Women and Children First: The Impact of Sexually Transmitted Infections on Maternal and Child Health

In 2000, all 189 Member States of the United Nations (UN) adopted the UN Millennium Declaration, committing them to pursue eight measurable targets, the Millennium Development Goals (MDGs) [1, 2] to be achieved by 2015. The MDGs were intended to: (1) eradicate severe poverty and hunger; (2) achieve universal primary education; (3) promote gender equality and empowerment of women; (4) reduce child mortality; (5) improve maternal health; (6) combat HIV/AIDS, malaria, and other infectious diseases; (7) ensure environmental sustainability; and (8) develop a global partnership for development. The unprecedented effort required to achieve the MDGs addresses issues and conditions especially relevant to the health and survival of women—particularly mothers—and infants, children, and youth. Despite calls for universal access to reproductive and sexual health, no MDG addressed these issues, which are critical to maternal and child health and remain neglected [3]. The MDGs proposed dramatic reductions in, or elimination of, scourges that have plagued humankind since its beginnings including severe poverty, famine, and pregnancy-related mortality as well as one emerging infectious disease , human immunodeficiency virus (HIV) infection, only recognized in the last decades of the 20th century, which was singled out for particular attention [1, 2]. Arguably, never before has elimination of the inequalities at the root of these scourges been articulated even as a possibility, let alone as goals to be urgently pursued. But without an MDG focused on reproductive health, progress on this issue relies on its being buoyed by efforts towards addressing the eight MDGs. Progress towards achievement of MDG indicators has been impressive; some (such as the halving of the number of people living in extreme poverty) were achieved before 2015 [4]. Others, including reduction of HIV mother-to-child transmission to less than 2% [5], are either on schedule or achievable by 2016-2017. Much, however, remains to be done. It is in that context that the disproportionate and largely preventable toll that sexually transmitted infections (STIs) exact on women, including mothers, and infants, children, and youth, is reexamined. Women, particularly adolescent women, are especially vulnerable to STIs due to, among other factors, a larger exposed mucosal surface area, hormonal effects, changes in the protective female genital tract microflora, and the intermittent presence of ectopy, especially in adolescence [6–8]. These groups are also at increased risk due to sexual partnerships with older men, little power over when, where, and how sex occurs, and other social and cultural factors. …