Awareness about reproductive health

Reproductive health:
Reproductive health is a broad topic, intimately tied to every person's quality of life. It is about helping people navigate the hormonal changes in their bodies, whether in adolescence or in menopause. It is about choosing whether and when to be pregnant, and being able to have a safe and healthy pregnancy. It is about understanding ourselves as sexual beings and how our sexuality affects our relationships and our health. Reproductive health is about helping people live long and satisfying lives.

Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.
Implicit in this are the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
situation of Sexual and Reproductive Health in Bangladesh

The sexual and reproductive health for women in Bangladesh is poor. Maternal mortality is unacceptably higher than any other developing countries seven though the numbers are gradually going down (from 570[1] two decades ago to 350[1] a decade ago, to 194 per 100.000 live births[1] in 2010. The maternal mortality rate is still high–much higher which is the most common cause of death for women under 34 years[1] and it requires a comprehensive action. Bangladesh has one of the highest rates of child-marriage in the world. It also has one of the lowest rates of birth registration in the world, which constrains legal protection against child marriages. 74% of the girls marry before the age of 18, and over one third even before the age of 15. Early marriage leads to early pregnancy, as the girls are expected to give birth within the first year of marriage. One third of teenage girls aged 15 to 19 are mothers or are already pregnant. Adolescent mothers are significantly more likely to suffer from birthing complications than adult women. In fact, early marriages are considered the most important factor standing in the way of a breakthrough in maternal mortality reduction. Besides, one fifth of all maternal deaths are due to obstetric causes related to unsafe abortion and its complications.
Further, maternal malnutrition, infections during pregnancy, anaemia and repeated pregnancies contribute to low birth weight babies and thus, also, to a high maternal mortality rates. Also, 14% of pregnant women’s deaths are associated with violence and injuries [1].
Virtually all deliveries (77%) take place at home [1] without any assistance from the skilled attendants. A skilled birth attendant is present in about 27% of cases [1].
Though confronted with manifold SRH problems, women and men lack access to adequate and quality health services. For unmarried adolescents access to SRH services is even more restricted.
The poor reproductive situation of mothers also reflects on child health. The number of infant deaths per 100.000 live births is 52[1].
Of every 10,000 ever-married women, about 17 suffer from fistula [1]; an abnormal connection between the lower portion of the large intestine and the vagina and between vagina and urethra[1]. This often results from an injury during childbirth and prolonged labor respectively, and can cause serious infections. It is an indication of poor sexual and reproductive health care. The symptoms often cause emotional distress as well as physical discomfort. A significant number of women living with fistula in Bangladesh are not aware of treatment possibilities that could change their lives. Many live alone, ostracized by husbands, family, and community. Some women are accused by community members of being afflicted with a curse
The girls, but also their spouses, enter marriage without having received any significant SRHR education, either from parents, siblings or teachers. For information, they can only turn to their peers or quacks,which leads to the dissemination of serious misconceptions. An increasingly popular source of information on sex is the Internet, which is predominantly filled with porn, a dubious source that does not educate them at all about safe sex and much less on how to maintain healthy sexual relationships[1]. In fact it plants all sorts of misconceived role models in their heads, and causes an extra-ordinary amount of stress, manifesting itself, amongst others, in exceptionally high suicide rates [1].
For young boys, the lack of sex education not only results in unwanted pregnancies, but they are also particularly vulnerable to STIs, HIV/AIDS and drug abuse.[1] Many drugs are sold by quacks who present them as if they would enhance their sexual power, but in reality these drugs are just harmful and often addictive[1].
Adolescence is the transitional stage for changing behavior, values, beliefs and attitudes. It is also the prime period of sexuality development. Young students are the second frequent visitors to sex workers [1]. They are thus at high risk of contracting sexually transmitted diseases.
The population of Bangladesh is described as a young population, one third of it is below 14 years of age [ 1] and 21% of the people aged between 10 and 19[1].
The maternal mortality rate among adolescents is almost double the national average and the infant mortality rate is also 30% higher than national average.[1] At the same time, adolescent fertility in Bangladesh is one of the highest in the world, with 135 births per 1000 women below 20.
One of the key reasons why young adolescents in Bangladesh do not have access to adequate information about their own sexual and reproductive health and rights, is that there is a strong social and cultural taboo around the issue. This causes a silence that is reflected in all aspects of life. The predominant restrictive norms and beliefs on women’s roles and position and the voiceless status of unmarried boys and girls reflect a deeply rooted gender and age discrimination. Women cannot seek SRH services alone. Unmarried women are particularly excluded from SRH services. Unmarried men also suffer from condemnation when seeking help for SRH problems.
The socio-culturally induced silence starts at the onset of puberty: young adolescents do not know why their bodies are changing, why they start to menstruate or ejaculate or how to deal with this. As a consequence they suffer from shame and distress. Even more importantly, when they are confronted with sexuality they do not know how they can negotiate or make their own choices. So most adolescents enter into marriage and pregnancy without any adequate preparation, with all the SRH effects mentioned. In fact, most parents actively push their daughters into early marriages to avoid stains on the family honour (and dowry devaluation) by pre-marital sexual activity. Paradoxically, in their effort to protect their children, they actually push them into traumas and great SRH hazards.
One important misconception that nurtures the taboo around SRHR is the assumption that information about sexuality would encourage adolescents to have premarital sex or to portray promiscuous behavior. However, there is an overwhelming weight of evidence that shows that sex education that discusses contraception does not increase sexual activity among unmarried adolescents.[1]
Despite the cultural norms and taboos, many adolescents are exposed to sex before marriage and thus are vulnerable to unwanted pregnancy[1].
Adolescents are practically vulnerable to STIs like HIV/AIDS, as they are even more unaware of the risks of sexual behaviour than adults. Bangladesh is still a low HIV prevalence country, but its vulnerability is very high. The percentage of Bangladeshi men that visits prostitutes is significantly higher than anywhere else in Asia[1]. Most men still do not use condoms in commercial sex encounters: condom usage is only 4% – the lowest in the region. The syphilis rate is also high; among female sex workers as high as 40%[1].
Also, child sexual abuse and exploitation are becoming everyday affair in Bangladesh[1]. For both boys and girls, initial experiences of sexual exploitation invariably involve sexual violence or rape. Rates of sexually transmitted infections are high among victims of sexual exploitation and access to–and acceptance of–condoms are limited. Psychological problems and discrimination within the local community make reintegration to normal life a challenging process for exploited and abused children[1].
Increasing awareness about sexuality and reproduction key to enable youth to make the right and informed decisions and enjoy harmonious relations safe from health risks and psychological trauma. It is, however, hampered by low levels of education. The average literacy rate is 48%, and the female adolescent literacy rate in rural areas is deplorable[1]. In Bangladesh, only 80% of students enrolled in grade one complete primary school. High dropout rates and poor quality teaching are serious problems for primary schools. Only 46% of boys and 53% of girls attend secondary school[1]. The current curriculum contains only minimal information about SRHR and often teachers are reluctant to even teach this content[1].
Early marriage and sexual harassment cause girls to drop out of education and limits their opportunities for social interaction[1]. Only 53% per cent of adolescent girls are enrolled in secondary school and even fewer attend regularly[1].
It is not only that youth lack adequate information and suffer from the taboo surrounding SRHR issues, but the low social status and the lack of rights of women[1] also seriously hamper them in making decisions to protect themselves from sexual and reproductive health problems and unwanted pregnancies. Violence against women is accepted in all layers of society and rape, acid throwing, harassment, forced prostitution and trafficking are on the rise[1]. Domestic violence remains the biggest threat facing adolescent girls[1].
Lack of SRHR education is a pressing health and a women’s rights issue. But it also worsens poverty. Bangladesh, with an estimated population of around 150 million, has the highest density of population in the world. Land and resources are becoming scarcer, and the current population growth is not sustainable[1]. Although poverty declined during the last decade but still 26 percent of whom live below the national poverty line of US $2 per day.The demographic structure, particularly the over-presence of young people (40% in age 15-24 years) will cause the population to continue to increase and stabilize at around 250 million in 2085[1]. Meanwhile, food prices continue to rise sharply, land is scarce and crops are vulnerable to natural disasters. Already, most Bangladesh’s citizens do not have access to an adequate diet. The rapid population growth will increase the demand for food and fuel, driving up the price even more[1]
The contraceptive prevalence rate has increased to 61% in 2011. The use of modern methods constitutes 52%, The use of permanent and long-lasting methods has declined and accounts for 13% only. Discontinuation rate is also high [1].
Although abortion is illegal in Bangladesh, the government has long supported a network of menstrual regulation (MR) clinics.650,000 menstrual regulations are performed each year in Bangladesh [2]. And another 500,000 abortion take place each year. . Due to this high-unwanted pregnancy rate 1-2 million women terminate their pregnancy either by MR or abortion. Most abortions are done by the unskilled practitioners. At least 8.000 women die from complications of unsafe abortions. Besides this around 100.000 women suffer from long run morbidity from the complications of unsafe abortion[1].
In short: Bangladesh’s girls and boys are not in a position to exercise their sexual and reproductive health rights. They lack reliable and timely information and life skills. This does not only cause considerable stress and avoidable violence and health risks, but also is the major cause for the high maternal mortality rates. Girls marry and have children at too early an age and do not practice effective contraception methods. Their parents and teachers are silent and act more on taboos than on the need to protect their children’s health. These taboos are fed by customary traditions and far-reaching gender discrimination.

Sexual health:
A state of physical, emotional, mental and social well-being related to sexuality :not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled (World Health Organization, Draft Working Definition, October 2002)
Sexuality:

A central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, roles and relationships. While sexua by the interaction of biological, psychological, social, economic, political, lity can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced cultural, ethical, legal, historical and religious and spiritual factors (World Health Organization, Draft Working Definition, October 2002)
Sexualrights
Embrace human rights that are already recognized in national laws, international human rights documents and other international agreements. These include the right of all persons, free of coercion, discrimination and violence, to:
• receive the highest attainable standard of health in relation to sexuality, including access to sexual and reproductive healthcare services
• seek and impart information in relation to sexuality
• receive sexuality education
• have respect for bodily integrity
• have a free choice of partner
• decide to be sexually active or not
• have consensual sexual relations
• have consensual marriage
• decide whether or not and when to have children
• pursue a satisfying, safe and pleasurable sexual life
The responsible exercise of human rights requires that all persons respect the rights of others (World Health Organization, Draft Working Definition, October 2002).

Repoductive Rights
Human Rights Day 10 December 1967 1966 Declaration on Population by World Leaders signed by 30 Heads of State. Statement on population by the UN Secretary-General, U Thant.
'The Universal Declaration of Human Rights describes the family as the natural and fundamental unit of society. It follows that any choice and decision with regard to the size of the family must inevitably rest with the family itself, and cannot be made by anyone else. But this right of parents to free choice will remain illusory unless they are aware of the alternatives open to them. Hence, the right of every family to information and the availability of services in the field is increasingly considered as a basic human right and as an indispensable ingredient of human dignity.' (U Thant statement)
Reproductive rights in WPPA 'All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so; the responsibility of couples and individuals in the exercise of this right takes into account the needs of their living and future children, and their responsibilities toward the community' (para. 14(f) in the Principles and Objectives).
' It is recommended that all countries:
• respect and ensure, regardless of their overall demographic goals, the right of persons to determine, in a free, informed and responsible manner, the number and spacing of their children;
• Encourage appropriate education concerning responsible parenthood and make available to persons who so desire advice and the means of achieving it;
• Ensure that family planning, medical and related social services aim not only at the prevention of unwanted pregnancies but also at the elimination of involuntary sterility and subfecundity in order that all couples may be permitted to achieve their desired number of children, and that child adoption may be facilitated;
o Equal status of men and women in the family and in society improves the overall quality of live. This principle of equality should be fully realized in family planning where each spouse should consider the welfare of the other members of the family; (para. 42).
o Improvement of the status of women in the family and in society can contribute, where desired, to smaller family size, and the opportunity for women to plan births also improves their individual status (para. 43)

Maternal mortality:
Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. To facilitate the identification of maternal deaths in circumstances in which cause of death attribution is inadequate, a new category has been introduced: Pregnancy-related death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.
Live birth refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles - whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.
Maternal mortality rate in Bangladesh has declined by 66% over last few decades, estimated at a rate of 5.5% every year. The latest Bangladesh Maternal Mortality Rate is 170 per 100,000 live births as per UN and WHO estimates (2014). The MMR was 600 per 100,000 live births in 1975 and 574 in 1990. Bangladesh is well on track and striving hard to attain the target of 143 deaths per 100,000 live births by 2015 as envisaged in MDG-5. The contraceptive prevalence rate is around 61% as against the target of 72% to be achieved by 2015.
The extensive drive for pre-natal care, introduction of health vouchers scheme for poor women, deployment of community based skilled birth attendants, and introduction of the midwifery programme by the Government and United Nations Population Fund (UNFPA), other UN and development partners and NGOs in service delivery contributed to such successes. Additionally, a number of favorable changes occurred during this period like income per head increased sharply, the poverty rate fell and the education levels of women of reproductive age improved substantially.

While the above mentioned achievements would lift our morale, there is no scope to be complacent as yet. There are many challenges ahead which the nation has to face with unwavering determination, such as, more than 5000 women die during child birth every year; 70% of pregnant mothers suffer from acute anemia and the high rate of adolescent pregnancy persist in Bangladesh. It is estimated that about 16 women per 1 maternal death suffer from various diseases related to pregnancy and child birth e.g. Obstetric Fistula, Uterine Prolapse, anemia, etc.
The major causes of Maternal Mortality are - postpartum hemorrhage (31%), Eclampsia / pre-eclampsia (20%), delayed & obstructed labour (7%), Abortion (1%), other direct cause (5%) and indirect cause (35%).
The key factors affecting maternal deaths are knowledge attitude and practice of family planning and safe motherhood care as well as accessibility& availability of contraceptives. Bangladesh has achieved success in family planning programs against the backdrop of low literacy rate, low status of women, low income and so on. Major successes in population sector programs were achieved in expanded access to family planning services with the introduction of a broader range of modern and effective methods. Use of contraceptives and quality family planning services can avert more than 32% of maternal deaths and 10% of child mortality if couples spaced their pregnancies more than two years apart. According to the BDHS 2011, the unmet need for Family Planning is 13.5% and the family planning programme of the Government is focusing on addressing this issues.
UNFPA Bangladesh supports Family Planning service delivery in Bangladesh through system strengthening vis a vis quality assurance, capacity building of newly recruited doctors and FWVs for clinical contraception and post-partum FP, capacity building of field workers on inter-personal communication and internet communication technology and strengthening training centres through procurement of equipment, national FP campaign, the observance of FP Service and Campaign weeks and World Population Day, promoting the use of long acting and permanent method for eligible couples and training on inter-personal communication (IPC) and implementation of the National Plan of Action on ASRH.
UNFPA has been supporting the Directorate General Of family Planning (DGFP) in providing Emergency Obstetric Care through 70 Maternal and Child Welfare Centres (MCWCs) throughout the country. The components of this support are through training of doctors on Emergency Obstetric and Neonatal Care.
The proportion of births attended by skilled health personnel has increased from 5% in 1990 to 31.7% in (BDHS 2011) but still 71% of delivery occurs at home. To reduce maternal mortality and morbidity, UNFPA is supporting the community skilled birth attendant (CSBA) as well as training and establishment of the new Midwifery cadre. To comply with the Honourable Prime Minister's commitment at the 65th General Assembly at the UN to create new cadre of 3000 midwives in country, UNFPA is supporting the Government to develop the midwife as a professional. Efforts include capacity assessment and assistance for midwifery education, development of strategic directions and mentorship programmes.
More than 1100 students have already enrolled in a 3 year diploma midwifery course since 2012. The first batch will come out in 2015. For the time being, UNFPA has been supporting the 6-month post- basic advanced midwifery training for nurse-midwife through Nursing Institutes/ colleges in the public sector. Since 2010, a total of 1103 nurse-midwives have been trained. They are serving in different public sector hospitals. These programmes are supported by UNFPA through the Directorate General Of Health services (DGHS)
Pregnancy and childbirth-related complications are the chief causes of maternal mortality and morbidity in Bangladesh. In addition, the status of women is low and this severely hinders their families and their access to reproductive health care. Obstructed labor is the most common cause of obstetric fistula (OF), the immediate causes of obstetric fistula are obstructed labor and a lack of emergency obstetric care, pervasive poverty is an important underlying cause. Women who suffer from OF are mostly very poor, malnourished, lack basic education and live in remote, rural hard to reach areas. The traditional practice of early marriage and childbearing contributes to a risk of obstructed labor and fistula. The low status of women, particularly young women just after marriage, play a fundamental part in fistula development. Some women are denied access to health care, or are actually harmed due to cultural beliefs and traditional practices. Some women may live in seclusion and, for many, the responsibility to decide for seeking health care in pregnancy, or even after prolonged labor, depends upon the husband or other family members, including the mother-in-law. When these women fail in their perceived duty to bear live children and, still worse, develop the stigmatizing condition of OF, they are often rejected by their husband's family and have no means of subsistence. They are usually immediately abandoned and left to fend for themselves.
In Bangladesh as per study undertaken in 2003, 1.69/1000 ever married women are suffering with obstetric fistula. Taking into account; three global approaches Prevention, Treatment and Rehabilitation to end obstetric fistula Bangladesh government's health department with technical and financial support of UNFPA launched the project in October 2003. Since then this project is facilitating capacity development of service providers, nationwide campaign to aware community about obstetric fistula, rehabilitation of the fistula victims through skill development so that they can return to their normal lives. UNFPA supports Fistula treatment, rehabilitation, prevention and awareness programme to bring an immediate tangible change in the quality of life of the women suffering from Fistula.
For prevention, treatment and rehabilitation of Fistula patients UNFPA has helped to set up the National Fistula Centre at Dhaka Medical College hospital and also strengthening additional nine Medical Colleges Government Hospitals for the treatment of fistula patients. An integral part of this technical support is the capacity development of services providers where 250 Doctors and about 300 Nurses received training on Fistula Surgery. About 3,500 cases treated in government medical college hospitals since 2003.
Infant mortality:
The death of a baby before his or her first birthday is called infant mortality. The infant mortality rate is an estimate of the number of infant deaths for every 1,000 live births. This rate is often used as an indicator to measure the health and well-being of a nation, because factors affecting the health of entire populations can also impact the mortality rate of infants. There are obvious differences in infant mortality by age, race, and ethnicity; for instance, the mortality rate for non-Hispanic black infants is more than twice that of non-Hispanic white infants.
Infant mortality
Situation and trends
In 2015, 4.5 million (75% of all under-five deaths) occurred within the first year of life.
The risk of a child dying before completing the first year of age was highest in the WHO African Region (55 per 1000 live births), over five times higher than that in the WHO European Region (10 per 1000 live births).
Globally, the infant mortality rate has decreased from an estimated rate of 63 deaths per 1000 live births in 1990 to 32 deaths per 1000 live births in 2015. Annual infant deaths have declined from 8.9 million in 1990 to 4.5 million in 2015.
Situation of Bangladesh:
Home > Health
Child mortality rate in Bangladesh drops 73 percent in 25 years, Unicef report shows

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Bangladesh has brought down the child mortality rate by 73 percent in the last 25 years.

Related Stories
• Under-5 mortality rates halved: Unicef
A United Nations Children's Fund (Unicef) report published on Tuesday said the under-five mortality rate in Bangladesh in 1990 was 144 per 1,000.

But in 2015, the rate is 38 per 1,000.

The Levels and Trends in the Child Mortality Report 2015 also showed that the child mortality rates across the world have halved, 53 percent, over the same timeframe.

The number of under-five deaths has dropped to below 6 million for the first time this year, a figure that is in stark contrast to the 12.7 million deaths in 1990.

Unicef Deputy Executive Director Geeta Rao Gupta said the development was a great achievement.

“But the far too large number of children still dying from preventable causes before their fifth birthday – and indeed within their first month of life – should impel us to redouble our efforts to do what we know needs to be done.”

The report was released by Unicef, the World Health Organisation, the World Bank Group and the Population Division of UNDESA.

The achievement, however, has showed that a lot has to be done to reach the Millennium Development Goal of a two-thirds reduction between 1990 and 2015.

According to the UN, Bangladesh has already achieved the target of reducing under-five mortality rates.

The mortality rate was 46 per 1,000 last year, while the target was 48 for 2015.

Sixty-two of the 162 countries, whose data were evaluated to make the report, have also reached the goal.

However, the report indicates that 16,000 children under five are still dying every day.

A massive 45 percent of under-five deaths occur in the neonatal period – the first 28 days of life, the report pointed out, terming prematurity, pneumonia, complications during labour and delivery, diarrhoea, sepsis, and malaria as leading causes.

Nearly half of all under-five deaths are associated with malnutrition.

The report highlights that a child’s chance of survival still depends vastly on where he or she is born.
Section 04

Despite the fact that sexual and reproductive rights are human rights, violations take place on a daily basis. Many women and girls around the world do not have control over their own bodies and struggle to access the information, sex education and reproductive health services they need for a healthy life. They are persecuted for making decisions, or prevented from doing so at all. Religious and cultural norms, gender and racial discrimination, and poverty all disproportionately affect women and girls’ ability to enjoy their sexual and reproductive rights. Opposition to sexual and reproductive rights is growing globally, there is a very real backlash, and our rights to express our sexuality and make decisions over our own bodies are being eroded.
The problems are very real and have very real impacts for people’s lives around the world. In Burkina Faso women and girls are not given contraception unless they are accompanied by their husbands or parents. In Tunisia and Algeria, rape survivors can be forced to marry their rapists. In El Salvador abortion is criminalised in all circumstances, criminalising women, girls and health professional. In Ireland, abortion is illegal except when the life of the woman or girl is at risk but in practice does not adequately protect them. And in Northern Ireland women and girls do not have the same access to abortion as women in the rest of the UK and likewomen in Ireland, have to travel to England to obtain often life-saving healthcare. In effect this denies women and girls’ rights to privacy, freedom of expression, access to information, right to live without violence and intimidation, right to non-discrimination, their right to life and is contrary to the total ban on torture.
Bangladesh’s socio-cultural environment contains pervasive gender discrimination, so girls and women face many obstacles to their development. Girls are often considered to be financial burdens on their family, and from the time of birth, they receive less investment in their health, care and education. With the advent of puberty, differences in the ways that adolescent girls and boys are treated become much more pronounced. Adolescence is not viewed as a distinct phase of life; instead the onset of physical maturity is seen as an abrupt shift from childhood to adulthood. At puberty, girls’ mobility is often restricted, which limits their access to livelihood, learning and recreational and social activities. Bangladesh’s rates of child marriage and adolescent motherhood are among the highest in the world. Maternal mortality rates also remain extremely high. Poor maternal health is the result of early marriage, women’s malnutrition, a lack of access to and use of medical services and a lack of knowledge and information. Most women give birth without a skilled attendant. In the home, women’s mobility is greatly limited and their decision-making power is often restricted. For instance, about 48 per cent of Bangladeshi women say that their husbands alone make decisions about their health, while 35 per cent say that their husbands alone make decisions regarding visits to family and friends1 .