Thursday, 23 February 2012

Comprehensive Reproductive Health Care: A Human Rights Mandate

Debate continues over whether treatment for infertility, including new reproductive technologies, should be considered a health right. Use of the human rights framework could assist in alleviating stigma, promoting awareness of infertility, and increasing availability of treatment. This approach has been successful to a modest
degree with the issue of female genital cutting. Support for the recognition and treatment of infertility as a health right comes from several sources.

Many infertility consumer groups consider the need to give birth to a healthy baby a human right based on the United Nation's 1948 Universal Declarations of Human Rights. Article 16.1 of this document states that: "Men and women of full age, without any limitation due to race, nationality or religion have the right to marry and found a family." (Emphasis added)

The Programme of Action of the 1994 International Conference on Population and Development (ICPD) in Cairo provides more explicit recognition of infertility as a health priority. ICPD signaled a clear shift towards a more broadly defined concept of reproductive health; for the first time neglected "non-fertile" populations such as menopausal women, girls, and the infertile were on the reproductive health agenda. ICPD also marked the first instance where the international reproductive health agenda was developed with input from the populations that international health promotion efforts would target. Infertility and sub-fertility came to light significant, under recognized, global health issues at this time. The ICPD Programme of Action states that reproductive health care, in the context of primary care, should include prevention and appropriate treatment of infertility. Additionally, it mandates that further diagnosis and treatment for infertility should be available as needed. (28) A final support for infertility as a right came in 1998 when the United States Supreme Court ruled that reproduction is basic civil right. In the case Bragdon vs. Abbot the Court ruled that reproduction is a major life activity and people with physical or mental impairments that substantially limit reproduction qualify under the Americans with Disabilities Act.

ICPD also marked the beginning of a movement to provide comprehensive reproductive health care. National policies and international donor organizations are often one sided in their focus to prevent unwanted pregnancies without emphasis on other kinds of family planning including treating infertility. Serious unacknowledged and unmet need exists for affordable infertility services. Without the expensive technical expertise of full-scale treatment programs, a significant number of infertility cases can be treated in low-resource settings by incorporating limited infertility services into existing family planning and reproductive health care programs. In addition, family planning programs can win trust and enhance use by addressing this sensitive and neglected issue. The Family Planning Association of India in Bhiwandi, India and the Comprehensive Reproductive Health for All Projects at the Women's Health and Action Research Center in Benin City, Nigeria are two projects which successfully offer integrated reproductive health care, including infertility treatment, in low resource settings. Multiple low technology services are offered by these projects beginning with education and counseling on fertility awareness and the causes of infertility. These clinics attempt to foster openness towards sexuality issues while divesting their clients of myths and false attitudes regarding infertility. Reorienting community perceptions to involve men in the diagnosis and treatment of infertility is also an important component of comprehensive reproductive health care provision. Treatment begins with a through reproductive history and can include lab tests, semen analysis, and minor pharmacological and surgical therapies including prescription of ovulatory drugs. When needed, these facilities also provide referrals for higher level infertility services, plus counseling, and adoption. Prevention is a special emphasis in low-resources settings; these projects treat infections and offer clean delivery, abortion, and post-abortion care in order to reduce fertility-threatening infection. Results from these two projects demonstrate that even in resource poor settings, clients are willing to pay for infertility services. Existing community gender and reproductive health education programs can also be a cost-effective method to provide information on the causes and prevention of infertility in order to decrease the condition’s harmful effects.

When human rights agreements are respected and comprehensive reproductive health care is provided, family planning will be achieved in its fullest sense--helping women and men have the families they desire. Considering infertility treatment separately from reproductive health is ultimately irrational as the goals of comprehensive reproductive health care include the aims of infertility treatment. Reproductive health care can only be enhanced through the inclusion of infertility services. Governments and non-governmental health organizations who subscribe to human rights ideals have an obligation to work towards alleviation of the stigma of infertility through raising awareness and providing treatment. If reproduction is to be considered a human or civil right for everyone, as stated in several human rights documents, then treatment of infertility must be made more available and affordable.

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