A CALL TO ACTION
FOR NEW ALLIANCES BETWEEN WOMEN AND MEN
TO END REPRODUCTIVE TRACT INFECTIONSReproductive tract infections (RTIs) pose grave threats to women's lives throughout the world. RTIs include sexually transmitted diseases (STDs); infections related to procedures such as unsafe deliveries and abortion or IUD insertion; and infections due to over growth of organisms normally found in the genital tract. Men also experience RTIs particularly STDs but the prevalence and the consequences for women are much more severe.
Worldwide, there are well over 250 million new cases of STDs every year, which have devastating health and social consequences. Nonetheless, women and men generally are not aware that they are vulnerable to RTIs, and policy-makers do not understand the substantial costs of failing to prevent RTIs:
- Some STDs increase HIV transmission, and therefore the HIV epidemic cannot be controlled without controlling STDs.
- RTIs are the most common preventable cause of involuntary infertility and potentially fatal tubal pregnancy; they also cause fetal loss and infections of newborns.
- RTIs lead to severe emotional distress, pain, and marital discord; their consequences carry enormous economic costs, because they reduce women's productivity in both the household and the workplace, and because treatment of consequences such as pelvic inflammatory disease and septic abortion is very expensive.
- A sexually transmitted virus kills hundreds of thousands of women each year through cervical cancer, the most common cancer among women in Southern countries. An additional 500,000 women die annually as a result of unsafe deliveries and septic abortions; many of these deaths involve infection due to poor medical practice or lack of access to services.
Severe imbalances in the relations between women and men, in all spheres of public and private life, are established early in life. These make it impossible for most girls and women to protect themselves against RTIs in sexual relations and in health services. For example, men generally determine when and under what conditions sex takes place. They frequently do not take responsibility to protect their partners against infection, and they may or may not respect the wishes of the woman. The only protective technology currently widely available is the male condom, and many women are unable to persuade men to use it. The culture of silence surrounding sexuality further prohibits women from seeking health care, emotional support, and information for their sexual health.
The need to address RTIs is more urgent than ever. The present global political and economic context, however, fosters the spread of RTIs and is hostile to actions needed to prevent and control them. Northern governments, multilateral institutions, and Southern governments have shifted away from human development, and toward economic growth and privatization. Such policies are destroying or making basic health services and other essential resources (such as water and education) inaccessible to poor people. Compensatory programs, such as "social well-being programs," in no way offset this destruction of basic services. Furthermore, national governments, for ideological or political reasons, also institute or maintain harmful policies, such as restrictions on contraception or safe abortion.
Such international and national contradictions undermine a comprehensive approach to women's health that is responsive to the needs of women as they perceive them, and that enables women to take control of their sexual health and reproductive rights.
To break the culture of silence surrounding sexuality and RTIs, actions are required in both the public and the private spheres. To remove the burdens RTIs place on women, health systems, and national budgets, we call on governments, international donors, and health professionals to:
The struggle to prevent and control RTIs must be inclusive. We must pay special attention to the needs and involvement of young people.
- Re-establish basic human needs as the objective of development policies.
- Integrate services for the prevention and control of RTIs into ongoing health programs, especially family planning, maternal and child health, and primary health programs, to reach both symptomatic and asymptomatic women and to optimize the cost-effectiveness of programs.
- Provide safe abortion services.
- Invest in improving the quality of reproductive health services and education, and in training all health providers about RTIs.
- Develop and make universally available simple, inexpensive, rapid diagnostic tests for STDs, particularly for women who do not have symptoms.
- Develop safe and effective vaginal microbicides that protect women against STDs, including HIV, and that women can use without the cooperation of their partners.
- Mobilize all public education channels so that young people, women, and men have access to information about sexuality and about the causes, dangers, prevention, and cure of RTIs.
- Substantially increase support for women's organizations to enable them to inform and support girls and women, to demonstrate effective approaches to prevention and control of RTIs, and to participate in policy-making.
We call on men to collaborate with us to develop more caring, respectful, responsible sexual relationships and to redress the imbalances in gender power relations in all aspects of public life.
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