• An estimated 50 million induced abortions are performed each year, with some 20 million of these performed in unsafe circumstances or by untrained providers.

  • Almost 600,000 women each year die due to pregnancy-related causes, 99 percent of them in developing countries. Approximately 7.6 million infants die in the perinatal period each year.

  • There are more than 333 million new cases of curable sexually transmitted diseases worldwide each year. Largely as a result of these infections, a high proportion of couples in some regions cannot conceive the children they want. Among those who have sexually transmitted infections who do achieve pregnancy, between 30 and 70 percent will transmit the infection to their infants, and many will deliver prematurely or suffer a miscarriage or stillbirth.

  • Nearly 22 million people are estimated to be infected with the human immunodeficiency virus (HIV, the virus that causes AIDS), of whom 14 million are in sub-Saharan Africa, with rapidly increasing numbers of infected persons in South and Southeast Asia. The risk of transmission of HIV through heterosexual contact is increased two-to five-fold by infection with other sexually transmitted diseases (STDs).

Although a great deal of research and experimentation with programs need to be done, there are measures available now that could have an effect on these interrelated problems. We recommend a multisectoral approach involving public services, the private sector, and policy changes. Even poor countries could make progress on the major reproductive health problems with well targeted efforts and the support of the international community.

HEALTHY SEXUALITY

Healthy sexuality is a vital component of reproductive health, both in its own right as an aspect of emotional and mental well-being and as a determinant of other aspects of reproductive health. Healthy sexuality should include the concept of volition and informed decision-making. Cultures differ in norms about sexuality, particularly those concerning sexual behavior of young people before marriage and women's rights to refuse unwanted sexual relations within marriage or to initiate sexual relations. But many serious health problems are caused by behavior that violates norms that are shared across cultures, such as those against sexual violence and sexual exploitation of children.

Sexuality education and communication are needed to contribute to changing norms and behavior to build images of responsible sexual behavior. Sexuality education programs do not currently reach most young people and adults, and programs that do exist often provide little



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