Reproductive Health Priorities Change Throughout Life — August 2002

Interest in promoting sexual abstinence among adolescents as a means of protection against unplanned pregnancy, HIV, and other sexually transmitted infections (STIs) has been growing. But reproductive health counseling of adolescents should include information about both abstinence and the use of contraceptive methods, according to the current issue of Network, an international quarterly health bulletin published by Family Health International (FHI).

"The World Health Organization states that age alone is not a medical reason to deny any available contraceptive method to an adolescent," says Dr. Roberto Rivera, director of FHI's Office of International Research Ethics and principal author of a World Health Organization (WHO) special communication on adolescent contraception. "Many adolescents — married and unmarried — are sexually active and have the right to information that will enable them to protect themselves from unplanned pregnancy and STIs." This is particularly important because girls in many parts of the world are initiating sexual activity earlier and marrying later, and are thus exposed longer than ever to the risk of unplanned pregnancy and STIs.

The current issue of Network highlights various stages of a woman's reproductive life, each of which is characterized by different priorities for contraception and protection from STIs and differing needs for reproductive health information. Women in their peak childbearing years, for example, need to understand that contraceptive use will not jeopardize their fertility, but that STIs can. "While women are often aware of the benefits of family planning, mistaken fears that contraceptives — particularly hormonal methods and intrauterine devices (IUDs) — could cause infertility sometimes inhibit them from adopting a highly effective contraceptive method or result in them abandoning it," notes Dr. Priscilla Ulin, an FHI senior research scientist whose work has included research on contraceptive decision-making.

Providers working with clients in their peak childbearing years should keep such fears in mind, taking care to dispel myths about an association between contraceptive use and infertility. They should also counsel women who highly value their fertility about how to protect themselves against STIs, some of which can lead to pelvic inflammatory disease, a common cause of infertility.

Meanwhile, women approaching menopause need to be aware of their continuing risks for unplanned pregnancy and STI infection. Between peak childbearing years and menopause, a woman's fertility gradually declines, reducing her risk of an unplanned pregnancy. Yet, a risk still exists. Contraception is particularly important for a sexually active older woman: Pregnancy late in life presents increased risks to her health and that of her fetus. And, while AIDS is commonly perceived as an illness that afflicts only young people, sexually active older women and men may need to protect themselves from HIV infection.

Reproductive health care providers working with older people at possible risk for HIV infection may want to consider discussing sexuality with them or asking questions about their sexual activity. Providers should be prepared to discuss HIV/AIDS, its risk factors, and safe sex practices — including consistent and correct condom use — with older clients. Suggesting that an older, at-risk client be tested for HIV infection, particularly if that person reports feeling sick, also may be appropriate. Postponing testing and treatment increases the chance that HIV-infected people will transmit the virus and may result in life-threatening delays in treatment.

FHI is a nonprofit research organization based in the United States that seeks to improve reproductive health worldwide, with an emphasis on developing countries. Network is provided free to family planning providers and other health professionals worldwide.

For more information, please contact:

Kim Best, Managing Editor, 919-544-7040