Services for the Health in Asian ＆ African Regions (SHARE) = SHARE is a citizen sector organization (NGO) that engages in international cooperation mainly through providing health service.
Reproductive health deals with the "health" and "rights" of reproduction, and involves issues such as "safe and satisfactory sexual life" and "safe motherhood." "Reproductive rights" are about choices to have or not to have, when, how many children you want, and also rights to receive necessary information and services about reproduction and sexual health. Issues about equality between the sexes, population problems, and bioethics are also addressed in reproductive health.
According to WHO, the definition of Reproductive Health is the ability to "have responsible, satisfying and safe sex lives" as well as the "capability to reproduce and the freedom to decide if, when and how often to do so." It also implies that the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. As it is about "health" as well as "rights", it has also been called Reproductive Health & Rights. Reproductive Health addresses wide range of issues on reproduction and also described as a challenge which both male and female are facing. Most of SHARE's projects are related to Reproductive Health issues. In this section, issues in safe pregnancy and childbirth will be discussed.
WHO estimated that there were 529,000 maternal deaths in 2000. 527,000 of them were reported in developing countries, taking up 99.6 % of the total maternal deaths. The maternal deaths are unfortunately increasing from the estimated number of 515,000 in 1995.
Maternal Mortality Ratio, the ratio of the number of maternal deaths per 100,000 live births, in Thailand, Cambodia and East Timor, where SHARE is currently working, are 44, 450, and 660 respectively. These numbers are striking because the same ratio in Japan is only 10. As women in developing countries get pregnant more than those in dcveloped countires, they are faced with higher risk of death than their counterparts. To be more precise, the number of women's death due to pregnancy and childbirth in Thailand, Cambodia, and East Tomore are 1 out of 900, 36, and 30 respectively while it is 1 in 6000 in Japan.
The primary reasons for the huge difference are; 1) most women in developing countries have their babies at home, and 2) local health care providers often cannot provide adequate care when the women face abnormal sympthoms and/or incidence during pregnancy and childbirth. It has been said that there are distinctive delays at three levels through which an abnormal incident turns into an unfortunate outcome. The first delay takes place at home where a decision whether the woman should go to a health care facility or not is not made in a timely manner. In addition to difficulty in making the right decision, this often has to do with women's social status and limeted access to medical care due to the status. The second delay is caused by the distance from home to health care facility as well as lack of or limited infrastructure, transportation, money and/or weather conditions. The third delay takes place in the health care facility where adequate and timely care is not often provided.
As a result, maternal mortality would not be easily reduced unles improvements come in multiple levels: individual, community and health care. As a first step, it is very important that women receive health education and become conscious about their own health. The women's knowledge would also help improve children and families' health status. Based on this idea, SHARE has focused on mothers' roles in healthier family and community, organizing study groups on health issues and help them work as a trained health volunteer in the community.
Improvements in health services enable the following four "Safe Motherhood Initiatives" to happen in the community.
(1) To controle the number of pregnancies by "birth control and sexual sterilization",
(2) To receive adequate "prenatal checkups",
(3) To have "safe and clean childbirth" by a birth attendant who has adequate knowledge, skills and experiences, and
(4) To receive "basic obstetrical services" in case of an emergency,
The above initiatives have been promoted widely in developing countries, and SHARE has also incorpoated the initiatives in our projects.
In developing countries, human resources and funds for health care has been chronically fallen short. As important as bringing outside resources into developing countries, it is indispensable to come up with ways to provide efficient and adequate care even in the limited resources. It will be necessary to build a health system in which not only issues on Reproductive Health are solved, but also other areas of health system are improved.
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