RSU tackles stigma to spotlight sexual and reproductive health in healthcare

According to the World Health Organization (WHO), sexual and reproductive health encompasses a wide range of services, including access to contraception, fertility and infertility care, maternal and perinatal health, the prevention and treatment of sexually transmitted infections, protection against sexual and gender-based violence, and education on safe and healthy relationships. In essence, sexual and reproductive health means that a person is physically, mentally and socially satisfied in all matters relating to their reproductive system and its functions. Practically speaking, this means people can enjoy a satisfying and safe sex life, experience healthy pregnancies and childbirth, and decide whether, when and how often to have children.

Historically, sexual and reproductive health has been a taboo subject in Eastern European countries, including Latvia. This is why the situation in this area is not optimal: maternal mortality rates are among the highest in the European Union; knowledge about contraceptives and how to use them is incomplete; the number of newly diagnosed HIV cases is one of the highest in the European Economic Area; and coverage of organised cervical cancer screening in Latvia remains low. This highlights the importance of researching sexual and reproductive health to identify problematic situations and develop potential solutions.

In 2023, the Rīga Stradiņš University (RSU) Institute of Public Health conducted a monitoring study on factors and habits affecting the sexual and reproductive health of Latvian residents, in collaboration with the research centre TNS Latvija and the association Papardes zieds, and on behalf of the Ministry of Health of the Republic of Latvia. This was the fourth study of its kind conducted in Latvia in 26 years; the first study was conducted in 1997, followed by studies in 2003 and 2011. The study aimed to identify trends in changes to sexual and reproductive health, as well as the factors influencing these changes. Compared to previous studies, the latest study covered a much wider age range, from 15 to 64 years (previous studies involved people aged 15 to 49). The situation in Latvia was assessed based on the results obtained, the effectiveness of the state policy implemented between 2011 and 2018 was evaluated, and areas requiring more attention in future health policy-making processes were identified.

Key findings of the study

• Over the past ten years, Latvia has adopted many important strategic and action documents on the promotion and preservation of sexual and reproductive health. However, there is a lack of a unified approach, regular monitoring and coordination when it comes to assessing their implementation and effectiveness;
• Fewer than half of women attend parenting classes during pregnancy. Only one in ten women are vaccinated against influenza during pregnancy. Although smoking and alcohol consumption during pregnancy have decreased since 2011, 10% of pregnant women in Latvia still smoke. While almost all women give birth in maternity wards and one in five has a birth plan, unfortunately, maternal mortality remains high in Latvia;
• Almost half of those who have ever had sexual intercourse do not use contraception, even though they do not plan to become pregnant. Furthermore, about 20% use low-efficiency contraception; 
• Approximately a quarter of women believe that screening for cervical and breast cancer is unnecessary;
• More and more people are obtaining information about sexual and reproductive health issues from the internet;
• Fewer than a third of the population believe that schools have provided sufficient information about sexuality as a positive aspect of human potential, offering satisfaction and promoting well-being. Among younger age groups, the proportion of people dissatisfied with the information schools provide about sexuality is decreasing;
• Financial difficulties are often seen as the main obstacle to maintaining and promoting sexual and reproductive health. This can affect the number of children a family wants, as well as preventive doctor visits and participation in screening programmes; 
• Although almost one-fifth of women and 14% of men have problems in their sex lives, fewer than one-fifth of them consult a doctor; 
• The most common sexually transmitted disease in Latvia is urogenital chlamydia;
• Covid-19 has led to an increase in all forms of violence against women and men, including physical and emotional abuse.

The RSU Institute of Public Health has ensured the continuity of monitoring research in the field of sexual and reproductive health in Latvia. This provides a realistic assessment of the current situation and can inform the development of a strategic vision for sexual and reproductive health in Latvian health and other sectoral policies. The study's up-to-date data also helps state and non-governmental organisations, as well as the private sector, plan and implement public education and support projects more effectively.

At the initiative of the Ministry of Education and Science of the Republic of Latvia, the results of the study were used to prepare methodological materials for teachers, with the aim of improving their knowledge and understanding of sexual and reproductive health issues, and consequently that of young people.

Similarly, the results of the monitoring study justified the establishment of a new free health service in the municipality of Riga. In 2024, in collaboration with the Latvian Midwives Association, the Resilience Centre and the Riga Social Support Center for Children, Youth, and Families young people from diverse family and social backgrounds can access information on sexual and reproductive health and relationship building. The service includes individual consultations and group discussions on topics relevant to young people in this field. Young people can also receive condoms and hygiene kits at the centre.

Over the course of the study the "measured" temperature in the field of sexual and reproductive health also sparked debate in the public sphere, including among the media and policymakers, regarding the factors that influence sexual and reproductive health and its significance in the context of Latvia's demographic situation. RSU Institute of Public Health researchers have been personally involved in raising awareness of these issues by presenting the study's results, explaining trends and changes, and providing policymakers with recommendations to promote understanding of sexual and reproductive health and its role in improving population well-being.

By confronting stigma and providing evidence-based insight, RSU is playing a leading role in transforming how Latvia approaches sexual and reproductive health. Their work not only informs policy, but also helps build a healthier, better-informed, and more empowered society.