Reproductive and sexual health: ‘We need to get comfortable talking about it’

Doctors say medical curriculum should include sexual health studies.

KARACHI: “Our discomfort in discussing these issues [reproductive and sexual health] is the reason why the country still does not have a strategy to reduce maternal mortality,” said Dr Sikander Suhani at a seminar, Rights Based Approach to Reproductive Health, on Monday.

The event was organised at the Dow University of Medical Sciences (DUHS) in collaboration with Aahung, an NGO working in the reproductive health sector, and several undergraduate and postgraduate students attended it.

Speaking about the role of gynaecologists and practitioners in discussing sexual health issues with patients, Dr Suhani said that comfort level is the main problem. “Many times a doctor gets confused thinking of the right terms to explain a sexual problem,” he added.

The discomfort was evident even in the jam-packed hall, where postgraduate trainees, house officers and doctors all refrained from asking any questions from the panelists, despite constant prodding from the latter.

Panelists urged that reproductive and sexual health studies be included in the medical curriculum. Dr Shabeen Naz Masood, consultant obstetrician and gynaecologist at Sobhraj Maternity Hospital, said that exclusion of sexual health issues from the curriculum is a hurdle. What we are taught and what we eventually experience are two different things, she said. She was not taught how to talk to a patient who had come to her with a reproductive problem. She has learnt this with time.

“We need to address this issue seriously. We have already lost many mothers to pregnancy-related deaths every year. And the numbers will keep increasing if we do not maintain a balance between our beliefs and providing help to those who need it the most,” said Professor Sadiqua Jafferey, a senior gynaecologist.

“What medical students of today and yesteryear are reading is imported,” said Dr Raza Ur Rehman, a senior psychiatrist at Civil Hospital, Karachi. “We have the expertise to address the rising sexual health challenges as well as the ability to teach our children about it,” he said.

Many of the speakers spoke about the importance of addressing reproductive and sexual health issues. Raising awareness among the doctors’ fraternity and practitioners was the topmost task.

The chief guest, Dr Musarat Hussain, consultant psychiatrist and ex-director Jinnah Postgraduate Medical Centre, said that reproductive health comes under health sciences, which has been neglected in the past years. “As a result of that, we have a rising number of patients who roam around looking for the right person to talk to,” he said. “We have to let go of shame and guilt if we really want to understand the problem and treat our patients properly.”

Prof Umer Farooq, Pro-Vice Chancellor DUHS and Sindh Medical College Principal, said that reproductive health is a neglected topic. “There is a common belief that doctors do not have the scope or the understanding to treat sexually-transmitted diseases. To have a whole subject in the curriculum is vital because training curricula of reproductive rights basically stresses respect for clients, confidentiality, informed consent, autonomous decision-making, quality of care and avoiding bias.”

In Pakistan, where 60 per cent of the population lives in rural areas, it is estimated that the vast majority has never received any kind of medical attention during pregnancy, childbirth or sickness. Each year, millions of women become pregnant. Fifty million women worldwide develop complications during pregnancy and childbirth. Out of which half a million women die from these complications. In Pakistan, one in every 38 women dies from pregnancy-related causes.

Published in The Express Tribune, January 25^th, 2011.