Yearning for children and the heartbreak of barrenness have been a part of life since the beginning of mankind, chronicled throughout history by religious accounts, myths, legends, art, and literature. Whether driven by biological drive, social necessity, or psychological longing, the pursuit of a child or children has compelled men and women to seek a variety of remedies, sometimes even extreme measures. In fact, in all cultures involuntary childlessness is recognized as a crisis that has the potential to threaten the stability of individuals, relationships, and communities. Every society has culturally approved solutions to infertility involving, either alone or together, alterations of social relationships (e.g., divorce or adoption), spiritual intercession (e.g., prayer or pilgrimage to spiritually powerful site), or medical interventions (e.g., taking of herbs or consultation with ‘medicine man’).While spiritual and medical remedies for involuntary childlessness are common and often used early on by involuntary childless couples, social solutions demanding the alteration of relationships have been shown to be the last alternative individuals or couples usually consider.
Reproductive health is a state of complete physical, mental and social well-being in all aspects relating to the reproductive system and to its functions and processes. This implies that individuals are able to have a satisfying and safe sex life, and the capacity to reproduce and the freedom to decide if, when and how often to do so. Access to such treatments that provide the provisions for the same, is implicit as a fundamental right to an individual, this is a basic component of reproductive health and its prevention and appropriate treatment, where feasible, are essential. It is in this context that, the state of an individual not being able to reproduce is seen. The term that has been coined to describe this state has been named as infertility. Infertility is a world-wide problem affecting people of all communities, though the cause and magnitude may vary with geographical location and socio-economic status.
Dramatic contrasts are apparent between industrialized and developing countries in terms of reproductive health services and status. These include access to contraception, antenatal care, safe facilities in which to give birth and trained staff to provide pregnancy, delivery and postpartum care; the diagnosis and treatment of sexually transmitted infections (STIs) including HIV, infertility treatment, and care for unsafe or unintended pregnancy. Around the world, reproductive health initiatives aim to address the complex of economic, socio-demographic, health status and health service factors associated with elevated risk of morbidity and mortality related to reproductive events during the life course. At present, the central contributing factors to disparities in reproductive health have been identified as: reproductive choice; nutritional and social status; co-incidental infectious diseases; information needs; access to health system and services and the training and skill of health workers. The most prominent risks to life are identified as those directly associated with pregnancy, childbirth and the puerperium, including haemorrhage, infection, unsafe abortion, pregnancy related illness and complications of childbirth. There is however, very limited consideration of mental health as a determinant of reproductive mortality and morbidity especially in the developing regions of the world.
Mental health problems may develop as a consequence of reproductive health problems or events. These include lack of choice in reproductive decisions, unintended pregnancy, unsafe abortion, sexually transmissible infections including HIV, infertility and pregnancy complications such as miscarriage, stillbirth, premature birth or fistula. Mental health is closely interwoven with physical health. It is generally worse when physical health including nutritional status is poor. Depression after childbirth is associated with maternal physical morbidity, including persistent unhealed abdominal or perineal wounds and incontinence.
Women’s sexuality and reproductive health needs to be considered comprehensively with due consideration to the critical contribution of social and contextual factors. There is tremendous under-recognition of these experiences and conditions by the health professionals as well as by society at large. This lack of awareness compounded by women’s low status has resulted in women considering their problems to be ‘normal’. The social stigma attached to the expression of emotional distress and mental health problems leads women to accept them as part of being female and to fear being labeled as abnormal if they are unable to function.
The World Health Report 2005: Make Every Mother and Child Count (WHO, 2005) recognizes the importance of mental health in maternal, newborn and child health, especially as it relates to maternal depression and suicide, and of providing support and training to health workers for recognition, assessment and treatment of mothers with metal health problems. The International Conference on Population and Development (ICPD) Programme of Action and the Beijing Platform for Action urged member states to take action on the mental health consequences of gender-based violence and unsafe abortion in particular so that such major threats to the health and lives of women could be understood and addressed better. In addition, the mental health aspects of reproductive health are critical to achieving Millennium Development Goal (MDG) 1 on poverty reduction, MDG 3 on gender equality, MDG 4 on child mortality reduction, MDG 5
on improving maternal health and MDG 6 on the fight against HIV and AIDS and other communicable diseases. Moreover, humans are emotional beings and reproductive health can only be achieved when mental health is fully addressed as informed by the WHO’s definition of health and the definition of right to health in the International Covenant of Economic, Social and Cultural Rights.