The Culture of Silence
Reproductive Tract Infections
Among Women in the Third World




Introduction

Women have internalized the ethic of nobility in suffering such that pain and discomforts emanating from their reproductive and sexual roles are accepted as the very essence of womanhood... Social stigma and hence the culture of silence [are] attached to sexual and reproductive problems, the geneses of which are invariably perceived to be women. -- Mere N. Kisekka

Reproductive tract infections (RTIs) are common diseases with profound social and health consequences for Third World women, men and children. As one of the world's most neglected health problems, RTIs are related in important ways to girls' and women's basic sexual and reproductive health and to the acceptability of family planning programs. Yet, in allocating scarce human and financial health care resources to developing countries, policy makers, program planners, and international donor agencies have generally given low priority to RTIs. In part this is because of the mistaken belief that RTIs are not fatal, that they are too expensive and too complicated to treat, and that in most developing countries they affect only small and specialized segments of sexually active adults such as prostitutes. Each of these assumptions, however, can be challenged by a growing body of evidence.

The culture of silence surrounding RTIs must be broken not only by women, who often place their own health needs after those of their husbands, children, and other family members, but also by health professionals and the international health and family planning communities. The purpose of this paper is to summarize the published data on RTIs among women in developing countries in order to raise questions and encourage discussion about alternative approaches to the diagnosis, treatment ancd prevention of common RTIs.

What can be done to address the problem? Both prevention and treatment of RTIs are possible. Inexpensive, simple approaches to diagnosis and treatment are already available for some RTIs, and additional methods can be developed or adapted to local conditions in diverse Third World settings. Primary health care and family planning professionals can also integrate culturally appropriate educational programs on RTI prevention and treatment into existing clinic and community services to increase awareness of the effects of RTIs on health and well-being. In view of the connections between sexually transmitted diseases (STDs) and HIV transmission, and contraceptive use and acceptability, there is an urgent need for focused, innovative thinking on long-range solutions.


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