion 13%, obstructed labor and others). • Indirect: related to conditions precede, but aggravated by, pregnancy ( anemia, diabetes, malaria, tuberculosis, cardiac diseases, hepatitis, and increasingly HIV) WHO,2005
- 26. Impact of reproductive patterns on women health Reproductive pattern Mechanism through which maternal health is affected Number of pregnancies Each pregnancy carries a risk of morbidity and mortality Higher-risk pregnancies First-time mothers 2-4 higher risk for obstructed labor, induced hypertension, obstetric complications due to initial adaptation High-order pregnancies Hemorrhage and uterine rupture and reproductive injuries Pregnancy at very young maternal ages Physiological immature reproductive system and reduced timely care seeking. Pregnancy at old maternal ages Body in poor condition for pregnancy and child birth Short interbirth intervals Inadequate time to rebuild nutritional stores and regain energy level. Unwanted pregnancies ending in unsafe abortions Increased exposure to injuries, infections, hemorrhages, and deaths Pregnancy for women already in poor health Aggravated health conditions.
- 27. Mechanisms to reduce maternal morbidity and mortality. • Reduced exposure to pregnancy by reducing fertility (family planning). • Optimization of access to emergency obstetric care (assisted virginal delivery, removal of placenta, using vacuum extraction or aspiration, anesthesia and cesarean section, blood transfusion, ectopic pregnancy and safe abortion….etc). • Improvement of general health status and treatment of pregnancy- and childbirth-related complications (antenatal care, postnatal care, safe motherhood, treatment of maternal illness….etc).
- 28. Conclusion • Improvements are needed in the quality of family planning services, especially in the areas of information exchange and methods choice to reduce fertility and unwanted pregnancy. • Maternity care needs to be significantly expanded to , while preventive services ( including education of both men and women in health and sexuality, family planning, and prevention of STIs) need to be increased. • At societal level, programs need to be supported to improve the status of women through education, changes in laws, and cultures.
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