Sexual and reproductive health, a human right

By Carol Aloysius

One of the most important human rights (a much talked of topic these days!) that every man and woman on this planet is entitled to, is the right to Reproductive Health and well-being. Access to accurate information on sex and the ability to exercise voluntary control over our bodies and sexuality not only paves the way for a happy family, but ensures the health of the two most vulnerable segments of the family: mothers and children.

An organisation that has been in the forefront of raising awareness and providing free access to all who wish to information on reproductive health is the Family Planning Association of Sri Lanka (FPASL) which this year celebrates its sixtieth anniversary.

In addition, the FPASL is one of the oldest pioneer non-state organisations to introduce scientific methods of planning one’s family (contraceptives) thereby ensuring that every child born into a family is a wanted child.

The Sunday Observer spoke to the President of the FPASL Dr Pramilla Senanayake to find out more about the kind of contraceptives currently available to our women (and men) and how safe they were.

Excerpts…

Q. How did the Family Planning Association of Sri Lanka originate?

A. The Family Planning Association of Sri Lanka, commonly known as the FPA Sri Lanka is a Non-Governmental Organisation (NGO) established in 1953. A group of volunteers comprising medical professionals and philanthropists concerned about the health of mother and child pioneered the project.

Q. What is the kind of work you do? What have you achieved these past 60 years?

A. The FPASL has worked to improve the health and quality of life of women and their families and beyond to improve the reproductive health of the nation. Much has been achieved in those six decades. Maternal and infant mortality in our country have fallen to levels of which a rich developed country might be proud of. Millions of women have enjoyed greater freedom of reproductive choice and the chance of a fuller happier life. The incidence of sexually transmitted infections is relatively low and the scourge of AIDS has blighted very few lives.

Almost incidentally the danger of population explosion in Sri Lanka has also been averted. The FPA while promoting the well-being and quality of life of members from diverse communities, focuses on the poor, marginalised, stigmatised, socially excluded and underserved communities. Youth is another focus group.

Q. Contraceptives have been around in Sri Lanka for quite some time. When were they first introduced and why? Was it mainly to save the lives of women who were dying at an early age due to, too many babies too soon?

A. Contraceptives are of two main types. Natural methods and modern methods. Natural methods include rhythm, withdrawal etc and have been around from ancient times.

Modern methods have evolved over the past few centuries and have been researched quite extensively prior to introduction. In Sri Lanka almost all contraceptive methods have been introduced from around the turn of past century. Prior to the introduction of contraceptive methods there was a higher number of children born in families, often with a lesser interval between pregnancies.

This caused high maternal mortality ratio in the country as indicated in the Gapminder Compilation of MMR, where MMR (Maternal Mortality Rate) which was around 2000/100,000 live births in 1900 had fallen to 200/100000 in 1960s and further to 35/100,000 in the year 2000.

It was around mid 1950s - 60s that the family planning movement gathered momentum in Sri Lanka. However, there may have been other contributory factors as per capita income, education and health services that contributed to this reduction in MMR.

Q. Prior to the introduction of scientific methods of family planning, what method did most women use here?

A. As I mentioned earlier, natural methods of family planning were prevalent in all societies, which were practiced perhaps with limited knowledge and reliability. Failure rate of these practices may have been high, hence children being born at short intervals and a high maternal and infant mortality.

Q. Was sterilisation and vasectomy the first methods used or the Pill?

A. The Pill was introduced in 1960s globally and it was made available in Sri Lanka. It was first used in Sri Lanka for clinical trials conducted at De Soyza Hospital in 1961. Sterilisation has been a medical procedure even prior to this, but was not used widely in the country till 1968, when the Government expanded the program.

Q. Which of these methods was more popular and why?

A. In 1960s the Oral Contraceptives and IUDs were the most popular methods of contraceptives, which were overtaken by the three months injection subsequently. Among the temporary methods available, there are hormonal and non hormonal methods. Hormonal methods are the Oral Contraceptives, Injection and the sub-dermal implants. Non-hormonal methods are IUD (Intra Uterine Device) and Condoms. Permanent methods are female and male sterilisation.

Q. Are they easily accessible to everyone who wants them?

A. These methods are provided free by the Ministry of Health through the MOH Clinics.

Q. Which of these methods require surgery procedure?

A. Only permanent methods will require surgical procedure done in a theatre.

Q. What is the least painful and easiest to personally manipulate method for a woman?

A. Among all methods the client administered ones would be the Oral Contraceptive and the Condoms.

Q. What are the complications of each procedure used?

A. There are hardly any complications associated with these methods, if administered by a qualified medical person under proper conditions. There could be side effects of each method which could be mild and transient in nature.

Q. Can a woman using these methods conceive again if she wished? Or are they permanent methods that can’t be reversed?

A. All temporary methods are reversible and the user can conceive, when she opts to.

Q. What about sterilisation? Once a woman gets her tubes tied after child birth, can she have them untied? Does it involve a complicated surgical procedure?

A. A woman who wishes to conceive after sterilisation can reverse the procedure through surgery. However, the success rate of such procedure remains low.

Q. Can a male who has undergone vasectomy have it reversed?

A. A man who wishes to conceive after sterilisation can reverse the procedure through surgery. However, the success rate of such procedure remains low.

Q. Is the use of contraceptives well accepted in this country? What is the level of acceptance?

A. Contraceptive Prevalence Rate in the country is 68 percent, which is quite high..

Q. I understand there are still a few pockets of resistance to accepting these methods. Is this due to religious and cultural reasons?

A. Resistances exist due to many reasons and are not confined to any ethnicity or religion.

Q. Today more and more women marry later in life. What is your advice to these women with regard to planned families? Should they delay conceiving when their body clock tells them their time is running out?

A. Our advice to women on conceiving children is based on their choice. They should have children when they want at intervals they decide on, depending on the woman’s age. It is advisable to avoid teenage pregnancies for better maternal health.

Q. Is it true that the largest number of women who practise scientific methods of family planning are ever married women who have completed their family?

A. Married women who have completed their family should practice a scientific method to avoid pregnancy and resultant consequences.

Q. Since some young people in our conservative society are still uninformed about the contraceptive options they have, and there is also a rise in teenage pregnancies, do you agree that the subject should be introduced into the curricular of Grades 12 and 13 students to prepare them for marriage?

A. Age appropriate Sexual and Reproductive Health Education has been introduced but needs improvement in delivery.

Q. What is the goal of the FPA in our changing society?

A. Ensuring sexual and reproductive health as a right for all.

Q Is providing contraceptives for those who need them and request them the most important part of your work?

A. While the vast majority of couples want assistance in controlling their fertility in our society, we have couples who are infertile or who are unable to have children.

It is very much the role of the FPA to provide Counselling and treatment for these couples too.We want every couple to have the number of children they wish at the right time in their lives and spaced adequately. To this end helping those who are unable to have children is a key part of our activities.

Q. Your message to women, young people and married couples?

A. Each individual and couple has the right to enrich their relationships and to improve their quality of life by advocating sexual reproductive health rights and accessing the services required.

Sources: WHO and Health Ministry

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How family planning helps save children’s lives

The use of a family planning method after child birth can help women space births. It is recommended the mother waits at least two years before trying to become pregnant again. This will also allow the mother to pay more attention to the child resulting in increased neonatal, infant and child well being.

Some family planning methods also have special benefits for the child by increasing the quantity of breast milk.

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Benefits of family planning

Saves women’s lives. Using a suitable family planning method can significantly reduce maternal death and ill health. It could also preventing unplanned and unwanted pregnancies, thus reducing the need for unsafe abortions.

Some family planning methods improve women’s health by reducing the likelihood of disease transmissions (condoms) and protecting against certain cancers and health issues (oral contraceptive pill).

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Facts on preventing unwanted pregnancies

Preventing an unwanted pregnancy will prevent one in two maternal deaths. Women over 35 years are five times more likely to die during pregnancy of child birth than women aged 20-24 years.

The risk of maternal death is 1:5 to three times higher for women with five or more children than women with two to three children.

Girls between 15-19 have a risk up to three times than girls aged 20-24 to die during pregnancy and childbirth.

World Mental Health Day on October 10 :

Traditional approach to mental diseases

By Ayur Dr. Saman Hettige

The oldest classification in psychiatry is found in Ayurveda and Desheeya chikithsa. The traditional system of psychiatry which is over five thousand years old probably the oldest systematic psychiatric treatment in the world, classifies 22 psycho pathologies. It emphasises the importance of biological predisposition to amalgamate with the environmental factors to develop a psychiatric disease in human being. The theme of this year's day is “Mental health and older adults”.

There are 450 million psychiatric patients around the world. According to the World Health Organisation (WHO), one in every four families consists a psychiatric patient. One million patients commit suicide every year. By 2220 psychiatric problems will become second only to the heart diseases. In Ayurvedic classical text such as Sussrutha Samhitha, Charaka Samhitha, and Madava Nidana and in our traditional system of psychiatry many a psychological conditions and psychiatric conditions have been discussed in length.

This could have been the oldest recorded classification of psychiatric disorders in the world.

What is astounding is that all diseases, which have been discussed four to five thousand years ago, are now being classified in modern psychiatric classifications.

The overall perception of health in Ayurveda depends on three factors, Waa, Pith and Sem. If imbalance is caused to any of these two it can either create a disorder in one's physical health or create an imbalance in Mano dhosa. Mano Dhosa consists of three elements of power which control the activities of the brain, one's behaviour, cognition and thoughts. These factors are mainly responsible for one's mental health. Imbalance of three Mano dhosa’s namely Sathwa, Rajas and Thamas leads to psychiatric disorder.

Human behaviour is a strange phenomenon that can be disturbed in many ways. According to traditional psychiatric concepts human behaviour is totally controlled by the human brain.

When the brain loses it balance, it will get diseased or sick, and affect human behaviour in every way. Severe distortion of reality is a common outcome. Thinking perception and emotion may deteriorate, and there may be a withdrawal from social activities. Their behaviour becomes abnormal or disordered presence with hallucinations, delusions and extremes of emotionality either aggressive or violent or do unwanted things. Their speech become abnormal. Their feelings and thoughts get distorted. They will start feeling or thinking in an abnormal or unusual way.

They start feeling that they are being charmed or poisoned or they are being followed by police or the CID or suspicious about family members or neighbours. These are called delusions. Delusions are abnormal beliefs and this is called Moha Unmada in Ayurvedic psychiatry. In Darshana Unmada or visual hallucinations they see animals geographical pictures different colours.

There are different types of hallucinations. Besides auditory and visual hallucinations olfactory (smell), gustatory (taste) tactile (touch) or somatic (bodily or visceral sensations).

In our society there is a mythical belief that the cause for the mental diseases is of an evil spirit or by an influence of a ghost or a God. A patient thinks that he or she has a direct connection with God or he or she is about to get a special divine power from God or a deceased person. This condition is well described in our classical texts (under 22 types of psychopathologies) as Butha unmada. Butha means invisible spirit, god, ghost or whatever according to their belief. Unmada means a psychiatric condition.

In ayurveda the treatment is mainly divided into three. Ukthhi Viyapashra (Rational theraphy), Daivap Viyapashra (Spiritual therapy) and Sathvawviyapashra (Psycological therapy) Acute patients are also treated with Desheeya Chikiths such as Kasaya (Decoctions), Guli, Kalka which comes under Yukthi Viyapashra or rational therapy in ayurveda and use Nila or the pressure points to controlled the patient.

Treatment connected with occult science is important for patients who suffer from Butha Unmada (Hallucinosis). Also in this condition they start hearing voices.

The Manasa Ayurveda Hospital Boralesgamuwa, Neelammahra will conduct a mental health campaign at the hospital premises on October 10 from 10 am to 4 pm. to create awareness on issues regarding mental health.

One can never leave addiction

It is often said that once people develop an addiction, they can never completely eliminate their attraction to the abused substance. New findings provide further support for this notion by suggesting that even long-term abstinence from cocaine does not result in a complete normalisation of brain circuitry. Scientists are currently trying to answer some of the ‘chicken and egg’ questions surrounding the abuse of drugs. In particular, one of those questions is whether individuals who abuse psychostimulants like cocaine are more impulsive and show alterations in brain reward circuits as a consequence of using the drug, or whether such abnormalities existed prior to their drug use. In the former case, one might expect brain alterations to normalize following prolonged drug abstinence.

To address these questions, Krishna Patel at Institute of Living/Hartford Hospital and colleagues compared neural responses between three groups of people who were asked to complete a task that resembles bidding on eBay items. The three groups consisted of 47 healthy controls, 42 currently drug-abusing cocaine users, and 35 former cocaine users who had been abstinent an average of four years. They also compared all three groups on their levels of impulsivity and reward responding.

They found that active users showed abnormal activation in multiple brain regions involved with reward processing, and that the abstinent individuals who were previously cocaine dependent manifested differences in a subset of those regions.

Both current and former cocaine users displayed similarly elevated impulsivity measures compared to healthy controls, which may indicate that these individuals had a pre-existing risk for addiction. Indeed, the degree of impulsivity correlated with several of the brain activation abnormalities.

- medicalxpress