Improving reproductive health: integrating STD and contraceptive services

The International Conference on Population and Development held in Cairo in 1994 recommended that family planning (FP) services be expanded, with more attention given to the prevention and treatment of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Although such integration of FP and STD services seems a natural union, historical, philosophical, and structural differences in the two fields pose obstacles to integration in many settings. This paper examines selected experiences with FP/STD integration in the United States and developing countries and reviews practical issues that have application to FP providers, STD prevention programs, and those in general practice. Priority areas for future research include: 1) the usefulness and uses of STD risk assessment in FP populations, 2) the relationship between STD/HIV transmission and use of various contraceptive methods, 3) the feasibility of getting high-risk individuals to use dual methods for pregnancy and STD prevention, and 4) the impact adding STD services will have on training requirements, clinic costs, and quality of care within established FP programs. As clinicians in public and private settings assume more comprehensive roles in the provision of both types of services, program managers can facilitate the process of FP and STD service integration by promoting a focus on meeting the client's reproductive health needs.