Sexual and reproductive health management (SRHM) encompasses issues related to maternal, neonatal and child health, family planning, sexually transmitted infections/reproductive tract infections (STIs/RTIs), HIV/AIDS, sexual abuse, unintended pregnancies, abortion and post abortion care, infertility and sexual dysfunction. SRHM is of great concern in the healthcare system of Pakistan not only due to the high burden of problems, but also due to the incapacity of healthcare professionals to deal with the complexity of physical, social and psychological risk factors.
Evidence shows that there is a need for healthcare providers to incorporate current research on contraception in their practice while building on communication and counselling skills to focus on the preventative aspects of healthcare. Though Pakistan is considered a low risk high prevalence country for HIV/AIDS, research studies point to the incapacity of healthcare providers as only 45% have been found to have correct knowledge about transmission and prevention of HIV/AIDS whereas 82% were found to be unaware of syndromic management of STIs. A study done in Karachi revealed doctors especially general practitioners are deficient in appropriately managing and counselling STI patients as less than 45% of private and public GPs have been trained on such issues after completion of medical education. In fact, specialists of urology and dermatology were more likely to manage STIs correctly than gynaecologists. This on one hand poses difficulties for controlling the spread of STIs while on the other hand it increases the risk for HIV/AIDS, prevalence of infertility and neonatal infections. The social and psychological morbidity linked to STIs and other SRH problems often remains unaccounted and afflicts society as mental health problems.
Objectives and Strategies
Considering the situation of sexual and reproductive health management in Pakistan, it is important to work on developing the knowledge and skills of health care professionals (HCPs) so that they are able to deal effectively with sexual health issues and prevent, diagnose, treat and rehabilitate clients without compromising client rights. HCPs must be equipped with up-to-date knowledge about the management of STIs/RTIs and HIV/AIDS as well as have the necessary skills for counselling, contact tracing and ensuring condom use and compliance so that clients may be empowered to make responsible decisions and adopt safe and healthy sexual behaviours/practices.
To endorse the holistic management of SRH issues and address the gaps in knowledge and skills of HCPs, Aahung has developed a sexual health module, RTI guidelines and a book on prescribing sexual health. The above resources were developed after extensive consultation with experts from various medical and nursing institutions across Pakistan and are utilized for capacity building of HCPs on sexuality, sexual health, sexual and reproductive health rights (SRHR), sexual history taking and client centeredness, communication skills, dealing with violence, child sexual abuse and neglect, management of STIs/RTIs, abortion and post abortion care. It is hoped that in the longer run, wider utilization of Aahung’s resources by HCPs will help in reduction of maternal, neonatal and child morbidity and mortality, promote family planning and contraceptive usage, improve management of STIs/RTIs and HIV/AIDS.