Monday, October 31, 2005
Topic 1 - Introduction to Sexual and Reproductive Health
It is the capacity for enjoyment of sexif you live a life where you dont enjoy ittheres
something wrong with you
An ability to control your sexual and reproductive behaviour
This concept encompasses a lot of thingssuch as rape you dont have control!
Or how about if you want to have sex, but you cant?
Fear, shame, guilt, and false beliefs
So whats a false belief?
Its not talking about how Christians believe that you shouldnt
have sex unless youre married
False beliefs instead are like, If you masturbate youll go
Shame and guilt: its not that you should never feel shame and guilt for
Freedom also from:
Organic disorders, diseases, and deficiencies
We should treat things that relate to sex! i.e. Fertility treatmentswhy
shouldnt we be entitled to them? Yet we complain about dealing with
It is a positive and life-affirming part of being human
Knowledge of yourself and others
For example, no privacy in nursing homesor actively stopping
Capacity for intimacy
Our attitudes about sexuality, our ability to understand and accept our own sexuality
(the quote is on the website somewhere)
Its a fundamental part of our being! Later on it becomes more importantfertility issues
are a big source of health care dollar expenditure today!
Our biological capacity to reproduce, and our expectations (quote on site)
Issues in Sexual and Reproductive Health in Canada
Teen pregnancy rates
This is an enormous health problemeven if it doesnt affect us personally, we pay for it!
Personally, through our taxes
And also that we dont get tax dollars used on us because theyre being used on
the health problems of teen pregnant mothers and their children
This is prevalent even in developed countries
High rates of low-birthweight infants
This is especially bad in low-income groups
The fact that we dont prevent all LBW is mostly because of no political will
Sexually transmitted diseases
HIV, AIDS, etc.
This is especially a problem in young people However that is changingsince Viagra came on the market, middle-aged women
are having more STDs!
The economic burden of this was $36 billion in 1999 (for all STDs)
About 7% of couples (more if you restrict age)
Canadians spend around $30 million on in-vitro fertilization (a lot of this is private dollars)
Sexual abuse/family violence
The health related cost for violence against women and children is $1.54 billion/year
Issues in Sexual and Reproductive Health Globally
Maternal mortality is usually unnecessary! We have the skills to handle the situation! So
whenever it happenswe want to find out why
However, that is not the case in the developing world
By the way, maternal mortality is defined as death due to complications of
pregnancy or childbirth
In 2000what was the deal with MM?
In the developing world, it is < 20 / 100,000 live births
So this is already quite lowand they are probably preventable
That wasnt always the casein the Victorian Age in England it
was around 10%!
Howeverin sub-Saharan Africait is 920/100,000 live births
Again, all of these cases were probably preventable if they had
access to the resources we have!
In the developing world in general (so more than sub-Saharan Africa),
there are about 500,000 maternal deaths per year
It associated with high rates of teenage pregnancies (if you are a
teenager, there is a 2X rate of maternal mortality)
This is because your body at that age is designed to grownot
to have a baby!
So what are the things associated with MM (in descending order):
No skilled attendant at delivery (i.e. a mid-wife)
Low literacy rates
Not having an institution (hospital/clinic/birthing center) to deliver your
Not having available contraception
Ante-natal care (so we are talking about both pre and post-birth)
The GNP (gross national product)the lower the countrys GNP, the
higher the mortality rates
Note: literacy rates seem to be a determinant of all these other factors
anyway! Some think that it is a CAUSAL factor of things like GNP
Severe maternal morbidity
So this means the mother doesnt diebut there are SEVERE health consequences
If you have high MM, you probably also have high maternal morbidity!
Also very highly correlated to the top 2similar causal factors, etc.
Before, abortions were self-inducedyou can eat stuff that causes the body not to want to
continue with the pregnancyhowever they also have a good chance of killing the mother
But now in the developing world (specifically sub-Saharan Africa), doctors do itand thats
actually how they make a lot of their income!
Many doctors are untrainedand so they might not even do it right!
In 1994, there was a study in Kinshasa, Zaire
15% of women there had an abortion They found it was correlated with education the more educated you are, the
more likely you are to have had an abortion
Pregnant girls must often leave school! Thats why you have to abort the baby if
you want to continue with your education
HIV / AIDS
There are FEW effective programs in the developing world for HIV/AIDS
There are many cultural barriers to overcome!
In Africa, there are MORE THAN 25 million people dead from AIDS
12 million orphans!
More than 3 million NEW cases of HIV per year!
Most people will die from thisunless they die of something else first
In South Africa, more than 6 million people are infected, and 600 people die per
Other sexually transmitted diseases
This is only starting to be a problem in Canada
As our borders are more fluid and we get people from elsewhere in the world, we see
more people who have had this done!
Unmet family planning needs
Its hard to plan your family size in Africaits hard to control your reproductive rateand
therefore, the rates of abortion are high!
Contraception is unavailable in much of the developing world
In sub-Saharan Africa (2000): 5-6 births/woman on average
The use of contraception is correlated with educationif you are educated, you are more
likely to be able to get to it
Determinants of Sexual and Reproductive Health
Social and Economic Environment
For example: Income, SES (socioeconomic status), social support, education,
employment, and working conditions
Low SES is associated with:
Earlier sexual activity
Increased risky sexual practices (i.e. without a condom)
Increased risk of tee