2. Objectives
• At the end of the session you are expected to:
Describe the major maternal health problems
Describe the status of women
Identify factors affecting reproductive health
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4. Maternal health problems
• Women have the right to the enjoyment of the highest attainable
standard of physical and mental health.
• This is vital to their life, well-being and their ability to participate in all
areas of public and private life.
• However, they are largely suffering from problems related to sexual
health, pregnancy, contraceptive side effects etc.
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5. Maternal health problems...
• Death and illnesses from reproductive causes are highest
among poor women every where
• In Poor, illiterate and politically powerless, high rates of
reproductive illness and death are the norm.
• Highest in developing countries including Ethiopia.
• Women’s health is very important not only because of their
number but also their health is a key to the health of the
present and future generation. 7/1/2023
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6. Maternal health problems…
• Women’s health needs differ from men because of their
biological & gender differentials in exposure to risk factors
• The life cycle of women between menarche and menopause
involves psychosocial and physiological functions of
fertility.
• So their health needs are more than men in this area
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8. Health problems affecting
women through out life cycle
• Infancy and childhood(0-9)
• Adolescence(10-19)
• Reproductive years(15-49)
• Post reproductive years(45 +)
• Life time health problems()
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9. Maternal health problems…
The major maternal health problems include
o Unintended pregnancy & Unsafe abortion
o Problems related to Pregnancy & childbirth
o HTP
o VAW
o HIV/AIDS & STIS
o Cancers of Reproductive organs
o Malnutrition and etc…
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10. (1)Unwanted pregnancy & unsafe abortion
Worldwide nearly 230 million (1 in 6) WCA lack
information on and access to a full range of contraceptive
methods.
Contraceptive services, even where they exist, often do not meet
women’s needs.
In developing countries more than 120 million couples
have an unmet need for safe and effective contraception
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11. Unwanted pregnancy & unsafe abortion…
• women have little control over sexual relations and
contraceptive use,
• This limits their ability to prevent unintended pregnancies
• 20% - 50% of all women report having experienced sexual
coercion, abuse, or rape, putting them at high risk for
unwanted pregnancy.
• Adolescents and unmarried women are particularly
vulnerable 7/1/2023
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12. Unwanted pregnancy & unsafe abortion…
• Out of 182 million pregnancies occurring each year in the
developing world about 80 million or 40% are unwanted or
ill-timed.
• 46 million unwanted pregnancies end in abortion each year,
• Unsafe abortions threaten the lives of a large number of
women, representing an important public health problem.
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13. Unwanted pregnancy & unsafe abortion…
• About 20 million unsafe abortions take place each year
95% of them in the developing world.
• Complications of unsafe abortion kill at least 78,000
women every year.
• Hundreds of thousands experience short- or long-term
disabilities
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14. Estimated annual number of unsafe abortions, globally and by major regions, 2003 and 2008.
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15. Global and regional estimates of mortality due to unsafe abortion, 2008
a. Japan, Australia and New Zealand have been excluded from the regional estimates, but are included in the total for
developed countries.
b. No estimates are shown for regions where the incidence of unsafe abortion is negligible.
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16. (2)Problems related to Pregnancy & childbirth
• Every day at least 1,600 women die from the complications of
pregnancy and childbirth.
• A minimum of 585,000 women dying each year.
• Each year over 50 million women experience pregnancy-related
complications, many of which lead to long-term illness or disability.
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17. Problems related to Pregnancy & childbirth…
• A total of 99% of all maternal deaths occur in developing countries
• More than half of these deaths occur in sub-Saharan Africa and one
third in South Asia.
• Complications of pregnancy and childbirth are the leading cause of
death and disability for women in developing countries.
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19. Pregnancy & childbirth…
• The common maternal health problems during pregnancy and child
birth includes
• Eclampsia
• Anemia
• APH
• Obstructed labor, fistula, uterine prolapse
• PPH
• Sepsis, Etc…
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20. 7/1/2023 20
Source: WHO 2010. * Nearly all(99%) abortion deaths are due to unsafe
abortion. ** this category includes deaths due to obstructed labor or anemia
21. (3)Harmful traditional practices (HTP)
• Is threat to the health of mothers
• Eg. FGM, early marriage, Abduction, rape etc.
Female genital mutilation (FGM)
• FGM is practiced all over the world, more in Africa & Asia
• 100 million women and girls are estimated to have had FGM in Africa
• According to WHO report
• Every year around 2 million young girls suffer from FGM
• ETHIOPIA…………
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22. (4) Violence Against Women (VAW)
• "Any act of gender-based violence that results in, or is likely
to result in, physical, sexual or psychological harm or
suffering to women, including threats of such acts, coercion or
arbitrary deprivation of liberty, whether occurring in public or
in private life.
(Defined by The UN Declaration on the Elimination of VAW , 1993)
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23. Violence Against Women (VAW)...
• VAW is one of the most alarming health problems
• WHO estimated that:
• About one-quarter of the world’s women are subjected to
violence and abuse in their homes
• Over 50% in Thailand &
• As high as 80% in Pakistan
• Ethiopia?
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Life time prevalence physical ,sexual violence and physical or
sexual or both was 49% ,59% and 71% respectively[WHO
Multicounty study,2005]
24. VAW...
• Domestic violence is the most widespread
Studies in 35 countries suggested that about 25-50% of all
women have been physically abused by their partner
Adolescent girls and young women experience violence
disproportionately.
40-58 % of sexual assaults are committed against girls aged 15
and younger.
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26. VAW...
Violence can have numerous negative consequences for
women’s sexual and RH, such as:
Restricted access to FP information
Unwanted pregnancies
Unsafe abortion and its complications
High-risk pregnancies and lack of follow up
STIs, including HIV/AIDS
Persistent gynecological problems
infertility
Psychological problems, including fear of sex and
loss of pleasure
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27. (5) HIV/AIDS/STIs
• The HIV pandemic remains the most serious of infectious
disease challenges to public health.
• According to AIDS Epidemic updates of 2012
• Globally, 34.0 million PLHIV at the end of 2011.
• An estimated 0.8% of adults aged 15-49 years worldwide are living with
HIV,
• Sub-Saharan Africa
• 1 in every 20 adults(4.9%) living with HIV and
• accounting for 69% of the people living with HIV Worldwide.
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28. HIV/AIDS/STIs…
• Ethiopian situation
• MOH/FHAPCO, 2012
More than 800,000 PLHIV
1million children are AIDS orphaned
1.5%(Male=1, Female=1.9%)[EDHS,2011]
Urban 4.2% & rural 0.6%
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29. HIV/AIDS/STIs…
• Every day, more than 1 million people are infected with a curable STDs worldwide
• An estimated 333 million cases worldwide each year
• About 165 million among women aged 15-49 years
• Various STDs increase the risk of HIV transmission by at least 3-4 times.
• The four most common STDs:
• syphilis, gonorrhea, Chlamydia and trichomoniasis are relatively easy to cure
through antibiotic treatment.
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30. (6) Reproductive organ cancers
• Cervical cancer is an important women’s health problem in
developing countries, killing some 200,000 women each year.
• It is the third most common cancer overall and the leading cause
of death from cancer among women in developing countries.
• At least 370,000 new cases each year;
80% in developing countries.
Occurs worldwide, but the highest incidence rates are found in
Central and South America, eastern Africa, South and South-East Asia
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31. 7/1/2023 31
Worldwide incidence rates of cervical cancer per 100,000 females (all ages),Age
standardized to the WHO standard population (2005)
Source: WHO(2006)
32. (7)Malnutrition
• An estimated 450 million adult women in developing countries are
stunted, a direct result of malnutrition in early life.
• Micronutrient deficiency are common problems among women,
Particularly Anemia
• According to EDHS 2011,
• 17% of mothers have any form of anemia
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37. Factors...
• RH is a crucial part of general health and a central feature of
human development.
• In most developing-country settings, much of the loss of life and
human productivity that is due to poor RH could be prevented
with affordable and cost-effective programs.
• However, a number of factors exist affecting the existence and use
of RH services.
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38. Factors...
• The factors affect:
The needs for RH
The health care system &
Health seeking behavior & service utilization
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39. Factors...
• RH affects, and is affected by, the broader context of people's lives, including
• Economic circumstances
• Education
• Employment
• Living conditions
• Family environment
• Social and gender relationships and
• The traditional and legal structures within which they live.
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40. Factors...
• Sexual and reproductive behaviors are governed by
complex biological, cultural and psychosocial factors.
• Therefore, the attainment of RH is not limited to interventions by
the health sector alone.
• The status of girls and women in society, and how they are
treated or mistreated, is a crucial determinant of their
reproductive health.
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41. Factors...
• Factors that affect RH operate at several levels:
At Households and communities
At the health system
At the public polices and actions
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42. 1. Households and community
1.1.Households factors
• Health behavior :-
avoiding or minimizing risks
Using FP methods
Practicing safe sex
Dietary habits
Utilization of health services
Decision making process & control of resources
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43. Households factors…
• Household resources and assets
Household income and owning
Access to information
Quality of housing
Education of household members
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44. 1.2 Community factors
• Gender norms and practices
• Existence of effective community groups & social
cohesion
• Cultural and religions values
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45. 2. Health system factors
• Quality : Availability of service, supplies and skilled
professionals
• Access: Physical and financial accessibility
Referral for complications and emergencies
Health information campaigns
Logistic management system for FP and other commodities
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46. Other related sectors
Transportation,
Communications
Education, and
Water and sanitation.
Agriculture
Etc.
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47. 3.Government policies and actions
• The manner in which revenue is raised for RH
• The amount of budget allocated for RH
• Laws and regulations
• The methods of consultation with stakeholders
• Representing women in decision making positions.
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48. • What can be Done to overcome these problems?
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49. Solutions
• Lifecycle approach to health
• Women’s right to the enjoyment of the highest
standard of health must be secured throughout the
whole life cycle
• Women empowerment & right based approach to RH
• Good health is essential to leading a productive
fulfilling life, and the right of all women to control all
aspects of their health is basic to their empowerment.
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50. Solution...
• Improve access & utilization of contraceptive methods
• Mobilizing and providing sufficient resources to meet
the growing demand for access to information, counseling,
services and follow-up on the widest possible range of
safe, effective, affordable and acceptable contraceptive
methods
• Comprehensives post abortion care & safe abortion
service
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51. Solution...
Providing Good quality RH services
Improving access to Essential obstetric care
Equipping the facility with skilled human power,
equipments & necessary supplies
Promoting good referral system
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52. Solution...
• Making STDs and HIV/AIDS prevention and control an integral
component of reproductive and sexual health programs
• Avoiding of all forms of VAW & care and support for victims of
VAW
• Avoiding all forms of harmful traditional practices.
• Good nutrition & Micronutrient supplementation for mothers
• etc
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