"Reproductive Tract Infections" INTRODUCTION

When women ask for reasons for their STDs, even professionals keep silent. Gender and sexuality must be the starting points for our work to break the silence. - Maria Margarita Diaz, Brazil
We can't disconnect RTIs from questions of power. And you can't disconnect power from gender. - Andaiye, Barbados

INTRODUCTION
Reproductive tract infections (RTIs) include iatrogenic infections (those that result from inadequate medical procedures), endogenous infections (those caused by overgrowth of organisms normally present in the reproductive tract), and sexually transmitted diseases (STDs) These infections cause suffering for both women and men around the world, but their consequences are far more devastating and widespread among women than among men.

RTIs kill unknown thousands of women each year through their association with cervical cancer, the most common and preventable cancer among women in Southern countries. In addition, an estimated 500,000 women die annually from unsafe deliveries and septic abortions; many of these deaths involve infection due to poor medical practice or lack of access to services.

RTIs are the most common preventable cause of involuntary infertility in women, and of potentially fatal tubal pregnancy. They also cause miscarriage and infections in newborns.

RTIs in women can cause emotional distress, pain, and marital discord. The economic costs to society include the loss of women's productivity and the expense of treating the severest consequences of RTIs, such as pelvic inflammatory disease (PID).

Some STDs increase the likelihood of transmission of human immunodeficiency virus (HIV), the virus that causes AIDS, especially from men to women The HIV epidemic cannot be controlled unless STDs are controlled.

RTls cause suffering for both women and men around the world, but their consequences are far more devastating and widespread among women than among men.
To the extent that RTIs have been recognized as a public health issue, they have been approached as diseases to be mapped by epidemiologists, prevented through public education campaigns, and cured by health professionals. Yet these conventional approaches are not working: RTIs are rampant in many countries, and their prevalence probably is increasing.
Participants in "Reproductive Tract Infections among Women in the Third World: Ending the Culture of Silence" (the 1992 Barbados conference) focused on the woman, rather than on the disease. They raised a number of questions from this perspective. For example:

In what ways are women vulnerable to RTIs, and how do they experience their infections, personally and culturally?

How can women protect their sexual and reproductive health in the private context of power imbalances with their male partners, and in the public context of stigma, inadequate information, discrimination, and weak, inaccessible services?

What do women's health advocates suggest can be done locally, nationally, and globally to end the culture of silence about RTIs?

Power imbalances have a major impact on women's vulnerability to RTIs, their ability to protect themselves, and the perception and management of such infections in private and public.
To answer these questions, participants assessed the interactions between public policies and private behaviors in three interrelated dimensions:

overarching political and economic conditions;

underlying sociocultural conditions; and

intimate relations between women and men.

Discussions centered on sexuality (the sexual relationships between individual women and men) and gender roles (the social relationships between women and men at all levels of public and private life). Although participants came from diverse backgrounds, they identified many common patterns of sexuality and gender across societies - in particular, pervasive imbalances of power between women and men. Power imbalances have a major impact on women's vulnerability to RTIs, their ability to protect themselves, and the perception and management of such infections in private and public.
Participants analyzed the global political and economic forces that affect the provision of information and services, assessed the sociocultural conditions that establish the terms of both intimate sexual encounters and public relationships, described a new vision of sexual and gender relations, and made practical recommendations.
The participants' call to action urges donors, international agencies, national governments, and health professionals to re-allocate resources to invest in improved services, technologies, and public education. Participants recognized that creating new alliances of women within and beyond the South, between women's health advocates and social institutions, between adults and young people, and between women and men is essential to preventing RTIs and to achieving more caring, responsible, and respectful sexual and gender relationships.

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