Sexual and reproductive health
Sexual and reproductive health (SRH)[1] is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life.[2][3][4] Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights,[5] to encompass individual agency to make choices about their sexual and reproductive lives.
"Sexual health" redirects here. For other uses, see Sexual health (disambiguation).
The term can also be further defined more broadly within the framework of the World Health Organization's (WHO) definition of health―as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity"―.[6] WHO has a working definition of sexual health (2006) as '“…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled[5].” This includes sexual wellbeing, encompassing the ability of an individual to have responsible, satisfying and safe sex and the freedom to decide if, when and how often to do so. UN agencies in particular define sexual and reproductive health as including both physical and psychological well-being vis-à-vis sexuality.[7] Furthermore, the importance of ensuring sexual lives are pleasurable and satisfying, and not only focused on negative consequences of sex has been emphasized by many agencies such as the World Association of Sexual Health[8][9] as well as considering the positive impacts on health and well-being of safe and satisfying relationships.[10] A further interpretation includes access to sex education, access to safe, effective, affordable and acceptable methods of birth control, as well as access to appropriate health care services, as the ability of women to go safely through pregnancy and childbirth could provide couples with the best chance of having a healthy infant.
The critical Guttmacher- Lancet Commission on Sexual and reproductive health and rights states state 'Sexual and reproductive health and rights (SRHR) are essential for sustainable development because of their links to gender equality and women’s wellbeing, their impact on maternal, newborn, child, and adolescent health, and their roles in shaping future economic development and environmental sustainability. Yet progress towards fulfilling SRHR for all has been stymied because of weak political commitment, inadequate resources, persistent discrimination against women and girls, and an unwillingness to address issues related to sexuality openly and comprehensively. As a result, almost all of the 4·3 billion people of reproductive age worldwide will have inadequate sexual and reproductive health services over the course of their lives'.[11]
Individuals face inequalities in reproductive health services. Inequalities vary based on socioeconomic status, education level, age, ethnicity, religion, and resources available in their environment. Low income individuals may lack access to appropriate health services and/or knowledge of how to maintain reproductive health.[12] Additionally, many approaches involving women, families, and local communities as active stakeholders in interventions and strategies to improve reproductive health.[13]
Overview[edit]
The WHO assessed in 2008 that "Reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for women, and 14% for men."[14] Reproductive health is a part of sexual and reproductive health and rights. According to the United Nations Population Fund (UNFPA), unmet needs for sexual and reproductive health deprive women of the right to make "crucial choices about their own bodies and futures", affecting family welfare. Women bear and usually nurture children, so their reproductive health is inseparable from gender equality. Denial of such rights also worsens poverty.[15]
LGBT+ sexual and reproductive health[edit]
The sexual and reproductive health of LGBT+ people face challenges through issues like the ongoing HIV pandemic, binary organization of "men" and "women"'s reproductive health, alongside stigma and repression that limit LGBT+ people from accessing the healthcare they need.[33][34] Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality. It is important to not only consider the sexual/physical health of an individual but also the cultural and contextual factors that influence an individual's well-being. The lack of competent providers and stigma attached to homosexuality have a great impact on the sexual health of the LGBTQ+ population. The LGBTQ+ population faces a number of obstacles in terms of sexual and reproductive health. The different stigmas and biases that come with these barriers make receiving proper care difficult. Some of these stigmas that follow those in the LGBTQ+ population in terms of their sexual and reproductive health are associating certain diseases, and other illnesses with this community. This leaves those in the LGBTQ+ population in a position that makes them vulnerable, as well as victims of a number of health disparities. The overall health of those in the LGBTQ+ population is determinant on sexual and reproductive health as these all make up the health of these individuals. Those in the LGBTQ+ community face also face discrimination from providers and insurance companies, on top of all of the other barriers and limits on access to care that they endure. All of these factors have led to those in the LGBTQ+ population having worse health outcomes.[35]
Female genital mutilation (FGM), also known as female genital circumcision or cutting, is the traditional, non-medical practice of altering or injuring the female reproductive organs, often by removing all or parts of the external genitalia.[78] It is mostly practiced in 30 countries in Africa, the Middle East, and Asia, and affects over 200 million women and girls worldwide. More severe forms of FGM are highly concentrated in Djibouti, Eritrea, Ethiopia, Somalia, and Sudan.[79]
The WHO categorizes FGM into four types:
FGM often takes the form of a traditional celebration conducted by an elder or community leader. The age that women undergo the procedure varies depending on the culture, although it is most commonly performed on prepubescent girls. Certain cultures value FGM as a coming of age ritual for girls and use it to preserve a woman's virginity and faithfulness to the husband after marriage. It is also closely connected with some traditional ideals of female beauty and hygiene.[80] FGM may or may not have religious connotations depending on the circumstances.[78]
There are no health benefits of FGM, as it interferes with the natural functions of a woman's and girls' bodies, such as causing severe pain, shock, hemorrhage, tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue, recurrent bladder and urinary tract infections, cysts, increased risk of infertility, childbirth complications and newborn deaths. Sexual problems are 1.5 more likely to occur in women who have undergone FGM, they may experience painful intercourse, have less sexual satisfaction, and be two times more likely to report a lack of sexual desire. In addition, the maternal and fetal death rate is significantly higher due to childbirth complications.[81]
FGM can have severe negative psychological effects on women, both during and after the procedure. These can include long-term symptoms of depression, anxiety, post-traumatic stress disorder, and low self-esteem.[78] Some women report that the procedure was carried out without their consent and knowledge, and describe feelings of fear and helplessness while it was taking place. A 2018 study found that larger quantities of the hormone cortisol were secreted in women who had undergone FGM, especially those who had experienced more severe forms of the procedure and at an early age. This marks the body's chemical response to trauma and stress and can indicate a greater risk for developing symptoms of PTSD and other trauma disorders, although there are limited studies showing a direct correlation.[82]
The Istanbul Convention prohibits FGM (Article 38).[83] Legislation has been introduced in certain countries to prevent FGM. A 2016 survey of 30 countries showed 24 had policies to manage and prevent FGM, although the process to provide funding, education, and resources were often inconsistent and lacking. Some countries have seen a slight decline in FGM rates, while others show little to no change.[80][84]
The International Conference on Population and Development (ICPD) was held in Cairo, Egypt, from 5 to 13 September 1994. Delegations from 179 States took part in negotiations to finalize a Programme of Action on population and development for the next 20 years. Some 20,000 delegates from various governments, UN agencies, NGOs, and the media gathered for a discussion of a variety of population issues, including immigration, infant mortality, birth control, family planning, and the education of women.
In the ICPD Program of Action,[87] 'reproductive health' is defined as:[88]
This definition of the term is also echoed in the United Nations Fourth World Conference on Women,[89] or the so-called Beijing Declaration of 1995.[90] However, the ICPD Program of Action, even though it received the support of a large majority of UN Member States, does not enjoy the status of an international legal instrument; it is therefore not legally binding.
The Program of Action endorses a new strategy which emphasizes the numerous linkages between population and development and focuses on meeting the needs of individual women and men rather than on achieving demographic targets.[91] The ICPD achieved consensus on four qualitative and quantitative goals for the international community, the final two of which have particular relevance for reproductive health:
The keys to this new approach are empowering women, providing them with more choices through expanded access to education and health services, and promoting skill development and employment. The programme advocates making family planning universally available by 2015 or sooner, as part of a broadened approach to reproductive health and rights, provides estimates of the levels of national resources and international assistance that will be required, and calls on governments to make these resources available.
Half of the development goals put on by the United Nations started in 2000 to 2015 with the Millennium Development Goals (MDGs). Reproductive health was Goal 5 out of 8. To monitor the progress, the UN agreed to four indicators:[92]
Progress was slow, and according to the WHO in 2005, about 55% of women did not have sufficient antenatal care and 24% had no access to family planning services.[93] The MDGs expired in 2015 and were replaced with a more comprehensive set of goals to cover a span of 2016–2030 with a total of 17 goals, called the Sustainable Development Goals. All 17 goals are comprehensive in nature and build off one another, but goal 3 is "To ensure healthy lives and promote wellbeing for all at all ages". Specific targets are to reduce global maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of newborns and children, reduce the number by 50% of accidental deaths globally, strengthen the treatment and prevention programs of substance abuse and alcohol.[94] Goal 4 emphasizes the fact that no one should be left out in providing quality education. Target 4 specifically mentions the inclusion of persons with disabilities, indigenous peoples and children in vulnerable situations. In addition, one of the targets of the Sustainable Development Goal 5 is to ensure universal access to sexual and reproductive health.[95]