Public Choices, Private Decisions: Sexual and Reproductive Health ...

32 Sexual and Reproductive Health and the Millennium Development Goals
Good health
is much
more than
the absence
of disease
Secondly, SRH issues cut across traditional measurement lines. SRH
includes diseases (e.g., AIDS) and ‘non-diseases’ or normal physiological
processes (e.g., pregnancy), as well as including both communicable diseases
(e.g., STI) and non-communicable ones (e.g., breast cancer). These disease
groups are usually measured and classified separately, making estimating the
total SRH burden more difficult.
Thirdly, it is important to measure factors that either increase or decrease
a person’s risk of exposure to poor SRH outcomes. And such risk factors often
relate to lifestyle, culture and behavior. But data on these factors are usually
hard to obtain as they touch on intimate topics that are difficult for individuals
or communities to discuss. And often those at the greatest risk of suffering
adverse SRH outcomes are the same people who are hardest for such surveys to
reach (such as sex workers or adolescents).
Fourthly, the measurement of the disease burden does not take into account
impacts on families, communities and society, but only reductions in individual
functioning. Intergenerational impacts of poor realization of reproductive
health are excluded, including those beyond the area of physical impairment.
Finally, and fundamentally, good health is much more than the absence
of disease. And this becomes abundantly clear with SRH – arguably more so
than in other areas of health. Throughout history great emphasis has been
placed on sexuality, pregnancy and childbearing. Indeed, much of our personal
identity as well as our social and personal relationships hinge on this part of
our lives – which is closely related to our overall health and well-being. Today’s
measurement tools are not able to capture such positive aspects of health and
well-being (see further discussion in Section 3 under Goal 3).
Estimates of the overall SRH burden
Despite the difficulty of assessing the overall SRH burden, estimates of the
extent to which adverse outcomes lead to death and disability have been made.
These show that lack of access to SRH is (and has long been) a major public
health concern, especially in developing countries.
A recent costing study of SRH interventions (Vlassoff et al. 2004) reviewed
the burden of disease estimates for components of SRH (table 2.1 and 2.2).
According to these estimates, death and disability due to SRH accounted for
18.4 percent of the overall global disease burden and 32 percent of the disease
burden among women of reproductive age (15–44). Maternal conditions
(including hemorrhage or sepsis due to childbirth, obstructed labor, pregnancyrelated
hypertensive disorders and unsafe abortion) accounted for 2.1 percent
of all disability-adjusted life years (DALYs) 2 lost (and 13 percent among women
of reproductive age) in 2001. And this disease burden has stayed relatively constant
over the past decade, decreasing from 2.2 percent in 1990 to 2.1 percent
in 2001. Perinatal conditions (including low birth weight, birth asphyxia and
birth trauma) accounted for 6.7 percent of all DALYs lost in 2001. HIV/AIDS