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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
many of the conclusions and recommendations are also relevant to the formerly socialist countries in transition to market economies and to high-income countries.
Reproductive health overlaps with, but is not the same as, women's health. Reproductive health includes the health of men; reproductive rights include men's rights. However, the programmatic discussion in the following chapters deals more with women than with men, for several reasons. For example, sexually transmitted diseases are more often recognized and treated among men than among women, and the challenge for policy is to design services that reach women effectively and appropriately. Sexual violence and circumcision are more serious threats to health for women than for men. Abortion, pregnancy care, and safe delivery all have more direct effect on women's health than on men's, although men's views and behavior affect these aspects of reproductive health. Most problems and interventions we discuss below cannot simply be classified as women's health or men's health. Prevention of sexual coercion, condom use for prevention of sexually transmitted diseases (STDs), prevention of infertility, provision of contraceptive methods, and communication of information for health promotion are all measures to improve the sexual and reproductive health of both women and men. And pregnancy and delivery care, education in general, and sexuality education can improve the health and development of all children.
Many of the barriers to achieving reproductive health in developing countries described in this report exist in developed countries as well, but the problems are particularly acute in the developing countries.
Nearly 90 percent of all the births in the world occur in developing countries—115 million births per year. These 115 million births are the outcomes of about 180 million pregnancies. A significant proportion of these births—about one-fifth—are unintended. An estimated 50 million induced abortions are performed each year, with some 20 million of these performed in unsafe circumstances or by untrained providers. There are estimated to be more than 333 million new cases of curable sexually transmitted diseases worldwide each year. Partly as a result of these infections, an unknown, but in some countries tragically high, number of couples cannot have the children they want. Almost 600,000 women each year die from pregnancy-related causes (complications of pregnancy, delivery, puerperium, or abortion), 99 percent of them in developing countries. About 1 in 48 women in developing countries dies from these causes, compared with only about 1 in 1,800 women in developed countries.