In the paper, Anna Glasier (University of Edinburgh, UK), Metin Gulmezoglu (World Health Organization) and colleagues highlight the enormous burden of sexual and reproductive ill-health. Every year, 340 million new patients acquire gonorrhoea, syphilis, chlamydia, or trichomonas, more than 120 million couples have an unmet need for contraception, 80 million women have unintended pregnancies, and an estimated 19 million women undergo unsafe abortions; 70 000 of them die as a result.
Cheap, effective measures are available to prevent unintended pregnancy, provide safe abortions, help women safely through pregnancy and childbirth, and prevent and treat sexually transmitted infections. But opposition from conservative groups is hampering the provision of these life-saving strategies in almost all countries. The authors say that overcoming this opposition is the greatest challenge to sexual-health promotion globally and the best example of the detrimental intrusion of politics into public health.
In a Comment to introduce the Online/Series, Richard Horton, Editor of The Lancet, states: "Sex, abortion, and birth control, and sexually transmitted infection (including HIV/AIDS) are taboo subjects for many countries, cultures, and religions. For example, for largely political reasons, the USA has blocked programmes to save the lives of women from unwanted pregnancy. For doctrinal reasons, the Catholic Church has rejected simple and effective techniques that would have substantial impact not only on fertility rates but also on rates of human development."
In an accompanying Comment, Gareth Thomas (UK Department for International Development), writes: "Some conservative forces sadly do not want to address the difficult issues of sex, sexuality, and adolescents' and women's right to control their fertility. They prefer to see the world only in terms of their own ideology. Such an attitude is pulling us backwards when we need to go forwards."
Over the past 12 years, the visibility of SRH and rights on the international development and political landscape has decreased. SRH has been left out of the Millennium Development Goals, minimising the level of priority that these issues have been given in development and health programmes and financing worldwide. For example, between 1995 and 2003, donor support for family planning commodities and service delivery fell from US$560 million to US$460 million.
In their Comment to accompany the Online/Series, Dr Glasier and Dr Gulmezoglu, state: "The series is about neglect. It is about conditions for which simple, cheap, and effective interventions have existed for more than 50 years, but which are not available in many parts of the world because governments do not care enough. But it is also about politics and how politics can intrude into public health-with devastating effect."
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Contact: The Lancet press office
WHO, Christopher Powell in Geneva
On his first day in office, US President George W Bush reinstated the Mexico City Policy, meaning no US family-planning assistance can be provided to foreign NGOs working in abortion. The policy not only prohibits the use of US funds by such NGOs for abortion, but also bans the use of funding from any other source to provide counselling and referral for abortion; to do abortions in cases other than those with threat to the mother's life, rape, or incest; or to lobby to legalise or increase availability of abortion in their country. Similarly, at the UN General Assembly special session on children, held in May, 2002, some delegations (Iran, Iraq, Libya, Sudan, the Vatican, and the USA) wanted the phrase reproductive health services redefined to exclude legal abortion; the family characterised as marriage only between a man and a woman; and to include wording that would have recognised a couple's right to information about family planning but not access to contraception.
Contact: Joe Santangelo