Sexual and Reproductive Health: Concepts and Current Status Amongst Nigerians By

1. Sexual and Reproductive Health: Concepts and Current Status Amongst Nigerians By DR. Lawrence Omo-Aghoja MBBS (BENIN), FWACS, FMCOG, FICS, CGCP (London) Associate Professor of Obstetrics & Gynecology Faculty of Clinical Medicine, DELSU MEGA CPD 2014 [This paper is published in the AJMHS]

2. Outline • Background • Concepts • Definition • Components • Practitioners • Currents status amongst Nigerians • Determinants of Nigerians’ sexual & reproductive Health • A word for the future • conclusion

3. Background • The concept of SRH is relatively new in the context of the dynamics of contemporary global issues • Sexual & reproductive health (SRH) emerged as a specific concern in the context of increasing rates of liberal sexual behavior • SRH is closely linked to 3 foremost challenging issues of our times requiring global attention –Health, Population & Environment • Largely influenced by sociocultural & religious considerations

4. Awareness was raised following the passionate works of leading advocates & champions of women’s health issues & maternal wellness • First was the seminal publication of Allan Rosenfield in the mid 80s when he asked the critical question where is the M in MCH? • About same time Harrison working in Zaria in Northern Nigeria noted: • social, • cultural & • educational factors • As crucial underpinning determinants of maternal morbidity & mortality, • and also the association of early marriages was also shown [6% of mothers under 15 years accounting for 30% of maternal deaths]

5. The focus B4 then was on child survival • Maternal health issues were essentially seen in the context of reproduction & family planning • International conferences relevant to women’s SRH – • WPC in Bucharest (1974), • CEDAW (1979) • ICP Mexico (1984), [these were prior these alarms] • WCHR (1993) • ICPD (1994) • WCOW (1995) • ICPD+5 (1999) • WCOW+5 (2000) • Led to Sexual & Reproductive Rights

6. Following the 1994 ICPD in Cairo there was a radical departure in the scope of SRH to include adolescent SRH & rights issues. • Men were also observed to need SRH services & their involvement was necessary • At the ICPD, the consensus of evidence was that ensuring access to SRH services for all & protecting reproductive rights were essential strategies for improving the lives of all people

7. To further buttress this, Kofi Annan –the immediate past Secretary General of UN aptly summed it up this way: • The Millennium Development Goals, particularly the eradication of poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And that means stronger efforts to promote women’s rights, and the greater investment in education and health, including reproductive health and family planning.

8. What is Sexual & Reproductive Health • This is a state of complete physical, mental & social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and to its functions and processes • It therefore implies that people are able to have a satisfying & safe sex life & that they have the capability to reproduce & the freedom to decide if, when and how often to do so.

9. It includes the right of men & women to be informed & to have access to safe, effective, affordable and acceptable methods of family planning of their choice…&… to appropriate health-care services that will enable women go safely through pregnancy & childbirth & provide couples with the best chance of having a healthy infant.

10. Sexual & Reproductive Rights • Sequel to ICPD 1994 in Cairo • Participating countries in this & indeed other mentioned conferences adopted “sexual & reproductive rights as human rights, & affirmed them as an inalienable integral & indivisible part of universal human rights”

11. Reproductive rights implies d recognition of all couples & individuals to decide freely & responsibly d number, spacing and timing of their children & to have information & means to do so. It also includes their right to make decision concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents • Sexual rights is synonymously defined • Accumulated evidence since ICPD shows that when people can exercise their reproductive rights, they experience far-reaching benefits throughout their lives, as do their families, their communities, & their countries

12. Scope & Components of SRH • RH as defined by ICPD programme of Action includes the following: • Safe motherhood & child survival • Family planning information & services • Prevention & management of infertility & sexual dysfunction in both men & women • Prevention & management of complications of abortion • Provision of safe abortion services where the law permits

13. Prevention & management of reproductive tract infections, especially STIs, including HIV/AIDS • Adolescent reproductive health, responsible & safe sex throughout life & gender equality • Elimination of harmful practices, such as FGM, childhood marriage, & domestic & sexual violence against women • Management of noninfectious conditions of the reproductive tract/system • Genital tract fistula • Malignancies • FGM complications • Menopause • Andropause

14. Practitioners of SRH • OBGYN Physicians • Sociologist & Social workers • Counselors • Trained nurse/midwives • Teachers • Community stakeholders & heads of family • Religious leaders • Just any body

15. Lack of SRHR: Reasons & Implications • Stigmatization • Cultural norms • Lack of political will • Absence legislation • Govts failure to allocate funding for education & services promoting SRHR • Results on grave health consequences including mortality

16. Current status of SRH Amongst Nigerians • In 1998 Nigeria adopted the Regional Reproductive Health Strategy • Endorsed all its components except “the provision of safe abortion services” which is against the law in Nigeria • Have equally signed onto the MDG with its implication for reproductive health • Despite these pronouncements, the status of sexual & reproductive health of Nigerians remains abysmally poor

17. Available data suggest that they are getting worse • Indices: • Increasing rates of liberal sexual behavior • Increasing incidence of STIs including HIV/AIDS • Widespread unintended & unwanted pregnancy • High rates of unsafe abortion • Yet poor CPR (about 15% -NDHS 2008) • Horrifying rates of maternal & neonatal mortality & morbidity

18. Increasing number of disadvantaged children in the community & declining quality of life • Increasing prevalence of gender-based violence & harmful traditional practices • Prostitution is commonplace • Child abandonment is seen frequently • Absent SRH programme for adolescent • Menopausal symptoms are widespread • Late presentation of cervical cancer & other genital tract cancers • High rates of infertility • VVF is extremely high in Nigeria, >800,000 • Nil programme for men

19. Determinants of Sexual & Reproductive Health • Social change – increasing rates of sexual activities with decreasing age @ sexual debut • Unprotected sexual intercourse/multiplicity/casual sex partners • Economic status of individuals • Employment status • Inadequate infrastructure • Lack of educational facilities or no access • Lack of basic health services • Rural-Urban migration

20. Increasing Biosocial Gap • Religion • Culture – in particular gender inequality • Absence or presence of youth friendly reproductive health facilities & services • Inadequate funding by govt and other relevant stakeholders

21. A word for the future • Ensure universal access to sexual & reproductive health services for all, through the primary health care system • Make sexual & reproductive health an integral part of national development planning & include all aspects of sexual & reproductive health, including adolescent reproductive health, within national monitoring & reporting of progress • Build & strengthen the capacity of primary health care systems, from communities to hospitals, to facilitate the delivery of quality, user-friendly sexual & reproductive health services

22. Strengthen linkages between sexual & reproductive health & HIV/AIDS in legislation, policies, & programmes • Ensure the supply of sexual & reproductive health commodities, including a full range of safe, effective contraceptives & particularly male & female condoms, is secure & increase funding to cover existing shortfalls • Give priority to meeting the sexual & reproductive health needs of poor & marginalized groups, including adolescents & PLWHIV/AIDS, & sensitize health care providers to their peculiar needs

23. Make sexuality & reproductive health education a mandatory part of school curricula & accessible to out-of –school youth • Implement fully & effectively the ICPD programme of Action and its Key Actions, as well as Beijing Declaration & platform for Action & Beijing +5 political declaration & outcome document • Increase budget allocations & donor contributions for sexual & reproductive health services, information & education, to meet – at a minimum –the ICPD commitments of our quota of US$20.5 billion in 2010 [failed woefully] & US$21.7 billion in 2015

24. Conclusion • Women’s right to the enjoyment of the highest standard of health must be secured throughout the whole life cycle in equality with men … Good health is essential to leading productive & fulfilling life, & the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment • The society where individuals ve knowledge, skills & confidence to enjoy their sexuality, to choose when or if to ve children, & to keep themselves safe from harm – is a society I want to be part of.