an Eldis Resource
The Lancet sexual and reproductive health series
Research and advocacy to improve sexual and reproductive health services
Authors:
A Glasier (ed); A M Gulmezoglu (ed); The Lancet
Publisher:
World Health Organization , 2009
The Lancet sexual and reproductive health series aims to stimulate awareness and action among decision makers, policymakers, medical researchers and other professionals on emerging and significant SRH issues, while serving as a tool for evidence-based advocacy and advancing research on preventable illness and death. Four of the articles outline components of interventions regarding sexual behaviour, family planning, safe abortion and STIs and the final one makes recommendations for the future.
1. Sexual behaviour: lessons learned
• No single, general approach to sexual health promotion will work everywhere.
• Public health interventions need to address the broader determinants of sexual behaviour, such as gender, poverty and mobility.
• Risk reduction messages need to respect diversity and preserve choice. For example, the preoccupation with ABC strategies (Abstinence, Be Faithful, and Use Condoms) distracts attention from the need for broader, integrated programmes in which all components are mutually reinforcing.
• School-based sex education improves awareness of risk and knowledge of risk reduction strategies
• Preventive programmes focusing on naturally occurring social networks have been used to reduce the level of risky behaviour among gay men in Russia; to increase contraceptive use among married women in Bangladesh and to increase condom use among sex workers in India.
• Strong social prohibitions and sanctions, especially where legislated, may pose the greatest challenges to reduce high risk sexual behaviour.
2. Family Planning: key components
• Support from religious, secular and traditional leaders and professional groups
• High level political commitment, organisational ability and adequate funding
• 10% to 20% of government family planning budgets should be allocated to educational campaigns and social marketing which can increase awareness as seen in Kenya in the late 1990s.
• Mobilising support at the community level is important, though these efforts require considerable skill, sensitivity, and local cultural knowledge, such as the case of Bangladesh programmes to increase contraceptive use.
• A range of family planning services must be made accessible and affordable through medical facilities, social marketing, and outreach services.
3. Safe abortion: key components
• Manual vacuum aspiration for surgical evacuation within 12 weeks of pregnancy.
• The combined use of mifepristone and misoprostol for an early medication abortion.
• Prompt and appropriate treatment of complications and timely evacuation of incomplete abortions
• Post-abortion counselling, education, and family-planning services
4. STIs: successful interventions
• Diagnostic tests, antibiotics, antivirals, and vaccines are effective at the individual level, but often not available in resource-poor settings.
• Syndromic management is a core strategy for managing individuals with STIs in resource-poor settings.
• Antenatal syphilis screening is a partner level intervention that could prevent half a million foetal deaths per year through rapid on-site syphilis testing and treatment.
• Systematic population level screening can reduce the incidence of pelvic inflammatory disease and Chlamydia prevalence.
• Population level vaccination against HPV could prevent up to 70% of all cervical cancers worldwide.
• STI control strategies should not solely focus on HIV/AIDS prevention programmes.
• Surveillance needs improvement, as well as research on resistance patterns.
Recommendations:
• Interventions may be scaled up through the expansion or replication of services, the integration of additional services into already existing ones, or a special effort to get the issue on the policy agenda.
• Advocacy efforts need to be scaled-up, especially at the national level, to convince policymakers of the importance of SRH programmes.
• It is critical that existing and new donors increase support for SRH programmes and services that have been designed and developed at the country level.
