REPRODUTION HEALTH

2. COMMUNITY HEALTH
NURSING-II
• By:
• ANWAR ALI MALIK,
• BSN (G) M.ED, MPH
• V.PRINCIPAL
• HIMAS CON
• malikstar2000@gmail.com
• 03333398310

3. Reproductive Health
• Reproductive health is defined as” A state of
complete physical, mental, and social wellbeing
and not merely the absence of disease or
infirmity, in all matters related to the
reproductive system and to its functions and
process”.
• This definition is taken and modified from the
WHO definition of health.

4. • Reproductive Health addresses the human
sexuality and reproductive processes, functions
and system at all stages of life.
• It means that people are able to have “a
responsible, satisfying and safe sex life, they have
the capability to reproduce and the freedom to
decide if, when and how often to do so.”
• Men and women have the right to be informed
and, have access to safe, effective, affordable and
acceptable methods of their choice for the
regulation of fertility which are not against the law.

5. • Reproductive Health...
• They have the right of access to appropriate
health care services for safe pregnancy and
childbirth and, provide couples with the best
chance of having a healthy infant.
• Reproductive health is life-long, beginning
even before women and men attain sexual
maturity and continuing process till woman's
child-bearing years (i,e 15 to 49).

6. Components of Reproductive Health
1. Quality Family Planning Services
2. Promoting Safe Motherhood: Prenatal, Safe
Delivery and Post-natal care, including Breast
feeding;
3. Prevention and Treatment of Infertility.
4. Prevention and management of complications of
unsafe abortion;
5. Safe abortion services, where not against the law;

7. 6. Treatment of Reproductive Tract Infections
RTI, including sexually transmitted STI infections
including HIV/AIDS.
7. Information and Counseling on human
sexuality, responsible
parenthood/fatherhood/motherhood and
Sexual and Reproductive health;
8. Active discouragement of harmful practices,
such as female genital mutilation (circumcision)
and violence related to sexuality and
reproduction;
9. Functional and accessible referral.

8. MOTHER & CHILD HEALTH CARE (MNCH)
• It is a branch of public health, which is
planned for health supervision of the mother
and child, not only physical but mental and
emotional health.
• AIMS:
• Making available the best possible care for
women during pregnancy, labour and
puerperuim.
• Best possible care to childen while they are
growing and are valnurable.

9. OBJECTIVES OF MNCH SERVICES
 Improve the health of mother and child.
 To reduce maternal mortailty and morbidity.
 To reduce birth rate.
 to reduce infant mortality and morbidity.
 To decrease prenatal deaths.
 To reduce death rate.
 To ensure birth registration.
 To study and obtain information regarding women
education, family income, environment nd psychological
status.
 To promote the reproductive health, physical and
physiological development of child and adolscent in

10. COMPONENTS OF MNCH
Antenatal Care
Intranatal Care
Postnatal Care
Infant Care
• under five years
• Immunization.
• Nutritional disorders
Training Programs.
Health Education.

11. MATERNITY CYCLE
• The stages in maternity cycle are;
• Fertilization
• Antenatal care (care of mother during
pregnancy)
• Intranatal care (cae of mother during child
birth and also of child care)
• Postnatal care (care of mother after
delivery)
• Inter-conceptional peroid (the time period
between pregnancy).

12. CAUSES OF MATERNAL MORTALITY
1. MAIN CAUSES:
 Haemorrhage (21%) ;due to abortion, ectopic
pregnancy, placenta previa, placenta abruption, and post
partum hemorrhage, rupture of uterus due to obstructed
labour, retained plaenta and membranes.
Hypertensive disease (19%); of pregnancy or eclampsia
or pregnancy induced hypertension.
Purperal sepsis or infection elsewhere.
Anemia in pregnancy.
Pulomonary embolism and amniostic fluid embolism.
Malnutrition.
Anaesthesia accidents i,e cardaic arrest, inhalation of
gastric contents.

13. 2. CONTRIBUTORY CAUSES:
Death due to pre-existing diseases, which gets
aggaravated by pregnancy e.g. heart disease.
3. BIOLOGICAL FACTORS: Age, parity, social class.
4. SOCIAL FACTORS: Birth interval, literacy, family size,
delivery by untrained Dai or BTraditional birth attendants.

14. HEALTH REALTED PROBLEMS ACROSS A WOMEN’S LIFETIME
There are divided as:
1. INFANCY & CHILDHOOD(0-9 YEARS);
 Sex selection.
 genital mutilation.
 Disciminatory nutrition.
2. ADOLSCENCE (10-19 YEARS);
 Early childbearing.
 Unsafe abortion.
 STD’s, and AIDS.
 Under nutrition and micronutrients.
 substance abuse.
3. REPRODUCTIVE YEARS (20-44 YEARS);
 Unplanned pregnancy.
 Unsafe abortion.
 STd’s, and AIDS.
 pregnancy omplications.
 Malnutrition, especially iron deficiency anaemia.

15. 4. POST- REPRODUCTIVE YEARS (ABOVE 45 YEARS);
 Cardiovascular diseases.
 Gynaecological disturbances.
 Osteoporosis.
 osteoarthritis.
 diabetes.
5. LIFE TIME HEALTH PROBLEMS;
 Gender violence.
 Certain occupation and environmental health hazards.
 Depression.

16. Birth Spacing/ Reproductive Health
1. Discourage early marriages
2. Legislative measures
3. Providing incentives for smaller families
4. Spread awareness
5. Women empowerment
6. Eradicate poverty
7. Education
8. Integrated health, population & nutrition
services
9. Easy and cheap availability of contraceptives
10. Development
16
MEASURES TO REDUCE MMR:

17. • In societies where women are poor, illiterate, and
politically powerless, high rates of reproductive illnesses
and deaths are the normal.
• Ethiopia has one of the highest maternal mortality in the
world; it is estimated to be between 566 – 1400 deaths
per 100,000 live births.
• Ethiopia has one of the highest maternal mortality in the
world; it is estimated to be between 566 – 1400 deaths
per 100,000 live births

18. Magnitude (Burden) of Reproductive Health
Problem in World
• The term “Reproductive Health “is most often consider
with one aspect of women’s lives; motherhood.
• Complications associated with various maternal issues
are indeed major contributors to poor reproductive
health among millions of women worldwide.
• 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.

19. Source: UNIA estimates and PDHS 2017-18
Maternal & Child Mortality (Pakistan Demographic and Health
Survey 2017-18)
306
249
211
178
140
2000 2005 2010 2015 2019
Maternal
deaths
per
100,000
live
births
Maternal Mortality
Child Mortality
Annual 9,500
maternal
deaths
Annual 0.5
million children
deaths

20. 20
SOURCE:
IHME
2019
Disease Groups for RMNCH & CD Number of deaths
Maternal & Neonatal disorders 265,947
Respiratory infections & TB 131,272
Enteric infections 101,485
Nutritional deficiencies 14,630
HIV/AIDS & sexually transmitted infections 8,874
Neglected tropical diseases & malaria 7,109
Other infectious diseases 55,039
TOTAL RMNCH & CD 584,359 (38.9%)
TOTAL Injuries 85,346 (5.6%)
Breakdown of Deaths (2019)
TOTAL Non-Communicable Diseases 830,172 (55.3%)
Total Annual Deaths (2019): 1,499,877

21. 21
Institutional Deliveries (2017-
18)
Punjab: 69%
Sindh: 72%
KP: 62%
AJK: 62%
GB: 62%
Islamabad: 84%
Balochistan:35%
Source:
PDHS
1991,
2007,
2013,
2018
Modern CPR (2017-18)
Punjab: 27%
Sindh: 24%
KP: 23%
AJK: 19%
GB: 30%
Islamabad: 35%
Balochistan:14%
Maternal Care

22. 22
EPI Coverage (2017-18)
Punjab: 80%
Sindh: 49%
KP: 55%
Balochistan: 29%
AJK: 75%
GB: 57%
Islamabad: 68%
Source:
PDHS
1991,
2007,
2013,
2018
35%
28%
47%
6%
54%
5%
66%
4%
All Baic Vaccines No Vaccine
PDHS 1990-91 PDHS 2006-07
2012-13 2017-18
Highest number
(84 in 2020) of
Polio cases in
the World
ARI cases
67.1 million new
cases
Diarrheal
cases
49.4 million
new cases
Child Health Care

23. Addressing determinants of health - Inter-sectoral
Policies
23
In Pakistan half of
the RMNCH
related burden
can be reduced
through inter-
sectoral policies,
which demand
collaboration
with other
sectors and
partners
GENDER
EMPOWERMENT
The Way Forward

24. 24
80% of
curative
healthcare
services
80% of
preventive &
primary
healthcare
services
Spending on
Health
1 % of GDP
2 % of GDP
 Requirement: US$
271(Rs. 76,693) per
person per year to
achieve (The Lancet)
 Per capita health
expenditure: US$ 45
(Rs. 4,688)
 Per capita government
health expenditure:
US$ 15
 Total health
expenditure ratio to
GDP: 3%
Spending in Health in Pakistan

25. 25
SOURCE:
IHME
2019
Cause of Death
1 Neonatal
disorders
2 Ischemic heart
disease
3 Stroke
4 Diarrheal
disorders
5 Lower
respiratory
infections
6 Tuberculosis
7 COPD
8 Diabetes
9 Chronic kidney
disease
10 Cirrhosis
Premature
Deaths
1 Neonatal
disorders
2 Ischemic heart
disease
3 Lower
respiratory
infections
4 Diarrheal
disorders
5 Tuberculosis
6 Stroke
7 Congenital
defects
8 Cirrhosis
9 Typhoid &
Paratyphoid
10 Chronic kidney
Years Lost with
Disability
1 Dietary Iron
deficiency
2 Depressive
disorders
3 Headache
disorders
4 Low back pain
5 Other MSK
6 Gynaecological
diseases
7 Diabetes
8 Age related
Hearing loss
9 Neonatal
disorders
10 Anxiety
disorders
Behavioural
Environmental
Metabolic
Risk
1 Malnutrition
(MCH)
2 Air pollution
3 High systolic BP
4 Dietary risks
5 Tobacco
6 Unsafe WASH
7 High fasting
plasma glucose
8 High body-mass
index
9 High LDL
cholesterol
10 Kidney
dysfunction
Top Ten Burden & Risks (2019)

26.  Weak Governance in health
sector
 Low Financial allocation for health
(1% of GDP in public sector)
 Inadequate Access to ‘Universal
Health Coverage’ and Quality of
care
 Crises in Health workforce
 Frequent Health emergencies
 Addressing determinants of
health
 Harnessing research and
Key Challenges

27. Towards Good Health & Happiness of A
THANK YOU