Promote, prevent, influence : The action programme for the promotion of sexual and reproductive health in 2014-2020 (original) (raw)

Central contents in pre-conception health, care and counselling according to international literature ... Introduction THL-Directions 14/2018 9 Promote, prevent, influence mentioned in this action plan in brief only. Different programmes, strategies and recommendations are briefly presented in the context of each particular theme. The basis and structure of the action programme This action programme is based on the first action programme for promotion of sexual and reproductive health for 2007-2011. 11 The action programme is based on client-orientation and equality: clients in sexual and reproductive health services are to be treated equally, individually, and with dignity, respecting their autonomy and promoting equally highlighting of their needs and wishes without discrimination on the basis of sex, sexual orientation, age, disability, ethnic or national origin, language or other individual characters. With the purpose to update the previous action programme, this programme follows much the same structure. Sexual counselling and sexual and reproductive health services have been integrated into corresponding themes. The chapter that deals with sexual behaviour, combined with sexual and reproductive health knowledge, is new, as well as the chapters on sexuality education, multiculturalism and mental health. Objectives and actions for achieving them are described in the end of each chapter. Some of the objectives are highly detailed, some are more general. Representatives of the National Institute for Health and Welfare and the Ministry of Social Affairs and Health have discussed the choices of responsible actors for the actions in their common meetings. The responsible actors are recommendations, being best choices to implement the actions. However, these recommendations do not exclude any person or organ not stated as a responsible actor. Sexual and reproductive health as a basis of the action programme Sexual and reproductive health and related changes over time can reliably be monitored in Finland by means of different registers. The changes to be monitored are, for instance, mode of childbirth, inductions of labour, and use of analgesia. As for neonates, prematureness, low birth weight and mortality are the changes to be monitored. In induced abortions, the focus is on prevalence, methods, and reasons, and in sexually transmitted diseases, it is on prevalence. Furthermore, information on sexual and reproductive health have been received both via various national surveys, such as Terveys 2000 and Terveys 2011 (Health 2000 and Health 2011), FINRISKI, FINSEX and Maamu, Kouluterveyskysely (School Health Promotion study), Health Behaviour in School-aged Children by WHO, PESESE survey, and separate qualitative and quantitative surveys. Nevertheless, the follow-up information on sexual health or needs of sexual consultancy for men, elderly people, and special groups, for instance, is missing or it is scarce. From international perspective, the sexual and reproductive health in Finland is at outstanding level, assessed by several indicators. The total fertility rate has remained for many decades relatively high compared with other European countries, being 1.8 in 2012. 12 According to the birth register, the amount of children born during the last ten years has increased approximately by 5%. 13 Health of newborn infants is excellent. Perinatal mortality rate (stillborns and deaths at under seven days of life), for instance, was in 2012 at the lowest level during the whole 25 year history of the birth register information collection: 3.9 per thousand births. The Caesarean section rate was 16% in 2012, and the rate has remained low in international comparisons. The percentage of parturients under 20 years of age has decreased, too: 2% in 2012. The rate of induced abortions among women under 20 years has also decreased in the 2000s: 11 induced abortions per thousand women in the same age group. Hospital districts have focused on their personnel's know-how. 14 Most hospital districts have employees who have completed continuing education in sexual counselling and/or sexual therapy. Furthermore, most hospital districts offer sexual counselling and/or sexual therapy services. Despite this, there are still several needs and targets for development in sexual and reproductive health promotion also in Finland.  Primiparas are increasingly older: the average age was 28.4 years in 2012. 13  The number of parturients over 35 years of age has increased: a fifth of all parturients in 2012. 13  Parturients have more often chronic diseases: around 8% in 2010. 15 Main results of the intermediate assessment, needs and targets for development and responding to them The intermediate assessment of the sexual and reproductive health action programme for 2007-2011 was carried out in spring 2009 through structured information collection and surveys. 28 According to the assessment, sexual counselling has professionalised, prerequisites for pregnancy and delivery care, as well  to develop, clarify and coordinate cooperation with primary health care (e.g., common treatment paths, treatment chains, patient information system, competence in sexual health in primary health care),  to exploit networks,  to increase staff resources in sexual counselling and in planning and coordination of sexual health promotion,  to establish regional working groups for coordination, assessment and development of sexual and reproductive health,  to determine sexual counsellor's job description and establish appointments for them,  to define the task and role of a sexual health contact person,  to ensure equal availability of sexual counselling services,  to decrease the amounts of induced abortions and sexually transmitted diseases,  to intervene at early stage in alcohol abuse, economic problems and mental health issues,  effects of population ageing on sexual and reproductive health. Some of these targets and needs have partly been overcome after the intermediate and final assessments, some of them being still current. New recommendations have been drawn up for maternity clinics and for cooperation between primary health care and specialised care. 29 Sexual and reproductive health has been researched both through separate studies 22, 30-33 , and the Maamu survey in 2010-2012 by the National Institute for Health and Welfare. 34 A new immigrant health data collection was started in 2014. Various practices have been developed in order to prevent and recognise sexual violence and help victims, such as broaching violence as a part of health care services, the Action Plan for the Prevention of Circumcision (FGM) 5 of Girls and Women and a guide Turvataitoja nuorille (Safety skills for the youth). 35 Goals and key points of the action programme The goal of the action programme is to promote sexual and reproductive health by increasing awareness, developing services and strengthening sexuality education so that it reaches equally all the people of all Introduction THL-Directions 14/2018