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Reproductive Health and Family Planning
Some 340 million new cases of sexually transmitted
bacterial infections occur each year (including
syphilis, gonorrhoea, chlamydia and trichomoniasis)
in people between ages 15 and 49.(23) While most are
treatable, many are undiagnosed and go untreated
because of the lack of accessible services.(24) Untreated
STIs are a leading cause of infertility, which affects
60 to 80 million couples worldwide.
More than three fourths of the 5 million new
cases of HIV infection each year are sexually transmitted
(see Chapter 8). An STI that goes untreated
can increase the risk of HIV infection and transmission
by up to 10 times.(25) Another viral STI, the human
papillomarvirus, is linked to cervical cancer, which kills 240,000 women each year. Condoms, both male
and female, are the only contraceptive methods that
provide significant protection against viral and bacterial
STIs.(26)
The ICPD called for screening and treatment for
STIs, along with information and counselling, to
become “integral components of all reproductive
and sexual health services”.(27)
GENDER DIFFERENCES. Over the past decade, increasing
attention has been given to the critical role of gender
in diagnosing and treating STIs. Women are at greater
risk of infection than men, and screening is more difficult:
70 per cent of women with STIs do not have
symptoms (compared to 10 per cent of men).(28)
The management of STIs can have an important
place in the provision of family planning. Where
equipment is not available to test for STIs, health
workers use a “syndromic approach” to diagnosis,
based on risk factors and client symptoms. But this
approach has limitations, and infections often go
undiagnosed and untreated.(29)
Untreated STIs in pregnant women can facilitate
the transmission of infection to the infant and raise
the risk of a pre-term or low birth weight delivery
or infant blindness.(30)
INTEGRATION. Providing STI screening, diagnosis and
treatment as part of reproductive health care offers
the opportunity to reach millions of women who seek
such services, many of whom have no other contact
with the health care system. Experience shows that
integrating STI prevention, family planning, and
counselling on sexuality and partner relationships
can result in greater use of services.(31)
Integrated services, rather than stand-alone facilities
or treatment by private doctors, allow savings in
costs, staff, supplies and equipment, and are typically
more convenient for clients.(32) But efforts to dismantle
vertical STI programmes have met some resistance.
Indonesia began integrating STI services with
other reproductive health services in 1995. To overcome
the stigma associated with STI care or concerns
about sex workers using health facilities, STI services
were offered outside normal clinic operating hours
and in separate examination rooms.(33)
In the 2003 UNFPA global survey, 43 countries
reported taking measures since the ICPD to integrate
information on STIs and/or HIV/AIDS prevention into
primary health care.(34) Ecuador, Liberia, Mozambique
and Zimbabwe, for example, now include STI services
in primary health facilities.(35)
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