Sexual and reproductive health

Infertility

Key issues

A woman holding her baby in her arms, Nigeria
The World Bank/Anne Hoel

Reproductive Rights: Addressing “reproduction” within the public health sphere of reproductive health is crucial in order to fully and adequately address Reproductive Rights.

A young child living some steps with the support of his father, Bolivia.
WHO/Antonio Suarez Weise

Male engagement: Men, often viewed as less willing to access reproductive health care, will do so when concerned about a fertility problem; and, may support and access health care if their partner is unable to become pregnant. Global prevalence of male infertility is unknown.

Continuum of care: Providing care to women and couples before and between pregnancies improves the chances of mothers and babies to be healthy. Pre-pregnancy, and specifically that associated with subfertility/infertility care, has been a crucial weak link in the continuum of care in reproductive health when addressing Universal Access to Reproductive Health (MDG5b) and long term maternal morbidities and disabilities.

Gender identity: Elements of adult and gender identity may never be realized in infertile individuals due to the loss of an experience of pregnancy, childbirth, as well as a lack of family and generational continuity and inclusivity within their broader community.

Mental health: High rates of clinically significant symptoms of depression and anxiety, suicidal tendencies, and a strong conceptualization of grief affects infertile individuals.

Mental health and psycho-social consequences in Humanitarian settings: “Mental health and psychosocial problems and resources need to address major sources of distress, such as poverty, child abuse and infertility.”

Misconceptions affecting barriers to health care: Infertility can be considered as a permanent result of past contraceptive use, caused by vaccine immunizations, due to fate or retribution for past discretions and often regarded as only a women's problem. infertility is often considered completely preventable despite its many non-preventable causes. STis are considered a cause of infertility, yet data has also shown the opposite: that infertility can increase STI acquisition. Cultural, political and religious barriers block access to care for those afflicted by infertility.

Peri-conception: Any intervention provided to women of childbearing age preceding, including and immediately following conception to improve health outcomes for women, newborns and children.

Replacement fertility and demographics changing reproductive health needs: No single country in the European Union and, few transitional and developed Asian countries had a total fertility rate above replacement level in 2009. Many of these countries are coming close to or already defined as, low- or very low-fertility countries.

Reproductive Rights: Addressing “reproduction” within the public health sphere of reproductive health is crucial in order to fully and adequately address reproductive rights as defined and affirmed within the International Committee on Population and Development, ICPD, as "a state of complete physical, mental and social well-being ... in all matters related to the reproductive system" which "implies that people … have the capability to reproduce and the freedom to decide if, when and how often to do so.”

Stigma: An inability to have a child or to become pregnant can result in being greatly ostracized, feared or shunned, may be used as grounds for divorce and will often justify a denial to access any family traditions. Disproportionately having an effect on women, the burden of disease is often assumed to fault the woman, as pregnancy and child birth are manifested in the woman. Discrimination against the infertile may include that a girl will never pass into womanhood (regardless of age) if she never becomes pregnant, are no longer marriageable and become viewed as a burden on families, communities or societies. Although quoted to be more stigmatizing in developing countries, even in developed countries, asking a question of a woman or a couple as to why there are no children in their relationship, is considered culturally unacceptable and taboo.

Violence: Intimate partner violence (IPV), gender-based violence (GBV) and domestic violence have been shown to have significant associations with individuals and couples suffering from unwanted childlessness or involuntary infertility. (link, Facts, Views and Vision.


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Continuum of care

Global consensus on preconception care to reduce maternal and childhood mortality and morbidity