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    • Introduction
    • History
    • Midwifery and nursing A midwife is a person who having been regularlyadmitted to a midwifery education,but recognized bythe country in which it is located,has successfullycompleted the prescribed course of studies inmidwifery and has aquire the requisite to beregistered and or legally licenced to practicemidwifery.
    • In India
    • IN KERALA Ancient Times- Untrained Dais 1901-dais Given Skill Training For 1year 1939-jphn Course Of 1 ½ Year Duration Started ,Later To2year 1972-bsc.Nursing Started In Kerala At Govt.HospitalTrivandrum 2011-1year Course Of Independent Nurse MidwiferyPractice/Training At Govt Hospital Trivandrum.
    • Development of maternity servicesand obg nursing education…In India 1854-midwifery Course Started In School OfNursing In Madras 1909-midwifery Programme Was Changed To 3yrProgramme
    • IN KERALA 1906-2yr Prog Started In Govt Hosp Trivandrum 1954-school Of Nursing Started In Govt HospitalTrivandrum 1972-school Of Nursing Upgraded To Bsc.Nursing 1990-msc Nursing 1996-msc Nursing In Obstetric And Gynecologic Nursing
    • Gynecological nursing-recentadvancements
    • Obg nursing –global perspective
    • Maternal and children health.HEALTHSOCIETYHealthy children need healthy mothersCHILDMOTHERMaternal and child health.
    • Maternal healthHealth of women during pregnancy, childbirth and the postpartumperiod.Motherhood, for too many women it is associated with suffering, ill-health and death.Haemorrhage, infection, HBP, unsafe abortion and obstructed labourstill are major direct causes of maternal morbidity and mortality.
    • Maternal health care Is a concept that encompasses family planning,preconception, prenatal, and posnatal care. Goals of preconception care can includeproviding education, health promotion,screening and interventions for women ofreproductive age to reduce risk factors thatmight affect future pregnancies
    • Child health.• Childs health includes physical, mentaland social well-being too.• Each year more than 10 million childrenunder the age of five die.• At least 6.6 million child deaths can beprevented each year if affordable healthinterventions are made available to themothers and children who need them.
    • Maternal & child health.• There are birth-related disabilities thataffect many more women and gountreated like injuries to pelvicmuscles, organs or the spinal cord.• At least 20% of the burden of disease inchildren below the age of 5 is related topoor maternal health and nutrition, aswell as quality of care at delivery andduring the newborn period.
    • Maternal mortality.• Maternal deaths are clustered around theintrapartum (labour, delivery and theimmediate postpartum); the mostcommon direct cause globally isobstetric haemorrhage.• Other major causes are: obstetrichaemorrhage; anaemia; sepsis/infectionobstructed labour; hypertensivedisorders and unsafe abortions.
    • Children < 5 years mortality (2008).• Globally, 80 percent of all child deathsto children under five are due to only ahandful of causes:• pneumonia (19 %),• diarrhea (18 %),• malaria (8 %),• neonatal pneumonia or sepsis (10 %),• pre-term delivery (10 %),• asphyxia at birth (8 %),• measles (4 %),• HIV/AIDS (3 %).
    • Lack of Quality health care
    • Lack of national care
    • Malnutrition Most people in the developing countries aremalnourished Malnutrition has a significant impact on the vulnerablegroups – pregnant women, lactating women andchildren It can result in maternal complications such as anemia post partum haemorrhage toxemia of pregnancy low birth weight in baby Children are most affected in utreo and during periodof weaning Malnourished children are more susceptible toinfections
    • Interventions to prevent malnutritioncan be direct and indirect Direct measures Food supplementation Food fortification Iron and folic acid supplementation Nutritional education Indirect measures Food hygiene Education Environmental sanitation Vaccination to prevent disease Provision for clean drinking water
    • Infection Although infections have been controlled to a greatextend in developed countries, they continue to be amajor problem in developing countries Maternal infection can result in IUGR low birth weight abortions peurperal sepsis Upto 25 percent of pregnant women have urinary tractinfection Cytomegalovirus, herpes and toxoplasma infection arealso seen among mothers Children are at risk for diarrhoeal diseases, respiratorytract diseases and skin conditions
    • Infections can be controlled by adequate nutrition sanitation immunization better primary health care services
    • Uncontrolled Reproduction Unregulated fertility has adverse effectson both mother and children Decrease in birth spacing results ininadequate care for the existing child andrisk of more complications duringpregnancy ( such as anemia, IUGR,abortion) The risk increases greatly after the 4thpregnancy
    • Interventions mainly include family planning services form an importantpart of MCH programs Measures like Intrauterine contraceptivedevice, oral contraceptive pills, longacting injectable medroxy progesteroneacetate, female sterilisation and barriermethods can be used.
    • Core interventions to preventchild deaths.• Preventive interventions:• Vaccination• Folic acid supplementation• Tetanus toxoid• Syphilis screening and treatment• Pre-eclampsia and eclampsia prevention(calcium supplementation)• Intermittent presumptive treatment formalaria in pregnancy
    • Core interventions to preventchild deaths.• Preventive interventions:• Antibiotics for premature rupture ofmembranes• Detection and management of breech(caesarian section)• Labor surveillance• Clean delivery practices• Breastfeeding
    • Core interventions to preventchild deaths.• Preventive interventions:• Zinc• Hib vaccine• Water, sanitation, hygiene• Antenatal steroids• Vitamin A• Nevirapine and replacement feeding toprevent HIV transmission• Measles vaccine
    • Core interventions to preventchild deaths.• Preventive interventions:• Prevention and management of hypothermia• Kangaroo mother care (skin-to-skin contact)for low birth-weight newborns• Newborn temperature management• Insecticide-treated materials• Complementary feeding
    • Core interventions to preventchild deaths.• Treatment interventions:• Detection and treatment of asymptomaticbacteriuria.• Corticosteroids for preterm labor.• Newborn resuscitation• Community-based pneumonia case management,including antibiotics• Oral rehydration therapy
    • Core interventions to preventchild deaths.• Antibiotics for dysentery, sepsis,emerging and reemeging diseases.• Antimalarials• Zinc for diarrhea• Vitamin A in respiratory diseases.
    • Female Infanticide AndFemale Feticide Female Feticide is the act of aborting a babybecause it is of a female gender. Sex selectiveabortion is a big problem in India. The number ofabortions by medical professionals have increasedso much that today it has become a industry eventhough it is punishable by law.
    • Female Infanticide is the act of killing afemale girl either new-born or within thefirst few years of life. It could beactively, murdering throughsuffocation, poisoning etc. Such acts canalso be passive, where no interest istaken with regards to feeding or towardsher general health in affect total neglect.
    • Marriages
    • Education
    • Trafficking, slavery
    •  Within the framework of the World HealthOrganizations (WHO) definition of health asa state of complete physical, mental andsocial well-being, and not merely the absenceof disease or infirmity. reproductive health, orsexual health/hygiene, addresses thereproductive processes, functions andsystem at all stages of life.
    •  Reproductive health, therefore, implies that people are able tohave a responsible, satisfying and safer sex life and that theyhave the capability to reproduce and the freedom to decide if,when and how often to do so. One interpretation of this impliesthat men and women ought to be informed of and to haveaccess to safe, effective, affordable and acceptable methodsof birth control; also access to appropriate health care servicesof sexual, reproductive medicine and implementation of healtheducation programs to stress the importance of women to gosafely through pregnancy and childbirth could provide coupleswith the best chance of having a healthy infant..
    • According to the WHO, "Reproductiveand sexual ill-health accounts for 20%of the global burden of ill-health forwomen, and 14% for men."
    • Sexual health
    •  An unofficial working definition for sexual health is that"Sexual health is a state of physical, emotional, mentaland social well-being in relation to sexuality; it is notmerely the absence of disease, dysfunction or infirmity.Sexual health requires a positive and respectful approachto sexuality and sexual relationships, as well as thepossibility of having pleasurable and safe sexualexperiences, free of coercion, discrimination andviolence. For sexual health to be attained andmaintained, the sexual rights of all persons must berespected, protected and fulfilled."
    • Childbearing and health Early childbearing and other behaviours can have healthrisks for women and their infants. Waiting until a womanis at least 18 years old before trying to have childrenimproves maternal and child health. If an additional childis to be conceived, it is considered healthier for themother, as well as for the succeeding child, to wait atleast 2 years after the previous birth before attempting toconception. After a fetal fatality, it is healthier to wait atleast 6 months.
    •  The WHO estimates that each year, 358 000 women diedue to complications related to pregnancy and childbirth;99% of these deaths occur within the mostdisadvantaged population groups living in the poorestcountries of the world.Most of these deaths can beavoided with improving womens access to quality carefrom a skilled birth attendant before, during and afterpregnancy and childbirth.
    • International Conference on Population andDevelopment (ICPD), 1994 The International Conference on Population and Development(ICPD) was held in Cairo, Egypt, from 5 to 13 September1994. Delegations from 179 States took part in negotiations tofinalize a Programme of Action on population anddevelopment for the next 20 years. Some 20,000 delegatesfrom various governments, UN agencies, NGOs, and themedia gathered for a discussion of a variety of populationissues, including immigration, infant mortality, birth control,family planning, and the education of women.
    • Reproductive health is defined as“a state of complete physical, mental and social well-beingand...not merely the absence of disease or infirmity, in allmatters relating to the reproductive system and itsfunctions and processes. Reproductive health thereforeimplies that people are able to have a satisfying and safesex life and that they have the capability to reproduce andthe freedom to decide if, when and how often to do so.
    •  Implicit in this last condition are the right of men andwomen to be informed [about] and to have access tosafe, effective, affordable and acceptable methods offamily planning of their choice, as well as othermethods of birth control which are not against thelaw, and the right of access to appropriate health-careservices that will enable women to go safely throughpregnancy and childbirth and provide couples with thebest chance of having a healthy infant.”
    • The ICPD achieved consensus on four qualitative andquantitative goals for the international community,the final two of which have particular relevance forreproductive health: Reduction of maternal mortality: A reduction ofmaternal mortality rates and a narrowing ofdisparities in maternal mortality within countries andbetween geographical regions, socio-economic andethnic groups.
    •  Access to reproductive and sexual health servicesincluding family planning: Family planning counseling,pre-natal care, safe delivery and post-natal care,prevention and appropriate treatment of infertility,prevention of abortion and the management of theconsequences of abortion, treatment of reproductive tractinfections, sexually transmitted diseases and otherreproductive health conditions; and education,counseling, as appropriate, on human sexuality,reproductive health and responsible parenthood.
    •  Services regarding HIV/AIDS, breast cancer,infertility, delivery, hormone therapy, sexreassignment therapy, and abortion should be madeavailable. Active discouragement of female genital mutilation(FGM)
    • Millennium Development Goals Achieving universal access to reproductive health by2015 is one of the two targets of Goal 5 - ImprovingMaternal Health - of the eight MillenniumDevelopment Goals. To monitor global progresstowards the achievement of this target, the UnitedNations has agreed on the following indicators: 5.3: contraceptive prevalence rate 5.4: adolescent birth rate 5.5: antenatal care coverage 5.6: unmet need for family planning
    •  According to the MDG Progress Report, regionalstatistics on all four indicators have either improvedor remained stable between the years 2000 and2005. However, progress has been slow in mostdeveloping countries, particularly in Sub-saharanAfrica, which remains the region with the poorestindicators for reproductive health. According to theWHO in 2005 an estimated 55% of women do nothave sufficient antenatal care and 24% have noaccess to family planning services.
    • MDGs and maternal/child health• Millennium Development Goal 4 aims toreduce child deaths by two-thirdsbetween 1990 and 2015.• Millennium Development Goal 5 has thetarget of reducing maternal deaths bythree-quarters over the same period.
    • MDGs and maternal/child health• Unfortunately, on present trends, mostcountries are unlikely to achieve eitherof these goals.• A recent review of MDG progress, showthat the world have only 32% of the wayto achieving the child health goal andless than 10% of the way to achievingthe goal for maternal health.
    • Reproductive health and abortion An article from the World Health Organization callssafe, legal abortion a "fundamental right of women,irrespective of where they live" and unsafe abortion a"silent pandemic".The article states "ending the silentpandemic of unsafe abortion is an urgent public-health and human-rights imperative.".
    •  It also states "access to safe abortion improves women’shealth, and vice-versa, as documented in Romaniaduring the regime of President Nicolae Ceaușescu" and"legalisation of abortion on request is a necessary butinsufficient step toward improving women’s health" citingthat in some countries, such as India where abortion hasbeen legal for decades, access to competent careremains restricted because of other barriers
    •  WHO’s Global Strategy on Reproductive Health, adoptedby the World Health Assembly in May 2004, noted: “As apreventable cause of maternal mortality and morbidity,unsafe abortion must be dealt with as part of the MDG onimproving maternal health and other internationaldevelopment goals and targets." The WHOsDevelopment and Research Training in HumanReproduction (HRP), whose research concerns peoplessexual and reproductive health and lives, has an overallstrategy to combat unsafe abortion that comprises fourinter-related activities:
    •  to collate, synthesize and generate scientifically soundevidence on unsafe abortion prevalence and practices; to develop improved technologies and implementinterventions to make abortion safer; to translate evidence into norms, tools and guidelines; and to assist in the development of programmes andpolicies that reduce unsafe abortion and improve accessto safe abortion and high quality post-abortion care This strategy does not involve studying the possibleeffects of abortion on aborted fetuses
    • Sexual education Burt defined sex education as “the study of thecharacteristics of beings; a male and female. Suchcharacteristics make up the persons sexuality. Sexuality is animportant aspect of the life of a human being and almost allthe people including children want to know about it. Sexeducation includes all the educational measures which in anyway may of life that have their center on sex. He further saidthat sex education stands for protection, presentationextension, improvement and development of the family basedon accepted ethical ideas.”
    •  Leepson sees sex education “as instruction invarious physiological, psychological and sociologicalaspects of sexual response and reproduction.” Kearney also defined sex education as “involving acomprehensive course of action by theschool, calculated to bring about the sociallydesirable attitudes, practices and personal conducton the part of children and adults, that will bestprotect the individual as a human and the family as asocial institution
    •  sex education may also be described as "sexualityeducation", which means that it encompasses education aboutall aspects of sexuality, including information about familyplanning, reproduction(fertilization, conception anddevelopment of the embryo and fetus, through tochildbirth), plus information about all aspects of ones sexualityincluding: body image, sexual orientation, sexualpleasure, values, decisionmaking, communication, dating, relationships, sexuallytransmitted infections (STIs) and how to avoid them, and birthcontrol methods. Various aspect of sex education are to rightin school depending on the age of the students or what thechildren are able to comprehend at a particular point in time.
    •  Rubin and Kindendall expressed that sex educationis not merely a unit in reproduction and teaching howbabies are conceived and born. It has a far richerscope and goal of helping the youngster incorporatesex most meaningfully into his present and futurelife, to provide him with some basic understandingon virtually every aspect of sex by the time hereaches full maturity.
    •  Sex education may be taught informally, such aswhen someone receives information from aconversation with a parent, friend, religious leader, orthrough the media. It may also be delivered throughsex self-help authors, magazine advice columnists,sex columnists, or sex education web sites. Formalsex education occurs when schools or health careproviders offer sex education.
    •  Slyer stated that sex education teaches the youngperson what he or she should know for his or herpersonal conduct and relationship with others.Gruenberg also stated that sex education isnecessary to prepare the young for the task ahead.According to him, officials generally agree that somekind of planned sex education is necessary.
    •  Sometimes formal sex education is taught as a fullcourse as part of the curriculum in junior high schoolor high school. Other times it is only one unit within amore broad biology class, health class, homeeconomics class, or physical education class.
    •  Some schools offer no sex education, since it remains acontroversial issue in several countries, particularly theUnited States (especially with regard to the age at whichchildren should start receiving such education, theamount of detail that is revealed, and topics dealing withhuman sexual behavior, e.g. safe sex practices,masturbation, premarital sex, and sexual ethics).
    •  The existence of AIDS has given a new sense ofurgency to the topic of sex education. In manyAfrican nations, where AIDS is at epidemic levels(see HIV/AIDS in Africa), sex education is seen bymost scientists as a vital public health strategy..
    •  Some international organizations such as PlannedParenthood consider that broad sex educationprograms have global benefits, such as controllingthe risk of overpopulation and the advancement ofwomens rights (see also reproductive rights). Theuse of mass media campaigns, however, hassometimes resulted in high levels of "awareness"coupled with essentially superficial knowledge of HIVtransmission
    •  According to SIECUS, the Sexuality Information andEducation Council of the United States, 93% of adultsthey surveyed support sexuality education in high schooland 84% support it in junior high school. In fact, 88% ofparents of junior high school students and 80% ofparents of high school students believe that sexeducation in school makes it easier for them to talk totheir adolescents about sex. Also, 92% of adolescentsreport that they want both to talk to their parents aboutsex and to have comprehensive in-school sex education
    •  Sexual Education In IndiaIn India, there are many programs promoting sexeducation including information on AIDS in schoolsas well public education and advertising. AIDS clinicsproviding information and assistance are to be foundin most cities and many small villages.
    •  “India has a strong prevention program which goeshand in hand with care, support and treatment. Wehave been able to contain the epidemic with aprevalence of just 0.31 %. We have also broughtabout a decline of 50% in new infections annually.”As per the words of Shri Gulam Nabi Azad, Hon’bleMinister of Health and Family Welfare, 2011.
    • Other countries Indonesia, Mongolia, South Korea have a systematicpolicy framework for teaching about sex withinschools. Malaysia and Thailand have assessedadolescent reproductive health needs with a view todeveloping adolescent-specific training, messagesand materials. Bangladesh Myanmar, Nepal and Pakistan have nocoordinated sex education programs. In Japan, sex education is mandatory from age 10 or11, mainly covering biological topics such asmenstruation and ejaculation.
    •  In China and Sri Lanka, sex education traditionally consistsof reading the reproduction section of biology textbooks. InSri Lanka young people are taught when they are 17–18years old. However, in 2000 a new five-year project wasintroduced by the China Family Planning Association to"promote reproductive health education among Chineseteenagers and unmarried youth" in twelve urban districtsand three counties. This included discussion about sexwithin human relationships as well as pregnancy and HIVprevention.
    •  The International Planned Parenthood Federationand the BBC World Service ran a 12-part seriesknown as Sexwise which discussed sexeducation, family life education, contraception andparenting. It was first launched in South Asia andthen extended worldwide
    •  Morality
    • Lesbian, gay, bisexual, andtransgender youth
    • REPRODUCTIVE & SEXUALHEALTH IN INDIA Reproductive health implies that people are able tohave a responsible, satisfying and safer sex life andthat they have the capability to reproduce and thefreedom to decide if, when and how often to do so.According to the WHO, “Reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for women and 14% for men. The WHOestimates that each year, 3, 58, 000 women die dueto complications related to pregnancy and childbirth.
    • Challenges FacingReproductive and Sexual Healthin India
    • IlliteracyIn India, the problems related to reproductive andsexual health among women is highest amongst therural population. Illiteracy is the leading cause of thissituation. Ensuring literacy of the girl child can helpdelay the age at which a woman gets married andthereby reduce other disparities.
    • Gender InequalityWomen in India for years have been exposed togender inequality that has been the root cause ofsexual and reproductive diseases. Optimum sexualand reproductive health can be attained by healthand social interventions.
    • Lack of Proper and AdequateNutritionThe lack of proper nutrition has a profound effect onthe health of a woman as she advances intomotherhood. “When it comes to reproductivehealth, pregnancy care is very crucial. Duringpregnancy, the nutritional deficiency has a negativeimpact on the heath of both mother and the baby. Inthis period, women are vulnerable to problems likeanaemia, post-delivery bleeding, low birth weightbabies, etc
    •  . Also, in developing countries, Tetanus remains as aleading cause of maternal and neonatal morbidityand mortality,” said Dr Amita Shah, obstetrics &gynaecologist, Columbia Asia Hospital, Gurgaon.She adds that the Reproductive and Child healthprogramme mandated by the Ministry of Health andFamily Welfare that promotes the concept of healthof women from womb to tomb is taken seriously
    • Lack of Decision-Making PowerThe lack of power to decide how and when to have a child hasamounted to the increase in maternal mortality. “The women shouldhave the right to have safe sex, to decide on when she wants to getpregnant or opt for a legal abortion. Women empowerment can besuccessful only when societal norms enable the women to accessthese rights and empowers them to take right decisions. Thereshould be an advanced health system in place to deal withpregnancy related complications, which is also very important,” addsDr Shah.
    • Spread of STDsGenerally, women don’t have any access tocontraceptives, thereby increasing the number ofunwanted and unplanned pregnancies and severesexually transmitted diseases.
    • REPRODUCTIVE ANDHEALTH SERVICES Family Planning Services Counseling to enable couples to make an informedchoice Prenatal care Safe delivery and post natal care Prevention and appropriate treatment of infertility Prevention of spontaneous abortion and management ofconsequences of induced abortion Treatment of reproductive tract infections, sexuallytransmitted diseases and other reproductive healthconditions Education on responsible parenthood
    •  Other Specific Health Services pertain to: HIV/AIDS Breast cancer Delivery Hormone therapy Sex reassignment therapy Abortion
    • Thank you…