Year : 2011 | Volume
: 36 | Issue : 2 | Page : 83--84
Sexual and reproductive health services: Priorities for South and East Asia
Distinguished Scholar, Population Council, New Delhi, India
Distinguished Scholar, Population Council, New Delhi
|How to cite this article:|
Pachauri S. Sexual and reproductive health services: Priorities for South and East Asia.Indian J Community Med 2011;36:83-84
|How to cite this URL:|
Pachauri S. Sexual and reproductive health services: Priorities for South and East Asia. Indian J Community Med [serial online] 2011 [cited 2022 May 18 ];36:83-84
Available from: https://www.ijcm.org.in/text.asp?2011/36/2/83/84116
Ensuring universal access to sexual and reproductive health (SRH) services in South and East Asia (SEA), essential for achieving many, if not all, of the Millennium Development Goals, especially those related to maternal health, child survival, HIV/AIDS and gender equality, requires implementation of the following priority interventions:
Strengthening Health Systems
A fundamental need for ensuring universal access to SRH services is the establishment of well-managed, robust health systems. Public sector programmes, the major providers of services for the poor are besieged with problems related to infrastructure, human resources, logistics, management and accountability. The reality is that most of the people, including the poor, go to the private sector (formal and informal) for reproductive health services, e.g., maternal care, abortions, treatment of sexually transmitted infections (STIs), etc. However, serious issues of an unregulated private sector that provides questionable quality of care have yet to be addressed. There is a clear need to ensure that programmes are well-managed, effectively monitored, and held accountable. Effective decentralisation to ensure accountability to the community and strengthening of local governance is an urgent need.
Success stories in SEA provide important lessons for programming. Sri Lanka, for example, has managed to halve its maternal mortality ratio (MMR) every six to 11 years by adopting sound strategies, allocating sufficient resources, providing free healthcare and making education for all a priority. MMR dropped from 340 to 44 per 100,000 live births between 1960 and 2005. More than 95% of births in Sri Lanka take place in hospitals with a skilled nurse, midwife, or doctor in attendance. Immunisation coverage is almost universal and 95% women receive antenatal care.  Malaysia and Thailand have also demonstrated success. However, women in several countries in SEA do not have access to services. To prevent maternal mortality, every woman must have access to a skilled birth attendant even if she delivers at home. But if lifethreatening complications arise, she should be able to reach a referral facility, with requisite equipment and qualified staff, on time.
Ensuring Convergence of Services
An important guiding principle is to design and implement integrated services to address clients' multiple needs. Integration, convergence, etc. are buzzwords that have revisited the health field for decades.  But even today, most health services are provided through vertical programmes. Services for family planning, maternal and child health, HIV/AIDS and STIs are obvious examples. Since there are important linkages among these, there is a clear need to ensure horizontal integration of these services. Linking STI/HIV with reproductive health services would improve access to STI/HIV services for women who might otherwise not seek these because of stigma. It would also improve access to reproductive health services for people living with HIV and AIDS whose reproductive health needs and rights are usually overlooked. However, this concept has not been operationalised. Consequently, services continue to be administered through vertical programmes that originate from different government departments funded by different donors each with its own agenda. The result is multiplicity and fragmentation which is wasteful and inefficient. Mainstreaming SRH services within primary health care programmes, critical for addressing clients' multiple needs, requires political commitment to ensure that adequate technical and financial support is provided.
Promoting Sexual and Reproductive Health and Rights of Adolescents and Young People
Of the 1.15 billion adolescents in the world, over 700 million live in Asia. Youth (15−24 years) comprise about a third of the population of SEA. The sheer size of this population sub-group coupled with dramatic lifestyle changes pose serious challenges for designing programmes to address their special needs. Adolescents are typically poorly informed about how to protect themselves from unwanted pregnancies and STIs including HIV/AIDS. They must have ready access to information and services that provide privacy, confidentiality, respect, and informed consent. Young people's greatest need is for accurate information -- about their bodies, about handling relationships, about sexuality, reproduction, and contraception. This need is shared by all young people, rich and poor, sexually active and inactive, married and unmarried, males and females.  Sensitivity around adolescent sexuality has seriously impeded programme development. In India, for example, sex education has yet to be included in schools because it is a politically contentious issue.
In South Asia, there is strong pressure for girls to marry young and to have children early; 47.4% of girls in India aged 20−24 years are married before age 18 and 42% give birth before 20 years of age.  Thus, two-fifths of Indian girls become mothers during adolescence. The median age at first birth is 17.9 years in Bangladesh,  19.9 years in Nepal,  and 21.8 years in Pakistan.  Adolescent mothers face a higher risk of maternal death and their children suffer higher levels of morbidity and mortality. Early marriage and childbearing also impedes young women's educational and employment opportunities. Even when married adolescents are the intended target of formal programmes, many are unable to receive services because they lack freedom of movement, autonomy, and access to resources. Decisions to seek care are made for them by husbands and mothers-in-law.  The situation of unmarried youth is much worse; very few can access SRH services as society severely disapproves of sexual activity outside of marriage.  Yet, premarital sexual activity is on the rise. Thus, countries in the region are in transition. To reap the benefits of the demographic dividend, they must invest in programmes for young people.
|1||UNICEF. Sri Lanka shines in slashing maternal, neonatal mortality, Related stories by IANS, January 15, 2009.|
|2||Pachauri S. Reproductive health: The concept, ideology andoperational issues. In: Sengupta J, Ghosh D, editors. Perspectives in Reproductive Health. New Delhi, India: New Age Publishers Ltd.; 1996. p. 47-60.|
|3||Pachauri S. India's population problem: Divergent perspectives, past experience and future programme strategies. In: Khan ME, editor. Work, Health and Contraception from Women's Perspective. Baroda, India: Centre for Operations Research and Training; 1998. p. 333-47.|
|4||National Family Health Survey (NFHS-3), 2005-06. Vol. 1. Mumbai, India: IIPS, International Institute for Population Sciences (IIPS) and Macro International; 2007.|
|5||Bangladesh Demographic and Health Survey 2007. National Institute of Population Research and Training (NIPORT), Mitra and Associates, and Macro International. Dhaka, Bangladesh and Calverton, Maryland, USA: National Institute of Population Research and Training, Mitra and Associates, and Macro International; 2009.|
|6||Nepal Demographic and Health Survey 2006. Ministry of Health and Population (MOHP) [Nepal], New ERA, and Macro International Inc. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and Macro International Inc; 2007.|
|7||Pakistan Demographic and Health Survey 2006-07. National Institute of Population Studies (NIPS) [Pakistan], and Macro International Inc. Islamabad, Pakistan: National Institute of Population Studies and Macro International Inc; 2008.|
|8||Santhya KG, Ram U, Acharya R, Jejeebhoy SJ, Ram F, Singh A. Associations between early marriage and young women's marital and reproductive health outcomes: Evidence from India. Int Perspect Sex Reprod Health 2010;36:132-9.|
|9||Santhya KG, Jejeebhoy SJ. Sexual and reproductive health needs of married adolescent girls. Econ Polit Wkly 2003;38:4370-7.|