UNFPAState of World Population 2004
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HOME: STATE OF WORLD POPULATION 2004: Reproductive Health and Family Planning
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Reproductive Health and Family Planning

Family Planning and Sexual Health
Contraceptive Access and Use
Unmet Need
Choice of Methods
Sexually Transmitted Infections
Quality of Care
Stronger Voices for Reproductive Health
Securing the Supplies
Men and Reproductive Health

Sexually Transmitted Infections

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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