Press Release WHO/86
16 November 1998
FIRST-EVER ANALYSIS OF GLOBAL DISEASE BURDEN OF SEXUAL ACTIVITY AND REPRODUCTION PUBLISHED
WHO experts Dr Christopher Murray and Dr Alan Lopez have just published Health Dimensions of Sex and Reproduction*: a first-ever attempt to quantify globally the burden of ill-health associated with sexual activity and reproduction. This book combines into the Disability-Adjusted Life Year or DALY measure the burden from premature mortality with that from living with disability.
Reproductive ill-health accounts for 5-15% of the global burden of disease, even by the most restrictive of definitions, the book's authors have found. The main contributors to this are deaths and disability related to pregnancy and childbirth, sexually transmitted diseases including HIV/AIDS, and reproductive tract cancers. Moreover, ten-year projections over the period 1990-2000 suggest that reproductive ill-health will continue to be a major cause of death and disability globally.
One of the most innovative features of Health Dimensions of Sex and Reproduction, the third volume in the Global Burden of Disease and Injury series, is the attempt to calculate, for the first time, how much of the burden of disease is the consequence of unsafe sex. The calculations presented here show that, globally in 1990, unsafe sexual activity accounted for over one million deaths (2% of all adult deaths worldwide) and for almost 50 million disability-adjusted life years (3.5% of the total DALYs lost).
The authors have defined safe sex as "consensual sexual contact with a partner who is not infected with any sexually transmissible pathogens and involving the use of appropriate contraceptives to prevent pregnancy unless the couple is intentionally attempting to have a child".
The heaviest burden occurs both in infants, who are affected by the reproductive health of their mother, and in adults of reproductive age (15-44 years). In women of reproductive age, 12% of deaths and 15% of DALYs lost are the result of unsafe sex. In Sub-Saharan Africa these proportions rise to 26% and 30% respectively. This high burden is not confined to Africa, however, with India, Latin America and the Caribbean also registering unsafe sex as a significant proportion of the total burden.
Many of the most severe consequences of unsafe sex (pelvic inflammatory disease, cervical carcinoma, infertility and consequences of unsafe abortions) occur in women. Not only is this burden in women extremely large, but also, it was until recently, relatively unrecognized. However, because a large proportion of HIV infections is a consequence of unsafe sex, the burden of unsafe sex in men is also comparatively high.
Unsafe sex is a major, but by no means the only, risk factor for death and disability related to sex and reproduction. Even wanted pregnancy and childbirth can be hazardous for women and lack of adequate and appropriate care can adversely affect them and their infants. Globally, maternal causes account for around half of the total burden of disease due to reproductive ill-health. A large proportion of the maternal burden is due to obstetric complications such as severe bleeding, infections and obstructed labour. This burden of disease is avoidable, as relatively simple, cost-effective public health interventions are available.
A striking feature of the analysis presented in Health Dimensions of Sex and Reproduction is that it highlights the young age at which a large proportion of the burden of disease due to reproductive ill-health occurs. The volume demonstrates clearly that measuring ill-health by counting the number of deaths alone is inadequate for a proper understanding of the dimensions of the problem. DALYs are used in this analysis as a measure of disease burden as they incorporate the age at which the condition occurs and the time lived with a disability from a cause of reproductive ill-health, which makes them preferable to simple mortality indicators previously available for causes of reproductive ill-health.
"It is almost five years since the International Conference on Population and Development reached consensus around the concept of reproductive health. This volume shows that while its precise boundaries remain to be clarified, the burden of reproductive health hazards is large and of major public health concern," noted Dr Julio Frenk, Executive Director of WHO's Evidence and Information for Policy cluster.
Health Dimensions of Sex and Reproduction is the third volume in the Global Burden of Disease and Injury Series, which is published by the Harvard School of Public Health on behalf of WHO and the World Bank. Volume IV The Global Epidemiology of Infectious Diseases and Volume V The Global Epidemiology of Non-Communicable Diseases -- are expected to be published within the next year.
* Health Dimensions of Sex and Reproduction: the Global Burden of Sexually Transmitted Diseases, HIV, Maternal Conditions, Perinatal Disorders and Congenital Anomalies, edited by Christopher J L Murray and Alan D Lopez, ISBN 0-674-38335-4.
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