Reproductive health characteristics among women living in severe poverty in urban Haiti – BioMed Central

Aligning Global Health Research with the Sustainable Development Goals

The global health agenda is increasingly framed by the Sustainable Development Goals (SDGs), which provide a comprehensive blueprint for peace and prosperity. Central to this framework is the understanding that sexual and reproductive health and rights (SRHR) are not peripheral issues but are foundational to achieving multiple development targets. This report synthesizes key research findings to illustrate the critical links between reproductive health and the advancement of the SDGs, particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities).

The Foundational Role of SRHR in Achieving SDG 3 and SDG 5

Universal access to sexual and reproductive healthcare is a specific target under SDG 3 (Target 3.7) and a critical enabler for SDG 5. Research underscores that progress in SRHR is essential for empowering women and ensuring their full participation in society. Key areas of focus include:

• The historical and ongoing challenges in establishing comprehensive reproductive health services.
• The necessity of generating robust evidence to guide policies that protect and advance SRHR.
• Addressing specific vulnerabilities, such as the intersection of sexual violence and reproductive health among youth, which directly undermines both health (SDG 3) and gender equality (SDG 5).
• Promoting safe sexual practices, such as condom use, which is vital for preventing unintended pregnancies and the spread of infections, contributing to overall public health.

Maternal and Neonatal Health: A Critical Imperative for SDG 3

Reducing maternal and neonatal mortality (SDG Targets 3.1 and 3.2) remains one of the most significant challenges in global health, particularly in low- and middle-income countries (LMICs). Adverse pregnancy outcomes represent a profound failure to protect the health and well-being of women and newborns.

Addressing Preventable Maternal Mortality and Morbidity in LMICs

The causes of maternal mortality and near-miss events in LMICs are often preventable and deeply rooted in systemic inequalities, hindering the achievement of SDG 10. Research identifies several key determinants:

1. Socioeconomic Factors: Poverty, low educational attainment, and lack of access to quality antenatal care are consistently linked to poor maternal outcomes.
2. Infectious Diseases: Conditions like malaria, intestinal helminths, and other maternal infections are significant contributors to stillbirth and maternal death.
3. Obstetric Complications: Pre-eclampsia and eclampsia are major risk factors for adverse outcomes, with a disproportionate impact in LMICs.
4. Systemic Failures: Inadequate healthcare infrastructure and lack of skilled birth attendants contribute significantly to the high mortality rates observed.

The Tragedy of Stillbirth and Pregnancy Loss: A Barrier to Well-being

Stillbirth and miscarriage are described as neglected tragedies with profound psychological, social, and economic costs. Achieving SDG 3 requires a concerted effort to prevent these losses. Key findings include:

• Globally, the burden of stillbirths is immense, with risk factors including maternal obesity, socioeconomic inequalities, and infections.
• Recurrent pregnancy loss is a significant clinical issue requiring standardized guidelines and greater support for affected individuals.
• A history of stillbirth or abortion can negatively impact subsequent pregnancies, highlighting the need for targeted post-loss care.

Environmental and Social Determinants of Adverse Pregnancy Outcomes

Progress towards the SDGs is contingent on addressing the broader determinants of health. Environmental exposures and social conditions significantly impact pregnancy, linking reproductive health to goals concerning environmental protection and inequality reduction (SDG 10).

• Toxic Exposures: Exposure to heavy metals and other environmental toxins is associated with hypertensive disorders of pregnancy, pregnancy loss, and other adverse outcomes.
• Socioeconomic Disparities: Research consistently demonstrates that socioeconomic inequalities are a primary driver of adverse pregnancy outcomes, including stillbirth and perinatal mortality.

A Lifecourse Perspective on Women’s Health: Linking Reproductive History to Non-Communicable Diseases

Reproductive health is a sentinel for women’s long-term well-being and a critical component of the strategy to reduce premature mortality from non-communicable diseases (NCDs) under SDG Target 3.4. A woman’s reproductive history offers a unique window into her future risk for chronic conditions, particularly cardiovascular disease (CVD).

Reproductive Milestones as Predictors for Cardiovascular Health

Events across a woman’s reproductive life can signal an elevated risk for NCDs later in life. Integrating this knowledge into primary care is essential for prevention and early intervention, aligning with SDG 3.4.

1. Menarche: Early age at menarche is associated with an increased risk of CVD, breast cancer, and all-cause mortality. Factors influencing menarche timing include obesity, childhood stress, and environmental exposures.
2. Pregnancy Complications: Hypertensive disorders of pregnancy are strongly linked to a long-term increase in cardiovascular risk.
3. Menopause: Early and premature menopause are associated with a higher incidence of CVD. Socioeconomic position and lifestyle factors can influence the age of natural menopause.

The Biological Basis: Hormones and Health

The physiological mechanisms underlying the link between reproductive health and chronic disease are an active area of research. Sex hormones, particularly estrogen, play a significant role in regulating immune function and cardiovascular health. Understanding these pathways is crucial for developing targeted interventions to improve long-term health outcomes for women.

Research and Methodological Considerations for Achieving Health Equity

Achieving the health-related SDGs requires robust data, equitable research practices, and interventions tailored to vulnerable populations. The body of research highlights the importance of various methodologies and the need to address systemic gaps.

The Importance of Data and Surveillance in Tracking SDG Progress

Longitudinal cohort studies, demographic and health surveys, and systematic reviews are essential tools for understanding disease burden and identifying risk factors. These methods provide the evidence base needed to:

• Monitor trends in maternal mortality and NCDs.
• Identify determinants of adverse health outcomes in specific populations, such as in Haiti and other LMICs.
• Evaluate the effectiveness of public health interventions, such as community-based hypertension management.

Addressing Inequalities in Health Research and Interventions

A significant barrier to achieving SDG 10 (Reduced Inequalities) is the historical underrepresentation of diverse populations in clinical research. It is critical to advance the inclusion of underrepresented women to ensure that findings are generalizable and interventions are equitable. Furthermore, data collection must be reliable, though studies confirm that self-reported reproductive histories are generally valid and can be used effectively in epidemiological research.

Analysis of Sustainable Development Goals in the Article

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

The provided article, which is a list of references, touches upon several interconnected themes primarily revolving around health, gender, and inequality. Based on the topics of the cited papers, the following Sustainable Development Goals (SDGs) are addressed:

• SDG 3: Good Health and Well-being: This is the most prominent SDG, with numerous references focusing on various aspects of health, including reproductive health (Ref 1, 2, 14), maternal and child health (Ref 17, 18, 37, 38), non-communicable diseases like cardiovascular disease and hypertension (Ref 8, 23, 55, 58), and mental health (Ref 10, 11, 12).
• SDG 5: Gender Equality: Many references specifically address women’s health issues, such as sexual violence against youth (Ref 3), condom use among young women (Ref 4), and the overall agenda for women’s health (Ref 28). These topics are central to achieving gender equality and empowering women and girls.
• SDG 10: Reduced Inequalities: Several references highlight health disparities based on socioeconomic status and geographical location. Papers discuss issues in low- and middle-income countries (Ref 17, 18, 37), socioeconomic inequalities related to pregnancy outcomes (Ref 39, 49), and health challenges in specific disadvantaged communities like the urban slums of Haiti (Ref 56).

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

The references point to several specific targets within the identified SDGs:

1. SDG 3: Good Health and Well-being

   • Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
     • Explanation: References such as “Maternal mortality in low and Middle-Income countries” (Ref 37), “Global and regional causes of maternal deaths” (Ref 57), and studies on adverse birth outcomes and maternal near-miss events (Ref 34, 35) directly address the challenge of maternal mortality.
   • Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age.
     • Explanation: The extensive focus on stillbirths (Ref 18, 36, 46, 47, 49), perinatal mortality (Ref 40, 45), and adverse birth outcomes (Ref 19, 34) is directly related to this target, as stillbirths and neonatal deaths are major components of it.
   • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases (NCDs) through prevention and treatment and promote mental health and well-being.
     • Explanation: Numerous references cover NCDs, including cardiovascular disease (Ref 8, 23, 55, 72), hypertension (Ref 13, 56, 58), and cancer (Ref 26, 27, 71). Additionally, references on depression (Ref 10, 11) and stress (Ref 12) align with the mental health aspect of this target.
   • Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services.
     • Explanation: This target is supported by references on reproductive health in general (Ref 1, 2, 6, 14), sexual and reproductive health and rights (Ref 5), and specific services like condom use (Ref 4).

2. SDG 5: Gender Equality

   • Target 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres.
     • Explanation: The reference “Sexual violence and reproductive health among youth in Port-au-Prince, Haiti” (Ref 3) directly addresses this target by studying the intersection of sexual violence and health among young women.
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.
     • Explanation: This target is closely linked to Target 3.7 but with a focus on rights and empowerment. References on women’s health (Ref 28), reproductive health (Ref 1, 5), and factors associated with condom use among young women (Ref 4) all contribute to the understanding of women’s access to and control over their reproductive health.

3. 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.
     • Explanation: The theme of inequality is evident in references that analyze health outcomes based on socioeconomic factors. “Socioeconomic inequalities and adverse pregnancy outcomes” (Ref 39), “Socioeconomic inequalities in the rate of stillbirths” (Ref 49), and studies focusing on low-income countries (Ref 17, 18, 37) highlight the disparities in health that this target aims to eliminate.

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

The article’s references imply several indicators used to measure progress:

• Maternal Mortality Ratio (Indicator 3.1.1): This is directly implied by the titles of references 37 and 57, which focus on measuring and analyzing the causes of maternal deaths.
• Stillbirth Rate and Neonatal Mortality Rate (Indicator 3.2.2): The numerous studies on stillbirths (Ref 18, 36, 46, 47) and perinatal mortality (Ref 40) inherently rely on these rates as key metrics for assessing birth outcomes.
• Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease (Indicator 3.4.1): References studying cardiovascular disease (Ref 8, 55, 73) and cancer (Ref 26, 27) use mortality and incidence rates as primary measures of the burden of these NCDs.
• Proportion of women of reproductive age who have their need for family planning satisfied with modern methods (Indicator 3.7.1): The study on the “Prevalence and factors associated with condom use among sexually active young women in haiti” (Ref 4) is a direct measurement related to this indicator, as condom use is a modern method of family planning.
• Proportion of women and girls subjected to sexual violence (related to Indicator 5.2.1): Reference 3, which examines “Sexual violence and reproductive health among youth,” implies the measurement of the prevalence of sexual violence as a key indicator.
• Disaggregated Health Data: The references on socioeconomic inequalities (Ref 39, 49, 80) imply the use of health data disaggregated by income, education, and location to measure progress towards reducing health disparities, which is fundamental to monitoring SDG 10.

4. Summary Table of SDGs, Targets, and Indicators

Source: reproductive-health-journal.biomedcentral.com