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Reproductive Health and Family Planning
Gaps in reproductive and sexual health care account
for nearly one fifth of the worldwide burden of
illness and premature death, and one third of the
illness and death among women of reproductive age.(1)
At the Cairo conference, the international community
embraced a new, broad concept of reproductive
health and rights, including family planning and sexual
health. It called for integrating family planning
and maternal and child health care within a wider set
of services including the control of HIV and sexually
transmitted infections (STIs). Expanding access to
services and meeting clients’ expressed needs and
wishes were seen as essential to reducing unintended
pregnancies, improving maternal health and curbing
the HIV/AIDS pandemic.
The ICPD set the goal of ensuring universal voluntary
access to a full range of reproductive health care
information and services by 2015. Delegates also
agreed that sexual and reproductive health is a
human right, part of the general right to health.
There has been important progress since 1994
towards the ICPD goal of universal access to reproductive
health services. The 2003 UNFPA global survey
found that most countries have established or broadened
reproductive health policies and programmes.
Many have significantly changed the ways maternal
and child health services and family planning are
provided,(2) reorienting services to improve their quality
and better meet clients’ needs and desires. Rising
contraceptive use among couples indicates greater access to family planning.(3) Greater attention has been
given to reproductive rights in laws and policies.
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| REPRODUCTIVE HEALTH—A HOLISTIC CONCEPT |
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 functions and 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 regulation of fertility which are not against the law, and the right of access to appropriate
health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. |
| —ICPD Programme of Action, para. 7.2 |
Since 1994, governments, international agencies
and NGOs have focused on increasing the demand
for contraception, not just expanding supply. Raising
demand means better meeting clients’ needs and
desires, and offering a broad mix of family planning
methods and higher quality care, with well-supplied
facilities and well-trained, informative and courteous
personnel.
But millions of people—particularly the poor—
still lack access to quality services, including modern
family planning methods, emergency obstetric services,
and prevention and management of STIs. Demand is
growing faster than resources to meet it. And in many
countries, a variety of factors have constrained progress
in integrating existing services and realizing the
synergies envisioned by the ICPD.
GLOBAL SURVEY RESULTS. Country responses to the
2003 UNFPA global survey indicate progress in
expanding access to reproductive health and in integrating
family planning with other services. But they
also reported considerable challenges. In the decade
since the ICPD, countries have embraced the idea and
the practice of reproductive health. They have broadened
programmes to reach more people in need of
services, and integrated family planning with preand
post-natal care, delivery services, STI and
HIV/AIDS prevention, cervical cancer screening,
and referral for treatment where appropriate.
An increasing emphasis has also been placed on
improving access for underserved groups, including
the very poor and people living in rural areas, and on
ensuring that the poor have a stronger voice in policymaking,
so that information and services are adapted
for their special circumstances. Countries are also
integrating reproductive health, including family
planning and sexual health, with primary health-care
services in the context of health-sector reform and
far-reaching changes in organizational, administrative
and financing arrangements.
LEGAL DEVELOPMENTS. Since the ICPD, many countries
have adopted laws to expand access for all women and
men to reproductive health care and to ensure that pregnant women and adolescents are not barred from
or discriminated against in school or employment.
The UNFPA global survey found that 46 countries
had enacted new laws and legislation since 1994.
For example, in Papua New Guinea the requirement
for a “husband’s consent” for contraceptive use
has been removed and adolescents over age 16 can
access reproductive health services without parental
consent. The Lao People’s Democratic Republic has
adopted a national birth-spacing policy, reversing a
pro-natalist policy adopted in the 1990s. Under the new policy contraception is provided for free and
without coercion.
Belize’s National Health Policy outlines reproductive
rights, including voluntary counselling and
testing for HIV infection; ensures tax exemption for
NGOs in providing health services; and sets protocols
for family planning services.
Twenty countries reported in the global survey on
communications/advocacy campaigns that promote
reproductive rights. Eighteen highlighted institutional
changes. For example, in Micronesia, pregnant
students are allowed to continue at school and adolescents
are allowed access to contraception without
written parental consent. Ten countries adopted
family laws and legislation to make men more
responsible for reproductive health.
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12 |
WHO ADOPTS GLOBAL STRATEGY ON REPRODUCTIVE HEALTH TO ACHIEVE MDGs |
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In May 2004, the 57th World Health Assembly adopted the World Health Organization’s first strategy on reproductive
health. The aim is to accelerate progress towards meeting the Millennium Development Goals and the reproductive health goals of the ICPD and its five-year follow-up.
The strategy identifies five priority aspects of reproductive and
sexual health:
- Improving antenatal, delivery, postpartum and newborn care;
- Providing high-quality services for family planning, including
infertility services;
- Eliminating unsafe abortion;
- Combating STIs, including HIV, reproductive tract infections, cervical cancer and other gynaecological morbidities;
- Promoting sexual health.
The Assembly recognized the ICPD Programme of Action, and urged countries to:
- Adopt and implement the new strategy as part of national efforts to achieve the MDGs;
- Make reproductive and sexual health an integral part of planning and budgeting;
- Strengthen health systems’ capacities to provide universal access to reproductive and sexual health care, particularly maternal and neonatal health, with the participation of
communities and NGOs;
- Ensure that implementation benefits the poor and other marginalized groups including adolescents and men;
- Include all aspects of reproductive and sexual health in national monitoring and reporting on progress towards the MDGs.
See Sources
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The ICPD called on all countries to take steps to meet
the family planning needs of their populations and
to provide, by 2015, universal access to a full range of
safe and reliable family planning methods. The aims
were to help couples and individuals meet their reproductive
goals; to prevent unwanted pregnancies and
reduce high-risk pregnancies; to make quality family
planning services affordable, acceptable and accessible
to all; to improve the quality of family planning information,
counselling and services; and to increase men’s
participation in the practice of family planning.
BENEFITS OF CHOICE. Family planning enables individuals
and couples to determine the number and
spacing of their children—a recognized basic human
right. Practical benefits are gained at many levels:
- To individuals, improved maternal and infant health;
expanded opportunities for women’s education, employment
and social participation; reduced exposure
to health risks; and reduced recourse to abortion;
- To families, reduced competition and dilution of
resources; reductions in household poverty; and
more possibility for shared decision-making;
- To the society, accelerated demographic transition;
and the opportunity to use the “demographic bonus” (see Chapter 2) to speed economic
development.
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