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    Integrating sexual health interventions into reproductive health services: programme experience from developing countries.

    de Koning K; Hawkes S; Hilber AM; Waelkens MP; Colombini M

    Geneva, Switzerland, World Health Organization [WHO], 2005. [85] p. (Sexual Health Document Series)

    In 1994, at the International Conference on Population and Development (ICPD, 1994), 184 countries reached a landmark consensus on the need for a broad, integrated approach to sexual and reproductive health. Since that time, countries have been struggling to put the concept into practice. The first challenge has been to understand the broad concept of sexual and reproductive health, in order to identify the service interventions that should be added to an existing reproductive health (RH) or maternal and child health (MCH) programme to make it a sexual and reproductive health (SRH) programme. The second, more difficult, challenge has been to develop feasible, acceptable and cost effective strategies for providing these services within the existing, poorly resourced, primary health care programme base. To create SRH programmes, reproductive health services have to be expanded to better address sexual health. SRH programmes need to give attention to broader determinants of healthy sexuality and well-being. A recent WHO publication, Conceptual framework for programming in sexual health, offers a sexual health approach to service design and implementation. It stresses the need to recognize that not all sexual activity is for reproduction, and that other motivational factors, such as pleasure or a sense of obligation, are often more important determinants of individual sexual health and well being. To improve sexual health, programmes must address sexuality throughout the lifespan, from adolescence to old age, for both men and women. They must also recognize the role of power in sexual relationships and how it affects people's ability to make decisions about their own bodies and sexual life, free from violence, discrimination and stigma. Individual decision-making and the ability to make informed choices can also be limited by social, cultural and legal barriers. Broad sexual and reproductive health care services must recognize and begin to address these constraints through targeted interventions. (excerpt)
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