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.