Contraception – the holistic approach regarding services – sustainable
contraceptive health care: how, who, where
O.E. Loeber
Mildredhuis-Rutgershuis, Centre for contraception, sexuality and abortion,
Arnheim, The Netherlands
The health care system in a given country is organized on the basis of
historical development of the society, governmental policy and professionals and
their interests.
The political philosophy dictates whether the health care is totally
dependent on the government as it was in Eastern Europe, where all decisions
were made on a central level or whether, as in Germany and Austria, most power
lies with the professionals, who defend their position fervently. In other
countries certain groups demanded and organized specific forms of health care,
like women’s health care, which has underlying political ideas about women’s
position in society. National policy defines a government’s strategy toward
reproductive health.
In most countries the health care system is developing towards a client
centred approach, in which there is an increasing focus on the rights and needs
of clients, as well as involving clients in participatory approaches in
implementation and evaluation of programmes. This system could partly be a
holistic one.
If a whole new system of healthcare were initiated an ideal system could be
one in which for general health issues general practitioners would be widely
available. They are or should be the epitome of a holistic approach because of
their broad field of interest.
For narrowly defined specialist problems high quality specialist care could
be provided in central hospitals and between these two levels there could be
another layer for holistic care. Not as widely available as the general health
care but more accessible and cheaper then the specialist care. These services
deal with problems centred around a specific topic, like reproductive and sexual
healthcare and take into account all the other issues that contribute to the
problem.
What are the characteristics of holistic contraceptive services?
They must have respect for male and female sexual rights, be youth friendly,
gender sensitive, promote male-involvement and affordable. The care involves
assessing the interrelationship between clients’ needs as well as promoting
among clients the awareness of their bodies and sexuality. The advices of the
providers to clients needs and possibilities should be fine-tuned. The
government should define policies that make this approach feasible. Logistics,
supply and effective management should be in place and regular evaluation is
needed to assess how well the services are functioning.
What topics could be covered apart from contraception?
For instance there could be STI tests and treatment, treatment of sexological
problems, screening for cancer, pregnancy control and delivery, treatment of
fertility problems, vasectomy and refertilisation, addressing of social issues,
i.e. financial problems in single motherhood, provision of abortion. There
should be prevention of these problems in the form of counselling and education
for those who need it.
To be truly holistic services, it is not necessary that all of these issues
are covered. The difference with other health services is rather the wider scope
of interest and knowledge of the provider that may lead to a better adapted
treatment and advice.
So if we see it as a laudable goal to establish these holistic services, what
then are the challenges? Of course this depends on the structures given in a
certain society. Changing these structures can be very difficult. When the
political situation changes as for example in eastern Europe the government, the
professionals and the clients have to learn new ways to organize society. If
power structures exist, it is not so easy to convince beneficiaries to give up
part of this power for the greater good. In countries where everything is
heavily regulated pressure groups and voluntaries are often marginalized as
being unprofessional.
Still it is more feasible to build upon and revitalize existing services
depending on the situation of a specific country. The existing power balance (who
is in charge, who is responsible, who earns the most money) will change in the
process.
Whatever system develops, if left only to the demands of the client or the
offerings by the provider without any regulation each system will in the end be
outrageously expensive. Most countries in Europe wrestle with this problem at
the moment.
Therefore some system of referral should be implemented or a financial
contribution by the client or limit for the provider is necessary to make him or
her aware and co-responsible for the cost of the healthcare.
Sustainable holistic contraceptive healthcare can be achieved through a
variety of strategies, adapted to local circumstances and improved through
evaluation and feedback.
