introduction to reproductive health by maranata dawit(Bsc, MPH)

1. Jinka University
college of medicine and health sciences
department of public health
Introduction to Reproductive Health
Instructor: Maranata Dawit(Bsc, MPH)

2. Objectives
At the end of this chapter you will be able to
- define reproductive health
- define reproductive health care
- define sexual issues
- know the historical development of RH
-understand the relationship of reproductive health and gender
- Identify the Components of Reproductive Health
- Explain the influence of gender on SRH

3. Reproductive health
• Reproductive health is defined as “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”
• This definition is taken and modified from the WHO definition of
health.

4. Cont…
• Reproductive health addresses the human sexuality and reproductive
processes, functions and system at all stages of life.
• 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.”

5. Cont…
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.
- 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 beyond a woman's child-bearing
years.

6. Cont…
• Reproductive health care is defined as the constellation of methods,
techniques and services that contribute to reproductive health and well-
being by preventing and solving reproductive health problems.
• Sexual health is a state of physical, emotional, mental, and social wellbeing
in relation to sexuality; it is not merely the absence of disease, dysfunction,
or infirmity.
-Three basic elements
1. A capacity to enjoy and control sexual and reproductive behaviors in accordance
with social and personal ethics
2. Freedom from fear, shame guilt, false beliefs and other psychological factors
inhibiting sexual response and impairing sexual relationship
3. Freedom from organic disorders, diseases and beneficiaries that interfere with
sexual and reproductive dysfunctions

7. Cont…
• Sexuality: it is a broad term covering what we physically are, what we
feel and do in relation to the sex we have as well as social rules and
guidelines existing for each gender.
For sexual health to be attained and maintained, the sexual rights of all
individuals must be respected, protected, and satisfied.
Sexuality is a central aspect of humanity and encompasses sex,
gender identities and roles, sexual orientation, eroticism, pleasure,
intimacy, and reproduction.

8. Cont…
Sexuality is experienced and expressed in thoughts, fantasies, desires,
beliefs, attitudes, values, behaviors, practices, roles, and relationships.
Sexuality is affected by the interaction of biological, psychological,
social, economic, political, cultural, ethical, legal, historical, religious,
and spiritual factors.

9. Historical development of RH
• During 1960’s, UNFPA established with a mandate to raise awareness about
‘population problems’ and to assist developing countries in addressing them.
• Rapid increase in availability of contraceptive technologies in 1960s to
reduce population growth
• In 1972 WHO established the Special Programme of Research, Development
and Research Training in Human Reproduction (HRP) whose mandate was
focused on research into the development of new and improved methods of
fertility regulation and issues of safety and efficacy of existing methods.

10. Cont…
• Population policies became widespread in developing countries during the
1970s and 1980s
• The dominant paradigm argued that rapid population growth would not only
hinder development, but was itself the cause of poverty and underdevelopment
• Population policies focused on the need to restrain growth; very little was said
about other aspects of population

11. Cont…
• Family planning (FP) programs were based on top-down approaches.
• Success was judged in terms of numeric goals and targets.
• However, many developing countries did not show much progress in
making FP universally accessible to their populations.

12. Cont…
• The significance of MCH was restated at Almata in 1978, when MCH was
identified as one of the essential components of PHC.
• At its establishment, WHO identified MCH as one of the four priorities.
Tuberculosis
Malaria
Venereal diseases
MCH
• The safe motherhood initiative launched in 1987 in response to ignorance
of the maternal component of MCH. “Where is ‘M’ in MCH”

13. ICPD,1994 Cairo
Paradigm shift
From top-down approach to program planning and implementation
 Possible to achieve the stabilization of world population growth
while attending to people’s health needs and respecting their right
in reproduction
Recognition of the needs of people in sexuality and reproduction
beyond fertility regulation
Criticism of the over emphasis on the control of female fertility
The advent of the HIV/AIDS pandemic

14. Objectives of RH
The broad objectives for reproductive health care were stated as follows:
• To ensure that comprehensive and factual information and a full range of
reproductive health services, including family planning are accessible,
acceptable and convenient for users;
• To enable and support responsible voluntary decisions about child bearing and
methods of family planning of their choice, as well as other methods of their
choice for regulation of fertility which are not against the law and to have
information, education and means to do so; and
• To meet the changing reproductive health needs over the life cycle and to do
so in ways sensitive to the diversity of circumstances of local communities.

15. Components of Reproductive Health
• Maternal and child health;
• Prenatal and postnatal care,
• Safe delivery,
• Breast-feeding
• Infant and women’s health care,
• Family planning
• counseling ,
• information
• Education,
• communication and services;

16. Cont…
• Prevention and appropriate treatment of infertility;
• Prevention of abortion and the management of the consequences of abortion;
• Prevention and Treatment of reproductive tract infections and STDs, including
HIV/AIDS;
• IEC and counseling, as appropriate, on human sexuality, reproductive health
and responsible parenthood.
• Diagnosis and treatment for complications of breast cancer and cancers of the
reproductive system;
• Discouragement of harmful practices, such as FGM, early marriage.

17. Factors affecting RH
• Reproductive health affects, and is affected by, the broader context of
peoples lives, including their
• economic circumstances
• Education
• employment
• living condition and family environment
• social and gender relationship and
• the traditional and legal structure within which they live.
• Sexual and reproductive behavior are governed by complex biological,
cultural and psycho social factors.

18. Cont…
• The status of women and girls in the society, and how they are treated or
mistreated, is a crucial determinant of their reproductive health.
• Educational opportunities for girls and women powerfully affect their status
and the control they have over their own lives and their health and fertility.
• The empowerment of women is therefore an essential element for health

19. Gender and RH
• Gender refers to the socially constructed roles, activities,
responsibilities assigned to men and women in a given culture,
location or time
• Sex refers to biological and physiological attributes that identify a
person as male or female

20. Cont…
Sex
• Type of genital organs
• Type of predominant hormone circulating in the body
• Ability to produce sperm or ova
• Ability to give birth and breastfeed children
Gender
• Learned and changed over time
• Functional at the house hold, community and national level
• Embedded in a society's social, cultural, economic and political system
• Gender differences interact with other inequalities such as race, age, social
class and ethnicity

21. Cont…
Gender Bias
Assumptions or beliefs expressed without reason or justice and which
are generally unfavorable
May lead to physical and psychological harm to women and men
Often affects women
Gender stereotype
Beliefs that are ingrained in our consciousness that many of us think
that gender role are natural and we don’t question them

22. Cont…
Gender Analysis
• A process of identifying gender specific division of labor, cultural
patterns, access to and control of/ over resources for the purpose of
understanding their implication for the design and implementation of
development project
Shows how gender issues are related to development
Requires accurate and gender disaggregated information

23. Cont…
Gender Mainstreaming
• The incorporation of gender issues into the analysis, formulation,
implementation, monitoring of strategies, programs, projects and
activities
• Addresses and helps reduce inequalities between women and men
• Helps to increase involvement of women in decision making process
about social values, development directions and resource allocations

24. Cont…
• Requires gender analysis
• Permits the identification of women and men access to benefits and
decision making
• Implies re-evaluation of current policy and development programs

25. Influence of Gender on SRH
• Gender-based inequality is a phenomenon that affects the majority of
world’s cultures, religions, nations and income groups.
• Gender has important health consequences for women at all stages of
life. It also affects health of men.
Health consequences for women include
• Sex-selective abortion and female infanticide
• Poor nutrition
• Harmful traditional practices like FGC

26. Cont…
• Sexual abuse
• Early sexual debut
• Limited ability to decide on fertility
• Limited access to health care
• Pressure to have many closely spaced children
• Men have primary authority to decide on sex and reproductive health
matters
• Violence against women
• Lack of communication since most RH issues are culturally sensitive
• Unequal access and control over resources
• Gender division of labor

27. Cont…
• Consequences for men include:
• Social pressure in conforming to stereotype gender role
• Lack of emotional outlet and support for men
• Economic responsibility assigned traditionally to men
• Dependency of women on men can be burden
• Men are expected to be sexually experienced, leading some men to experience
it at any cost.

28. Who is most affected by RH problems?
• Women bear by far the greatest burden of reproductive health problems.
• Women are at risk of complication from pregnancy and childbirth;
• they also face risk in preventing unwanted pregnancy, suffer the
complication of unsafe abortion; bear most of the burden of
contraception and are more exposed to contracting, and suffering
complication of reproductive tract infection, particularly sexually
transmitted diseases (STDs)

29. Cont…
• Among women of reproductive age, 36 % of all health years of life lost
is due to reproductive health problems such as; unregulated fertility,
maternal morbidity, and sexually transmitted disease including
HIV/AIDS.
• By contrast the equivalent figure for men is 12%
• Biological factors alone do not explain women’s disparate burden.
• Their social, economic and political disadvantages have a determinant
impact on their reproductive health.
• Young people of both sexes are also particularly vulnerable to
reproductive health problems because of lack of information and
access to service

30. Defining target group
• If you know where you want to go you are more likely to get there.
• That is why it is important to have goals. If you have goals, you know
what you are trying to do.
• Targets may be set for any primary health care services such as
immunizations, treatment of malaria, prenatal care and reproductive
health activities.

31. Rationale for Defining Target Population
• To set priority and deliver appropriate services to high risk groups.
• To utilize resources efficiently
• To determine the number of eligible for the services
• To plan the type of services to be provided
• To focus the efforts towards the target group
• To measure / evaluate changes
• To address equity in delivery of the health services

32. The Target Groups for RH Services
• The following populations are groups of priority concern in
reproductive health services. These groups are:
Women of childbearing age (15 – 49 years old)
 Adolescents (both male and female)
 Under five years old children

33. Women of child-bearing age (15 – 49 years
old)
• Women alone are at risk of complications from pregnancy and childbirth
• 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 the consequences of unsafe
abortion.
• Women are more vulnerable to contracting and suffering complications of
many sexually transmitted infections including HIV/AIDS.
• Deaths and illnesses from reproductive causes are highest among poor
women everywhere.

34. Adolescents (Both sexes)
• Adolescents lack reliable reproductive health information, and thus the basic
knowledge to make responsible choice regarding their reproductive
behavior.
• 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.
• Many adolescents are already sexually active, often at very young age.

35. Cont…
• 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.
• Adolescents are at high risk to acquire infertility associated with STIs
and unsafe abortion
• Current health services are generally not organized to fulfill the need
and demands of adolescents.

36. Under Five Children
• Children’s health is a base for healthy adolescence and childbearing ages.
• Proper health service for children serves to increase the opportunities of women to
have contact with the health institution.
• The health of children and women is inseparable.
• The morbidity and mortality of children in Ethiopia is one of the highest in the
world.
• Bearing high number of children has adverse consequences on health of the
mother, the general income distribution and health status of the family.