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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES. 1991; 626:1-10.WHO defines reproductive health as people having the ability to reproduce, to regulate fertility, and to practice and enjoy sexual relationships. It also means safe pregnancy, child birth, contraceptives, and sex. Procreation should include a successful outcome as indicated by infant and child survival, growth, and healthy development. 60-80 million infertile couples live in the world. Core infertility, i.e., unpreventable and untreatable infertility, ranges from 3% to 5%. Sexually transmitted diseases, aseptic abortion, or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983, the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty, literacy, and women's status. Sexual behavior, reproductive behavior, breast feeding, and smoking are life style determinants of reproductive health. Availability, utilization, and efficiency of health care services and level of medical knowledge also determine women's reproductive health.
New York, New York, United Nations Population Fund [UNFPA], 1991. , 48 p.Developing countries increased their commitment to implement population policies in the late 1980s and early 1990s with the support and guidance of UNFPA. These policies focused on improving, expanding, and integrating voluntary family planning services into social development. 1985-1990 data revealed that fertility began to fall in all major regions of the world. For example, fertility fell most in East Asia from 6.1-2.7 (1960-1965 to 1985-1990). This could not have occurred without strong, well managed family planning programs. Yet population continued to grow. This rapid growth hampered health and education, worsened environmental pollution and urban growth, and promoted political and economic instability. Therefore it is critical for developing countries to reduce fertility from 3.8-3.3 and increase in family planning use from 51-59% by 2000. These targets cannot be achieved, however, without government commitments to improving the status of women and maternal and child health and providing basic needs. They must also include promoting child survival and education. Further people must be able to make personal choices in their lives, especially in contraceptive use. Women are encouraged to participate in development and primary health care in Kerala State, India and Sri Lanka. The governments also provide effective family planning services. These approaches contributed significantly to improvements in fertility, literacy, and infant mortality. To achieve the targets, UNFPA estimated a doubling of funding to $9 billion/year by 2000. Lower costs can be achieved by involving the commercial sector and nongovernmental organizations, building in cost recovery in the distribution system of contraceptives, operating family planning services efficiently, and mixing contraceptive methods.