12 Reproductive health issues and sexually transmitted infections

Nupur Mahajan and Gautam Kshatriya

epgp books

 

 

 

Contents:

 

Reproductive health: an insight

  • Scope of reproductive health
  • Factors affecting reproductive health
  • Reproductive health indicators for global monitoring

    Reproductive health Issues in India

Sexually Transmitted Infections

  • Types of STIs
  • Scope of the problem
  • Prevention of STIs

Counselling and behavioural approaches

Barrier methods

  • Diagnosis of STIs
  • Treatment of STIs
  • STI case management

Vaccines and other biomedical interventions

  • Problems encountered in interventions for STIs
  • Interventions by WHO

    Learning Objectives:

  • To understand the concept of reproductive health
  • To know about the factors affecting reproductive health
  • To get an understanding of the reproductive health issues in India
  • To understand the type, scope, prevention, diagnosis and treatment of sexually transmitted infections

    Reproductive health: An insight

 

The World Health Organization defines “Health” as the condition of overall physical, mental and social well-being; and not merely the absence of disease or illness. Furthermore, reproductive health or sexual health is mainly concerned with the reproductive system, their functions and the processes for every stage of life (WHO, 1948). Therefore, reproductive health implies that individuals are capable to have a safe, responsible and satisfying sexual life; have the competence to reproduce and the choice to make a decision if, when and how frequently they want to do so (ICPD Program of Action, 1994). The concept of reproductive health also coupled the integration of the right of men and women to be educated about steps for safe sex and providing them easy access to secure, effective, and reasonably priced methods of fertility guideline of their own wish, and the right of usage of apposite health care facilities that will help women to be safe and protected throughout pregnancy and childbirth and provide couples with the efficient chances of having healthy infants (WHO, 1988). Reproductive health, therefore, refers to the diseases, illness, and disorders which affect the functioning and performance of male and female reproductive systems throughout life. Reproductive disorders consist of birth defects, developmental disorders, low birth weight, premature birth, infertility, impotency, and menstrual dysfunctions (NIH, 2015).

 

Reproductive health as a concept was first discussed at the International Conference on Population and Development (ICPD) held at Cairo in 1994. The key agenda of the conference was to promote reproductive health and well-being, planned and safe sexual and reproductive alternatives for individuals as well as couples that emphasize on their right to decide upon the age of marriage, size of family, and probable gap between consecutive childbirth. Sexuality and reproduction are the main facets of an individual’s identity and they are also basic to human welfare fulfilling the relationships within diverse cultural contexts.

 

The idea of reproductive health and management has an elementary vision that each child who is born is wanted; every birth which is facilitated is safe, every individual be it young or old is free from sexually transmitted infections, and furthermore, every woman is cared with dignity. It is evident that access to better quality health care facilities and services will provide significant help to women so that they can experience safe pregnancy and protected childbirth all over the world. However, women residing in developing countries still face disparities regarding the attention and health care services provided to them pre and post pregnancy and during pregnancy. They suffer from problems such as unwanted pregnancies, the incidence rate of maternal death and disorders is also evidently high, and they are vulnerable to sexually transmitted infections including HIV. Gender based violence; female genital mutilation and other conditions associated with female reproductive system and sexual behaviour are also a great concern in developing and underdeveloped countries (UNFPA, 2015). (Reproductive health issues are discussed in module number 9)

 

Scope of Reproductive Health

 

The International Conference on Population Development (ICPD) Programme of Action has identified six components in context to the primary health care associated with the reproductive health, which are:

  • Family planning related counselling, information, education, communication, and services
  • Education and services regarding prenatal care, safe methods of delivery, and post-natal care, with special emphasis on breast-feeding practices, infant and mother’s health care;
  • Prevention and apposite treatment of infertility;
  • Prevention of unsafe abortion and proper management of the subsequent consequences of abortion
  • Spreading awareness and providing proper treatment of Reproductive Tract Infections (RTls), sexually transmitted diseases (STDS) and other reproductive health problems
  • Facilitating information, education and counselling on issues of human sexuality, reproductive health and responsible parenthood.

    Factors affecting reproductive health

 

There is a complex interplay of socioeconomic, environmental, and cultural factors that contribute to the reproductive ill-health of populations, particularly women, in developing countries. Poverty, ignorance, illiteracy and malnutrition are major determinants of women’s health status. Also significant are the age at marriage and pregnancy, the number and frequency of childbearing, and the numbers of unwanted pregnancies and abortions that contribute to morbidity and mortality among women and their babies. The lower the status and worth of women in society, the higher the maternal mortality and not least important, are the health service-related factors such as lack of access to quality reproductive health services.

 

Diet and nutrition play a vital role in maintaining the health of an individual. Deficiency of Vitamin D and K is known to be a contributing factor of infertility. Thus, proper nutrition helps in balancing the reproductive health of men as well as women. Several studies have also indicated that the intake of vitamin rich diet facilitates the improvisation of sexual health and well-being.

 

The reproductive fertility of both men and women is also affected by their body weight. Overweight and obese women experience problems in ovulation, irregular or scanty periods, polycystic ovarian syndrome, and abnormalities in insulin response and have imbalance in estrogen levels. Women who are underweight may also have problems in ovulating during their monthly menstrual cycle. A woman’s age is also a significant factor which contributed to her ability to conceive. After the age of 35, there is a fall in production of eggs in a woman’s ovaries, their fertility begins to decline after this age. With the quantity, the quality and longevity of the produced eggs also starts deteriorating with age. Women nearing menopause have a higher risk of producing eggs with chromosomal abnormalities, which might lead to birth defects and miscarriage. Late age of pregnancy and conception also results in off springs having a higher risk of having birth defects such as Down’s syndrome, Edward’s syndrome or Patau’s syndrome and other chromosomal aberrations. On the contrary, early age of a girl at the time of her marriage may affect her reproductive health adversely. The early age of child bearing have higher risks of complications pertaining to it, because the body requires proper nutrition and strength to carry the foetus and for its overall development, which may not be possible in case of young girls being pregnant. This may lead to simultaneous induced abortions, fatigue, and even death in adverse cases. However, adolescent girls in many parts of the world are married at a very early age and they are often at a weak position to gain access to contraceptive measures or refuse sexual contact with their partners.

 

Gender disparity limits women’s and girls’ control over their sexual and reproductive choices and consent. This has been manifested all around the world with widespread violations of health and human rights, which include human trafficking for sexual purposes, sexual violence and coercion, practices of female genital mutilation, and an enduring pressure to get married and start bearing offsprings at a very early age. These types of violation are rampant in high, middle and low income countries, which the women in developing and underdeveloped countries being the worst sufferers.

 

Although accessibility of safe health care facilities is a key element of all the prime organizations undertaking reproductive and sexual health initiatives, globally, each year almost 10-15 million women are recorded to suffer severe or chronic illnesses which have been caused by complications which occur during pregnancy or childbirth. The organizations along with their allies at the ground level are trying to provide proper health care solutions and manage complications related to pregnancy and childbirth, however, still a major chunk of women are deprived of these facilities and this is resulting in high proportions of women being suffering with these chronic illnesses. If all women will have access to antenatal care before pregnancy, skilled care during childbirth, and proper look after and support in after childbirth, these figures will come down rapidly and it will facilitate the improvisation of the overall health status of a country.

 

Every year one fourth of all pregnancies result in abortion, of which one-fourth of these abortions are done through unsafe practices and steps. Unsafe abortion is when the practice is done by someone who lacks the necessary skills to perform the procedure safely, or when an abortion is carried out in unhygienic conditions, where the victim is vulnerable to infections. Globally, every year about 68,000 deaths occur due to unsafe abortions, out of which majority are young women, who are unaware of the unsafe abortion practices. About 90% of abortion-related deaths and disabilities around the world can be avoided only if women are aware of and are able to practice their right to access to effective contraception and safe abortion care.

 

Apart from these biological and social factors, environment to affects the reproductive health of women. Estrogen level fluctuates when it comes in contact with chemical fertilizers, pesticides and industrial solvents. Smoking and alcohol consumption also leads to severe reproductive problems such as damage to ovaries, alterations in menstrual cycle, early menopause, and reduction in production of fertile eggs. Stress is another factor, if severe enough, can halt menstruation.

 

Reproductive health indicators for global monitoring

 

Total fertility rate: TFR is defined as the total number of children a woman will have by the end of her reproductive period, provided she qualifies the prevailing age-specific rate of fertility throughout the phase of childbearing. TFR is one of the most extensively used fertility measures to gauge and assess effectiveness of the family planning programmes. This measure remains unaffected by the age structure of female population.

 

Contraceptive prevalence: This indicator estimates the percentage of women belonging to the reproductive age who are using (or if their partner is using) any kind of contraceptive method at a particular point of time.

 

Maternal mortality ratio (MMR): MMR is calculated as the number of maternal deaths per 100,000 live births which are caused due to complications with pregnancy and child birth.

 

Antenatal care coverage: This indicator measures the percentage of women who have been attended by skilled health care personnel, at least once during pregnancy, for reasons relating to pregnancy. Births attended by skilled health personnel: It computes the percentage of births which are attended and facilitated by skilled health personnel. This measure does not account for the deliveries assessed by traditional birth attendants.

 

Availability of basic essential obstetric care: It measures the number of services with operational basic essential obstetric care for every 500,000 individuals in a population. Essential obstetric care includes parenteral antibiotics, oxytocic drugs, sedatives for eclampsia, removal of placenta manually, and assisted vaginal delivery. These services are provided at the health centre level by trained attendants.

 

Availability of comprehensive essential obstetric care: This indicator assesses the number of facilities with an operational wide-ranging essential obstetric care per 500 000 individuals in a population. It integrates obstetric surgery, anaesthesia and blood transfusion facilities along with the basic obstetric care services.

 

Perinatal mortality rate: It measures the number of perinatal deaths per 1000 total births. Prenatal deaths include deaths occurring during late pregnancy, during childbirth and up to seven completed days of life which is the period from 22 weeks of gestation till the end of the first week after the birth of child. Total birth means a sum of live birth and IUFD (intrauterine fetal death) born subsequent to the foetus reaching the stage of viability.

 

Low birth weight prevalence: This measures the percentage of occurrences of live births who weigh less than 2.5 kg.

 

Positive syphilis serology prevalence in pregnant women: It is the percentage of pregnant women aged 15–24 (whose blood sample screened for syphilis showed positive serology for it) attending the antenatal clinics.

 

Prevalence of anaemia in women: It is referred to as the percentage of women of reproductive age that is 15–49 who have been screened for haemoglobin levels for anaemia. The levels below 110 g/l for pregnant women and below 120 g/l for non pregnant women are included in this percentage.

 

Percentage of obstetric and gynaecological admissions owing to abortion: Percentage of all cases admitted to the service delivery points facilitating the in-patient obstetric and gynaecological facilities, which have occurred due to abortion. These include cases of spontaneous and induced abortions but not the planned termination of pregnancy.

 

Reported prevalence of women with Female Genital Mutilation: This reports the percentage of women who have reportedly undergone female genital mutilation. The percentage is calculated on the basis of their responses to the interviews conducted in a community surveys.

 

Prevalence of infertility in women: This indicator computes the percentage of women aged 15-49 years who have been reportedly trying to get pregnant for two years or more, but are unable to conceive.

 

Reported incidence of urethritis in men: This estimates the percentage of women in their reproductive phase interviewed in a community survey reported to have at least one episode of urethritis in past one year.

 

HIV prevalence in pregnant women: It is the percentage of pregnant women aged between 15 and 24 taking medical assistance from antenatal clinics, whose blood was screened to be positive for HIV. Knowledge of HIV-related prevention practices: It calculated the total percentage of all respondents who were able correctly figure out all three main ways of preventing sexual transmission of HIV and also, those who rejected three chief misconceptions related to HIV transmission or prevention.

 

Reproductive health issues in India

 

(Reproductive health issues have been discussed at length in module no. 9 ‘Reproductive health: concepts and issues)

 

In India, women have been bearing the greatest burden of reproductive health problems since a long time. Women were at risk of complications from pregnancy and childbirth; they faced risks in preventing unwanted pregnancy, suffered the complications of unsafe abortion, bear most of the burden of contraception, and were exposed to contracting and suffering the complications of reproductive tract infections, particularly sexually transmitted diseases (STDs), HIV / AIDS. Among women of reproductive age, 36% of all healthy years of life lost were due to reproductive health problems such as unregulated fertility, maternal mortality and morbidity and sexually transmitted diseases including HIV/AIDS. By contrast, the equivalent figure for men was 12%. Biological factors alone were not the cause of women’s disparate burden. Their social, economic and political disadvantages had a detrimental impact on their Reproductive Health. Young people of both sexes were also particularly vulnerable to Reproductive Health problems because of lack of information and access to services. Reproductive Health was affected and was affected by, the broader context of people’s lives, including their economic circumstances, education, employment, living conditions and family environment, social and gender relationships, and the traditional and legal structures within which they lived. Sexual and reproductive behaviours were governed by complex biological, cultural and psychosocial factors. Therefore, the attainment of Reproductive Health was not limited to interventions by the health sector alone. Nonetheless, most Reproductive Health problems cannot be significantly addressed in the absence of health services, medical knowledge and skills. The status of girls and women in society, and how they were treated or mistreated, was a crucial determinant of their Reproductive Health. Educational opportunities for girls and women powerfully affected their status and the control they have over their own lives and their health and fertility. The empowerment of women was therefore an essential element for health

 

As per the National Family Health Survey III (2005-2006), nearly 21% pregnancies are either unwanted or mistimed. Total fertility refers to mean number of children born per woman in the age group of 15-49 years. Total wanted fertility represents the level of fertility that will result theoretically, if all unwanted births are prevented. Unmet need for family planning is an important indicator for assessing potential demand for family planning in India. There is a high unmet need for family planning, with 6.2 % for spacing and 6.6% for limiting methods among currently married women. Unmet need is also high amongst the illiterate and in the lowest wealth quintile. Male participation in sharing responsibility for contraception is low. As per NFHS-III, male sterilization was accepted by only 1% of currently married couples.

 

India’s maternal mortality ratio is unacceptably high at 230 per 100,000 live births (United Nations, 2008). Nearly 63,000 Indian women, accounting for almost 18 per cent of estimated global maternal deaths, die every year due to causes related to pregnancy and childbirth. The lifetime risk of maternal mortality is 1 in 70; i.e. one in every 70 pregnant women is at risk of death, even as she gives birth. Available data also indicates that a significant proportion of women suffer from obstetric morbidities.

 

Sexually Transmitted Infections and Reproductive Tract Infection

 

Several studies have highlighted a widespread in the prevalence of sexually transmitted and reproductive tract infections. The problem is further aggravated by the existing culture where women are generally unwilling to seek medical treatment for the symptoms arising due to these infections (UNFPA, 2015).

 

Sexually Transmitted Diseases

 

Diseases which spread through unsafe sexual contact are referred to as sexually transmitted diseases. In recent years, many experts of public health have suggested on replacing STD with sexually transmitted infection, or STI (American Sexual Health Association). A woman’s anatomy makes her more vulnerable to sexually transmitted infections than a man. Because a woman’s vagina provides a warm and moist environment which encourages the growth of bacteria, and the mucous membrane which covers the area allows easy access and breeding ground for viruses, which may lead to infections.

 

More than thirty different kinds of bacteria, viruses and parasites have been known to get transmitted through sexual contact. Eight types of sexually transmitted diseases are having a higher incidence rate, out of which four are curable, such as syphilis, gonorrhoea, chlamydia and trichomoniasis. The remaining four are caused by virus and thus, these viral infections are incurable till date. The viral infections are hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV). Although, these viral infections are incurable, the symptoms associated with these diseases can be reduced or can undergo modification through proper treatment.

 

STIs are spread predominantly by unsafe sexual contact. Some STIs can also spread via non-sexual means such as by transfusion of infected person’s blood or bodily fluids to normal person or through infected needles. Many STIs including chlamydia, gonorrhoea, primarily hepatitis B, HIV, and syphilis can also be transmitted from infected mother to the child during pregnancy and childbirth.

 

Generally, there are three different types of reproductive tract infections which have been observed in women:

  • Endogenous infections:

These infections are caused by the multiplication of pathogens present in the vagina.

  • Iatrogenic infections:

       These are caused by the introduction of infection causing pathogens through medical procedures like IUD insertion,

  • Sexually transmitted infections

       If detected at an early stage and properly treated, endogenous infections and many iatrogenic and sexually transmitted infections can be cured. However, if these are not treated or cared for properly, these infections can lead to severe complications during pregnancy and child birth, often resulting in congenital infections and chronic pain. Untreated long-term reproductive tract infections can also be termed as the risk factor for diseases related to pelvic inflammation and HIV.

 

Types of Sexually Transmitted Infections

 

Chlamydia and Gonorrhoea

 

Pelvic Inflammatory Disease (PID) is the infection of uterus, fallopian tubes and other reproductive organs. PID are a result of untreated sexually transmitted infections such as Chlamydia and Gonorrhoea. PID can have serious consequences which may have an effect on the fertility of woman, may lead to complications during pregnancy and child birth.

 

Genital Herpes

 

Herpes is a common disease among women. It is regarded as a skin infection of genitals, and may not have adverse health consequences. Once a person gets infected by the herpes virus, it will stay inside the body forever, however, it generally do not interfere with a woman’s ability to reproduce. Although, the herpes infection might have an effect on the health of the new born baby, but it is a rare phenomenon.

 

Human Immunodeficiency Virus (HIV)

 

Before the birth of baby, all pregnant women are recommended to get themselves tested for HIV. This is important to prevent the spread of this virus. The HIV can to be transmitted from a mother and child during the contact of blood during labor, and later through breastfeeding also. The advance testing of HIV in expectant women may be beneficial, as a positive tested woman may plan the well being of the unborn child with the doctor in advance or may medically terminate the pregnancy, if safe.

 

Scope of the problem

 

STIs have an intense impact on sexual and reproductive health globally.

 

About a million STIs are acquired every day. About 357 million new infections occur every year, out of which 1 out of every 4 is an STI. The statistics indicate the incidence of chlamydia (131 million), gonorrhoea (78 million), syphilis (5.6 million) and trichomoniasis (143 million). More than 500 million people around the world have genital herpes infection. HPV infection is the widespread STI, which an incidence rate of 290 million, at any given point of time.

 

STIs can have severe consequences beyond the direct impact of infection itself.

 

Herpes and syphilis can intensify the threat of acquiring HIV by three fold and more. Mother-to-child transmission of STIs may be responsible for stillbirth, neonatal death, congenital deformities, low-birth-weight, pneumonia, neonatal conjunctivitis, and other birth related complications. In 2012, out of 900,000 pregnant women known to be infected with syphilis have resulted in over 350,000 contracting severe birth-related complications, of which stillbirths were also present.

 

Prevention of STIs

 

Counselling and behavioural approaches

 

Counselling and behavioural interventions present primary avoidance against STIs and unintended/ mistimed pregnancies. These include comprehensive sexuality and adult education, pre- and post testing counselling for STI and HIV positive patients, counselling on adopting safer sex practices, condom promotion, and interventions focussing on the vulnerable population groups, such as sex workers, those who involve in sexual activities with the same sex person and people who inject drugs.

 

Counselling can help in improvisation of a person’s ability to observe the symptoms of STIs and understand the possible type resulting in the increase in the care seeking behaviour. Unfortunately, lack of awareness among the masses, shortage of trained health workers, and a widespread stigma attached to STIs has always been a barrier to greater and much more effective utilization of these interventions.

 

Barrier methods

 

The correct and consistent use of condoms is regarded as one of the most efficient methods for protection against STIs which includes HIV as well. Female condoms are also useful and safe, although they are not widely used in comparison to male ones.

 

Diagnosis of STIs

 

Accurate diagnostic tests for diagnosis of STIs are extensively used in developed countries. These are particularly useful in case of diagnosis of infections without visible symptoms or signs. On the other hand, these diagnostic tests are unavailable or used very rarely in developing and under developed countries. These tests are very expensive and available rarely in these countries, so accessibility is another issue. Patients need to wait for long to receive results from these tests and therefore, follow up is not always possible which can result in delayed or incomplete treatment.

 

Rapid syphilis and HIV tests are currently available in most of the countries of the world, which provide faster results and are also cost effective. The rapid syphilis test is widely being used in many resource limited areas. This test is accurate and provides results within 15 to 20 minutes and requires only minimal training for testing. Rapid syphilis tests have shown an increase in the figure of pregnant women who are being tested for syphilis. However, greater efforts are required in many developing and under developed countries for ensuring that all pregnant women undergo a syphilis test.

 

Quite a few rapid tests for other types of STIs are also under development and have the potential to improve STI diagnosis and treatment, especially in resource-limited settings.

 

Treatment of STIs

 

Out of 8 recognised STIs, four are completely curable. The curable STIs are chlamydia, gonorrhoea, syphilis, and trichomoniasis. For herpes and HIV, antivirals are the most the most effective medications which can alter the course of the disease. For hepatitis B, immune system modulators (interferon) and antiviral medications is known to help in combating against the virus and slowing the damage caused by them to the liver. However, HIV, herpes and hepatitis B are still incurable.

 

Resistance of STIs especially gonorrhoea to antibiotics has seen a rapid increase in recent years and this has resulted in reduction in treatment alternatives. The surfacing of decreased vulnerability of gonorrhoea to the “last line” treatment preference, such as oral and injectable cephalosporins, along with antimicrobial resistance shown to macrolides, penicillins, tetracyclines, sulphonamides, quinolones, makes gonorrhoea a multidrug-resistant virus. Antimicrobial resistance for other STIs also exist which make prevention and immediate treatment very critical.

 

STI case management

 

Under developed and developing countries rely on identifying recurring, easily recognizable symptoms for guiding treatment, without depending on laboratory tests. This is known as syndromic management. This approach relies on clinical algorithms and allows health workers to diagnose specific infections by observing the visible syndromes, such as abdominal pain, genital ulcers, vaginal discharge and urethral discharge.

 

Syndromic management is a simple, rapid and same-day treatment which is also inexpensive. But, this intervention alternative tends to miss out on infections which do not show any visible or easily observable symptoms, which is the case in majority of STIs globally.

 

Vaccines and other biomedical interventions

 

Safe and extremely effective vaccines are available for hepatitis B and HPV. These vaccines have been representatives of the major advances in the field of STI prevention and treatment. The vaccine against hepatitis B is a part of infant immunization programmes in more than 93% of countries worldwide and has been able to prevent about 1.3 million deaths from cancer and chronic liver disease.

 

HPV vaccine is available in routine immunization programmes in as many as 65 countries globally, in which most of the countries are high- and middle-income. If 70% vaccination cover is achieved in under developed and developed counties, HPV vaccination will be able to avert the deaths of more than 4 million women in the next decade.

 

Investigations for development of vaccines against herpes and HIV are in progress, with many vaccine candidates undergoing early clinical developmental procedures.

 

Other biomedical interventions for prevention of some STIs also include adult male circumcision and use of microbicides.

 

Male circumcision has been known to reduce the risk HIV infection among men which is acquired heterosexually by approximately 60%. It also gives some protection against herpes and HPV.

 

Tenofovir gel is a type of a vaginal microbicide which is observed to be having mixed results in terms of its ability to avoid HIV acquisition. However, it is effective against HSV-2.

 

Problems encountered in interventions for STIs

 

Although considerable efforts are being made for identifying simple interventions which can reduce unsafe sexual behaviour, behaviour changes among people remain a very complex and consistent challenge. Researchers have demonstrated that there is a need to focus on defining the populations carefully, carrying out extensive consulting sessions with the identified target populations, and involving them in designing, implementation and evaluation.

 

Health services related to the screening and treatment of STIs are still fragile. People in search of screening and treatment for STIs have to face many problems which include limited resources, poor quality of services, stigmatization, and little or no follow-up of sexual partners. In many countries, STI services are provided individually and are not included in primary health care or family planning services. In many areas, the available services are not able to provide proper screening of asymptomatic infections, lack trained personnel, laboratory capacity and adequate supplies of appropriate medicines.

 

Summary

 

To summarize, the factors affecting reproductive health of individuals can be broadly categorized into factors such as gender disparity and violence against women, diet and nutrition, body weight, age at conception and pregnancy, education and income status, etc. there are around 17 reproductive health indicators for global monitoring which gives an insight of the status of reproductive and sexual health at a world level. Sexually transmitted diseases are those which spread through unsafe sexual contact between the infected and uninfected individuals and also, through non-sexual means which include transfusion of infected body fluids into an uninfected person. Few STIs can be transmitted from pregnant women to the child during the phase of pregnancy. Endogenous, iatrogenic and sexually transmitted infections are three types of RTIs which may infect women around the world. Few STIs can be cured and treated if detected at an early stage however, few are non-curable. Preventions of STIs can be achieved through counselling and behavioural interventions, by providing comprehensive sex education, counselling for safe sex and risk reduction and also, in case a person has been detected with STIs, instead of secluding them and stigmatizing them a pre and post test counselling session must be organized for them.

you can view video on Reproductive health issues and sexually transmitted infections

 

References:

  • Brown, K. (2011). Factors Affecting Reproductive Health. Available from www.ehow.com/info_8336615_factors-affecting-reproductive-health.html, accessed on April 21, 2017.
  • Factors affecting Reproductive Health. Available from: http://www.womenandchildrenfirst.org.uk/what-we-do/keyissues/reproductive-health-and-planning/what-factors-affect-reproductive-health, accessed on April 21, 2017.
  • National Family Health Survey 3. 2006. Available from www.rchiips.org/nfhs/, accessed on April 21, 2017.
  • National Institute of Health. Available from:www.niehs.nih.gov/health/topics/conditions/repro-health/, accessed on April 20, 2017.
  • WHO Reproductive health factsheet. Available from: www.who.int/topics/reproductive_health/en/, accessed on April 20, 2017.
  • www.martinslibrary.blogspot.in/2012/11/the-components-of-reproductive health.html, accessed on April 20, 2017.
  • www.unfpa.org/sexual-reproductive-health, accessed on April 21, 2017.
  • www.wikipedia.org/wiki/Reproductive_health, accessed on April 20, 2017.

     Suggested readings:

  • Bogaards, J. (2012). Sexually transmitted infections and sexually transmitted diseases.
  • Pathak, R. K. (2008). Bio-social Issues in Health. A. K. Sinha (Ed.). Northern Book Centre.
  • Wingood, G. M., & DiClemente, R. J. (Eds.). (2013). Handbook of women’s sexual and reproductive health. Springer Science & Business Media.