sexual and reproductive health sexual and reproductive health sexual and reproductive health (srh) is a field of research, healthcare, and social activism that explores the health of an individual's reproductive system and sexual wellbeing during all stages of their life. sexual and reproductive health. top-left: hiv educational outreach session in angola. top-right: rapid hiv testing kit. middle-left: an african union mission to somalia (amisom) medical officer providing a general health check to a mother. middle-right: a resource stand with condoms and wider srh information at a transgender march in san francisco. bottom-left: midwives training at pacific adventist university. bottom-right: a selection of tampons and menstrual cups. part of a series onpublic health outline subfields community health dental public health environmental health epidemiology health economics health education health promotion health policy health politics mental health occupational safety sexual and reproductive health sanitation world health (global health - international health) prevention disease surveillance health promotion (behavior change) health indicators lists and categories terminology journals national public health agencies medicine portal society portal the term can also be further defined more broadly within the framework of the world health organization's (who) definition of health―as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity"― to denote sexual wellbeing, encompassing the ability of an individual to have responsible, satisfying and safe sex and the freedom to decide if, when and how often to do so. un agencies in particular define sexual and reproductive health as including both physical and psychological well-being vis-à-vis sexuality. a further interpretation includes access to sex education, access to safe, effective, affordable and acceptable methods of birth control, as well as access to appropriate health care services, as the ability of women to go safely through pregnancy and childbirth could provide couples with the best chance of having a healthy infant. individuals face inequalities in reproductive health services. inequalities vary based on socioeconomic status, education level, age, ethnicity, religion, and resources available in their environment. low income individuals may lack access to appropriate health services and/or knowledge of how to maintain reproductive health. additionally, many approaches involving women, families, and local communities as active stakeholders in interventions and strategies to improve reproductive health. overview the who assessed in 2008 that "reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for women, and 14% for men." reproductive health is a part of sexual and reproductive health and rights. according to the united nations population fund (unfpa), unmet needs for sexual and reproductive health deprive women of the right to make "crucial choices about their own bodies and futures", affecting family welfare. women bear and usually nurture children, so their reproductive health is inseparable from gender equality. denial of such rights also worsens poverty. according to the american college of obstetricians and gynecologists, fertility starts to drop considerably around the age of 32, and around 37, it has a particularly deep nose dive. by age 44, chances of spontaneous pregnancy approach zero. as such, women are often told to have children before the age of 35, and pregnancy after 40 is considered high risk. if pregnancy occurs after the age of 40 (geriatric pregnancy), the woman and baby will be monitored closely for: high blood pressure gestational diabetes birth defects (i.e. down syndrome) miscarriage low birth weight ectopic pregnancy adolescent health teenage birth rate per 1,000 females aged 15–19, 2000–2009 further information: teenage pregnancy and adolescent sexuality adolescent health creates a major global burden and has a great deal of additional and diverse complications compared to adult reproductive health such as early pregnancy and parenting issues, difficulties accessing contraception and safe abortions, lack of healthcare access, and high rates of hiv, sexually transmitted infections and mental health issues. each of those can be affected by outside political, economic and socio-cultural influences. for most adolescent females, they have yet to complete their body growth trajectories, therefore adding a pregnancy exposes them to a predisposition to complications. these complications range from anemia, malaria, hiv and other stis, postpartum bleeding and other postpartum complications, mental health disorders such as depression and suicidal thoughts or attempts. in 2016, adolescent birth rates between the ages of 15-19 was 45 per 1000. in 2014, 1 in 3 experienced sexual violence, and there more than 1.2 million deaths. the top three leading causes of death in females between the ages of 15-19 are maternal conditions 10.1%, self-harm 9.6%, and road conditions 6.1%. the causes of teenage pregnancy are vast and diverse. in developing countries, young women are pressured to marry for different reasons. one reason is to bear children to help with work, another on a dowry system to increase the families income, another is due to prearranged marriages. these reasons tie back to the financial needs of girls' families, cultural norms, religious beliefs, and external conflicts. adolescent pregnancy, especially in developing countries, carries increased health risks, and contributes to maintaining the cycle of poverty. the availability and type of sex education for teenagers varies in different parts of the world. lgbt teens may develop additional problems if they live in places where homosexual activity is socially disapproved or illegal; in extreme cases, there can be depression, social isolation, and even suicide among lgbt youth. maternal health main article: maternal health maternal mortality rate worldwide, as defined by the number of maternal deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management, excluding accidental or incidental causes 99% of maternal deaths occur in developing countries, and in 25 years, the maternal mortality globally dropped to 44%. statistically, a woman's chance of survival during childbirth is closely tied to her social-economic status, access to healthcare, where she lives geographically, and cultural norms. to compare, a woman dies of complications from childbirth every minute in developing countries versus a total of 1% of total maternal mortality deaths in developed countries. women in developing countries have little access to family planning services, different cultural practices, lack of information, birthing attendants, prenatal care, birth control, postnatal care, lack of access to health care, and are typically in poverty. in 2015, those in low-income countries had access to antenatal care visits averaged 40% and were preventable. all these reasons led to an increase in the maternal mortality ratio (mmr). one of the international sustainable development goals developed by united nations is to improve maternal health by a targeted 70 deaths per 100,000 live births by 2030. most models of maternal health encompass family planning, preconception, prenatal, and postnatal care. all care after childbirth recovery is typically excluded, which includes pre-menopause and aging into old age. during childbirth, women typically die from severe bleeding, infections, high blood pressure during pregnancy, delivery complications, or an unsafe abortion. other reasons can be regional such as complications related to diseases such as malaria and aids during pregnancy. the younger the woman is when she gives birth, the more at risk she and her baby are for complications and possible mortality. map of countries by fertility rate (2020), according to the population reference bureau there is a significant relationship between the quality of maternal services made available and the greater financial standings of a country. sub-saharan africa and south asia exemplify this as these regions are significantly deprived of medical staff and affordable health opportunities. most countries provide for their health services through a combination of funding from government tax revenue and local households. poorer nations or regions with extremely concentrated wealth can leave citizens on the margins uncared for or overlooked. however, the lack of proper leadership can result in a nation's public sectors being mishandled or poorly performing despite said nation's resources and standing. in addition, poorer nations funding their medical services through taxes places a greater financial burden on the public and effectively the mothers themselves. responsibility and accountability on the part of mental health sectors are strongly emphasized as to what will remedy the poor quality of maternal health globally. the impact of different maternal health interventions across the globe stagger variously and are vastly uneven. this is the result of a lack of political and financial commitment to the issue as most safe motherhood programs internationally have to compete for significant funding. some resolve that if global survival initiatives were promoted and properly funded it would prove to be mutually beneficial for the international community. investing in maternal health would ultimately advance several issues such as gender inequality, poverty, and general global health standards. as it currently stands, pregnant women are subjugated to high financial costs throughout the duration of their term internationally which is highly taxing and strenuous. in addition, if either parent has a genetic disease, there is risk of these being passed on to the children. birth control or technical solutions (assisted reproductive technology) can be an option then. lgbt+ sexual and reproductive health the sexual and reproductive health of lgbt+ people face challenges through issues like the ongoing hiv pandemic, binary organization of "men" and "women"'s reproductive health, alongside stigma and repression that limit lgbt+ people from accessing the healthcare they need. sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality. it is important to not only consider the sexual/physical health of an individual but also the cultural and contextual factors that influence an individual's well-being. the lack of competent providers and stigma attached to homosexuality have a great impact on the sexual health of the lgbtq+ population. the lgbtq+ population faces a number of obstacles in terms of sexual and reproductive health. the different stigmas and biases that come with these barriers make receiving proper care difficult. some of these stigmas that follow those in the lgbtq+ population in terms of their sexual and reproductive health are associating certain diseases, and other illnesses with this community. this leaves those in the lgbtq+ population in a position that makes them vulnerable, as well as victims of a number of health disparities. the overall health of those in the lgbtq+ population is determinant on sexual and reproductive health as these all make up the health of these individuals. those in the lgbtq+ community face also face discrimination from providers and insurance companies, on top of all of the other barriers and limits on access to care that they endure. all of these factors have led to those in the lgbtq+ population having worse health outcomes. contraception access to reproductive health services is very poor in many countries. women are often unable to access maternal health services due to a lack of knowledge about the existence of such services or lack of freedom of movement. some women are subjected to forced pregnancy and banned from leaving the home. in many countries, women are not allowed to leave home without a male relative or husband, and therefore their ability to access medical services is limited. therefore, increasing women's autonomy is needed in order to improve reproductive health, however, doing so may require a cultural shift. according to the who, "all women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth". combined oral contraceptive pill the fact that the law allows certain reproductive health services, does not necessarily ensure that such services are actually in use by the people. the availability of contraception, sterilization, and abortion is dependent on laws, as well as social, cultural, and religious norms. some countries have liberal laws regarding these issues, but in practice, it is very difficult to access such services due to doctors, pharmacists, and other social and medical workers being conscientious objectors. condoms offer effective protection from stis and unwanted pregnancies. in developing regions of the world, there are about 214 million women who want to avoid pregnancy but are unable to use safe and effective family planning methods. when taken correctly, the combined oral contraceptive pill is over 99% effective at preventing pregnancy. however, it does not protect from sexually transmitted infections (stis). some methods, such as using condoms, achieve both protection from stis and unwanted pregnancies. there are also natural family planning methods, which may be preferred by religious people, but some very conservative religious groups, such as the quiverfull movement, oppose these methods too