Dramatic contrasts are apparent between industrialized and developing countries in terms of reproductive health services and status. These include access to contraception, antenatal care, safe facilities in which to give birth and trained staff to provide pregnancy, delivery and postpartum care; the diagnosis and treatment of sexually transmitted infections (STIs) including HIV, infertility treatment, and care for unsafe or unintended pregnancy. Around the world, reproductive health initiatives aim to address the complex of economic, socio-demographic, health status and health service factors associated with an elevated risk of morbidity and mortality related to reproductive events during the life course.
At present, the central contributing factors to disparities in reproductive health have been identified as: reproductive choice; nutritional and social status; co-incidental infectious diseases; information needs; access to health system and services and the training and skill of health workers. The most prominent risks to life are identified as those directly associated with pregnancy, childbirth and the puerperium, including haemorrhage, infection, unsafe abortion, pregnancy-related illness and complications of childbirth. There is, however, very limited consideration of mental health as a determinant of reproductive mortality and morbidity especially in the developing regions of the world. Mental health problems may develop as a consequence of reproductive health problems or events. These include lack of choice in reproductive decisions, unintended pregnancy, unsafe abortion, sexually transmissible infections including HIV, infertility and pregnancy complications such as miscarriage, stillbirth, premature birth, or fistula. Mental health is closely interwoven with physical health.
It is generally worse when physical health including nutritional status is poor. Depression after childbirth is associated with maternal physical morbidity, including persistent unhealed abdominal or perineal wounds and incontinence. Women’s sexuality and reproductive health needs to be considered comprehensively with due consideration to the critical contribution of social and contextual factors. There is tremendous under-recognition of these experiences and conditions by the health professionals as well as by society at large.
This lack of awareness compounded by women’s low status has resulted in women considering their problems to be ‘normal’. The social stigma attached to the expression of emotional distress and mental health problems leads women to accept them as part of being female and to fear being labeled as abnormal if they are unable to function.