-character:footnote'>[29]  Access to reproductive health services, including contraception, reduces a woman’s exposure to fatal obstetric complications, which account for approximately 80 percent of maternal deaths globally and enables a women to plan the timing and spacing of her children.[30]

 

The interactions between sexual and reproductive health and HIV/AIDS are deeply entwined and need to be addressed simultaneously.  The majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding.[31]  Likewise, females are more vulnerable to STDs, and therefore HIV, because they often engage in sexual activity earlier than males, they have sex with older and more experienced partners, and biologically they are more vulnerable due to characteristics of the genital tract of young girls.[32]  Yet, more than 201 million women around the world do not have access to contraceptive supplies and services;[33] and, the WHO found that in most developing countries the best indicators of STD levels in women come from surveys taken at antenatal, family planning, or gynecological clinics.[34] 

 

Therefore, family planning services that incorporate contraception for both preventing unintended pregnancies and protecting couples from STDs and HIV will allow couples to realize their own childbearing intentions, promote less volatile age structures, enable slower urban population growth, promote economic productivity, and lessen pressure on limited natural resources.[35]  Furthermore, interventions to prevent HIV are at least 28 times more cost-effective than antiretroviral therapy.[36]  For these reasons, the availability of and access to culturally appropriate contraception is an important public health concern.

 

V.                 Barriers to Access and Development of New Contraceptive Technologies

 

According to Swartz and Gabelnick, “Financial factors, political pressures and legal concerns are among the obstacles that have impeded the research and development of new contraceptive products.”[37]  Microbicides research provides an excellent example of these obstacles.  Microbicide researchers need a large sample size of women at high risk for STDs in order to evaluate the products effectiveness.  Yet, they also need to provide trial participants with condoms and counsel them to use the condoms so the data about effectiveness is only available when a condom fails or is not used.  If condoms are used, then microbicides may not be necessary.  However, research from developing countries indicates that condoms are not normally or regularly used.  So microbicides would give women control in protecting herself; however, is a new product enough?  There are still issues of partner communication about sex and societal structures that position women in a subordinate and therefore disadvantaged role where their voices and actions are limited.  Likewise, the cost of a clinical trial is expensive and “pharmaceutical companies have little interest due to regulatory complexities, difficulties in securing patent protection, and product-liability suits.”[38] 

 

VI.              Public Health Programs and Policies Addressing Reproductive Health

Although there are many barriers to the development of new contraceptive technologies, many family planning programs exist due to the vast consequences of unmet need.  Many programs that implement current technologies and educational outreach have been invested in and found successful throughout the world. In the U.S., a family planning program, authorized under Title X of the Public Health Service Act, is administered within the OPA by the Office of Family Planning (OFP) with a budget of $288 million for fiscal year 2005. The Title X program is the only Federal program devoted solely to the provision of family planning and reproductive health care. The program supports a nationwide network of approximately 4,600 clinics and provides reproductive health services to approximately 5 million persons each year.

 

The program is designed to provide access to contraceptive supplies and information to all who want and need them with priority given to low-income persons. A broad range of effective and acceptable family planning methods and related preventive health services are available on a voluntary and confidential basis. In addition to contraceptive services and related counseling, Title X supported clinics also provide a number of preventive health services such as: patient education and counseling; breast and pelvic examinations; cervical cancer, STD and HIV screenings; and pregnancy diagnosis and counseling. For many clients, Title X clinics provide the only continuing source of health care and health education. [39]

 

However, the United States’ domestic and international policies related to family planning are very exclusive in terms of the range of services that funds can be directed towards. This exclusivity is apparent in its international policy known as the U.S. Global Gag Rule, which bars U.S. family planning assistance to foreign nongovernmental organizations (NGOs) who, with their own, non-U.S. funds, engage in abortion-related activities in their country. NGOs refusing to abide by these restrictions lose vital U.S. family planning funds and technical assistance. Organizations that do not sign the Global Gag Rule also lose access to U.S.-donated contraceptives, including condoms.[40]

 

Such a policy has not stopped many developing countries from initiating family planning clinics, services, and campaigns to increase access to reproductive health educational materials, promote access and use of screenings, and encourage the use of prevention methods, specifically the often free distribution of condoms.  Haiti began a project to increase access to reproductive health care with the training of 16 health promoters and the initiation of clinical services in Cange, Haiti, a rural area where only dirt roads connect villages.  During the project’s first year, a total of 698 contraceptive clients, mostly adults, were served.  By 2002, the program grew significantly serving nearly 2,000 clinic clients, expanded its adolescent services to include supplying 4,000 adolescents with community-based distribution of contraceptives, and reduced its cost per client by more than 50 percent.[41]

 

Adolescents are a substantial target of many family planning programs throughout the world, particularly in the developing world.  The devastation of HIV/AIDS has brought the youth’s presence and sexual decision-making to center stage.  Nations are losing their future generations of laborers and professionals.  For these reasons and others related to stages of development, programs focusing on adolescents are receiving a lot of attention and investment. 

 

Peer Outreach for Reproductive Health project in Thailand provided more than 50 youth in the community training as peer health educators.  Due to the peer to peer educational outreach concerning reproductive health issues, each year more and more young people are seeking contraceptive services offered at the various family planning clinics throughout Thailand.[42]  The Promotion of Youth Responsibility Project in Zimbabwe also targets the health needs of youth.  It is a six-month multimedia campaign directed toward young people and training health care providers in interpersonal communication and youth counseling skills. An evaluation of the project found that youth in campaign sites were more likely than youth in comparison sites to abstain from sex, have fewer recent sexual partners, and use contraceptives and clinic services.[43]  Another evaluation compared three youth-friendly pilot projects in Zamia. In each, peer educators and health care providers were trained; two of the projects included community outreach component designed to increase the project’s reach in the community.[44] 

 

Projects geared towards the youth are becoming more prevalent throughout the world.  Investment in healthy, viable futures for young people is likely to be the key to long-term progress and stability in much of the developing world.  For this reason, reproductive and sexual behavior interventions for adolescents are being tied with their educational and economic options.[45]

  

VII.            Conclusion

 

Family planning and reproductive health will continue to be a hot topic area in which investments will be made since HIV is a global pandemic.  Likewise, the benefits for meeting individuals’ reproductive health needs exceed the costs.  Current methods for evaluating the costs and benefits of contraceptive services undervalue its services because pregnancy the condition that contraception prevents is not a disease.  However, contraceptive services have important medical and non-medical benefits.  A woman’s ability to space or limit the number of her pregnancies has a direct impact on her health and well-being as well as the outcome of her pregnancy.[46]  In exercising their reproductive rights, women are safeguarding their own health and rights, preserving our planet’s resources, and improving the quality of life for themselves, their partners, and their children.[47]  For these reasons, the need for new pregnancy and STD/HIV prevention options that improve the currently available methods is an important public health endeavor. 

 

References



[1] Camp, Sharon, PhD. 2003.  Statement by Sharon Camp: Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. The Alan Guttmacher Institute (AGI). New York City, NY.

[2] Birth control. Wikipedia, the free encyclopedia. http://en.wikipedia.org/wiki/Contraception

[3] Ibid.

[4] Learning Modules: Glossary. The World Bank Group. http://www.unesco.org/education/tlsf/theme_c/mod13/www.worldbank.org/depweb/english/modules/glossary.htm

[5] Schwartz, Jill L. and Gabelnick, Henry L. Special Report: Current Contraceptive Research. Perspectives on Sexual and Reproductive Health, 2002, 34(6): 310-316.

[6] EngenderHealth. Family Planning. New York, NY. www.engenderhealth.org.

[7] Ibid.

[8] Trussell, J. Contraceptive efficacy. In: Hatcher, R. A., Trussell, J., Stewart, F., Nelson, A., Cates, W., Guest, F., Kowal, D. Contraceptive Technology. Eighteenth Revised Edition. New York, NY, Ardent Media, 2004.

[9] Feminist Women's Health Center. Birth Control Comparisons. Cedar Rivers Clinics. Seattle, WA. http://www.fwhc.org/birth-control/index.htm.

[10] Ibid.

[11] EngenderHealth. Emergency Contraception. New York, NY. http://www.engenderhealth.org/wh/fp/cemerg.html.

[12] Planned Parenthood Federation of America, Inc. Your Contraceptive Choices. September 2003.

[13] World Health Organization. Reproductive Health and Family Planning. http://www.who.int/reproductive-health/family_planning/methods.html.

[14] Ibid.

[15] Schwartz, Jill L. and Gabelnick, Henry L. Special Report: Current Contraceptive Research. Perspectives on Sexual and Reproductive Health, 2002, 34(6): 310-316.

[16] Family Health International. Microbicides. http://www.FHI.org/en/Topics/microbicide.htm.

[17] Ibid.

[18] Family Health International. Microbicide Products Enter Human Trials: A variety of experimental products use different mechanisms to protect against HIV and other diseases. Network, 2000, 20(2): 1-11.

[19] Schwartz, Jill L. and Gabelnick, Henry L. Special Report: Current Contraceptive Research. Perspectives on Sexual and Reproductive Health, 2002, 34(6): 310-316.

[20] Ibid.

[21] Schwartz, Jill L. and Gabelnick, Henry L. Special Report: Current Contraceptive Research. Perspectives on Sexual and Reproductive Health, 2002, 34(6): 310-316.

[22] Ibid.

[23] Schwartz, Jill L. and Gabelnick, Henry L. Special Report: Current Contraceptive Research. Perspectives on Sexual and Reproductive Health, 2002, 34(6): 310-316.

[24] Ibid.

[25] World Health Organization. Reproductive Health and Family Planning. http://www.who.int/reproductive-health/family_planning/methods.html.

[26] Ibid.

[27] WHO, Estimates of DALYs by sex, cause and WHO mortality sub-region, estimates for 2001, 2002. http://www3.who.int/whosis/menu.cfm?path=evidence,burden,burden_estimates_2001,burden_estimates_2001_subregion&language=english.

[28] Camp, Sharon, PhD. 2003.  Statement by Sharon Camp: Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. The Alan Guttmacher Institute (AGI). New York City, NY.

[29] Ibid.

[30] Ibid.

[31] World Health Organization (WHO), UNFPA, UNAIDS, and International Planned Parenthood Federation (IPPF). 2005. Sexual and Reproductive Health & HIV/AIDS: A Framework for Priority Linkages.

[32] World Health Organization (WHO). 1995. Workbook 1: The Transmission and Control of STD/HIV. http://whqlibdoc.who.int/temp/Tomas/GPA%20Documents/STD-CaseMan-Wb1-E-Wh95e18b.pdf

[33] Singh, Susheela, Darroch, Jacqueline E., Vlassoff, Michael, Nadeau, Jennifer. 2003. Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. The Alan Guttmacher Institute (AGI). New York City, NY.

[34] World Health Organization (WHO). 1995. Workbook 1: The Transmission and Control of STD/HIV. http://whqlibdoc.who.int/temp/Tomas/GPA%20Documents/STD-CaseMan-Wb1-E-Wh95e18b.pdf

[35] Population Action International. September 2005. Fact Sheet: How Access to Sexual & Reproductive Health Services is Key to the MDGs. Washington, DC.

[36] Marseille, E, et al., HIV prevention before HAART in sub-Saharan Africa. Lancet, 2002, 359(9320): 1851-56.

[37] Schwartz, Jill L. and Gabelnick, Henry L. Special Report: Current Contraceptive Research. Perspectives on Sexual and Reproductive Health, 2002, 34(6): 310-316.

[38] Family Health International. Microbicide Products Enter Human Trials: A variety of experimental products use different mechanisms to protect against HIV and other diseases. Network, 2000, 20(2): 1-11.

[39] Department of Health and Human Services: Office of Public Health and Science: Office of Population Affairs: Office of Family Planning. http://opa.osophs.dhhs.gov/titlex/ofp.html

[40] The Global Gag Rule Impact Project. The Global Gag Rule & Contraceptive Supplies. Population Action International, Ipas, Planned Parenthood Federation of America, EngenderHealth, and Pathfinder International.

[41] PPFA-International. Five years of achievement: 1998-2003. Planned Parenthood Federation of America, Inc. New York, NY.

[42] Ibid.

[43]Boonstra, H. October 2004. Issue in Brief: The Role of Reproductive Health Providers in Preventing HIV. The Gutmacher Report on Public Policy. The Alan Guttmacher Institute, UNAIDS, UNFPA, and International Planned Parenthood Federation.

[44] Ibid.

[45] Esim, S., Malhotra, A., Mathur, S., Duron, G., Johnson-Welch, C. 2001. Making It Work: Linking Youth Reproductive Health and Livelihoods. International Center for Research on Women (ICRW). Washington, DC.

[46] The Alan Guttmacher Institute and UNFPA. 2003. Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. The Alan Guttmacher Institute (AGI). New York City, NY.

[47] EngenderHealth. Family Planning. New York, NY. www.engenderhealth.org.