The work of the Sexual and Reproductive Health (SRH) Programme in the WHO African is to strengthen the capacity of Member States in the Region for accelerated action to implement the reproductive and women's health strategies by supporting countries to develop guidelines, approaches and tools to ensure universal coverage of interventions through:
- Control of Sexually Transmitted and Reproductive Tract Infections, and HIV/AIDS
- Gender Mainstreaming in Sexual and Reproductive Health
- Prevention of Cervical Cancer
- Prevention of Unsafe Abortion
- Repositioning Family Planning
Each year some 500 million new cases of syphilis, gonorrhoea, chlamydia and trichomoniasis occur in men and women; overall, STI prevalence rates continue to rise in most countries.
The majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding. The interactions between sexual and reproductive health and HIV/AIDS are now widely recognized. In addition, sexual and reproductive ill-health and HIV/AIDS share root causes, including poverty, gender inequality and social marginalization of the most vulnerable populations.
Unsafe or unprotected sex increases a person’s chances of contracting HIV, other sexually transmitted infections and unwanted pregnancy.
Of the 2.7 million new HIV infections worldwide in 2010, 70% (1.9 million) were in sub-Saharan Africa. Most newly infected people in this region acquire the virus during unprotected heterosexual intercourse. The prevalence of HIV infection among young women in sub-Saharan Africa is disproportionately higher than among young men.
In 2010, 71% of people living with HIV aged 15–24 years were women and one quarter of all new HIV infections globally were in young women aged 15–24 years.
This is attributed to women having a sexual debut earlier than men, and fewer numbers using condoms than men (42% versus 63.6%) during the sexual act, sexual violence against women and girls and biological factors. In addition, adolescent girls have an increased risk because they are often married to older partners, who are more likely to have been exposed to HIV. For example in one study, the husbands of adolescent girls were found to have HIV 30% of the time, while the male peers of these girls had only a 12% HIV rate.
Several other infections result from risky sexual behaviour. HPV, which is responsible for almost all cervical cancer, is sexually transmitted.
Cervical cancer is the leading cause of cancer deaths in the Region. Other sexually transmitted infections such as syphilis, gonorrhoea and chlamydia are entirely attributable to unsafe sex, and still occur in several African countries.
The main objective in this area is to provide guidance on strategies for controlling sexually transmitted infections (STIs) and reproductive tract infections (RTIs), including strategies to prevent mother-to-child transmission of HIV and other STIs and to improve strategies for the integration of RH and HIV/AIDS. The following outcomes are expected:
- improved access to, and uptake of key HIV/AIDS and SRH services, better access of people living with HIV/AIDS (PLWHA) to SRH services tailored to their needs,
- improved coverage of underserved and marginalized populations, such as injecting drug users, sex workers or men who have sex with men, with SRH services,
- greater support for dual protection against unintended pregnancy and sexually transmitted infections (STIs), including HIV, for those in need, especially young people,
- improved quality of care and enhanced programme effectiveness and efficiency.
Gender mainstreaming is both a strategy for planning and a tool for advocacy to reduce harmful effects of the social determinants of health, for men and women. However the health professionals are not adequately prepared to address gender specific health needs of women and men in their work. Special attention must be paid to particular groups who experience greater mortality and morbidity related to sexual and reproductive conditions than those who are in a better situation.
Due to a significant societal disadvantage, girls and women have limited access to health care. As an evidence of the burden of disease related to gender inequality, it is estimated that of all adults living with HIV in sub-Saharan Africa, 61% are women. Maternal mortality is also higher in developing countries than in the industrialized world. Sexual and gender-based violence affect mostly women.
It is therefore critical that public health actors must be able to identify the factors that put women and men at risk, and address these factors through effective interventions. The SRH Programme and the Gender and Women's Health Programme will support countries to seek structural changes focused on the needs of people in view to ensure universal access to appropriate quality sexual and reproductive health care.
Worldwide three quarters of cervical cancer cases occur in developing countries where programmes for screening and treatment are seriously deficient. Cervical cancer is the commonest cancer among sub-Saharan African women. It affects the younger age group as a result of early sexual activity, several sexual partners and history of sexually transmitted infections mainly linked with human papilloma virus (HPV).
One way to prevent cervical cancer is through screening and early treatment programmes. Early detection and management of precancerous lesions require political and technical input. Challenges faced by countries are: lack of awareness of people about cervical cancer, absence of policy framework, inadequate infrastructures, insufficient of data and evidence.
Since 2005, a pilot project on cervical cancer prevention is conducted by WHO, Headquarters and the Regional Office for Africa, in collaboration with International agency for research on cancer, in six African countries to strengthen national programmes. The objective of the project is to assess the acceptability and feasibility of implementing a cervical cancer prevention programme based on a "se and treat approach" using a technique called visual inspection with acetic acid (VIA) followed by cryotherapy at primary health care level.
Well organized, screening and early treatment programmes have been effective in preventing the cervical cancer. However, they are difficult to implement in low-resource setting. Since 2006, different vaccines that protect against certain types of HPV infection were licensed. African countries need to consider whether and how to use these new vaccines. The SRH Programme in the Regional Office is planning operational research on the use of HPV vaccines in selected settings.
Worldwide, an estimated five million women are hospitalized each year for treatment of abortion-related complications, such as hemorrhage and sepsis. Complications due to unsafe abortion procedures account for an estimated 13% of maternal deaths worldwide, or 67,000 per year. Almost all abortion-related deaths occur in developing countries. They are highest in Africa, where there were an estimated 650 deaths per 100,000 unsafe abortions in 2003, compared with 10 per 100,000 in developed regions. Approximately 220,000 children worldwide lose their mothers every year from abortion-related deaths.
Additional consequences of unsafe abortion include loss productivity, economic burden on public health systems, stigma and long-term health problems, such as infertility. More than one-third of the approximately 205 million pregnancies that occur worldwide annually are unintended and about 20% of all pregnancies end in induced abortion. Of the 23 million pregnancies that occur in developed countries, more than 40% are unintended, and 28% end in induced abortion. Of the 182 million pregnancies that occur in developing countries, more than one-third are unintended, and 19% end in induced abortion (8% are safe procedures and 11% are unsafe).
The average woman must use some form of effective contraception for at least 20 years if she wants to limit her family size to two children, and 16 years if she wants four children. Two-thirds of unintended pregnancies in developing countries occur among women who are not using any method of contraception. More than 100 million married women in developing countries have an unmet need for contraception, meaning they are sexually active; are able to become pregnant; do not want to have a child soon or at all; and are not using any method of contraception, either modern or traditional.
The reasons why women (married and unmarried) do not use contraceptives most commonly include concerns about possible health and side effects and the belief that they are not at risk of getting pregnant. The aim of this component is to determine unsafe abortion prevalence and practices, to produce norms, tools and guidelines on preventing unsafe abortion, and to assist countries in reducing unsafe abortion among others, by preventing unwanted pregnancies and improving access to quality post-abortion care.
Every day, 1,600 women and more than 10,000 newborns die from preventable complications during pregnancy and childbirth. Almost 99% of these maternal and 90% of neonatal deaths occur in the developing countries. As the first pillar of safe motherhood and essential component of primary health care, family planning plays a major role in reducing maternal and newborn morbidity and mortality.
Family planning enhances efforts to improve family health. However, traditional beliefs, religious barriers and lack of male involvement have weakened family planning interventions. Research has confirmed high "unmet need" for family planning in sub-Saharan Africa in term of the number or percentage of married women who say they prefer avoid a pregnancy but are not using any method of contraception.
In recognition of the family planning importance, the ministers of Health adopted a framework 2005-2014 for accelerated action to reposition family planning on national agenda and in reproductive health services. The framework, developed by the WHO Regional Office for Africa, in collaboration with its partners calls for increased efforts to advocate the recognition of the pivotal role of family planning in achieving health and development objectives at all levels, as targeted by MDGs 4, 5 and 6.
SRH Programme is supporting countries to: (i) raise awareness at policy and political level on the benefit of family planning, (ii) develop or review family planning policies, (iii) improve the quality of family planning and other reproductive health services and (iv) foster integration of family planning into reproductive health.