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

More documents

Recommendations

Info

42 Sexual and Reproductive Health and the Millennium Development Goals It has been estimated that for every woman who dies in pregnancy or childbirth approximately 30 more suffer injuries, infection and disabilities Maternal and child health As will be described in the following sections of this report (specifically, in the discussion of Goal 5 in Section 3) maternal health must go beyond simply measuring the number of maternal deaths averted. It must also include measurements of other aspects of maternal health, notably the promotion of healthy, voluntary and safe sexual, reproductive and childbearing choices. This includes having access to key aspects of SRH, such as family planning, including safe and effective contraceptive choices; prevention, treatment and care of STIs and HIV/ AIDS; and access to care before, during and after childbirth. Since discussions of trends in these key aspects of SRH are included in Section 3, the following will focus on the burden of maternal mortality and morbidity worldwide. Maternal mortality and morbidity In no other area of health is the disparity between developed and developing countries as great as it is within maternal health. Women in the developing world face a risk of death during pregnancy that is many times higher than women in industrialized countries. A woman has a 1 in 2,800 lifetime chance that she will die from pregnancy-related complications in industrialized countries, while the corresponding risk in developing countries is 1 in every 61. The lifetime risk is even greater in sub-Saharan Africa – 1 in every 16 – reflecting both higher pregnancy rates and the greater risk associated with each pregnancy (UNICEF, WHO and UNFPA 2004). Maternal mortality is notoriously difficult to measure due to weak civil registration systems in developing countries as well as the size of the population needed for estimating maternal deaths from household surveys (given the rarity of the event and thus the need to measure it per 100,000 live births). Maternal mortality estimates also suffer from severe misclassification and underreporting. In recent years, WHO and the United Nations Children’s Fund (UNICEF) (with assistance from UNFPA) have worked to revise these estimates for underreporting and misclassification, as well as to generate estimates for countries without data. It is estimated that maternal mortality takes some 529,000 lives per year (table 2.6), the majority divided almost equally between Africa with 251,000 and Asia with 253,000. Worldwide, the maternal mortality ratio (MMR) is estimated to be about 400 deaths per 100,000 live births. Sub-Saharan Africa has the highest rate at 920 deaths per 100,000 live births followed by South-central Asia with 335 deaths per 100,000 live births. Maternal deaths occur from both direct and indirect complications. Direct complications, which account for 80 percent of maternal deaths, include hemorrhage, sepsis, hypertensive disorders from pregnancy and abortion complications as well as obstructed labor. Indirect complications, such as malaria and AIDS, account for the remaining maternal deaths. The causes of indirect complications vary from region to region.
Section 2: The current situation 43 Table 2.6 Estimates of maternal mortality ratios, maternal deaths and lifetime risk for 2000 Notes: a. Includes, in addition to Europe, Australia, Canada, Japan, New Zealand and United States of America, which are excluded from regional totals b. Excludes Sudan, which is included in sub-Saharan Africa Source: UNICEF, WHO and UNFPA 2004 Region Maternal mortality ratio (maternal deaths per 100,000 live births) Number of maternal deaths Lifetime risk of maternal death 1 in: World total 400 529,000 74 Developed regions a 20 2,500 2,800 Europe 24 1,700 2,400 Developing regions 440 527,000 61 Africa 830 251,000 20 Northern Africa b 130 4,600 210 Sub-Saharan Africa 920 247,000 16 Asia 330 253,000 94 Eastern Asia 55 11,000 840 South-central Asia 520 207,000 46 South-eastern Asia 210 25,000 140 Western Asia 190 9,800 120 Latin America and the Caribbean 190 22,000 160 Oceania 240 530,000 83 The toll of disabilities and illness from maternal complications is significantly higher than the death rate, most dramatically for young women. It has been estimated that for every woman who dies in pregnancy or childbirth approximately 30 more suffer injuries, infection and disabilities. This means that at least 15 million women a year incur this type of damage. The cumulative total of those affected by maternal morbidity has been estimated at 300 million, or more than a quarter of adult women in the developing world (UNICEF 2003). Unsafe abortions It is estimated that approximately 27 million legal abortions and another 19 million illegal and unsafe abortions were performed worldwide in 2000. Unsafe abortions lead to about 68,000 maternal deaths each year and hundreds of thousands of disabilities, which disproportionately affect women in developing countries (WHO 2004b) (table 2.7). Thus, one in eight maternal deaths, on average, is due to an abortion-related complication. This is also the average in Africa, while in Asia it increases to one in six and increases again to one in five in Latin America and the Caribbean. The risk of death from an unsafe abortion is highest in Africa, where the case fatality rate is about seven deaths per 1,000 unsafe abortions. This rate falls to one in 1,000 in Latin America and the Caribbean and to 0.5 in 1,000 in Europe. Section 3 presents more information on this issue.
Page 1 and 2:
Public Choices, Private Decisions:
Page 3 and 4:
Public Choices, Private Decisions:
Page 5 and 6:
Contents Foreword vii Preface ix Ac
Page 7 and 8: Contents v 4.10 IPPF Rights of the
Page 9 and 10: Foreword The world has an unprecede
Page 11 and 12: Preface The Millennium Declaration
Page 13 and 14: Acknowledgements This report reflec
Page 15 and 16: Acronyms AGI AIC CCA CCM CDC CEDAW
Page 17 and 18: Executive summary Introduction Sexu
Page 19 and 20: Executive summary 3 Unsafe abortion
Page 21 and 22: Executive summary 5 A diseaseorient
Page 23 and 24: Executive summary 7 There is a stro
Page 25 and 26: Executive summary 9 Children born t
Page 27 and 28: Executive summary 11 Only one in fi
Page 29 and 30: Executive summary 13 Maternal morta
Page 31 and 32: Executive summary 15 SRH issues pos
Page 33 and 34: Executive summary 17 Young women an
Page 35 and 36: Executive summary 19 The expansion
Page 37 and 38: Section 1 Introduction At the Mille
Page 39 and 40: Section 1: Introduction 23 • Targ
Page 41 and 42: Section 1: Introduction 25 Table 1.
Page 43 and 44: Section 1: Introduction 27 Reproduc
Page 45: Section 1: Introduction 29 Ensuring
Page 48 and 49: 32 Sexual and Reproductive Health a
Page 73 and 74: Section 3 The impact of ensuring un
Page 75 and 76: Section 3: The impact of ensuring u
Page 109 and 110:
Section 3: The impact of ensuring u
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Section 4 What needs to be done In
Page 121 and 122:
Section 4: What needs to be done 10
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161:
Page 164 and 165:
148 Appendix 1 Gender equality is e
Page 166 and 167:
150 Appendix 1 services by 2015 thr
Page 169 and 170:
Appendix 2 MDG interventions by are
Page 171 and 172:
Appendix 2 155 Behavior change prog
Page 173:
Appendix 2 157 Outreach to men to i
Page 176 and 177:
160 Notes 1997). Such education eff
Page 178 and 179:
162 Notes medium variant has proven
Page 180 and 181:
164 Bibliography AGI and UNFPA. 200
Page 182 and 183:
166 Bibliography Debpuur, C., J.F.
Page 184 and 185:
168 Bibliography IPPF/WHR. 2000. Ma
Page 186 and 187:
170 Bibliography N. Birdsall, A.C.
Page 188 and 189:
172 Bibliography UN. 1989. Conventi
Page 190 and 191:
174 Bibliography UNAIDS. 1997. Impa
Page 192 and 193:
176 Bibliography UNICEF. 2001a. Ear
Page 194 and 195:
178 Bibliography WHO. 2005c. WHO mu
Page 196 and 197:
UN Millennium Project: Commissioned
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?