Abstract
Poor reproductive health can have devastating consequences on individuals and families, along with adverse impacts for health care systems, economic well-being and society. Good reproductive health contributes to healthy sexuality, individuals and families, as well as wanted children and more optimal societal and economic outcomes. Although a number of countries had earlier adopted the concept, it was the 1994 International Conference on Population and Development (ICPD) which explicitly recognized sexual and reproductive rights as fundamental to women’s health, and gave much momentum to the field. It also moved beyond the confines of traditional family planning approaches, set new goals for reproductive health and rights, and highlighted their importance for policymakers and publics worldwide. However, a political backlash soon ensued, the HIV/AIDS epidemic worsened with no apparent end in sight, and new funding priorities and mechanisms emerged.
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Notes
- 1.
In late 2012, UNAIDS reported that new infections in 25 low- and middle-income countries had dropped by 50 % in recent years, with 13 of those countries located in sub-Saharan Africa, a region where AIDS-related deaths had fallen by over one-third in the last 6 years. This progress helped raise optimism that after 30 years and 30 million deaths, real progress is being made towards an AIDS-free generation. However, in 2011 there were still 2.5 million new infections (down 700,000 from the 2001 figure) and 1.7 million deaths (600,000 fewer than in 2005) due to AIDS-related causes, and HIV/AIDS continues to be the chief cause of death for women of reproductive age worldwide (UNAIDS 2012).
- 2.
Emergency contraceptive pills are the most commonly used emergency contraceptive method and may comprise a larger dose of standard combined hormone oral contraceptive pills, progestin-only oral contraceptive pills, or a dedicated progestin-only emergency contraceptive product. The insertion of a copper intrauterine device (IUD) may also provide emergency contraception.
- 3.
As reported in the press release “5 million babies,” ESHRE (European Society of Human Reproduction and Embryology), 2 July 2012 (http://www.eshre.eu/ESHRE/English/Press-Room/Press-Releases/Press-releases-2012/5-million-babies/page.aspx/1606). The first ‘test tube’ baby was born as a result of in vitro fertilization (IVF) in 1978, since when ARTs have become available to ever more would-be mothers and fathers. Success rates from a single fresh treatment cycle of IVF and ICSI appear to be stabilizing at around a 30–32 % pregnancy rate for each embryo transferred.
- 4.
The Global Gag Rule has been a recurrent political flashpoint in the U.S. abortion debate ever since it was first announced by U.S. President Ronald Reagan at the time of the 1984 International Conference on Population held in Mexico City (and after which it is also referred to sometimes as the ‘Mexico City policy’). The policy required NGOs that receive funds from the United States Agency for International Development (USAID) for international population assistance (notably for family planning) to refrain from using their own, non-USAID funds to provide any activities that perform, counsel, or promote abortion services, even in cases of rape or incest. Successive U.S. Republican administrations have re-imposed the policy and misleadingly presented it as a direct step in defunding abortions conducted overseas, even though the U.S. government has been prohibited from directly funding such services under the 1973 Helms Amendment to the Foreign Assistance Act. Although aimed nominally at abortion, the policy has had multiple negative public health repercussions such as reducing access to family planning, postabortion care, maternal and child health services, and for some time, even to HIV-prevention and AIDS-related services (Crane and Dusenberry 2004; Kulczycki 2007).
- 5.
The President’s Emergency Plan for AIDS Relief (PEPFAR) program was created by in 2003 by President Bush and extended by his successor, President Obama. It authorized large new resource allocations for HIV/AIDS programs in severely affected low-income countries and has expanded the use and availability of anti-retroviral HIV/AIDS drug therapies in such nations, particularly in sub-Saharan Africa.
- 6.
The acronym LA/PM (long-acting and permanent method of contraception) is also used to refer to female sterilization and vasectomy, as well as IUDs and hormonal implants. These are all clinical methods of family planning, in contrast to the “re-supply” methods of condoms, pills and injectables. The term ‘long-acting’ helps focus attention on the method’s intrinsic characteristics rather than the length of time a client may actually use the method.
- 7.
The LNG-IUS offers endometrial health benefits, helps treat menorrhagia and, slightly reduces risk of pelvic inflammatory disease (PID). By reducing heavy menstrual bleeding, the LNG-IUS is also the contraceptive method of choice for most women who are more prone to iron-deficiency anemia (whereas copper-bearing devices tend to reduce hemoglobin).
- 8.
Depo-Provera contains a progestin, a drug very similar to progesterone, the hormone normally produced by the ovaries every month as part of the menstrual cycle. Also known as ‘Depo’ or simply as ‘the shot,’ DMPA has been used since the 1960s, although its introduction and acceptance in many parts of the world only occurred after it was approved by the US Food and Drug Administration in 1992. Combined injectable contraceptives are widely used outside the U.S. and include monthly injections of progesterone and estradiol taken to inhibit fertility. Injectables are also convenient, discrete, and have various non-contraceptive health benefits, as well as the possible side-effects noted in the text. There have also been longstanding fears about possible reduction in bone mineral density associated with prolonged DMPA use; and in 2011, a new possible association was reported with HIV acquisition and transmission, although this remains unproven and the evidence (based on an observational study design) is far from persuasive (see also Chap. 13).
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Kulczycki, A. (2014). Introduction and Overview. In: Kulczycki, A. (eds) Critical Issues in Reproductive Health. The Springer Series on Demographic Methods and Population Analysis, vol 33. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6722-5_1
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