As health scientists and researchers, one of the questions we get asked the most often about our work is, “Okay, but why should I care about that?” As someone who specializes in sexual and reproductive health, I’ll admit that this is a pretty easy question to answer. Sex and reproduction are not only essential to our survival as a human race, but they are also important parts of our day-to-day lives.
Every year, there are more than 208 million pregnancies that occur worldwide; more than 40% of these pregnancies are unplanned (Singh, Sedgh, & Hussain, 2010). The World Health Organization reports that every day in 2013, 800 women around the world died due to complications with pregnancy and childbirth, even though the majority of these deaths could have been prevented (World Health Organization, 2015). Further, over 10% of women worldwide do not have access to or are not using an effective method of contraception.
On a more individual level, while making decisions about sexual activity and family planning may not be all that we do, it certainly influences every aspect of our lives. Our occupational, educational, financial, and social outcomes are all directly affected by if, when, and how we have children. Further, our parents’ choices about birth spacing and family size undoubtedly impacted our childhoods and influenced how we envision and interact with our (current or future) families.
Yet despite the fact that sexual and reproductive health issues affect us all, talking about these topics continues to be a challenge. There is an ongoing debate between the social, political, and medical perspectives with regards to issues such as contraception, abortion, HIV/AIDS, and more. For example, changes made in 2015 to Ontario’s sexual health curriculum for public school students resulted in province-wide protests and some parents choosing to remove their children from school.
From a medical perspective, there is a substantial body of evidence that shows that access to high-quality, safe family planning services and sexual health education is beneficial not just for individuals, but for societies as a whole. Indeed, when abortion is legalized, we see significant drops in the rate of maternal mortality (Cates, Grimes, & Schulz, 2003; Khan, Wojdyla, Say, Gülmezoglu, & Van Look, 2006). With access to contraception, rates of unplanned pregnancy and teenage births are reduced (Peipart, Madden, Allsworth, & Secura, 2012; Singh et al., 2010). And when sexual education is comprehensive, we see increased condom use, lower pregnancy rates, and a decrease in sexual risk taking among youth (Kirby, Laris, & Rolleri, 2007; Starkman & Rajani, 2002).
But as researchers, it is no easy feat to navigate the complex relationships between evidence-based medicine, stigma, and social attitudes and acceptability. Even if the evidence base is available, how do we convince policy makers to incorporate these facts?
In the summer of 2015, Health Canada finally approved mifepristone, the gold-standard of medication abortion that has been widely used around the world for almost two decades (Foster et al., 2009). Yet, after an unprecedentedly long decision making process, the approved regimen for the medication was not consistent with the most up-to date medical evidence (World Health Organization Task Force on Post-ovlulatory Methods of Fertility Regulation, 2003). Health Canada also stipulated that mifepristone could only be prescribed by physicians, despite a large body of evidence that demonstrates it can be safely provided by a variety of advanced practice clinicians (Berer, 2009; Foster et al., 2015).
The mifepristone ruling is but one example of the competing perspectives in sexual and reproductive health research and policymaking. It reminds us that even in Canada – a developed country where abortion has been decriminalized for more than 25 years – the social context matters. This is not intended to be discouraging. As health scientists, it is these complexities that must drive us to continue asking, investigating, and pushing for evidence-based health care. These are the challenges that mean we should all “care about that”.
Berer, B. (2009). Provision of abortion by mid-level providers: international policy, practice and perspectives. Bulletin of the World Health Organization, 87, 58–63.
Cates, W., Grimes, D. A., & Schulz, K. F. (2003). The public health impact of legal abortion: 30 years later. Perspectives on Sexual and Reproductive Health, 35(1), 25-28.
Foster, A. M., Jackson, C. B., LaRoche, K. J., Simmonds, K., & Taylor, D. (2015). From qualified physician to licensed health care professional: the time has come to change mifepristone’s label. Contraception, 92(2), 200-202.
Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A.M., & Van Look, P. F. A. (2006). WHO analysis of causes of maternal death: a systematic review. Lancet, 367, 1066-1074.
Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. Journal of Adolescent Health, 40, 206-217.
Peipart, J. F., Madden, T., Allsworth, J. E., & Secura, G. M. (2012). Preventing unintended pregnancies by providing no-cost contraception. Obstetrics & Gynecology, 120(6), 1291-1297.
Singh, S., Sedgh, G., & Hussain, R. (2010). Unintended pregnancy: worldwide levels, trends, and outcomes. Studies in Family Planning, 41(4), 241–250.
Starkman, N., & Rajani, N. (2002). The case for comprehensive sex education. Aids Patient Care & STDs, 16(7), 313-318.
World Health Organization Task-force on Post-ovulatory Methods of Fertility Regulation. (2003). Medical abortion at 57 to 63 days’ gestation with a lower dose of mifepristone and gemeprost. Acta Obstetricia et Gynecologica Scandinavica, 80(5), 447-451.gestation with a lower dose of mifepristone and gemeprost. Acta Obstetricia et Gynecologica Scandinavica, 80(5), 447-451.
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