Sexual and reproductive health
Everyone has a right to adequate sexual and reproductive health care. However, despite various global commitments to sexual and reproductive health for all, profound inequalities and problems persist. Research plays an essential role in identifying and overcoming the effects of social and economic inequalities and health system deficiencies.
The Global Forum and UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) have conducted a consultative process towards the identification of gaps and priorities for research in this field.
One vision: sexual and reproductive health for all
The principle of sexual and reproductive health for all was agreed upon in September 1994 when 184 governments committed themselves to a remarkable Programme of Action at the International Conference on Population and Development (ICPD) in Cairo, Egypt. The result was a lasting paradigm shift in approaches to sexual and reproductive health: from controlling excessive population growth to sexual and reproductive health for all and from vertically structured family planning programmes to horizontally integrated primary health care and family planning services.
In the past 12 years, the Cairo consensus has been reaffirmed in a number of international forums.
The core aspects of sexual and reproductive health are:
- healthy sexuality;
- prevention and control of sexually transmitted infections, including HIV;
- helping women, men and couples to achieve their desired fertility;
- safe pregnancy and delivery as well as care for mothers and the newborns after delivery.
The reality: persistent inequalities, persistent problems
Despite these various global commitments to sexual and reproductive health for all, inequalities and problems persist:
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- A woman's lifetime risk of dying from pregnancy-related causes varies from one- in-six in some countries to one-in-1300 in others.
- HIV/AIDS prevalence among 15-49 year olds ranges regionally from under 1% to 35% or more.
- Almost four million babies die every year during the first four weeks of life, mostly in low- and middle-income countries.
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Inequalities can be attributed to four main sources
Inequalities relating to aspects of sexual and reproductive health can be attributed to four main sources:
- physiological, behavioural and environmental risk factors and limitations on information and resources;
- social, economic, cultural and personal factors;
- development resources and political priorities;
- availability of biomedical and technical tools.
These four sources indicate that sexual and reproductive health is dependent upon a number of integrated and mutually reinforcing factors. It must, therefore, be addressed with a coordinated package of essential information and health care services that takes into account all aspects of people's lives. The approach must be holistic.
The need: evidence for holistic action
The evidence needed to address the sources of these inequalities, however, has been scanty. For example, answers are needed to the following questions:
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- What are the factors that impede the use of existing childbirth emergency services and how to overcome them?
- What are the characteristics of effective intervention strategies that will reduce the risk-taking behaviours of young people as regards sexual and reproductive health?
- What are the cost-effectiveness and practicality of integrating related components of sexual and reproductive health services?
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Furthermore, many sexual and reproductive health problems are invisible even to the individuals themselves as a result, for example, of a lack of information, cultural taboos or shame.
Much more research is needed to make the invisible visible.
The tool: a framework and an agenda for priority research
The consultative process resulted in the proposal of a framework for analysing and filling gaps in our knowledge of sexual and reproductive health problems. Its perspective is two-sided: first of all, it approaches these issues as they are experienced physically and emotionally by individuals – men, women, boys and girls – throughout the course of their lives. Secondly, it considers the various ways relationships and living conditions influence the individual's capacity to make healthy sexual and reproductive choices.
Source: Research Issues in Sexual and Reproductive Health for Low- and Middle-income Countries, 2007
The objective: a favourable policy environment
It is important to conduct research using a multidisciplinary spectrum of approaches ranging from:
- basic research (including technological and product development);
- research into clinical management of conditions (symptoms, management, trials, best practices);
- demographic and fertility research;
- social sciences research (behavioural, economic, cultural and interpersonal determinants of health);
- research into generic health systems and services (the ways they are used as well as their quality, appropriateness, accessibility and availability).
Cross-cutting research questions in collaborative in-country and global research initiatives include:
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- social-science and epidemiological research into why some populations enjoy better sexual and reproductive health than others;
- policy and programme-based research on the quality of care and the accessibility of information and services;
- suggestions for technological support to improve and facilitate programme implementation and the scaling-up of interventions.
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By answering the research questions above, policy-makers and programme managers can help create a favourable policy environment for sexual and reproductive health. On this basis, they can contribute in pragmatic ways to the achievement of sexual and reproductive health for all.
The Global Forum and the World Health Organization have published the results of the consultative process. 'Research Issues in Sexual and Reproductive Health for Low- and Middle-income Countries' identifies issues and gaps in sexual and reproductive health and provides evidence for improving the quality, availability and use of sexual and reproductive health information, products and services among currently underserved populations in low- and middle-income countries.
| Photo credits |
| Photo 1 |
Mother and child, “River of Life” Photo
Competition (2004)
Photo: WHO/Nyaung U-than Htay |
| Photo 2 |
Family in Lesotho, Africa (November 1994)
Photo: WHO/JP Huble |
| Photo 3 |
Community health worker during a village
meeting with mothers and children in
rural Bangladesh (1996)
Photo: Andres de Francisco |
Last updated 10 January 2008
