New push to tackle priorities in sexual and reproductive health

Leaders of the World Health Organization (WHO) and UNFPA, the United Nations Population Fund, are coordinating action to reverse the global trend of deteriorating levels of sexual and reproductive health and reduce the adverse impact on mothers, babies and young people.

Globally, inadequate sexual and reproductive health services have resulted in maternal deaths and rising numbers of sexually transmitted infections (STIs), particularly in developing countries. WHO estimates that 340 million new cases of sexually transmitted bacterial infections, such as chlamydia and gonorrhoea occur annually in people aged 15 - 49. Many are untreated because of lack of access to services. In addition, millions of cases of viral infection, including HIV, occur every year. The sexually transmitted human papilloma virus (HPV) infection is closely associated with cervical cancer, which is diagnosed in more than 490 000 women and causes 240 000 deaths every year.

Around eight million women who become pregnant each year suffer life-threatening complications as a result of sexually transmitted infections and poor sexual health. Annually, an estimated 529 000 women, almost all in developing countries, die during pregnancy and childbirth from largely preventable causes.

"There is a really worrying rise in the number and severity of sexually transmitted infections," says Dr Anders Nordström, Acting Director-General, WHO. "But the consequences of poor sexual and reproductive health go well beyond STIs. They lead directly to completely preventable illness and death. It is unacceptable today for a woman to die in childbirth, or for a person to become HIV positive for lack of information and resources."

Young people are particularly vulnerable. More than 100 million curable sexually transmitted infections occur each year and a significant proportion of the 4.1 million new HIV infections occur among 15-to-24 year olds. In sexually active adolescents (aged 10-19 years), sexual and reproductive health problems include early pregnancy, unsafe abortion, STIs including HIV, and sexual coercion and violence.

"It is clear that the Millennium Development Goals 5 and 4 to reduce mother and child deaths by 2015 cannot be achieved without investing in sexual and reproductive health," says Ms Thoraya Ahmed Obaid, Executive Director, UNFPA. "For example, averting unintended pregnancy and reducing unmet need for family planning are key interventions in improving maternal health and reducing perinatal death. Yet, in developing countries and those in transition, an estimated 200 million women lack access to family planning."

In addition, in some cultures, three million girls and young women are subjected each year to genital mutilation/cutting which, in recent studies by WHO, has been shown to significantly increase the risk of death and serious injury for newborn babies and their mothers around childbirth.

Following a high-level meeting on Friday, the leaders agreed the agencies will coordinate action in countries to ensure programmes are more effective and accountable for results.

The aim is to scale-up work to put a number of global proposals and initiatives into action in countries: The Global Reproductive Health Strategy, endorsed by the World Health Assembly, a 2005 Resolution on achieving internationally agreed health-related development goals, including those contained in the Millennium Declaration, another on working towards universal coverage of maternal, newborn and child health interventions, and this year's World Health Assembly Resolution agreeing to the Global Strategy to tackle sexually transmitted infections.

A communiqué issued at the end of the meeting identified a number of priority areas including:

• A coordinated action plan to implement the Global STI Prevention and Control Strategy;
• Support to countries to increase skilled health attendants in target countries;
• Coordinated workplans on improving reproductive, maternal, newborn and adolescent health;
• "One framework" plans for the 16 African countries covered by the strategic framework just completed by the UN agencies;
• Advocacy for inclusion of sexual and reproductive health in national economic planning such as Poverty Reduction Strategies (PRSPs);
• Strengthening the linkages between HIV and sexual and reproductive health through coordinated action in HIV prevention, care and treatment;
• Joint training of country teams on the process for planning and working together at country level and joint competency reviews;
• Coordinated work in countries addressing:
  • Female genital mutilation/cutting
  • Obstetric fistula
  • Violence against women, including in emergencies
  • A pilot programme in two countries to introduce the Human Papilloma Virus (HPV) vaccine
  • Human resources for health.

"The key is to make practical plans in order to implement these strategies," says Ms Obaid. "We are faced with an urgent need to increase investment in sexual and reproductive health to ensure access to quality reproductive health services, including youth-friendly services, and to link HIV/AIDS and STI prevention with reproductive health services and vice versa."

"Country support and advocacy are going to be vital elements for any successful attempt to reduce the impact of poor sexual and reproductive health," says Dr Nordström. "Evidence shows that investments in and access to sexual and reproductive health, including family planning, are essential to breaking the cycle of poverty. This then frees national and household resources for investments in health, nutrition, and education, promoting economic growth with tangible returns."