"Infertility as a social and medical problem".

1. Barren marriage.

3. Abortion as a social phenomenon.

4. The role of social workers in the prevention of infertility.

Relevance chosen topic is the need to increase the birth rate in the Russian Federation to overcome the difficult demographic situation

object is infertility.

the role of social workers in the prevention of infertility.

The purpose of the control work is to study the causes of infertility in men and women and the role of social workers in the prevention of infertility.

Barren marriage.

Infertility- the inability of persons of working age to reproduce offspring. A marriage is considered infertile if a woman's pregnancy does not occur within a year of regular sexual activity without the use of contraceptives and methods. Infertility can be male or female. The male factor in a childless marriage is 40-60%.

Therefore, the diagnosis of infertility in a woman can only be made after the exclusion of infertility in a man (with positive tests confirming the compatibility of sperm and cervix).

Relative- the possibility of pregnancy is not excluded. Absolute - pregnancy is not possible. According to the WHO classification, the main groups of causes of infertility are distinguished:

violation of ovulation 40%

tubal factors associated with pathology of the fallopian tubes 30%

gynecological inflammatory and infectious diseases 25%

unexplained infertility 5%

The primary incidence of infertility, according to official statistics, was in 1998. 134.3 per 100,000 women. In total, 47,322 women applied for infertility during the year. These are married women who want to have children and have applied to a medical institution, therefore, the real level of infertility is much higher. According to special studies, the number of infertile marriages in Russia is 19%, according to international experts 24-25%. Thus, one in five married couples cannot have children.

The causes of infertility are socially determined, being the result of abortions, sexually transmitted, gynecological diseases, and unsuccessful births. Infertility often develops in childhood. Prevention of infertility should be aimed at reducing gynecological morbidity in women, preventing abortion, promoting a healthy lifestyle and optimal sexual behavior.

Infertility is an important medical and social problem, as it leads to a decrease in the birth rate. By solving the problem of infertility, it would significantly improve the reproduction rates of the population. Infertility is an important socio-psychological problem, as it leads to socio-psychological discomfort of spouses, conflict situations in the family, and an increase in the number of divorces.

coarsening of morals, antisocial behavior (fornication, alcoholism), aggravation of selfish character traits, violation of the psycho-emotional sphere and sexual disorders in spouses. Prolonged infertility creates great neuro-psychic tension and leads to divorce. 70% of infertile marriages end.*

Diagnosis of infertility is carried out by antenatal clinics, family planning service. And in some cases, inpatient treatment in gynecological departments is required.

Abortion.

According to experts, from 36 to 53 million abortions are performed annually in the world, that is, every year about 4% of women of childbearing age undergo this operation. In Russia, abortion remains one of the methods of birth control. In 1998 1,293,053 abortions were performed, which is 61 per 1,000 women. If at the end of the 80s 1/3 of all in the world, then since the beginning of the 90s, thanks to the development of family planning services, the frequency of abortions has been gradually decreasing. However, in Russia, compared with other countries, they still remain high.

In most countries of the world, abortion is legal. Only for 25% of women in the world, the reproduction of a legal aorta is not available (mostly they are residents with a pronounced clerical influence or a small population). All European countries, with the exception of the Republic of Ireland, Northern Ireland and Malta, allow artificial termination of pregnancy. Different countries have different laws governing the procedure for terminating a pregnancy.

L. V. Anokhin and O. E. Konovalov

1. Laws allowing abortion at the request of a woman. In most European countries, abortion can be performed up to 12 weeks of pregnancy, in the Netherlands up to 24 weeks, in Sweden up to 18 weeks. The age at which a girl can independently decide on an abortion:

Denmark and Spain - after 18 years

In a number of countries (Italy, Belgium, France), a woman is given 5-7 days without fail to think and make an informed decision. These laws operate in countries where 41% of the world's population lives.

3. Laws restricting the right to abortion. In a number of countries, abortion is allowed only in case of a threat to the woman's physical or mental health: congenital deformities, rape. Approximately 12% of the world's population live in conditions where the right to abortion is restricted.

4. Laws prohibiting abortion under any circumstances.

In the USSR legislation on abortion, three stages can be distinguished:

Stage 1 (1920-1936) - legalization of abortion.

2. stage (1936-1955) - the prohibition of abortion.

3rd stage (1955 to our time) - permission for abortion.

Currently, in Russia, any woman has the right to have an abortion at a gestational age of up to 12 weeks. Artificial termination of pregnancy for medical reasons is carried out with the consent of the woman, regardless of the gestational age. The list of medical indications is determined by the Order of the Ministry of Health No. 242 dated 12.12.96, artificial termination of pregnancy up to 22 weeks of pregnancy can be performed with the consent of the woman for social reasons.*

The system of prohibitions, including abortion, does not lead to the desired results. The ban on abortion and the lack of family planning programs lead to an increase in the number of criminal abortions. Teenagers use criminal abortion to terminate their first pregnancy. At the same time, in developing countries, more than half of maternal deaths are due to criminal abortions.

But even legal abortion has a serious negative impact.

* "Organization of the work of the antenatal clinic"

on the woman's body.

Abortion is the cause of secondary infertility in 41% of cases.

After an abortion, the frequency of spontaneous miscarriages increases by 8-10 times.

About 60% of primiparous women over the age of 30 suffer from miscarriage caused by first abortions. In young women who terminate their first pregnancy with an abortion, the risk of developing breast cancer increases by 2-2.5 times.

The role of social workers in the prevention of infertility.

- this is freedom in deciding the issue of the number of children, the timing of their birth, the birth of only desired children from parents ready for a family.

helps a woman regulate the onset of pregnancy at the optimal time to preserve the health of the child, reduce the risk of infertility; reduce the risk of contracting sexually transmitted diseases;

makes it possible to avoid conception during breastfeeding, reducing the number of conflicts between spouses;

guarantees the birth of a healthy child in case of an unfavorable prognosis for offspring;

contributes to the decision about when and how many children a particular family can have;

Increases the responsibility of spouses to future children, cultivates discipline, helps to avoid family conflicts.

· Provides an opportunity to have a sexual life without fear of unwanted pregnancy, without exposing yourself to stress, continue their studies, master a profession, build a career;

It gives husbands the opportunity to mature and prepare for future fatherhood, helps fathers provide for their families financially.

Childbirth is regulated in three ways:

2. sterilization

CONTRACEPTION.

In economically developed countries of the West, more than 70% of married couples use contraceptives. About 400 million women in developed countries use various methods of contraception to prevent unwanted pregnancies. Over 30 years of family planning services around the world, more than 400 million births have been avoided.

by the number of intrauterine devices and hormonal contraception. So, in 1998, 17.3% of women of childbearing age with intrauterine devices and 7.2% of those using hormonal contraception were under observation. It should be noted that while the number of women using spirals has not changed significantly since 1990, the number of women using hormonal contraception has increased by 4.3 times. Special studies show that in Russia approximately 50-55% of married couples are regularly protected from pregnancy.

social factors (in particular, the attitude towards contraception of the government of the country, the economic situation)

cultural factors (in particular traditions)

attitude towards religion

Legislative restrictions (limitation of the types of contraception that can be used)

When deciding on the choice of a contraceptive, the following points should be considered:

any method of protection is better than no protection at all;

The most acceptable method is the one that suits both partners;

The main requirements for methods of protection:

the reliability of the method;

minimal impact on the sexual partner;

ease of use;

·safety;

fast recovery of fertility

Thus, granting women the right to reproductive health care, including family planning, is a fundamental condition for their full life and the implementation of gender equality. The realization of this right is possible only with the development of the planning service, the expansion and implementation of the "Safe Motherhood" programs, the improvement of sexual and hygiene education, the provision of contraceptives to the population, especially young people. Only this approach will help solve the problem of abortion and STDs.

STERILIZATION.

indications and contraindications for surgical sterilization. There are only three social indicators:

3. Age over 30 with 2 children

However, sterilization cannot be regarded as the best way to prevent pregnancy; it is not very popular among the population.

1. V. K. Yuriev, G. I. Kutsenko “Public health and healthcare”

Publishing house "Petropolis" Saint-Petersburg, 2000

2. Journal "Sotsis" No. 12, 2003

Infertility is a serious problem of reproduction, in which there is a combination of social, mental and physical ill health in the family.

Physical ill health is a disease of a married couple as a whole.

The social factors of a fruitless marriage include: a decrease in the social activity of the most able-bodied group of the population; different influence of the frequency of infertile marriage on the demographic situation in the population and the state as a whole.

Mental trouble is characterized by the lability of the nervous system, the formation of an inferiority complex, the development of severe psychosexual disorders. And in the end, all this becomes the cause of either unstable family relationships, or leads to their destruction in general.

By studying the structure of infertile marriages, one can obtain data on the reproductive health of the population, which in turn indirectly characterizes the level and quality of medical care, as well as the level of general and medical culture of the population.

With a frequency of infertile marriages of 15% or more, a socio-demographic problem of a national scale arises. In recent years, for our country, the problem of infertility can already be considered as such for the following reasons:

1) barren marriage in Russia is about 14%;

2) increase in mortality;

3) a decrease in the birth rate;

4) the excess of mortality rates over the birth rate;

5) an increase in the number of divorce proceedings and in recent years the excess of the number of divorces over the number of marriages;

6) an increase in the general morbidity of the population;

7) equality in the number of abortions and childbirth, or even an excess of the number of the former.

Thus, the problem of infertility in marriage for Russia is not only medical, but socio-demographic national scale.

Infertility is the inability of a mature organism to conceive.

Infertile marriage is the absence of pregnancy after 12 months of regular unprotected intercourse.

There are male and female infertility. It can be absolute or relative. Absolute infertility means that the possibility of pregnancy is completely excluded (absence of organs, anomalies in the development of the genital organs). Relative - the probability of pregnancy is not excluded.

Infertility can be primary when there is no indication in the anamnesis of the presence of at least any pregnancy, provided that there is a regular sexual life without contraception, and secondary - when there were previous pregnancies (even ectopic, non-developing), but confirmed either visually (presence of a fetus), or histologically, or according to ultrasound (ultrasound), but after these pregnancies for 1 year with regular unprotected intercourse, the next pregnancy does not occur.

More on the topic Infertility - a socio-demographic problem:

Social and demographic characteristics of military personnel
Dependence of the development of autopsychological competence on professional, career and socio-demographic parameters

The demographic situation in Russia has been one of the key medical and social problems on a national scale for many years. Despite the purposeful activity of our state to increase the birth rate, natural population growth in most subjects of the Russian Federation is at a relatively low level. Among the many reasons for such a demographic situation, the unsatisfactory state of the reproductive health of the population, in particular infertility, is of particular importance.

Infertility (as defined by WHO) is the inability of a sexually active, non-contraceptive couple to achieve pregnancy within one year. According to a number of studies, in Russia, the frequency of infertile couples in 2016 reaches 16%, despite the fact that, according to WHO recommendations, an indicator of 15% is considered critical. According to the Scientific Center for Obstetrics and Gynecology of the Ministry of Health of the Russian Federation, 7-8 million Russian women and 3-4 million men are currently infertile in Russia. It has been established that every seventh married couple in Russia faces family planning problems due to infertility. The number of divorces among childless couples is on average 6-7 times higher than in families with children. Among such couples, the female factor of infertility plays the largest role, while the contribution of the male factor is almost 2 times less (Fig. 1).

Figure 1. The role of male and female factors of infertility in married couples

According to the Federal State Statistics Service, the prevalence of female infertility in Russia is growing every year (Fig. 2) .

Figure 2. Female infertility in Russia according to Rosstat data 2005-2014 per 100,000 women aged 18-49

There are several types of infertility, but two forms of pathology are most often distinguished: primary and secondary. Primary female infertility is the inability of a woman to give birth to a child due to the inability to become pregnant or carry and give birth to a live child. The reason for this, as a rule, are congenital anomalies in the development of female genital organs and ovarian pathology (polycystic ovary syndrome, premature ovarian failure). Secondary infertility is the inability of a woman to give birth to a child due to the inability to become pregnant or carry and give birth to a live child, but after she had a previous pregnancy, or she was able to carry and give birth to a live child earlier . The most common causes of secondary infertility are women over 30 years of age, abortions, sexually transmitted infections, and gynecological diseases (Table 1). According to the Scientific Center for Obstetrics and Gynecology, a year after an abortion, violations in the reproductive system are found on average in 15% of women, and after 3-5 years - in 53.5%.

Table 1.

Distribution of risk factors for infertility by significance rank

Risk factors		Rank place
Woman's age (over 30)
Abortion with complications
Sexually transmitted infections
Gynecological diseases
The level of education
Social status
The nature of the menstrual function
Gynecological operations
Marriage parity

In Russia, a large proportion is secondary infertility (Fig. 3), which can be prevented. That is, state policy should be aimed at preventing and reducing the prevalence of gynecological diseases in women, preventing abortion, promoting a healthy lifestyle and optimal reproductive behavior.

Figure 3. The proportion of primary and secondary infertility in women in infertile marriages in 2014

Male infertility also contributes significantly to a woman's inability to conceive a child. The main causes of male infertility are: genital infections (11%), varicocele (7%) and idiopathic oligo-, astheno-, teratozoospermia (15%). A combination of 2 or more factors of infertility in patients was detected in 32% of cases. Based on the fact that the male part of the population is reluctant to visit doctors for such a delicate problem, the prevalence of male infertility can actually be much higher than official data.

The reasons for the prevalence of infertility in Russia can also be called stressful and psychological factors, early sexual activity and a high prevalence of behavioral risk factors, especially among the younger generation.

In socio-demographic terms, infertility causes a general decline in the birth rate in the country, a decrease in population and labor resources. It is also necessary to note a number of negative aspects regarding the psychological state of men and women who are diagnosed with infertility. These are, first of all, emotional experiences, family conflicts, an increase in the frequency of antisocial acts, a feeling of inferiority of the individual.

Currently, a large list of various methods has been developed to help childless couples, including the technology of in vitro fertilization. As a result of this technique, about 0.5% of children are born in Russia, the total number of attempts per year is more than 30 thousand. The effectiveness of technology according to different sources ranges from 24 to 50%. Undoubtedly, the development of medicine makes it possible to actively and quite effectively solve the problem of infertility, but this entails a wide range of psychological problems, as well as financial costs, both on the part of married couples and on the part of the state. Based on the fact that secondary cases of infertility account for the majority, it is much more beneficial to prevent their occurrence.

Thus, infertility is the cause of many personal tragedies and the collapse of childless marriages, in addition, it is a serious demographic problem. The state of reproductive health of the population is the most important component of the socio-demographic development of the country. Restoration of the reproductive health of the population is the most important task on a national scale, the solution of which will ensure the growth of the country's population and its demographic stability in the long term.

Bibliography:

Apolikhin O.I., Moskaleva N.G., Komarova V.A. Modern demographic situation and problems of improving the reproductive health of the population of Russia. //Experimental and clinical urology. 2015. No. 4.
Dzhamaludinova A.F., Gonyan M.M. Reproductive health of the population of Russia // Young scientist. - 2017. - No. 14.2. - S. 10-13.
Health care in Russia. 2015: Stat.sb./Rosstat.-M., 2015.S.54.
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov [Electronic resource] http://patient.ncagp.ru
Nifantova R.V. Reproductive technologies in solving infertility problems as social innovations in the healthcare system.//Scientific notes of the Trans-Baikal State University. 2013.
Novoselova E.N. Reproductive strategies of urban agglomeration residents (on the example of Moscow).//Bulletin of Moscow University. Sociology and political science. 2015. №2.
Federal State Statistics Service [Electronic resource] http://www.gks.ru

"Infertility as a social and medical problem".

1. Fruitless marriage.

2. Female and male infertility.

3.Abort as a social phenomenon.

4. The role of social workers in the prevention of infertility.

The relevance of the chosen topic is the need to increase the birth rate in the Russian Federation to overcome the difficult demographic situation

The object is infertility.

Subject: the role of social workers in the prevention of infertility.

The purpose of the control work is to study the causes of infertility in men and women and the role of social workers in the prevention of infertility.

Barren marriage.

Infertility is the inability of people of working age to reproduce offspring. A marriage is considered infertile if a woman's pregnancy does not occur within a year of regular sexual activity without the use of contraceptives and methods. Infertility can be male or female. The male factor in a childless marriage is 40-60%.

Therefore, the diagnosis of infertility in a woman can only be made after the exclusion of infertility in a man (with positive tests confirming the compatibility of sperm and cervix).

Female infertility can be primary (in the absence of a history of pregnancy) and secondary (in the presence of a history of pregnancy). There are relative and absolute female infertility. Relative - the probability of pregnancy is not excluded. Absolute - pregnancy is not possible. According to the WHO classification, the main groups of causes of infertility are distinguished:

violation of ovulation 40%

tubal factors associated with pathology of the fallopian tubes 30%

gynecological inflammatory and infectious diseases 25%

unexplained infertility 5%

Social and psychological trouble is manifested by a decrease in interest in ongoing events, the development of an inferiority complex, a decrease in overall activity and performance. In marriage, coarsening of morals, antisocial behavior (fornication, alcoholism), aggravation of selfish character traits, a violation of the psycho-emotional sphere and sexual disorders in spouses can be observed. Prolonged infertility creates great neuro-psychic tension and leads to divorce. 70% of infertile marriages end.*

Diagnosis of infertility is carried out by antenatal clinics, family planning service. And in some cases, inpatient treatment in gynecological departments is required.

According to experts, from 36 to 53 million abortions are performed annually in the world, i.e. every year, about 4% of women of childbearing age undergo this operation. In Russia, abortion remains one of the methods of birth control. In 1998 1,293,053 abortions were performed, which is 61 per 1,000 women. If at the end of the 80s 1/3 of all in the world, then since the beginning of the 90s, thanks to the development of family planning services, the frequency of abortions has been gradually decreasing. However, in Russia, compared with other countries, they still remain high.

L.V. Anokhin and O.E. Konovalov

UK and Sweden - after 16 years

Denmark and Spain - after 18 years

Austria - after 14 years.

2. Laws allowing abortion for social reasons. About 25% of women in the world have the right to an abortion for social reasons.

4. Laws prohibiting abortion under any circumstances.

In the USSR legislation on abortion, three stages can be distinguished:

Stage 1 (1920-1936) - legalization of abortion.

2. stage (1936-1955) - the prohibition of abortion.

3rd stage (1955 to our time) - permission for abortion.

Currently, in Russia, any woman has the right to have an abortion at a gestational age of up to 12 weeks. Artificial termination of pregnancy for medical reasons is carried out with the consent of the woman, regardless of the gestational age. The list of medical indications is determined by Order of the Ministry of Health No. 242 dated 12/12/96, artificial termination of pregnancy up to 22 weeks of pregnancy can be performed with the consent of the woman for social reasons. *

But even legal abortion has a serious negative impact.

* "Organization of the work of the antenatal clinic"

on the woman's body.

Abortion is the cause of secondary infertility in 41% of cases.

After an abortion, the frequency of spontaneous miscarriages increases by 8-10 times.

The role of social workers in the prevention of infertility.

Within the framework of the competence of social services, it is possible to provide the population with specialized medical and psychological advice on the regulation of childbearing. Family planning is freedom in deciding the number of children, the timing of their birth, the birth of only desired children from parents ready for a family.

Family planning:

helps a woman regulate the onset of pregnancy at the optimal time to preserve the health of the child, reduce the risk of infertility; reduce the risk of contracting sexually transmitted diseases;

makes it possible to avoid conception during breastfeeding, reducing the number of conflicts between spouses;

guarantees the birth of a healthy child in case of an unfavorable prognosis for offspring;

contributes to the decision about when and how many children a particular family can have;

Increases the responsibility of spouses to future children, cultivates discipline, helps to avoid family conflicts.

· Provides an opportunity to have a sexual life without fear of unwanted pregnancy, without exposing yourself to stress, continue their studies, master a profession, build a career;

It gives husbands the opportunity to mature and prepare for future fatherhood, helps fathers provide for their families financially.

Childbirth is regulated in three ways:

1. Contraception

2. sterilization

CONTRACEPTION.

In Russia, the proportion of couples who use contraception against unwanted pregnancies is lower than in the economically developed countries of Europe, but there are no official statistics. Statistical records are kept only on the number of intrauterine devices and hormonal contraception. So, in 1998, 17.3% of women of childbearing age with intrauterine devices and 7.2% of those using hormonal contraception were under observation. It should be noted that while the number of women using spirals has not changed significantly since 1990, the number of women using hormonal contraception has increased by 4.3 times. Special studies show that in Russia approximately 50-55% of married couples are regularly protected from pregnancy.

The frequency of contraceptive use in certain countries is affected by:

social factors (in particular, the attitude of the country's government to contraception, the economic situation)

cultural factors (in particular traditions)

relation to religion

Legislative restrictions (limitation of the types of contraception that can be used)

When deciding on the choice of a contraceptive, the following points should be considered:

any method of protection is better than no protection at all;

The most acceptable method is the one that suits both partners;

The main requirements for methods of protection:

the reliability of the method;

· availability;

hygiene;

minimal impact on the sexual partner;

ease of use;

· safety;

fast recovery of fertility

STERILIZATION.

In order to protect women's health, reduce the number of abortions and deaths from them, since 1990, surgical sterilization of women and men has been allowed in Russia. It is performed at the request of the patient in the presence of appropriate indications and contraindications for surgical sterilization. There are only three social indicators:

1. age over 40;

2. having 3 or more children

3. Age over 30 with 2 children

However, sterilization cannot be regarded as the best way to prevent pregnancy; it is not very popular among the population.

Literature:

1. V. K. Yuriev, G.I. Kutsenko "Public health and healthcare"

Publishing house "Petropolis" Saint-Petersburg, 2000

2. Journal "Sotsis" No. 12, 2003

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The relevance of the chosen topic is the need to increase the birth rate in the Russian Federation to overcome the difficult demographic situation

object is infertility.

Subject: the role of social workers in the prevention of infertility.

The purpose of the work is to study the causes of infertility in men and women and the role of social workers in the prevention of infertility.

INFERTILITY MARRIAGE.

Female infertility can be primary (in the absence of a history of pregnancy) and secondary (in the presence of a history of pregnancy). There are relative and absolute female infertility.

Relative- the possibility of pregnancy is not excluded.

Absolute - pregnancy is not possible.

According to the WHO classification, the main groups of causes of infertility are distinguished:

violation of ovulation 40%
tubal factors associated with pathology of the fallopian tubes 30%
gynecological inflammatory and infectious diseases 25%
unexplained infertility 5%

The primary incidence of infertility, according to official statistics, was in 1998. 134.3 per 100,000 women. In total, 47,322 women applied for infertility during the year.

The causes of infertility are socially determined, being the result of abortions, sexually transmitted, gynecological diseases, and unsuccessful births. Prevention of infertility should be aimed at reducing gynecological morbidity in women, preventing abortion, promoting a healthy lifestyle and optimal sexual behavior.

Infertility is an important medical and social problem, as it leads to a decrease in the birth rate. Infertility is an important socio-psychological problem, as it leads to socio-psychological discomfort of spouses, conflict situations in the family, and an increase in the number of divorces. fertility infertility social