Introduction to
Reproductive Health
By : Waseem Hassan
Khyber Medical University
Objectives
By the end of the session, learner will be able to :
1. Integrate the role of a community Nurse & other health team members in
reproductive health care.
2. An overview of women’s health & its relationship to poverty, access & quality of
care.
Reproductive Health
” A state of complete physical, mental, and social well being and not
merely the absence of disease or infirmity, in all matters related to the
reproductive system and to its functions and process”.
Reproductive health addresses the human sexuality and reproductive
processes, functions and system at all stages of life and implies that
people are able to have “a responsible, 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.”
Development of Reproductive
Health
• Before 1978 Alma-Ata Conference
• • Basic health services in clinics and health centers
• Primary health care declaration 1978
• MCH services started with more emphasis on child survival
• Family planning was the main focus for mothers
• The Lancet 2006
Development of Reproductive
Health
Safe motherhood initiative in 1987
• Emphasis on maternal health
• Emphasis on reduction of maternal mortality
Reproductive health, ICPD in 1994
• Emphasis on quality of services
• Emphasis on availability and accessibility
• Emphasis on social injustice
• Emphasis on individuals woman's needs and rights
Development of Reproductive
Health
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
• World Summit 2005, declared universal access to 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.”
Millennium Development Goals
(MDGs)
1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education.
3. Promote gender equality and empower women.
4. Reduce child mortality.
5. Improve maternal health.
6. Combat HIV/AIDS, malaria and other diseases.
7. Ensure environmental sustainability.
8. Global partnership for development.
Burdon of Reproductive Health Problems
Half of the world’s 2.6 billion women are now 15 – 49 years of age. Without proper
health care services, this group is highly vulnerable to problems related to sexual
intercourse, pregnancy, contraceptive side effects, etc. Death and illnesses from
reproductive causes are the highest among poor women everywhere.
In societies where women are disproportionately poor, illiterate, and politically
powerless, high rates of reproductive illnesses and deaths are the norm
Burdon of Reproductive Health Problems
Women in developing countries and economically disadvantaged women in the
cities of some industrial nations suffer the highest rates of complications from
pregnancy, sexually transmitted diseases, and reproductive cancers.
Lack of access to comprehensive reproductive care is the main reason that so many
women suffer and die.
Most illnesses and deaths from reproductive causes could be prevented or treated
with strategies and technologies well within reach of even the poorest countries.
Men also suffer from reproductive health problems, most notably from STIs. But
the number and scope of risks is far greater for women for a number of reasons.
Components of Reproductive Health
Quality family planning services
Promoting safe motherhood: prenatal, safe delivery and post natal
care, including breast feeding
Prevention and treatment of infertility
Prevention and management of complications of unsafe abortion;
Safe abortion services, where not against the law
Components of Reproductive Health
Treatment of reproductive tract infections, including sexually transmitted
infections; Information and counseling on human sexuality, responsible
parenthood and sexual and reproductive health;
Active discouragement of harmful practices, such as female genital mutilation
and violence related to sexuality and reproduction;
Functional and accessible referral
The approach recognizes the central importance of gender equality, men's participation and responsibility.
Importance of reproductive
health
Reproductive Health is a human right stated in international law
Reproductive health plays an important role in morbidity, mortality and
life expectancy
Reproductive health issues are the leading cause f women's ill health
and mortality worldwide.
Reproductive Health Indicators
There are seventeen reproductive health indicators developed by the United
Nation Population Fund (UNFPA). Some of these are:
• Total fertility rate:
• Contraceptive prevalence
• Maternal mortality ratio
• Antenatal care coverage
• Births attended by skilled health personnel:
• Low birth weight prevalence
Conti…
• Availability of basic essential obstetric care:
• Perinatal mortality rate
• Prevalence of anemia in women
• Reported prevalence of women with FGM:
• Prevalence of infertility in women
• Reported incidence of urethritis in men:
Life Cycle Approach To Defining
Women's Reproductive Health
Stage of life cycle:
Perinatal
Health issues:
Fetal death, IUD, Low birth weight, immunizable disease
Management:
Perinatal care
Nutrition
immunization
Life Cycle Approach To Defining
Women's Reproductive Health
Stage of life cycle:
Infancy
Health issues:
Abnormal growth
Malnutrition
Communicable diseases
Accident
abuse
Management:
Growth monitoring, breast feeding, immunization, care of mother & child, health
education etc.
Life Cycle Approach To Defining
Women's Reproductive Health
Stage of life cycle:
childhood (1-10 yrs.)
Health issues:
Abnormal growth
Malnutrition
Infectious diseases
Accident
abuse
Management:
Growth monitoring, immunization, health education, ORS, etc.
Life Cycle Approach To Defining
Women's Reproductive Health
Stage of life cycle: Management:
Adolescents (11-19 yrs.)
Health issues: • Education on healthy
• Early child bearing lifestyle
• Abortion
• STIs/AIDs • Nutrition & fertility
• Under nutrition- macro µ
• Rising trend of substance abuse
awareness
• Acne • Family planning information
• Physiological changes in the body
• Secondary sex characteristics
& services
• Aggression • Treatment of STIs
• Violence/abuse
• Gender discrimination • Counselling
Life Cycle Approach To Defining
Women's Reproductive Health
Reproductive Years (20-44 yrs.) Management
Health issues:
• Screening
• Unplanned pregnancy
• STIs/AIDs • Education
• Abortion • Balance diet
• Pregnancy complications • Family planning information &
• Breast CA and menstrual abnormalities services
• Pregnancy
• Counselling
• Child bearing and rearing
• Contraception • STIs diagnosis & prompt
• Abuse and violence treatment
Life Cycle Approach To Defining
Women's Reproductive Health
Post-Reproductive years (45 + yrs.) Management
• Cardio-vascular diseases
• Early diagnosis & Rx
• Gynecological cancers
• Osteoporosis • Supportive care
• Osteoarthritis • Counselling
• Diabetes • Nutrition
• Cancers
• Sexual dysfunction
• Sub fertility/infertility
• STD/HIV
• Menopause
Maternal Mortality: A Global
Tragedy
• Annually, 585,000 women
die of pregnancy related
complications
• 99% in developing
world
• ~ 1% in developed
countries
Current Approach to Reduction of Maternal and neonatal
Mortality
21
Maternal Health: Scope of Problem
• 180–200 million pregnancies per year
• 75 million unwanted pregnancies
• 50 million induced abortions
• 20 million unsafe abortions
• 600,000 maternal deaths (1 per minute)
• 1 maternal death = 30 maternal morbidities
Current Approach to Reduction of Maternal and neonatal
Mortality
22
Maternal Death Watch
Every Minute...
• 380 women become pregnant
• 190 women face unplanned or
unwanted pregnancy
• 110 women experience a pregnancy
related complication
• 40 women have an unsafe abortion
• 1 woman dies from a pregnancy-
related complication
Current Approach to Reduction of Maternal and neonatal
Mortality
23
Maternal health profile in Pakistan
INDICATORS 1990 2000 2007 2015
Targets
MDG
MMR 550 350 276 140
Birth by SBA 18 40 39 >90
A/N Care 15 35 61 100
TFR 5.4 4.5 4.1 2.1
CPR 12 30 30 55
Current Approach to Reduction of Maternal and neonatal
Mortality
24
Maternal Mortality
MMR 2007
276 per 100,000 (PDHS 2007)
Major Causes of death
1. Hemorrhage
2. Infection
3. Eclampsia
4. Obstructed Labour
Current Approach to Reduction of Maternal and neonatal
Mortality
25
But WHY Do These Women Die?
The 3 delays model
• Delay in decision to seek care
• Lack of understanding of complications
• Acceptance of maternal death
• Low status of women
• Socio-cultural barriers to seeking care
• Delay in reaching care
• Mountains, islands, rivers — poor organization
• Delay in receiving care
• Supplies, personnel
• Poorly trained personnel with punitive attitude
• Finances
Current Approach to Reduction of Maternal and neonatal
Mortality
26
REPRODUCTIVE HEALTH AND
DEFINING TARGET POPULATION
The target population of a service includes for whom the service is primarily or
solely intended. These people may be of a certain age or sex or may have other
common characteristics.
1. Women of child-bearing age (15 – 49 years old)
2. Adolescents (Both sexes)
3. Under Five Children
Conti….
Women of child-bearing age (15 – 49 years old)
1. Women alone are at risk of complications from pregnancy and childbirth
2. Women face high risks in preventing unwanted pregnancy; they bear the burden of using and
suffering potential side effects from most contraceptive methods, and they suffer from the
consequences of unsafe abortion.
3. Women are more vulnerable to contracting and suffering complications of many sexually
transmitted infections including HIV/AIDS.
4. Deaths and illnesses from reproductive causes are highest among poor women everywhere.
Conti….
Adolescents (Both sexes)
1. Adolescents lack reliable reproductive health information, and thus the basic knowledge to make
responsible choice regarding their reproductive behavior.
2. In many countries around the world, leaders, community members, and parents are reluctant to provide
education on sexuality to young men and women for fear of promiscuity.
3. Many adolescents are already sexually active, often at a very young age.
4. The reproductive health status of young people, in terms of sexual activity, contraceptive use, child bearing,
and STIs lays the foundation for the country’s demographic feature.
Conti….
5. During adolescence normal physical development may be adversely affected by
inadequate diet, excessive physical stress, or pregnancy before physiological maturity is
attainted.
6. Adolescents are at high risk to acquire infertility associated with STIs and unsafe abortion
7. Conditions of work are designed for adults rather than adolescents and put them at
greater risk of accidental injury and death.
8. Current health services are generally not organized to fulfill the reproductive need and
demands of adolescents.
Conti….
Under Five Children
1. Children’s health is a base for healthy adolescence and childbearing ages.
2. Proper health service for children serves to increase the opportunities of women to
have contact with the health institution.
3. The health of children and women is inseparable
4. The morbidity and mortality of children in Ethiopia is one of the highest in the world.
5. Bearing high number of children has adverse consequences on health of the mother,
the general income distribution and health status of the family.
Factors affecting reproductive
health
1. Biological determinants
2. Sociocultural determinants
3. Economic determinants
Factors affecting reproductive
health
Poor health and poor nutrition can affect our reproductive health & is associated
with underweight children, increased morbidity and mortality rates among
children.
Same is the effect of the environment on male. There are several modifiable factors
affecting semen quality including air pollution, use of pesticides and harmful
chemicals, exposure to excessive heat, and can lead to decreased male fertility.
Factors affecting reproductive
health
Reproductive age of woman ranges from 15-44 or 15 -49 yrs.
Early & child marriages means losing the chance to gain life experience, education
& opportunities to work. Across the world , man marry later than the woman.
Very early child bearing brings increased risks of complication or even death &
adolescent girls are in a weak position to negotiate or have access to contraception
to prevent pregnancy or to refuse sexual relation.
Factors affecting reproductive
health
Gender inequality limits woman’s & girls control over their sexual and reproductive
lives.
Sexual violence and coercion means any act or attempt to obtain a sexual act, FGM
and pressure to marry and start bearing children at an early age.
Poverty
affect health and cause rapid population growth. High fertility rates can
exacerbate and perpetuates poverty both of individuals and countries.
Number of Births
Each pregnancy multiplies a woman’s chance of dying from complications of
pregnancy and childbirth.
Factors affecting reproductive health
Complications during pregnancy and child birth
Every year 10-15 million women a year suffer severe or long lasting illness or
disabilities caused by complication during pregnancy and child birth. These can be
prevented if women have access to antenatal care in pregnancy, skilled care during
child birth and care and support after the child birth.
It is particularly important that all birth must be attended by skilled health
professionals, that can make the difference between life and death.
Factors affecting reproductive health
Access to Skilled Attendance at birth
It is a key factor in saving lives and maintaining the health of both mothers and
babies.
Unsafe abortion
Every year a quarter of all pregnancies end in abortion and a quarter of these
abortions are unsafe because they are either performed by someone with out the
necessary skills or performed in unhygienic conditions or both.
About 90% of abortion related morbidity and mortality can be avoided if woman
have access to effective contraception and comprehensive, safe abortion care.
Factors affecting reproductive health
Safety and security
Women’s safety and security can be undermined in range of settings, including
their family, neighborhood, workplace and community through experience of
verbal, physical, and sexual harassment and violence.
Quality of health care
Quality of health care can be evaluated on the basis of structure, process, or
outcome. Receiving high quality of care is an important component maintaining the
health of any population
Factors affecting reproductive health
Social, emotional and psychological support
Social inclusion incorporates the degree to which women feel valued,
connected, empowered and able to participate within their community.
Interactions of factors such as poor physical or mental health,
inadequate housing or homelessness, exposure to violence and
economic insecurity will limit woman’s ability to integrate with their
community and fulfill their potential as a values citizens.
Social support can also improve health through a variety of mechanism
including emotional assistance, care giving, support for access to
treatment, and financial or physical health.
Nurse Role in Reproductive Health
Health promotion
According to WHO” the process of enabling people to increase control over and to
improve the health.
• Illness prevention
• Wellness
• Provide support & counseling
Encourage women in their health goals & behaviors
• Personal hygiene
• Stress management & well being
• Healthy life style & avoiding risky behaviors
Nurse Role in Reproductive Health
Preventing Diseases (STIs)
Diet & exercise
Sexuality issue menopause, contraception
Pre and post natal care
Recommend & promote regular examination
Nurse Role in Reproductive Health
Respect sexual orientation
It is an enduring pattern of romantic or sexual attraction
Provision of ante natal care. Monitoring the growth of the fetus and its
well being
Supplementation of requisite vitamins & micro nutrients
Promote and implement good prenatal care
Promote institutional deliveries
Promote delivery by trained personnel
Ensure clean delivery
Conti…
Promote & maintain optimal delivery progress practices
• Right identification of stage of delivery
• Progress of delivery
• Fetal heart rate monitoring
• Monitoring vital signs during delivery
• Episiotomy & supportive care of the baby
Conti…
Education
Conduct workshops & conferences relating to reproductive health care
& sensitize the community, healthcare professionals and policy makers.
Design curriculum in medical & para medical incorporating aspects of
reproductive health services.
Develop the separate channels in order to sensitize the public on
Reproductive Health services.
Practice counseling for eligible couples on the range of reproductive
health services.
Summary
• Pakistan has a long way to go
for achieving optimal RH
services
• A mix of services and
interventions is required to be
put in place for reducing MMR
• Effective linkages need to be
established between
community based and facility
based health workers for
better outcomes.
WHO 1999. Current Approach to Reduction of Maternal and neonatal
Mortality
45
