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Risky sex a global killer

5th November 2006

31052006_young_couple_sad1.jpgUnsafe sex is the second most important risk factor for disability and death in the world's poorest communities and the ninth most important in developed countries.

Cheap effective interventions are available to prevent unintended pregnancy, provide safe abortions, help women safely through pregnancy and child birth, and prevent and treat sexually transmitted infections.

Yet every year, more than 120 million couples have an unmet need for contraception, 80 million women have unintended pregnancies (45 million of which end in abortion), more than half a million women die from complications associated with pregnancy, childbirth, and the postpartum period, and 340 million people acquire new gonorrhoea, syphilis, chlamydia, or trichomonas infections.

Sexual and reproductive ill-health mostly affects women and adolescents. Women are disempowered in much of the developing world and adolescents, arguably, are disempowered everywhere.

Sexual and reproductive health services are absent or of poor quality and underused in many countries because discussion of issues such as sexual intercourse and sexuality make people feel uncomfortable.

The increasing influence of conservative political, religious, and cultural forces around the world threatens to undermine progress made since 1994, and arguably provides the best example of the detrimental intrusion of politics into public health.

Despite the call for universal access to reproductive health at the 4th International Conference on Population and Development in Cairo in 1994, sexual and reproductive health was omitted from the Millennium Development Goals and remains neglected.

The 1994 UN Cairo population conference reflected the growing awareness that population, poverty, health, education, patterns of production and consumption, and the environment are all inextricably linked. Although these links now seem obvious, at the time this awareness represented a major shift in attitude towards population growth.

Another major shift in attitudes was in the 15 guiding principles underpinning the programme of action, which incorporated several universally recognised human rights. These rights included the recognition that advancement of gender equality and equity and the empowerment of women, and the elimination of all kinds of violence against women, and ensuring women's ability to control their own fertility, are cornerstones of population and development-related programmes.

Nonetheless, WHO has identified unsafe sex as the second most important risk factor for disease, disability, or death in the poorest communities and the ninth in developed countries.

Every year, an estimated 210 million women have life-threatening complications of pregnancy, often leading to serious disability, and a further half a million women die in pregnancy, childbirth, and the puerperium (more than 99% of these deaths are in developing countries).

Three million babies die in the first week of life and about 3ยท3 million infants are stillborn every year. More than 120 million couples have an unmet need for contraception and 80 million women each year have unwanted or unintended pregnancies, 45 million of which are terminated. Of these 45 million abortions, 19 million are unsafe, 40% of them are done on women aged under 25, and about 68,000 women die every year from complications of unsafe abortion.

An estimated 340 million new cases of four common sexually transmitted bacterial and protozoal infections are acquired every year, at least a third of which affect people aged under 25. Such infections contribute to the global problem of infertility, which affects more than 180 million couples in developing countries (excluding China).

Nearly 5 million new HIV infections and 257,000 deaths from cervical cancer every year complete this long and dismal record of sexual and reproductive ill-health.

Physical and sexual violence, reported by between one in two and one in six women, is an underlying risk factor for many of these sexual and reproductive health problems.


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