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Social Determinants of Sexual and Reproductive Health: Informing Future Research and Programme Implementation / Edited by Shawn Malarcher

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Social determinants of sexual and reproductive health Informing future research and programme implementation Social determinants of sexual and reproductive health Informing future research and programme implementation WHO Library Cataloguing-in-Publication Data Social determinants of sexual and reproductive health: informing future research and programme implementation / edited by Shawn Malarcher. 1.Reproductive health services. 2.Sex factors. 3.Sexual behavior. 4.Research. 5.Socioeconomic factors. 6.Family planning services. I.Malarcher, Shawn. II.World Health Organization. ISBN 978 92 4 159952 8 (NLM classification: WQ 200) © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named author/editor alone is responsible for the views expressed in this publication. Cover photos: Photoshare Contents Acknowledgements iv Abbreviations and acronyms v 1. A view of sexual and reproductive health through the equity lens Shawn Malarcher 1 Section 1. Within the health system 13 2. Promote or discourage: how providers can influence service use Paula Tavrow 15 3. Financing mechanisms to improve equity in service delivery Dominic Montagu, Maura Graff 37 4. Scaling up health system innovations at the community level: a case-study of the Ghana experience John Koku Awoonor-Williams, Maya N. Vaughan-Smith, James F. Phillips 51 Section 2. Beyond the clinic walls 71 5. Sexual and reproductive health and poverty Andrew Amos Channon, Jane Falkingham, Zoë Matthews 73 6. Migration and women’s reproductive health Helen Smith, Xu Qian 93 7. The role of schools in promoting sexual and reproductive health among adolescents in developing countries Cynthia B. Lloyd 113 8. Sexual violence and coercion: implications for sexual and reproductive health Sarah Bott 133 Social determinants of sexual and reproductive health Acknowledgements The World Health Organization gratefully The editor is indebted to the reviewers acknowledges the contributions of the editor Mai Fuji, Mary Eluned Gaffield, Alison Harvey, of this book, Shawn Malarcher, and those of the Claudia Garcia Moreno, Dale Huntington, authors of the chapters: John Koku Awoonor- Ronnie Johnson, Nathalie Kapp, Suzanne Reier, Williams, Sarah Bott, Andrew Amos Channon, Julia Lynn Samuelson, and Lale Say for their Jane Falkingham, Maura Graff, Cynthia Lloyd, helpful comments and guidance in development Zoë Matthews, Dominic Montagu, of authors’ submissions. A special word of thanks Xu Qian, Helen Smith, Paula Tavrow, and is extended to Iqbal Shah and Erik Blas for their Maya Nicole Vaughan-Smith. guidance and support in producing this work. Thanks is also extended to individuals of the The Priority Public Health Condition Knowledge WHO Interdepartmental Working Group on the Network coordinated by the Department of social determinants of sexual and reproductive Equity, Poverty, and Social Determinants and the health: Marie Noel Brune, Jane Cottingham, Department of Reproductive Health and Research Catherine D’Arcangues, Peter Fajans, Mai Fuji, provided financial support for this work. Mary Eluned Gaffield, Claudia Garcia Moreno, Ronnie Johnson, Nathalie Kapp, Shawn Malarcher, Francis Jim Ndowa, Alexis Bagalwa Ntabona, Nuriye Ortayli, Anayda Portela, Julia Lynn Samuelson, and Lale Say. Without the contribution of these individuals, this work would not have been possible. iv Informing future research and programme implementation Abbreviations and acronyms AIDS acquired immunodeficiency IUD intrauterine device syndrome MDGs United Nations Millennium BPL below the poverty line Development Goals CBD community-based distribution MEDS Mission for Essential Drugs and Services (Kenya) CHAG Christian Health Association of Ghana MMR maternal mortality ratio CHPS community-based health planning and services MVA manual vacuum aspiration CHC community health compound NGO nongovernmental organization CHN community health nurse OECD Organisation for European- Cooperation and Development CHO community health officer OPEC Organization of Petroleum-Exporting CSDH Commission on Social Determinants Countries of Health PPH postpartum haemorrhage CYP couple-years of protection PRSP poverty reduction strategy paper DALY disability-adjusted life year QALY quality-adjusted life year DHMT district health management team RHR Department of Reproductive Health DHS Demographic and Health Surveys and Research DMPA depot medroxyprogesterone acetate RTI reproductive tract infection FBO faith-based organization SRH sexual and reproductive health GHI global health initiatives STD sexually transmitted disease HIV human immunodeficiency virus STI sexually transmitted infection HMO health management organization SWAp sector-wide approach HPV Human papillomavirus TFR total fertility rate ICPD International Conference on UNFPA United Nations Population Fund Population and Development (1994) UNIFEM United Nations Development Fund IMF International Monetary Fund for Women IOM International Organization for UN-HABITAT United Nations Human Settlements Migration Programme INSS National Social Security Institute USAID United States Agency for (Nicaragua) International Development IPV sexual intimate partner violence YLL years of life lost v Social determinants of sexual and reproductive health vi 1 A view of sexual and reproductive health through the equity lens Shawn Malarcher Department of Reproductive Health and Research World Health Organization, Geneva, Switzerland Informing future research and programme implementation hile the last two decades have seen system to meet the needs of the most vulnerable W improvements in access to and utilization individuals in society. of sexual and reproductive health (SRH) services, progress in many countries has been slow and – The relationship between poverty and poor after decades of investments – disappointing. Social reproductive health is well established. Greene activists and health analysts have highlighted the and Merrick conducted a thorough review of the potential role that persistent inequities in health social, financial and health consequences of key play in hindering progress towards achieving reproductive health indicators including maternal international and national development goals. survival, early childbearing, and unintended Health inequity is defined as "inequalities in health pregnancy. The report concluded that large deemed to be unfair or to stem from some form family size was associated with increased risk of of injustice. The dimensions of being avoidable maternal mortality and less investment in children's or unnecessary have often been added to this education. Unwanted pregnancy was positively concept."1 correlated with health risks of unsafe abortion. Short birth intervals were found to negatively A review of progress towards reducing inequities influence child survival, and early pregnancy in coverage of key maternal, newborn, and child was associated with lifelong risk of morbidities.4 health interventions concluded that most countries Researchers have also documented that large examined: families are more likely to become poor and less likely to recover from poverty than smaller family "have made gradual progress in reducing households.5 the coverage gap for key interventions since 1990. The coverage gaps, however, are still On a global scale, women living in low- and very wide and the pace of decline needs to middle-income countries experience higher levels be more than doubled to make significant of morbidity and mortality attributed to sexual progress in the years between now [2008] and and reproductive health than do women living 2015 to reach levels of coverage of these and in wealthier countries, as the following estimates other interventions needed for MDG 4 and 5. show. In general, in-country patterns of inequality are persistent and change only gradually if at ● Many developing countries continue to struggle all, which has implications
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