sexual and reproductive health and rights

1. Overview of Reproductive health system
and
Safe Abortion, Abuse &Violence
Mount Edmund | 19th Baisakh, 2080
By
Dr.Sharwajeet Jha
Intern MBBS(T.U)

2. एक हातले ताली बज्दैन।

3. What is reproduction?

4. Reproduction is the process of producing offspring that are biologically or genetically similar to the
parent organism.

5. What is reproductive health?

6. Reproductive health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity, in all matters relating to the reproductive system and to its functions
and processes.
It addresses safe sexual life, capability to reproduce and freedom to decide when and how often to do
so for both Men and Women.

9. Stages of life and the changes

10. Adolescence & Puberty
Adolescence is a period of transition from childhood into adulthood.
10 to 19 years
Marked by dramatic physical, psychological and social changes.
The onset of puberty "announces" an important step on the road to adulthood.
The onset of menstruation and the initiation of sperm production are important milestones at this
time.

11. Puberty
The physiological changes that occur in early adolescence (sometimes beginning
in late childhood) result in the development of sexual and reproductive capacity.
Physical growth and development manifest in a growth spurt. For instance, girls
experience breast development and hip enlargement, whereas in boys, there is the
appearance of "man-like"musculature.
These changes are accompanied by others such as the appearance of the axillary
and pubic hair in both boys and girls, and the change in the pitch of the voice and
the appearance of facial hair in boys. There is rapid maturation of the sexual
organs.

12. Menstruation : how much do you know about it?
What age does a girl normally start to mesntruate?
How long is menstrual cycle?
How many days does the period last?
How much blood flow is normal?
Do you think period blood is impure?
Does a girl become an adult the day she gets
her first period?
Is it risky or dangerous to engage in sports or
physical activities during menstruation?
What does the period blood consist of?

18. Sexual and reproductive Health Rights
SRHR imply that individuals are able to maintain good sexual and reproductive health and make
decisions about their bodies free from stigma, discrimination or coercion.
To support good sexual and reproductive health people need to access to an essential package of sexual and
reproductive health services like:
● Care for sexually transmitted infection (STIs)
● Maternal and newborn care
● Safe abortion care
● Infertility and cervical cancer
● counselling and care for sexual health and wellbeing
Policy and legal provisions :
● National health sector strategy 2016-2021
● Safe motherhood and reproductive Health Act 2018
● Nepal safe motherhood and newborn Health Programme roadmap 2030.

19. Know your rights!
According to Right to reproductive health and safe motherhood act 2018,
We have the right to -
● obtain education, information, counseling and service relating to sexual and
reproductive health.
● get information regarding contraceptives and use them
● determine the gap between births or the number of children
● get her examined or checked whether she is pregnant or not
● obtain abortion service
● Not to get contraceptives used forcefully
The reproductive health service obtained by every person and information regarding this
shall remain confidential.

20. What is
Contraception?

21. Contraception : What options do we have?
Prevention is better than cure.
What is Contraception ?
Contra_ - Against Conception - Pregnancy
The use of drug, device or surgery to prevent pregnancy or as a consequences of sexual Intercourse.
There is contraception for both MEN and WOMEN.

23. Types of contraception
For Men :
Permanent: Vasectomy
Temporary Male condoms , withdrawal
For Women:
Permanent: Tubal ligation
Temporary: IUDs, Depo provera, OCPs, Norplant, Femidom

24. ABORTION
● "Abortion" means the act of fetus coming out or taking it out of the womb or before the fetus
remained in the uterus born naturally.
● Types:
1. Spontaneous abortion aka Miscarriage
2. Induced abortion
Unsafe abortions—those performed by people lacking the necessary skills, or in inadequately
resourced settings—are responsible for between 5-13% of maternal deaths, especially in the
developing world.

25. METHODS OF ABORTION
● There are two methods of abortion:
1. Medical method or MTP(Medical Termination of Pregnancy)
1. Surgical method: These includes Manual Vacuum Aspiration(MVA), Suction and
evacuation,Dilation and curettage.

26. Complications of Unsafe Abortion
1. Infection
2. Incomplete abortion
3. Cervical injury
4. Uterine perforation
5. Heavy bleeding (hemorrhage)
6. Retained blood clots in the uterus.
7. Septic Shock
8. Death

27. If you had unsafe sexual relationship;how to find out you are pregnant?
First every woman should have a track of their period cycle, if your cycle is regular and you missed
your period , you had unsafe sexual contact, then you must keep in mind for the following factors
before thinking you might have been pregnant
● Change if your environment (if you have travelled to different place; temperature might bring
change in menstrual cycle)
● Your mental health(stress).
● Extreme exercises
● Pathological conditions like PCOD, thyroid disorders.

28. WHAT TO DO??
1. First Don't panic.
2. Share it with your partner , friend
and elder to you.
1. Visit a pharmacy and ask for Urine Pregnancy Test Kit.
If negative, take a deep breath and promise to
always practice safe sex, use protection!
But…….the result is positive then,

29. .
EMERGENCY CONTRACEPTIVE PILLS
ARE NOTMEANS
FOR ABORTION

30. If you are pregnant and you don't want to continue the Pregnancy,
YOU SHOULD VISIT HOSPITAL OR HEALTH CENTRES WITH SAS(Safe Abortion
Service) also known as Comprehensive Abortion Care(CAC)
The four key components of comprehensive abortion care as:
Pre and post counselling on safe
abortion methods and post-
abortion contraceptive methods;
Termination of pregnancies acc.
To national guidelies
Diagnosis and treatment of
existing reproductive tract
infections
Provide contraceptive methods
after termination & follow up

31. For SAS, one should always visit hospitals or health centers.
NEVER TAKE ABORTION PILLS ON SELF WITHOUT DOCTOR PRESCRIPTION FROM
PHARMACY.
First visit a doctor, And if Pregnancy period is upto 12 weeks, medical methods can be adopted as per
doctor advice.
Pregnancy beyond 12 weeks should be terminated with Surgical Method by expert health
professional.
SAS is available for first trimester abortion in all 77 district hospitals
And second trimester abortion i.e after 13 weeks is available in 22 hospitals.

33. LEGAL ASPECTS OF ABORTION
● Abortion was legalized in Nepal in 2002.
● Abortion can be done in following conditions:
1. Upto 12 weeks upon the consent of mother if she is above 18 yrs, if she is minor i.e below 18 yrs
it can be performed upon the consent from the guardian or parents.
2. Upto 18 weeks in case of Rape and Incest
3. At any weeks of pregnancy if fetus is not physically sound or if the continuation of pregnancy
endanger the life of the mother.

34. Reproductive Health Services In Nepal
UNFPA Nepal is supporting the Ministry of Health to achieve the ambitious targets set out in the new
Sustainable Development Goals, which call for bringing the maternal mortality ratio down to 70 deaths per
100,000 live births by 2030, by:
● Ensuring family planning services;
● Supplying contraceptives and live-saving medicines;
● Preventing and treating reproductive health morbidities like pelvic organ prolapse, obstetric
fistula and cervical cancer;
● Supporting ongoing efforts towards midwifery education as per WHO/ICM standards;
● Supporting the provision of adolescent-friendly services;
● Preventing child marriage and empowering married young women and girls;
● Upgrading adolescent sexual and reproductive health services

35. Few free reproductive health services provided by Government, different INGOs lile UNFPA, Marie
Stopes and NGOs like FPAN, Sunaulo pariwar Nepal:
1. Free contraceptive device distributed through FCHVs and Health posts.
2. Free reproductive health counseling services in Health post and hospitals for all reproductive
age people
3. Aama Surakshya Program in the public hospital for encouraging ANC Checkup and
Institutional delivery
4. Free Family Planning counseling for postpartum mother.

36. Dating Abuse
Teen dating abuse is a pattern of abusive behavior used to control another person. It
can be:
● Any kind of physical violence or threat of physical violence to get control.
● Emotional or mental abuse, such as playing mind games, making you feel crazy,
constantly texting you, or constantly putting you down or criticizing you.
● Sexual abuse, including making you do anything you don't want to do, refusing to
have safer sex, or making you feel bad about yourself sexually.

37. ● Child marriage has been illegal in Nepal since 1963.
● Currently legal age of marriage for both men and women is 20.
41% of girls in Nepal are married before the age of 18
Increment of भाͬग ͪववाह

40. Relationship Abuse and Violence

42. Violence
● An act that causes harm or intended to harm is
known as violence.
● It can be physical , mental or both.
- Physical violence occurs when people tries to hurt you
by physically .like slapping
-Sexual violence occurs when one person forced you to
do sexual activities.
-Emotional violence occur when one person make other
person upset or worthless.

43. RELATIONSHIP VIOLENCE
● The physical , emotional , and verbal abuses of one partner by the other partner
in current or formal dating .
● These type of violence are most common nowadays especially in youngster .
● Relationship violence can occur any type of relationship ,including hetrosexual
, LGBTQ+.
● Globally , more than 38% of all murders among women are done by intimate
partner.
● In relationship violence women suffer more than men but men also go through
it .

44. FACTOR CONTRIBUTING OF RELATIONSHIP
VIOLENCE :-
● Low level of education among women.
● One partner have more power in the relationship .
● Victim blaming ideas.
● Over possessiveness and jealousy .
● Gender based serotype reinforce the inequality.
● Use of drugs and alcohol.
These are the main factors that increases the chance of
relationship violence.

45. WARNING SIGN OF RELATIONSHIP
VIOLENCE??

47. IMPACT OF RELATIONSHIP VIOLENCE ON
VICTIM:-
● Physical injuries.
● Emotional trauma( anxiety, depression).
● Low self esteem.
● Social isolation .
● Substance abuse.
● May be suicide in extreme cases.

49. RESOURCES FROM WHERE YOU CAN SEEK
HELP IN CASE OF RELATIONSHIP
VIOLENCE:-
● National women commission:- governmental agency who protecting and
promoting women right .
● Nepal police :- you can file the complaints on women cell and seek help
from it.
● Sathi Nepal :-it provides counselling and support service for survivors of
relationship violence , including legal support and emergency shelter.
● Women rehabilitation center.
● Maiti Nepal .

51. Story Time

52. Once there was a young girl named Ganga who fell in love with a handsome
boy named Arjun. At first , their relationship was full of love , happiness
,kindness and laughter . However , over the periods of time , Arjun began to
display controlling and abusive behaviour towards Ganga .
Later on , Arjun would become jealous and over possessiveness when Ganga
spoke to other boy or went out with her friends without his permission . He
would insist on knowing where she was at all times and would get angry if
she did not answer his call or messages right away . He would often accuse
her of cheating and would check her phone and social media accounts to see
who she was talking to ,he would also become angry and violent when things
did not go his way

53. She thought that if she just tried harder to make him happy , things would get
better . But as time went went on, the abuse only become worse and worse .
Ganga was scared and confused . She loved Arjun , but she knew that
somethings was going wrong . She tried to talk to him about this behaviour ,
but he would always turn it around and blame her for everythings.
Oneday ,things become worse ,when Arjun hit Ganga during an argument
.she was left with scars on body, bruises and heart broken , she knew she
needed to get out of the relationship but did not know how to do it safety and
how to start ignoring.with the help of friends , Ganga was able to leave Arjun
and seek help from a domestic violence shelter .There ,she received support
and counselling to help her heal from the abuse and rebuild her life . She also
learned about the warning signs and abusive behaviour and how to stay safe
in future relationship

54. It was a long and difficult journey , but Ganga was able to find happiness
again ,She learned that love should never hurt and she deserved to be treated
with respect and kindness . Arjun was eventually arrested and forced
consequences for his action .

57. Thankyou!