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Health and Poverty

Overview
Reproductive Health and Poverty
Measuring Health Differentials between Rich and Poor
Supporting More Equitable Health Care

Reproductive Health and Poverty

Reproductive health issues are fundamentally different from almost all other health concerns. Sex and reproduction are at the core of life, a source of joy, affection and spiritual connectedness.

RIGHTS DENIED Worry about their reproductive health is also, particularly for women, another of the insecurities that mark the experience of poverty. In the absence of family planning-to which poor women have less access than the better off-the risk of unwanted pregnancy can make any sexual encounter a source of worry; (11) the possibility of a sexually transmitted infection, particularly HIV, adds to the insecurity. Pregnancy can be a hazardous and worrisome time; childbirth can lead to illness, debilitating injury or death.

Lower fertility, including fewer unwanted births, leads to better health outcomes for women and children. Unwanted children are more prone to respiratory and diarrhoeal infections than wanted children. Wanted or not, each additional sibling reduces the chance of a child receiving treatment by 2 to 8 per cent. Where vaccination levels are low, wanted children receive 50 to 100 per cent more vaccinations than unwanted ones do (12).

SOCIAL CONSTRAINTS People in many cultures find it hard to discuss sex and reproduction. In these circumstances exercising choices-planning for contraceptive use, for example-can be experienced as shameful and humiliating. Discussing genderbased violence, particularly sexual violence, is especially hard for poor women (13).

There is another crucial difference regarding reproductive health. Only women bear children. They are exposed to risks that men cannot fully appreciate. Women are also more exposed to shared risks, such as sexually transmitted diseases, for reasons both of biology and of social disadvantage.

Social constraints affect women's reproductive health care. Men are more likely to use formal health services, partly because they control the money needed to pay for them. Women are more likely to rely on traditional or other alternative services, because they are cheaper, closer at hand and more familiar (14). A woman may be unwilling to travel alone, or not allowed to go to health services without the approval of her husband or another man in the family or community.

Women's experience of health care also affects the way they use it: they are not guaranteed sensitive treatment at the clinic or hospital. Health workers tend to look down on poor women. Illiterate women in particular may feel unable to describe their condition or understand the advice they are given.

The reproductive health needs of the poor, and poor women in particular, do not command the attention of policy makers, or even of women themselves. The poor give priority to their many immediate and pressing needs. Pregnancy and childbirth are taken for granted-and so are the attendant risks, though they come from easily preventable causes.

17 REPRODUCTIVE HEALTH FOR BANGLADESH'S URBAN POOR

Bangladesh's urban population is growing by 6 per cent a year, three times the national growth rate. Growth is fastest in the slums, where there are some 225,000 persons per square kilometre. Half of slum inhabitants are poor; 30 per cent are classifiable as hard-core poor.

Rapid urbanization has produced degrading environmental and health conditions. Diarrhoea is almost twice as prevalent in the crowded slums of Dhaka and Chittagong as in rural areas. Malnutrition, tuberculosis, vaccine-preventable diseases and sexually transmitted infections are also more prevalent; immunization rates are lower.

Women in the slums have limited access to reproductive health information and care because health centres are not conveniently located. As a result:

  • 93 per cent of married teenagers have begun childbearing;
  • 22 per cent of girls give birth before age 15;
  • 63 per cent of women have never used a modern method of family planning;
  • 40 per cent became pregnant unwillingly due to lack of knowledge of services.

Under the Urban Primary Health Care Project, supported by UNFPA, the Asian Development Bank and the Norwegian Agency for Development Cooperation, 14 experienced NGOs are strengthening reproductive health services and training staff and managers.

Nine city-run maternity centres in Dhaka and 16 NGO-run clinics have been upgraded to comprehensive reproductive health centres. These handle referrals from 190 primary health care centres, and will eventually provide: pre- and post-natal care and normal delivery services; emergency obstetric care; clinical and non-clinical contraceptives; and treatment for reproductive tract and sexually transmitted infections.

So far, about 200 doctors, paramedics, counsellors and laboratory technicians have been trained in care and counselling. Ten centres now provide caesarean section delivery.

Within urban communities, the project provides information on safe motherhood, breastfeeding, family planning, sexually transmitted infections and HIV/AIDS.See Sources



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