Reproductive Health

Learning outcomes
At the end of the lecture, students will be able to
• Define reproductive health
• Explain the development of reproductive health
• State the need for reproductive health
• Mention the components of reproductive health
• State the reproductive health indicators
• Describe the reproductive health services
 Definition of Reproductive Health
• Reproductive health is a state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity, in all
matters relating to the reproductive system and its functions and
processes ( WHO, 2012)

• Reproductive health implies that people are able to have a 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.
Reproductive Health –what does it mean?
• Reproductive health does not only mean any abnormality related
to the reproductive system.
• It includes sexual health, the purpose of which is the
enhancement of personal relations and awareness.
• It does not merely refer to counseling and care for sexually
transmitted diseases and reproduction.
Reproductive age:
• Women of childbearing age 15 – 49 years are considered as
“reproductive age.”
Need for Reproductive Health
1. Women alone are at risk of complications from pregnancy and
childbirth.
2. Women face high risks in preventing unwanted pregnancy.
3. Women are more vulnerable to contracting and suffering
complications of many sexually transmitted infections including
HIV/AIDS. Women can protect themselves from sexually transmitted
infections and diseases only if they are well-informed about it.
4. Deaths and illnesses from reproductive causes are highest among
poor women everywhere.
contd…
5. Adolescents lack reliable reproductive health information.
6. Adolescents are at high risk of acquiring infertility associated with
STIs (sexually transmitted infections) and unsafe abortion.
7. Adults and adolescents need to be aware of sexual health,
reproduction, contraceptives, and STDs. This will help maintain good
reproductive health, physically and mentally.
8. Women must have access to proper medical services when they are
pregnant, have a safe delivery, and deliver a healthy baby.
Development of Reproductive Health
Before the 1978 Alma-Ata Conference:
• Basic health services in clinics and health centers
Primary Health Care Declaration in 1978:
• MCH services started with more emphasis on child survival
• Family planning was the main focus for mothers
Safe Motherhood Initiative in 1987:
• Emphasis on maternal health
• Emphasis on reduction of maternal mortality
contd…
Reproductive health, International Conference on Population and
Development (ICPD) in 1994 developed a program of action (PoA)
• Emphasis on quality of services
• Emphasis on availability and accessibility
• Emphasis on social injustice
• Emphasis on individual women’s needs and rights
Millennium Development Goals and Reproductive Health in 2000
• MDGs are directly or indirectly related to health
• MDG 4, 5, and 6 are directly related to health, while MDG
1,2,3, and 7 are indirectly related to health
contd…
World Summit in 2005
• declared universal access to reproductive health
Sexual and Reproductive Health
“Sexual and reproductive health is fundamental to the social
and economic development of communities and nations, and a
key component of an equitable society.” Reference: The Lancet 2006

United Nations in 2010

The original PoA was revisited to reflect their objective of
achieving universal reproductive health care by 2015.
contd…
Sustainable Development Goals in 2015
• Target 3.7: Sexual and reproductive health
• By 2030, ensure universal access to sexual and reproductive
healthcare services, including family planning, information and
education, and the integration of reproductive health into
national strategies.
Core aspects of reproductive health
1. Improving antenatal, perinatal, postpartum, and newborn care
2. Providing high-quality services for family planning, including
infertility services
3. Eliminating unsafe abortion
4. Combating sexually transmitted infections including HIV,
reproductive tract infections
Factors that affect reproductive health in women
• Age – the number of eggs reduces as age increases and it affects
the fertility rate. It also increases the risk of pregnancy
complications
• Tobacco use, smoking tobacco by either partner may lower the
chances of pregnancy
• Endometriosis
• Chronic diseases such as diabetes, lupus, arthritis, hypertension,
and asthma
• Hormone imbalance
• Environmental factors such as certain chemicals, pollutants, and
radiation are known to cause infertility
contd…
• Being underweight is linked to ovarian dysfunction and infertility in
women.
• Excessive exercise is known to affect ovulation and fertility in women
• Too much body fat or very low body fat
• Lack of sexual and reproductive health knowledge
• Cultural and religious practices
• Lack of access to sexual reproductive health facilities
• Having the premarital sexual activities hidden
Reproductive Health Indicators
• A health indicator is usually a numerical measure that provides
information about a complex situation or event.
• It helps to understand the reproductive health status of women in
the country.
• Maternal health care quality, availability and accessibility to
reproductive can be measured using maternal mortality.,
• The indicators provide a useful tool to assess needs and monitor
and evaluate program implementation and impact.
• Indicators are expressed in terms of rates, proportions, averages,
categorical variables, or absolute numbers.
• Total fertility rate:
Total number of children a woman would have by the end of her
reproductive period.
• Contraceptive prevalence (any method):
Percentage of women of reproductive age who are using (or whose
partner is using) a contraceptive method at a particular point in time.
• Maternal mortality ratio:
The number of maternal deaths per 100,000 live births from causes
associated with pregnancy and childbirth.
• Antenatal care coverage:
Percentage of women attended, at least once during pregnancy, by
skilled health personnel for reasons relating to pregnancy.

contd…
• Availability of basic essential obstetric care:
Number of facilities with functioning basic essential obstetric care
per 500 000 population.
Essential obstetric care includes, parenteral antibiotics, parenteral
oxytocic drugs, parenteral sedatives for eclampsia, manual removal of
placenta, manual removal of retained products, and assisted vaginal
delivery. These services can be given at a health center level.
• Perinatal mortality rate:
Number of perinatal deaths (deaths occurring during late
pregnancy, during childbirth, and up to seven completed days of life)
per 1000 total births.
contd…
• Low birth weight prevalence:
Percentage of live births that weigh less than 2500 grams.
• Prevalence of anemia in women:
Percentage of women of reproductive age (15–49) screened for
hemoglobin levels with levels below 11gms % for pregnant women
and below 12 gms for non-pregnant women.
• Prevalence of infertility in women:
Percentage of women of reproductive age (15–49) at risk of
pregnancy (not pregnant, sexually active, non-contraception, and
non-lactating) who report trying for a pregnancy for two years or more
Reproductive Health Care Services
Components:
• There are three essential components of sexual and reproductive health
care-
• Family planning – It has a significant impact on the well-being of families
and especially women. With better family planning and the use of
contraceptives, one can avoid unwanted pregnancies, and space births and
also protect themselves from STDs.
• Sexual health – It refers to a respectful and positive approach towards
sexual relationships. It is a very important prerequisite for good
reproductive health.
• Maternal health – It refers to the maintenance of a woman’s health during
pregnancy and after childbirth.
Package for Reproductive Health Services
Nutrition
support care
package for
mothers

Child health Antenatal care

care package package

Supportive
care package
for women
Essential Package for high-
newborn care risk pregnancy
package

Childbirth care
package
Reproductive Health Services
• Supportive care package for women:
- Advice and counseling for family planning, smoking cessation, and
awareness regarding safe sexual practices
- Prevention and management of sexually transmitted infections
• Nutrition support care package for mothers:
- Peri-conceptual folic acid supplementation
- Iron, folic acid, and calcium supplementation during pregnancy
• Antenatal care package:
- Detection, management, and treatment of HIV, STIs, anemia, pre-
eclampsia, and nutritional deficiencies
- Counseling on the benefits of breastfeeding, tetanus immunization and
newborn care. contd….
• Package for high-risk pregnancy:
- Management of pregnancy-induced hypertension(PIH),pre-
eclampsia and eclampsia
• Child birth care package:
- Support during labor and childbirth
- Training of skilled birth attendance for clean deliveries, external
cephalic version, induction of labor for prolonged pregnancy, active
management of the third stage of labor, caesarian births and
instrumental delivery
contd…
• Essential newborn care package:
- Breastfeeding, thermal care, kangaroo mother care, skin and cord care
- Neonatal resuscitation and immunization
- Post-natal visits and postnatal care for newborns at risk and low
birth weight
• Child health care package:
- Exclusive breastfeeding, complementary feeding, and vitamin A
supplementation through support groups for women and training
community health workers
- Case management of pneumonia and diarrhea
- Expanded Program on Immunization (EPI), pneumococcal vaccine, and
rotavirus vaccine
Modes of delivery of Reproductive Health Service
• Community level
• Outpatient level
• Primary care level
• Tertiary care level
• Referral level
Challenges faced by women in accessing reproductive
health services
• Poor physical accessibility
• High cost of service
• Social discrimination
• Long distance from home to the care facility
• Attitudes of the health care providers
• Cultural and religious beliefs
• Social stigma
• Lack of awareness about the services
Thank You