Effects of a comprehensive menstrual and sexual reproductive health intervention on RTI symptoms among adolescent girls in the Mwanza region: a mixed-methods analysis – BioMed Central

Report on Sexual and Reproductive Health Challenges in the Context of the Sustainable Development Goals

This report synthesizes findings from multiple studies to outline the critical challenges in sexual and reproductive health (SRH), particularly in low- and middle-income countries (LMICs). It frames these challenges within the United Nations Sustainable Development Goals (SDGs), highlighting the interconnectedness of health, education, gender equality, and economic stability.

The Burden of Reproductive Tract Infections (RTIs) and its Impact on SDG 3 (Good Health and Well-being)

Reproductive Tract Infections (RTIs), including Sexually Transmitted Infections (STIs), represent a significant global health burden that directly impedes progress toward SDG 3, which aims to ensure healthy lives and promote well-being for all. The high prevalence of these infections, especially among women and adolescents in Sub-Saharan Africa and India, undermines global health security.

Key Issues Affecting SDG 3 Targets

• High Prevalence in LMICs: Studies from Tanzania, India, and South Africa report a high burden of RTIs and STIs, often presenting asymptomatically. This silent epidemic complicates diagnosis and treatment, leading to severe health consequences and hindering the achievement of universal health coverage (Target 3.8).
• Link to HIV Acquisition: Research establishes a clear association between conditions like bacterial vaginosis and an increased risk of HIV acquisition. Addressing RTIs is therefore a critical strategy for combating the HIV epidemic, a key component of Target 3.3 (end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases).
• Challenges in Syndromic Management: The high rate of asymptomatic infections undermines the effectiveness of syndromic management approaches in low-resource settings, necessitating improved diagnostic capabilities and surveillance to protect population health.

Menstrual Health and Hygiene: A Critical Nexus for SDGs 4, 5, and 6

Menstrual Health and Hygiene Management (MHM) is not merely a health issue but a critical determinant of educational and gender equality outcomes. Inadequate MHM is a significant barrier to achieving SDG 4 (Quality Education), SDG 5 (Gender Equality), and SDG 6 (Clean Water and Sanitation).

Interconnected Challenges

1. Unhygienic Practices and Health Risks: Studies consistently link unhygienic menstrual practices—often due to a lack of access to clean materials and facilities—with a higher prevalence of RTIs. This directly impacts SDG 3 and underscores the importance of SDG 6, as access to water, sanitation, and hygiene (WASH) is fundamental for safe MHM.
2. Period Poverty and Socio-Economic Barriers: Socio-economic inequalities, termed “period poverty,” prevent women and girls from affording menstrual products. This issue is a manifestation of broader economic hardship and inequality, directly relating to SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities).
3. Impact on Education and Psychosocial Well-being: Unmet menstrual needs are associated with school absenteeism among adolescent girls in countries like Ethiopia, Kenya, and Tanzania. This educational disruption compromises SDG 4 and perpetuates cycles of poverty and gender inequality, undermining the empowerment targets of SDG 5.

Adolescent Sexual and Reproductive Health (ASRH): Foundational for Sustainable Development

Adolescents face unique global challenges in sexual and reproductive health. Ensuring their access to information and services is essential for achieving a wide range of SDGs, as health and well-being in adolescence set the foundation for a healthy and productive life.

Priorities for ASRH in the SDG Framework

• Knowledge and Awareness Gaps: Cross-sectional studies reveal significant gaps in awareness about RTIs and SRH among adolescents. This lack of knowledge increases vulnerability and highlights the need for comprehensive, school-based SRH education, which supports SDG 4 and SDG 3.
• Barriers to Youth-Friendly Services: Adolescents in Sub-Saharan Africa and other LMICs face numerous barriers to accessing SRH services, including stigma, lack of privacy, and judgmental provider attitudes. Overcoming these obstacles is crucial for fulfilling Target 3.7 (ensure universal access to sexual and reproductive health-care services).
• Integrated Interventions: Multifaceted interventions that combine education on MHM, SRH, and psychosocial support have shown promise in improving outcomes for schoolgirls. Such integrated approaches are necessary to holistically address the interconnected goals of health, education, and gender equality.

Systemic Barriers to Healthcare Access and their Threat to the 2030 Agenda

Progress across all health-related SDGs is contingent upon equitable and accessible healthcare systems. However, in many LMICs, systemic barriers prevent individuals, particularly in rural and remote areas, from receiving timely and adequate care.

Major Systemic Challenges

1. Geographic and Socio-Economic Disparities: Significant rural-urban disparities in health outcomes and access to care are widely documented. These inequalities, which are a direct challenge to SDG 10, are compounded by financial constraints that create barriers to care, undermining efforts toward SDG 1.
2. Health System Weaknesses: Challenges within health systems—including long waiting times, weak referral systems, and resource shortages—strain services and deter health-seeking behaviors. These issues impede progress toward universal health coverage (Target 3.8) and reflect the need for stronger, more resilient health infrastructure (SDG 9).
3. Financial Hardship: Financial strain is a primary determinant of whether individuals seek and receive healthcare. Removing financial barriers to essential services, especially for reproductive and maternal health, is a prerequisite for achieving equitable health outcomes and reducing poverty.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   The article’s references extensively cover topics directly related to health, particularly sexual and reproductive health. Numerous titles focus on Reproductive Tract Infections (RTIs), Sexually Transmitted Infections (STIs), and HIV, which are major public health concerns. For example, references like “High Prevalence of Sexually Transmitted and Reproductive Tract Infections (STI/RTIs)…” (5) and “Bacterial vaginosis and HIV acquisition…” (13) highlight the burden of communicable and reproductive diseases, which is a core component of SDG 3.

2. SDG 4: Quality Education

   Several references point to the importance of education in improving health outcomes. Titles such as “Awareness about reproductive tract infection…” (6, 26) and “School-based sexual and reproductive health education among adolescents…” (73) emphasize the role of knowledge and school-based interventions in promoting health, which aligns with the goal of providing inclusive and equitable quality education.

3. SDG 5: Gender Equality

   The focus on issues predominantly affecting women and girls, such as menstrual hygiene management, reproductive health, and access to related services, connects directly to SDG 5. References like “Menstrual hygiene management among adolescent girls…” (11) and the general theme of empowering women and girls through better health and hygiene are central to achieving gender equality.

4. SDG 6: Clean Water and Sanitation

   The article links health outcomes to water, sanitation, and hygiene (WASH). References such as “Menstrual hygiene practices, WASH access and the risk of urogenital infection…” (9, 22) and “…menstrual hygiene management and water, sanitation, and hygiene predict reproductive tract infections…” (32) explicitly connect the lack of adequate sanitation and hygiene facilities to health problems, particularly for women, which is a key concern of SDG 6.

5. SDG 10: Reduced Inequalities

   The references highlight significant disparities in health access and outcomes. This is evident in studies focusing on low- and middle-income countries, rural vs. urban populations, and socio-economic factors. Titles like “Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management…” (17, 31) and “Rural-urban disparities in health outcomes…” (48) directly address the issue of inequality in health, which SDG 10 aims to reduce.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being

  • Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
    • This target is relevant due to the numerous references discussing STIs, RTIs, and HIV (e.g., references 5, 13, 14, 15, 16), which are communicable diseases that the target aims to end.
  • Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.
    • This is addressed by references focusing on adolescent sexual and reproductive health (1, 69), access to services (70, 71, 72), and the need for health education (46, 73).
  • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
    • References discussing financial barriers to healthcare (64, 67), challenges in low-resource settings (39, 40), and general access to healthcare (47, 52) directly relate to this target.

• SDG 4: Quality Education

  • Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for… gender equality and promotion of a culture of peace and non-violence.
    • This is supported by references on school-based reproductive health education (46, 73, 74) and raising awareness about RTIs and menstrual hygiene (6, 26), which are crucial knowledge areas for well-being and gender equality.

• SDG 5: Gender Equality

  • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.
    • This target is central to the article’s themes, with references covering adolescent girls’ health (1, 6, 11), menstrual needs (12, 18, 28), and access to reproductive health services (45, 69).

• SDG 6: Clean Water and Sanitation

  • Target 6.2: By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.
    • This is directly addressed in references that link menstrual hygiene management (MHM) with WASH access (9, 22) and discuss how unhygienic practices due to poor sanitation lead to infections (8, 33).

• SDG 10: Reduced Inequalities

  • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
    • The article implies this target through its focus on disparities, such as socio-economic inequalities in MHM (“period poverty”) (17, 31), rural-urban health disparities (47, 48, 49), and the specific challenges faced by adolescents in low-income countries.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the titles of the cited works imply several indicators that can be used to measure progress:

• Prevalence of RTIs/STIs/HIV: References like “High Prevalence of Sexually Transmitted and Reproductive Tract Infections (STI/RTIs)…” (5) and “Bacterial vaginosis and HIV acquisition…” (13) suggest that the rate of these infections is a key indicator for Target 3.3.
• Awareness and Knowledge of Sexual and Reproductive Health: The title “Awareness about reproductive tract infection, its relation with menstrual hygiene management and health seeking behaviour…” (6, 26) implies that measuring the level of awareness among target populations (e.g., adolescent girls) is an indicator for Target 4.7.
• Utilization of and Access to SRH Services: References such as “Sexual and reproductive health services utilization and associated factors among adolescents…” (69) and “Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services…” (72) point to service utilization rates as a direct measure for Targets 3.7 and 5.6.
• Prevalence of Unhygienic Menstrual Practices: The focus on “unhygienic menstrual management practices” (8, 33) and “menstrual hygiene practices” (9, 10, 22) suggests that the proportion of women and girls using hygienic methods is a key indicator for Target 6.2.
• Unmet Need for Menstrual Hygiene Management: The phrase “unmet need for menstrual hygiene management” (18, 28) serves as a specific indicator to measure gaps in access to menstrual products and facilities, relevant to Targets 5.6 and 6.2.
• Disparities in Health Access and Outcomes: The study of “Rural-urban disparities in health outcomes” (48) and “Socio-Economic Inequalities in Menstrual Hygiene Management” (17, 31) indicates that measuring differences in health indicators across different demographic and geographic groups is crucial for monitoring Target 10.2.

4. Table of SDGs, Targets, and Indicators

Source: reproductive-health-journal.biomedcentral.com