Combined prevention of unintended pregnancy and STI
ESC Congress Library. Lazdane G. May 20, 2010; 4514
Dr. Gunta Lazdane
Dr. Gunta Lazdane
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Learning Objectives
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International policy documents calling for integration of reproductive health services, including family planning and STIs.
Information on the present situation and trends regarding the condom use in the WHO European Region and beyond.
Challenges of integration of STI and prevention of unwanted pregnancy at the primary health care and ways to overcome them.
Combined prevention of unintended pregnancy and STI

Gunta Lazdane, Regional Adviser, Reproductive Health, Division of Health Systems, World Health Organization Regional Office for Europe
Lali Khotenashvili, Medical Officer Division of Health Programmes, World Health Organization Regional Office for Europe

Many international policy documents call on countries to provide a full range of sexual and reproductive health (SRH) services in an integrated manner, however, many different definitions of integration have been proposed and various operational concepts have been put forward. The rationale for integration is to increase the effectiveness and efficiency of the health system and to meet people’s needs for accessible, acceptable, convenient, client-centered comprehensive care. This should include prevention of ill-health and provision of information, including prevention of unintended pregnancy and sexually transmitted infections (STI).
Sexuality education ideally should start in the family and school and be the basis for developing values related to sexual health and sexual behavior. The obtained knowledge should include positive sides as well as the risks of sexual relations. The overview of sexuality education in the countries of the WHO European Region reveals a wide variety of health education including sexuality education, both in substance and provision, that confirms that health system is to respond to diverse needs of population.

The condom is the main method of dual protection and the condom use can be used as a proxy indicator of the combined prevention of unintended pregnancy and STI. Different cultural and religious backgrounds, different policies on issues such as family planning and accessibility and affordability of contraception and abortion, different policies relating to youth-friendly services, and different education systems dealing with issues like gender, health education and sexual education explain the large discrepancies found in levels of condom use in Europe.
Data, from 30 countries participating in the Health Behaviour in School-aged Children 2005/2006 survey, on 15-year–old girls and boys who used a condom at the last sexual intercourse show a difference from 61 to 95% in girls and from 65 to 91 % in boys. However, there is a positive trend in the condom use of this age group in comparison to data from 1997/98 survey.
Access to quality primary health care services that includs promotion of safe sex and the prevention of unintended pregnancy and STI remain a challenge in many countries of the Region. Traditionally, these service areas have been separate, rather than integrated, and therefore neither takes advantage of the inherent synergy between preventing unwanted pregnancy and preventing STIs. The best examples on integration are addressing the needs of different vulnerable groups, especially youth.
WHO and other international organizations are assisting countries in improving health system performance in responding to the needs of the population and the trying to collect evidence on the impact of the combined prevention of unintended pregnancy and STI, but many challenges still remain and require joint actions.

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