Sexual and reproductive health: Progress and outstanding needs

Abstract

We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor.

Sexual and reproductive health and rights in changing health systems

“…Germain, Dixon-Mueller, and Sen (2009) showed that systematic separation, through funding and other mechanisms, of HIV/AIDS from the broader SRHR agenda served to weaken the latter even though systemic reforms towards greater accountability were pursued by the GFATM and others. Snow et al (2014) documents persistent inequalities in access to SRHR causing harm especially to women in the lowest two wealth quintiles, with 'key services … in shockingly short supply'. Furthermore, indirect evidence on HIV-and abortion-related and maternal deaths of adolescents suggests widespread gaps in access to health care (Chopra, Daviaud, Pattinson, Fonn, & Lawn, 2009;Houweling, Ronsmans, Campbell, & Kunst, 2007;Rashid, Akram, & Standing, 2011;Tilahun, Mengistie, Egata, & Reda, 2012).…”

Unsafe abortion and unsupervised births: understanding the challenges of pregnancy and childbirth in the rural highlands of Papua New Guinea

“…Dilation and curettage requires trained, skilled health personnel, management that may consequently place an additional burden on a struggling workforce. MVA, when undertaken in the first trimester, is quicker and associated with less blood loss when compared to dilatation and curettage [30].…”

“…A recent study within the settlements in Port Moresby, the Capital of PNG, identified childbirth as a leading cause of death (3/53; 5.7%). All maternal deaths were the result of poor transport systems [30]. Through a maternal mortality review in 2010, Kirby [29] linked maternal deaths in remote, rural areas of Milne Bay Province to the three delay framework, [31] described in Chapter Two of this thesis.…”

“…Dilation and curettage requires trained, skilled health personnel, management that may consequently place an additional burden on a struggling workforce. MVA, when undertaken in the first trimester, is quicker and associated with less blood loss when compared to dilatation and curettage [30].In addition, it may be carried out successfully by specifically trained nurses and midwives [31,32], thus reducing the clinical workload for doctors. Given the safety and effectiveness of both MVA and misoprostol in the first trimester [33,34] it is possible that some women presenting for post abortion care could be managed without the need of senior medical staff.…”

“…A significant problem in the industrialised world during the 19th century, postpartum sepsis was reduced with the introduction of aseptic techniques. Today, postpartum sepsis remains a significant problem in low and middle income countries with one in 20 postpartum women developing an infection requiring prompt treatment to prevent it from becoming fatal or leading to morbidity [30]. …”