Network: Reproductive Life Stages

Various stages of a woman's reproductive life — characterized by different priorities for contraception and disease protection, as well as different needs for reproductive health information — are highlighted in this issue of Network. Adolescents, for example, need information about both abstinence and the use of contraceptive methods. Women in their peak childbearing years need to understand that contraceptive use will not jeopardize their fertility, but that sexually transmitted infections (STIs) can. Meanwhile, women approaching menopause need to be aware of their continuing risks for unplanned pregnancy and STI infection.

In this issue Abstinence: An Option for Adolescents Interest in promoting sexual abstinence among adolescents as a means of protection against unplanned pregnancy, HIV, and other STIs has been growing. But reproductive health counseling of adolescents should include information about both abstinence and the use of contraceptive methods. (A two-page chart reviews Contraceptive Considerations for Adolescents.) Girls are beginning to initiate sexual activity earlier and marry later in many countries, making their Exposure to Risk Often Longer Now. Given adolescents' increasing vulnerability to the risk of unplanned pregnancy and STIs, many experts say that reproductive health programs should make youths' needs a priority. But, because adolescents are not a homogenous group, programs should be tailored to meet the needs of young people with different kinds of experiences. YouthLens: HIV Counseling, Testing Expanding for Youth reports that many young people in countries where HIV prevalence is high want to know their HIV status, and experts see voluntary counseling and testing (VCT) services for youth as a useful way to address their HIV prevention and care needs. Protecting Fertility Most women throughout the world greatly value their fertility. Although they are often aware of the benefits of family planning, mistaken fears that contraceptives could cause infertility sometimes inhibit them from adopting a highly effective contraceptive method or result in them abandoning it. 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 counsel women who highly value their fertility about how to protect themselves against STIs. Some STIs can ultimately result in infertility, which — as described in Infertility's Grim Consequences — can be a devastating event for women in many cultures throughout the world. As Menopause Approaches, Needs Change 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. Older women also tend to have more contraceptive experience, increasing their responsible and effective use of methods to prevent pregnancy, as described in The Benefit of Experience. Yet, a risk still exists. Because pregnancy late in life presents increased risks to her health and that of her fetus, contraception is particularly important for a sexually active older woman. (A one-page chart reviews Contraceptive Considerations for Older Women.) 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, as discussed in HIV/AIDS Does Not Spare Older People. The need for such risk awareness is underscored in 'No One Thinks Older Persons are at Risk,' a personal account by a woman infected with HIV at the age of 50. Finally, The Many Meanings of Menopause describes why providers need to identify and keep in mind various values, beliefs, and practices associated with the end of a woman's reproductive life. For example, when menstrual bleeding is highly valued as a sign of health and youth, menopausal women may welcome even abnormal bleeding as a sign of continued fertility and thus fail to seek necessary medical care.

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