1-Introduction to RH.pptx

Introduction to Reproductive Health
Gizachew W. (MPH/RH, assist. professor)
1/13/2023 Gizachew W.
1

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Presentation Outlines
 Definition and introduction
 Historical development of Reproductive Health
 Magnitude of Reproductive Health Problem
 Components of Reproductive Health
 Reproductive health indicators
 Gender and Reproductive Health/Gender differences:
 Target group for Reproductive Health
2

Learning objective
At the end of this chapter students able to
 Define reproductive health
 Understand the historical development of RH
 Explain the components and indicators of RH
 Identify target group for Reproductive Health
Gizachew
W.
1/13/2023
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Brain storming
• What is health??
• Reproductive Health??
1/13/2023 Gizachew W. 4

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Definition of RH
 Reproductive Health is a state…..
In all matters related to the reproductive system and
To its functions and process.
 It addresses the Human sexuality, Reproductive system,
Process and functions at all stages of life
 It 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.”
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RH Defn…..
• Reproductive health is life-long, beginning even
before women and men attain sexual maturity and
continuing beyond a woman's child-bearing years.
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RH Defn….
• Reproductive health care is:
 Constellation of methods,
 Techniques and
 Services that
 Contribute to reproductive health and
well-being
 By preventing and solving reproductive
health problems.
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Sexual health …Defn
• 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 of sexual health
 A capacity to enjoy and control sexual and reproductive behaviors
in accordance with social and personal ethics
 Freedom from fear, shame guilt, false beliefs and other
psychological factors inhibiting sexual response and impairing
sexual relationship
 Freedom from organic disorders, diseases and beneficiaries that
interfere with sexual and reproductive dysfunctions 8
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Sexual health …
• Sexual health needs a positive and respectful approach
to sexuality & sexual relationships, and the possibility
of having pleasurable and safe sexual experiences that
are
Free of coercion,
Discrimination, and
Violence
 For sexual health to be attained and maintained, the
sexual rights of all individuals must be respected,
protected, and satisfied.
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Sexuality …Defn
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.
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Sexuality …
 It experienced and expressed in thoughts,
fantasies, desires, beliefs, attitudes, values,
behaviors, practices, roles, and relationships.
 It affectedby the interaction of biological,
psychological, social, political, cultural,
ethical, legal, economic, historical, religious,
and spiritual factors.
,
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Component of sexuality
 Sensuality
 Sexual intimacy
 Sexual identity
 Sexual relations
 Sexualization
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Component…
Sensuality
– Awareness and feeling about our own body and other
people’s bodies, especially the body of a sexual partner
– It reflects our body image - whether we feel attractive and
proud of our own body
– It helps to experience pleasure and release from sexual
tension
– It satisfies our need for physical closeness, to be touched
and held by others in loving and caring ways
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Component…
• Sexual Intimacy
– The ability to be emotionally close to another human being
and have that closeness reciprocated.
– Sharing intimacy is what makes personal relationship rich.
– Focuses on emotional closeness
– Liking or loving another person
– Need to open up and share feelings and personal
information
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Component…
• Sexual Identity
– A person’s understanding of who she or he is
sexually, including the sense of being male or
female
– Components
• Gender Identity
• Gender Role
• Sexual orientation
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Component…
• Sexual relations
– Successful only if there is shared respect,
responsibility and understanding
– Important to have appropriate information prior to
initiating sexual activities in order to prevent
unwanted pregnancy and sexually transmitted
infections
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Components...
Sexualization
 Using sex or sexualization to influence, manipulate or control
others people behavior including;
• Flirting
• Seduction
• Withholding sex from a partner to ‘push’ the
partner or to get something,
• Offering money for sex
• Selling products with sexual messages, sexual harassment,
sexual abuse and rape
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Why RH is importance???
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The importance of RH
• Crucial part of general health and a central feature of
human development.
• crucial during adolescence and adulthood
• sets the stage for health beyond the
reproductive years
• Affects the health of the next generation
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Importance ...
• Reproductive health is a universal concern, but is of
special importance for women particularly during the
reproductive years.
• In old age general health continues to reflect earlier
reproductive life events
• Men too have reproductive health concerns and needs
though their general health is affected by reproductive
health to a lesser extent than is the case for women.
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Importance ...
• However, men have particular roles and
responsibilities in terms of women's reproductive
health because of their decision-making powers in
reproductive health matters.
• Because reproductive health is a prerequisite for
social, economic and human development.
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History of RH
• Pre-ICPD periods
– International conferences on population started since 1954
Rome
• To exchange scientific information on population variables,
their determinants and their consequences (standing room
only, pop bomb….)
– Second Pop. Conf
• Belgrade in 1965.
– Emphasized analysis of fertility as part of a policy
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History of RH…
• The conference held in Bucharest (1974), Romania, was the first of its
kind with an intergovernmental nature, 135 countries were participated.
oThe World Plan ofAction
 Population variable and development are interdependent and
population policies and their objectives are an integral part of socio
economic development policies.
• The next conference took place in Mexico City 1984.
– It reviewed and endorsed the agreements of the Bucharest conference
(1974)
– The rights of individuals and families were some of the issues
highlighted in the declaration signed
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• Pre-ICPD conferences were characterized by
– Widespread population policies in developing
countries (1970s and 1980s)
24

History of RH….
• 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” 1985
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History of RH…
Why special care for mothers and children?? Still
• Majority population in developing countries
• Vulnerable group of population
• Problems of mothers and children are intertwined
• Health problems are avoidable “Voiceless”
• Investment in to the future
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1/13/2023

ICPD,1994 Cairo
• This was the landmark conference, which shaped the
global policy for services that are in place today.
• It had a broader scope than previous population
conferences, reflecting the links between population
and poverty.
27

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
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Paradigm..
 The articulation of the concept of reproductive rights.
 An interpretation of international human rights treaties in terms
of women’s health in general and RH in particular gradually
gained acceptance during the 1990s.
• Three rights in particular were identified:
• The right of couples and individuals to decide freely and
responsibly the number and spacing of children and to have the
information and means to do so;
• The right to attain the highest standard of sexual and reproductive
health; and,
• The right to make decisions free of discrimination, coercion or
violence.
35
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Application of human right to SRH
1. The right to life: which means among other things that no
woman’s life should be put at risk by reason of pregnancy
2. The right to liberty and security of the person: which
recognizes that no person should be subject to female
genital mutilation, forced pregnancy, sterilization or
abortion
3. The right to be free from all forms of discrimination
including in one’s sexual and reproductive life
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Right …
4. The right to privacy
meaning that all sexual and reproductive health care
services should be confidential and all women have the
right to autonomous reproductive choices
5. The right to freedom of thought
which includes freedom from restrictive interpretation of
religious texts, beliefs philosophies and customs as tools to
curtail freedom of thought on sexual and reproductive
health care and other issues 38
31

Right …
6. The right to information and education,
as it relates to sexual and reproductive health for all,
including access to full information on the benefits,
risks, and effectiveness of all methods of fertility
regulations in order that all decisions taken are made
on the basis of full, free and informed consent
7. The right to choose whether or not to marry, found
and plan a family
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Right …
8. The right to decide whether or when to have children.
All persons have the right to decide freely and
responsibly on the number and spacing of their
children. This includes the right to decide whether or
when to have children and access to the means to
exercise this right
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Right …
9. The right to health care and health protection
which includes the right of clients to the highest possible quality
of health care and the right to be free from traditional practices
which are harmful to health
10.The rights to the benefits of scientific progress
which includes the right of sexual and reproductive health service,
clients to new RH technologies, which are safe, effective and
acceptable
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Right ...
11.The right to freedom of assembly and political
participation: which includes the right of all persons to
seek to influence communities and governments to
prioritize sexual and reproductive health and rights
12.The right to be free from torture and ill treatment
including the rights of all women, men, and young
people to protection from violence, sexual exploitation
and abuse
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Component of RH
• 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
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Component…
• Prevention and appropriate treatment of infertility
• Prevention of abortion and the management of the
consequences of abortion;
Treatment of
STDs,
reproductive
including
tract
HIV/
• Prevention and
infections and
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.
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W.
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What is new about the concept of reproductive
health?
• RH does not start out from a list of diseases or problems
such as: sexually transmitted diseases, maternal mortality etc
• RH does not start from a list of programmes such as
– Maternal and child health,
– Safe motherhood,
– Family planning….
• Reproductive health instead must be understood in the context of
relationships of: fulfillment and risk; the opportunity to have a desired
child and/or alternatively, to avoid unwanted or unsafe pregnancy.
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W.
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Magnitude of RH problems
• Complications associated with various maternal issues are indeed
major contributors to poor reproductive health among millions of
women worldwide.
• Death and illnesses from reproductive causes are highest among
poor women everywhere
• Most illnesses and deaths from reproductive causes could be
prevented or treated with strategies and technologies well within
reach of even the poorest countries.
39

RH problems….
• women in the age group 15-49 are
highly vulnerable to problems relatedto 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
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• In Ethiopia
– maternal mortality is high (412 per 100,000
live births in 2016 EDHS)
– contraception use in married women is 36%
– High unmet need for contraceptive(22%)
• Lack of access to comprehensive reproductive care is
the main reason that so many women suffer and die.
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• 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; such as;
 Biological
 Socio-cultural
 Socio-economic…
42

Factors affecting RH
• Reproductive health affects, and is affected by,the broader
context of people's lives, including:
 Economic circumstances
 Education
 Employment
 Living conditions and family environment
 Social and gender relationships
 Traditional structure.
 Legal structures within which they live.
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Who is most affected by reproductive
health problems?
Women!
• Women are at risk of complications
from pregnancy and childbirth.
• Face risks in preventing unwanted pregnancy
• Suffer the complicationsof unsafe abortion.
• Bear most of the burden of contraception
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Who is most affected by …
• They are more exposed to contracting, and suffering the
complications of reproductive tract infections, particularly sexually
transmitted diseases (STDs).
• Among women of reproductive age, 36% of all healthy years of
life lost is due to RH problems such as; unregulated fertility,
maternal mortality and morbidity, and sexually transmitted diseases
including HIV/AIDS.
• The equivalent figure for men is 12 %.
1/13/2023
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Reproductive Health indicators
 There are 17 WHO short list indicators of RH;
 Total Fertility Rate (TFR): Total number of children a woman would
have by the end of her reproductive period if she experienced the
currently prevailing age-specific fertility rates throughout her
childbearing life
 Contraceptive Prevalence Rate (CPR):
 Maternal Mortality Ratio (MMR): Annual number of maternal
deaths per 100,000 live births
 Antenatal Care Coverage: At least one ANC visit (excluding trained
or untrained traditional birth attendants), for reasons relating to
pregnancy
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Indicators….
 Percent of Births Attended by Skilled Health Personnel: (excluding
trained or untrained traditional birth attendants)
 Availability of Basic Essential Obstetric Care: Number of facilities
with functioning basic essential obstetric care per 500,000 population
 Availability of Comprehensive Essential Obstetric Care: Number of
facilities with functioning comprehensive essential obstetric care per
500,000 population
 Perinatal Mortality Rate (PMR): Number of perinatal deaths per 1,000
total births
 Low Birth Weight Prevalence: Percent of live births that weigh less than
2,500g
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Indicators…
 Positive Syphilis Serology Prevalence in Pregnant Women: Percent of
pregnant women (15-49) attending antenatal clinics, whose blood has
been screened for syphilis, with positive serology for syphilis
 Prevalence of Anemia in WomenPercent of women of reproductive age
(15-49) screened for hemoglobin levels with levels 110g/l for pregnant
women, and 120g/l for non-pregnant women
 Percent of Obstetric and Gynecological Admissions Owing to
Abortion: Percent of all cases admitted to service delivery points
providing in-patient obstetric and gynecological services, which are due
to abortion (spontaneous and induced, but excluding planned termination
of pregnancy)
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Sources of data to assess RH indicators
 Routine service statistics
 Population Census data
 Vital statistics reports
 Special studies
 Sample survey
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Gender and Reproductive Health
Define;
sex?
Gender?
Gender equity vs equality?
Gender discrimination
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W.
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Gender & RH…
Sex refers to biological and physiological attributes of that
identify a person as male or female
Gender refers to the economic, social and cultural attributes
and opportunities associated with being male or female in a
particular social setting at a particular point in time.
Gender equality means equal treatment of women and men in
laws and policies, and equal access to resources and services
within families, communities and society at large
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Gender & RH..
Gender equity means fairness and justice in the
distribution of benefits and responsibilities between
women and men. It often requires women-specific
programmes and policies to end existing inequalities.
Gender discrimination refers to any distinction,
exclusion or restriction made on the basis of socially
constructed gender roles and norms which prevents a
person from enjoying full human rights.
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Gender & RH…
Gender stereotypes refer to beliefs that are so ingrained in our
consciousness that many of us think gender roles are natural and
we don’t question them.
Gender bias refers to gender based prejudice; assumptions
expressed without a reason and are generally unfavorable.
Gender mainstreaming: the incorporation of gender issues into
the analysis, formulation, implementation, monitoring of
strategies, programs, projects, policies and activities that can
address inequalities between women and men
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The Social Construction of Gender
• The people involved, Family members, peers, teachers and people in
educational and religious institutions are usually the first to introduce
a child to appropriate codes of gendered behavior
• Social constructs of gender expressed in many forms;
 The place where they involved
 Division of labour
 Dressing codes
 The kinds of games girls and boys play
 Emotional responses
 Intellectual responses
 Physical segregation of boys and girls:
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Gender differences
Women give birth to babies, men do not.
 In many societies child rearing is the sole responsibility of
women.
 According to United Nations statistics, women do 67 per cent of
the world's work, yet their earnings for it amount to only 10 per
cent of the world's income.
In one case, a child brought up as a girl learned that when he was
actually a boy, his school marks improved dramatically.
Sex is not as important for women as it is for men.
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Gender….
In ancient Egypt, men stayed at home and did
weaving and family businesses.
Women inherited property and men did not.
 Men's voices break at puberty, women's don’t.
Men are naturally prone to violent behavior
Women are more vulnerable to STDs than men
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Power and decision-making
 In any social group men have greater access and control over resources
usually makes him more powerful than women.
 Men often have greater decision-making power over reproduction and
sexuality.
 Male power and control over resources and decisions is institutionalized
through the laws and policies of the state, and through the rules and
regulations of formal social institutions.
 Laws in many countries of the world give men greater control over wealth
and greater rights in marriage and over children.
 For centuries, religious institutions have denied women the right to
priesthood, and schools often insist that it is the father of the child who is
her or his legal guardian, not the mother.
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TARGET OF REPRODUCTIVE HEALTH
Why need to define target population?
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W.
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RH Target popn_...
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
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Target…
 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
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Target…
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 from the consequences of unsafe abortion.
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Target…
 Women are more vulnerable to contracting and
suffering complications of many sexually transmitted
infections including HIV/AIDS.
 From the equity point of view, this population group
constitutes about 24% of the population; which is a
significant proportion.
 Deaths and illnesses from reproductive causes are
highest among poor women everywhere
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Target…
 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
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Target…
• Many adolescents are already sexually active, often at a very young
age.
• The RH status of young people in terms of sexual activity,
contraceptive use, child bearing, and STIs lays the foundation for
the country’s demographic feature.
• During adolescence normal physical development may be adversely
affected by inadequate diet, excessive physical stress, or pregnancy
before physiological maturity is attainted.
• Adolescents are at high risk to acquire infertility associated with
STIs and unsafe abortion
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Target…
• Conditions of work are designed for adults rather than
adolescents and put them at greater risk of accidental
injury and death.
• Current health services are generally not
organized to fulfill the reproductive need and
demands of adolescents
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Target..,
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.
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Thank you!!

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