Widening Horizons J
Total Page：16
File Type：pdf, Size：1020Kb
Special Theme ± Reproductive Health Editorial Reproductive health: widening horizons J. Patrick Vaughan1 & Carla AbouZahr2 Ever since the concept of reproductive within a country.They point out that Two further articles examine issues health was put forward at the International programmes need to find better ways to work of measurement and estimating the burden Conference on Population and Develop- with these diverse views on ideal family size. of reproductive ill-health or disease.Sadana ment (ICPD), held in Cairo in 1994, there Several articles examine interventions points out that despite advances in the policy has been debate about where its boundaries for reducing the burden of disease associated agenda, sexual and reproductive health lie.Clearly, reproductive health is about with sex and reproduction.For example, lacks clear definitions and rigorous methods preventing and treating disease, but it is Berer emphasizes the need for an open for assessment, thereby complicating also about supporting normal functions such public health perspective on abortion and decision-making about priorities as pregnancy and childbirth.It is about presents a wide range of experiences from (pp.640±654). reducing the adverse outcomes of pregnancy countries that have sought to meet this Given that the DALY methodology Ð including maternal deaths and disabilities, need (pp.580±592).In poorer countries, for estimating disease burden will be used abortion complications, miscarriages, a woman's life-time probability of dying again for the year 2000, the final paper by stillbirths and neonatal deaths Ð but it is is about 200 times greater than in wealthier AbouZahr & Vaughan offers a critique of also about enabling people to have safe and ones, as is well documented by the studies its application to reproductive health fulfilling sexual relationships, and to decide of Prual et al.in West Africa (pp.593±602) and makes suggestions on how future DALY if and when to have children.Above all, and Walraven et al.for the Gambia estimates could be improved (pp.655±666). reproductive health is about life-enhancing (pp.603±613).Graham et al.focus on The Public Health Classic examines processes and how to nurture them in improving the quality of hospital obstetric the impact of reproductive health on women the face of adversities such as gender care (pp.614±620) and show how a practical and on poor groups in society.Dugald discrimination, inequity, exploitation, list of indicators for clinical audit were agreed Baird in his 1952 Cutter Lecture (1) chose conflict and economic disruption. by using consensus methods with health to focus on the impact of the prevailing Though it does not cover the full professionals from settings as varied as social and economic conditions on preg- spectrum of the new concept, the theme Ghana, Jamaica and Scotland. nancy and perinatal outcomes.Fathalla in section in this issue of the Bulletin presents As demonstrated by Dugald Baird his commentary takes up and amplifies some of the key components of reproductive over 50 years ago in the United Kingdom this theme (pp.677±678). health: family planning, abortion, maternal and again by Kusiako et al.using surveil- The papers in the theme section of morbidity and mortality, perinatal and lance data from Matlab, Bangladesh this issue of the Bulletin remind us that some neonatal mortality, sexually transmitted (pp.621±627), perinatal and infant mortality important lessons need to be relearnt. infections, and the difficulty of adequately are also important outcome indicators First, the poor fare far worse than the rest measuring the full dimensions of reproduc- for reproductive health and not only for of society on all reproductive health outcome tive ill-health. child survival. indicators.But poverty is not an insur- Although modern methods of A note of caution is sounded by mountable barrier to health when there fertility control are now much more widely Dehne et al.(pp.628±639), who warn that is high level political commitment to available in low-income and middle-income the enthusiasm for integrating family plan- investing in health.Second, gender-based countries, health planning is usually based ning and the control of sexually transmitted discrimination is an important determinant on the assumption that women and men diseases that sprang from the ICPD may of poor reproductive health.Women have similar desires about ideal family size. be misplaced.A wide review of secondary suffer the major burden of sexual and However, Ratcliffe et al.demonstrate from documentary sources, mainly from donor reproductive ill-health because they also the Gambia (pp.570±579) that desired agencies, suggests there are fewer benefits suffer discrimination in access to basic needs, fertility can be very different between women than had been expected from this approach. health services and the exercise of human and men, even in the same communities Langer et al.describe ways of dealing rights.And third, the intergenerational with the dual challenge of broadening impact of poor reproductive health needs the reproductive health agenda while to be more clearly acknowledged.Invest- promoting health sector reform ments in reproductive health bring benefits 1 Professor of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, (pp.667±676).Country experience shows both to the young people and adults of London, England. that the two movements have broadly today and to the infants and children 2 Senior Monitoring and Evaluation Adviser, UNAIDS, compatible aims and objectives and of tomorrow. n 1211 Geneva 27, Switzerland. Correspondence that reform also offers opportunities for should be addressed to this author. improving the delivery of reproductive 1. Baird D. Preventive medicine in obstetrics. Ref. No. 00-0736 health care. New England Journal of Medicine, 1952, 246: 561±568. Bulletin of the World Health Organization,2000, 78 (5) # World Health Organization 2000 569.