What is eproductive health?

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," reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system at all stages of life.[1] UN agencies claim sexual and reproductive health includes physical, as well as psychological well-being vis-a-vis sexuality.[2]

Reproductive health implies that people are able to have a responsible, satisfying, healthy reproductive system and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. One interpretation of this implies that men and women should be informed of and have access to safe, effective, affordable and acceptable methods of birth control; also access to appropriate health care services of sexual, reproductive medicine and implementation of health education programs to stress the importance of women to go safely through pregnancy and childbirth could provide couples with the best chance of having a healthy infant.

Individuals do face inequalities in reproductive health services. Inequalities vary based on socioeconomic status, education level, age, ethnicity, religion, and resources available in their environment. It is possible for example, that low income individuals lack the resources for appropriate health services and the knowledge to know what is appropriate for maintaining reproductive health

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."[4] 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.[5] According to the American College of Obstetricians and Gynecologists, fertility starts to drop considerably around the age of 32, and around 37, it has a particularly deep nose dive.[6] By age 44, chances of spontaneous pregnancy approach zero. As such, women are often told to have children before the age of 35, and pregnancy after 40 is considered a high risk. If pregnancy occurs after the age of 40 (geriatric pregnancy), the woman and baby will be monitored closely for

Adolescent health

Adolescent health creates a major global burden and has a great deal of additional and diverse complications compared to adult reproductive health such as early pregnancy and parenting issues, difficulties accessing contraception and safe abortions, lack of healthcare access, and high rates of HIV, sexually transmitted infections and mental health issues. Each of those can be affected by outside political, economic and socio-cultural influences.[9] For most adolescent females, they have yet to complete their body growth trajectories, therefore adding a pregnancy exposes them to a predisposition to complications. These complications range from anemia, malaria, HIV and other STIs, postpartum bleeding and other postpartum complications, mental health disorders such as depression and suicidal thoughts or attempts.[10] In 2016, adolescent birth rates between the ages of 15-19 was 45 per 1000.[11] In 2014, 1 in 3 experienced sexual violence, and there more than 1.2 million deaths. The top three leading causes of death in females between the ages of 15-19 are maternal conditions 10.1%, self-harm 9.6%, and road conditions 6.1%

The causes for teenage pregnancy are vast and diverse. In developing countries, young women are pressured to marry for different reasons. One reason is to bear children to help with work, another on a dowry system to increase the families income, another is due to prearranged marriages. These reasons tie back to financial needs of girls' family, cultural norms, religious beliefs and external conflicts

Adolescent pregnancy, especially in developing countries, carries increased health risks, and contributes to maintaining the cycle of poverty.[14] The availability and type of sex education for teenagers varies in different parts of the world. LGBT teens may suffer additional problems if they live in places where homosexual activity is socially disapproved and/or illegal; in extreme cases there can be depression, social isolation and even suicide among LGBT youth.

Maternal health

99% of maternal deaths occur in developing countries, and in 25 years, the maternal mortality globally dropped to 44%.[16] Statistically, a woman's chance of survival during childbirth is closely tied to her social economic status, access to healthcare, where she lives geographically, and cultural norms.[17] To compare, a woman dies of complications from childbirth every minute in developing countries versus a total of 1% of total maternal mortality deaths in developed countries. Women in developing countries have little access to family planning services, different cultural practices, have lack of information, birthing attendants, prenatal care, birth control, postnatal care, lack of access to health care and are typically in poverty. In 2015, those in low-income countries had access to antenatal care visits averaged to 40% and were preventable.[16][17] All these reasons led to an increase in the maternal mortality ratio (MMR).

One of the international Sustainable Development Goals developed by United Nations is to improve maternal health by a targeted 70 deaths per 100,000 live births by 2030.[17] Most models of maternal health encompass family planning, preconception, prenatal, and postnatal care. All care after childbirth recovery is typically excluded, which includes pre-menopause and aging into old age.[18] During childbirth, women typically die from severe bleeding, infections, high blood pressure during pregnancy, delivery complications, or an unsafe abortion. Other reasons can be regional such as complications related to diseases such as malaria and AIDS during pregnancy. The younger the women is when she gives birth, the more at risk her and her baby is for complications and possibly mortality

There is a significant relationship between the quality of maternal services made available and the greater financial standings of a country.[19] Sub-Saharan Africa and South Asia exemplify this as these regions are significantly deprived of medical staff and affordable health opportunities.[20] Most countries provide for their health services through a combination of funding from government tax revenue and local households.[19] Poorer nations or regions with extremely concentrated wealth can leave citizens on the margins uncared for or overlooked. However, the lack of proper leadership can result in a nation's public sectors being mishandled or poorly performing despite said nation's resources and standing.[19] In addition, poorer nations funding their medical services through taxes places a greater financial burden on the public and effectively the mothers themselves.[20] Responsibility and accountability on the part of mental health sectors are strongly emphasized as to what will remedy the poor quality of maternal health globally.[20] The impact of different maternal health interventions across the globe stagger variously and are vastly uneven.[19] This is the result of a lack of political and financial commitment to the issue as most safe motherhood programs internationally have to compete for significant funding.[20] Some resolve that if global survival initiatives were promoted and properly funded it would prove to be mutually beneficial for the international community. Investing in maternal health would ultimately advance several issues such as: gender inequality, poverty and general global health standards.[21] As it currently stands, pregnant women are subjugated to high financial costs throughout the duration of their term internationally that are highly taxing and strenuous.

Contraception

Access to reproductive health services is very poor in many countries. Women are often unable to access maternal health services due to lack of knowledge about the existence of such services or lack of freedom of movement. Some women are subjected to forced pregnancy and banned from leaving the home. In many countries, women are not allowed to leave home without a male relative or husband, and therefore their ability to access medical services is limited. Therefore, increasing women's autonomy is needed in order to improve reproductive health, however doing may require a cultural shift. According to the WHO, "All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth".

The fact that the law allows certain reproductive health services, it does not necessary ensure that such services are actually in use by the people. The availability of contraception, sterilization and abortion is dependent on laws, as well as social, cultural and religious norms. Some countries have liberal laws regarding these issues, but in practice it is very difficult to access such services due to doctors, pharmacists and other social and medical workers being conscientious objectors.

In developing regions of the world, there are about 214 million women who want to avoid pregnancy but are unable to use safe and effective family planning methods.[24] When taken correctly, the combined oral contraceptive pill is over 99% effective at preventing pregnancy. However, it does not protect from sexually transmitted infections (STIs). Some methods, such as using condoms, achieve both protection from STIs and unwanted pregnancies. There are also natural family planning methods, which may be preferred by religious people, but some very conservative religious groups, such as the Quiverfull movement, oppose these methods too, because they advocate the maximization of procreation.[25] One of the oldest ways to reduce unwanted pregnancy is coitus interruptus - still widely used in the developing world.

There are many types of contraceptives. One type of contraceptive includes barrier methods.[26] One barrier method includes condoms for males and females.[26] Both types stop sperm from entering the woman's uterus, thereby preventing pregnancy from occurring.[26] Another type of contraception is the birth control pill, which stops ovulation from occurring by combining the chemicals progestin and estrogen.[26] Many women use this method of contraception, however they discontinue using it equally as much as they use it.[27] One reason for this is because of the side effects that may occur from using the pill, and because some health care providers do not take women's concerns about negative side effects seriously.[27] The use of the birth control pill is common in western countries, and two forms of combined oral contraceptives are on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[28]

There are many objections to the use of birth control, both historically and in the present day. One argument against birth control usage states that there is no need for birth control to begin with.[29] This argument was levied in 1968 when Richard Nixon was elected president, and the argument stated that since birth rates were at their lowest point since World War II ended, birth control was not necessary.[29] Demographic planning arguments were also the basis of the population policy of Nicolae Ceaușescu in communist Romania, who adopted a very aggressive natalist policy which included outlawing abortion and contraception, routine pregnancy tests for women, taxes on childlessness, and legal discrimination against childless people. Such policies consider that coercion is an acceptable means of reaching demographic targets. Religious objections are based on the view that premarital sex should not happen, while married couples should have as many children as possible. As such, the Catholic Church encourages premarital abstinence from sex.[29] This argument was written out in Humanae Vitae, a papal encyclical released in 1968.[29] The Catholic Church bases its argument against birth control pills on the basis that birth control pills undermine the natural law of God.[30] The Catholic Church also argues against birth control on the basis of family size, with Cardinal Mercier of Belgium arguing, "...the duties of conscience are above worldly considerations, and besides, it is the large families who are the best" (Reiterman, 216).[30] Another argument states that women should use natural methods of contraception in place of artificial ones, such as having sexual intercourse when one is infertile.[29] Support for contraception is based on views such as reproductive rights, women's rights, and the necessity to prevent child abandonment and child poverty.[31][32] The World Health Organization states that "By preventing unintended pregnancy, family planning /contraception prevents deaths of mothers and children".[31]