1.
REPRODUCTIVE
HEALTH
By ::: Amal Mohamed

2.
 definition
 indicators
 Safe motherhood and its indicators
 Situation in Sudan
 Family planning


3.
DEFINITON
Defined as a state of complete physical,
mental and social well-being and not
merely the absence of reproductive
disease or infirmity. , in all matters
relating to the reproductive system and
to itsfunctionsand processes.[WHO]

4.
 Reproductive health, therefore,
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.
.

5.
 Implicit in this are the right of men and women
to be informed of and to have access to safe,
effective, affordable and acceptable methods of
fertility regulation of their choice, and
 the right of access to appropriate health care
services that will enable women to go safely
through pregnancy and childbirth and provide
couples with the best chance of having a healthy
infant.

6.
 Comprehensive reproductive health care
includes:
 counseling, information, education, communication and
clinical services in family planning;
 safe motherhood, including antenatal care, safe delivery
care (skilled assistance for delivery with suitable referral
for women with obstetric complications) and postnatal
care, breastfeeding and infant and women’s health care;
gynecological care, including prevention of abortion,
treatment of complications of abortion, and safe
termination of pregnancy as allowed by law;
 prevention and treatment of sexually transmitted diseases
(including HIV/AIDS), including condom distribution,
universal precautions against transmission of blood borne
infections, voluntary testing and counseling;

7.
 prevention and management of sexual violence;
active discouragement of harmful traditional
practices such as female genital mutilation; and
reproductive health programmes for specific
groups such as adolescents, including
information, education, communication and
services

8.
REPRODUCTIVE HEALTH
INDICATORS

9.
 During the 1990s, the official representatives of countries
worldwide attended international conferences (ICPD in
Cairo, the Fourth Women's Conference in WHO's Short
List of Reproductive Health Indicators for Global
Monitoring in Beijing) and endorsed a number of global
goals and targets in the broad area of sexual and RH. This
endorsement led to a proliferation of RH indicators on
which countries were asked to report. Subsequently, the
UN asked WHO to take the lead in organizing an
interagency technical process to examine the issue of RH
indicators and to reach consensus on a short list of
indicators for global monitoring.

10.
 WHO's resulting set of 17 indicators covers the
main RH areas and represents the consensus
among international agencies of the key
indicators for international comparison, global
monitoring, and follow-up to the international
conferences.
 The purpose of this set of indicators is to provide
an overview of the RH situation at global and
national levels. The objective is not to present a
comprehensive set of indicators for program
monitoring and evaluation. However, the data
collected for reporting the indicators should be
useful at the program management level

11.
1- TOTAL FERTILITY RATE
 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

12.
 calculated from age specific fertility rate
 date derived from : vital registration , population
censuses and population based surveys
 In sudan TFR is 5.9%

13.
2- CONTRACEPTIVE PREVELANCE
RATE
 Percent of women of reproductive age (15-
49) who are using (or whose partner is
using) a contraceptive method at a
particular point in time
 .. Children born within 2 years of an elder
sibling are 60% more likely to die in
infancy than are those born more than 2
years after their sibling. (Cleland, J et al.
Contraception and Health
www.thelancet.com; July 10, 2012).

14.
 Numerator: Number of women of
reproductive age at risk of pregnancy who
are using (or whose partner is using) a
contraceptive method at a given point in
time
 Denominator: Number of women of
reproductive age at risk of pregnancy at
the same point in time
 data collection method : population based
data survey
 Rate in Sudan is 11% prevelance was 20%
in rural and 3 % in urban areas

15.
3- MATERNAL MORTALITY RATE
 Annual number of maternal deaths per 100,000
live births
 Maternal mortality is widely acknowledged as a
general indicator of the overall health of a
population, of the status of women in society and
of the functioning of the healt system. It is
therefore useful for advocacy purposes, in terms
both of drawing attention to broader challenges
faced by governments and of safe motherhood.
 Is 509 per 100,000 live births in Sudan

16.
 Maternal deaths are difficult to measure owing to many
factors, including their comparative rarity and context-
specific factors such as reluctance to report abortion-
related deaths, problems of memory recall and lack of
medical attribution.
 source of data :
 - vital registration
 - health facility based data ( could be over or under
estimated )
 population based survery *** ( main source in many
developing countries )

17.
4- ANTENATAL CARE COVERAGE
 Percent of women attended at least once during
pregnancy, by skilled health personnel (excluding
trained or untrained traditional birth
attendants), for reasons relating to pregnancy.
 At least one visit is 68.9%
at least four visits 47.1% [Global Health
Observatory Data Repository- WHO]

18.
5- PERCENT OF BIRTH
ATTENDED BY SKILLED
HEALTH PERSONNEL
 Percent of births attended by skilled health
personnel (excluding trained or untrained
traditional birth attendants)
 Numerator: Number of pregnant women
attended, at least once during their pregnancy,
by skilled personnel for reasons related to
pregnancy during a fixed period
 Denominator: Total number of live births during
the same period

19.
source of data :
 vital statistics
 population based surverys
 Percent in Sudan is 57%>…

20.
 This indicator is one of four mutually supportive
indicators in the minimum list measuring
maternal health service coverage. The other
three indicators are: “antenatal care coverage”,
“availability of basic essential obstetric care” and
“availability of comprehensive essential obstetric
care”.
 In combination, these indicators measure
progress towards the goal of providing all
pregnant women with antenatal care, trained
attendants during childbirth, and referral
facilities for high-risk pregnancies and obstetric
emergencies

21.
6- AVAILABILITY OF BASIC
ESSENTIAL OBSTETRIC
CARE
 Number of facilities with functioning basic
essential obstetric care per 500,000 population

22.
7- AVAILABILITY OF
COMPREHENSIVE ESSENTIAL
OBSTETRIC CARE
 Number of facilities with functioning
comprehensive essential obstetric care per
500,000 population

23.
 health facility based survey
 population based survey (household)

24.
8- PERINANTAL MORTALITY RATE
 Number of perinatal deaths (still births plus
early neonatal deaths) per 1,000 total births
 Neonatal mortality is 31 per 1000 live births

25.
9- LOW BIRTH WEIGHT
PREVALENCE
 Percent of live births that weigh less than 2,500g
 One third of infant are born with a low birth
weight in Sudan [UNICEF]

26.
10- POSITIVE SYPHLIS
SEROLOGY PREVELANCE IN
PREGNANT WOMEN
 Percent of pregnant women (15-24) attending
antenatal clinics, whose blood has been screened
for syphilis, with positive serology for syphilis
 Data collected by sentinel survelliance

27.
11- PREVALENCE OF ANEMIA IN
WOMEN
 Percent of women of reproductive age (15-49)
screened for hemoglobin levels with levels 11g/dl
for pregnant women, and 12g/dl for non-pregnant
women
 57.7% in Sudanese pregnant women in 2005

28.
SOURCE OF DATA
 health facility based data
 special population survery

29.
12-PERCENT OF OBSTETRICS AND
GYNECOLOGY ADMISSION 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)

30.
13- REPORTED PREVALENCE OF
WOMEN WITH FGM
 Percent of women interviewed in a community
survey reporting having undergone FGM
 Sudan is 88%
 Nigeria 27%
 Egypt is 91% (highest total number)
 Somalia 98% highest prevelance rate

31.
14-PREVALANCE OF INFERTILITY IN
WOMEN
 Percent of women of reproductive age (15-49) at
risk of pregnancy (not pregnant, sexually active,
non-contracepting, and non-lactating) who report
trying for a pregnancy for two years or more
 Proportion of women who has their first birth at
18 in 2008 is 17%

32.
15- REPORTED INCIDENCE OF
URETHRITIS IN MEN
 Percent of men aged (15-49) interviewed in a
community survey reporting episodes of
urethritis in the last 12 months

33.
16- HIV PREVALENCE AMONG
PREGNANT WOMEN
 Percent of pregnant women (15-24) attending
antenatal clinics, whose blood has been screened
for HIV and who are sero-positive for HIV

34.
17- KNOWLEDGE OF HIV
RELATED PREVENTION
PRACTICE
 Percent of all respondents who correctly identify
all three major ways of preventing the sexual
transmission of HIV and who reject three major
misconceptions about HIV transmission or
prevention

35.
STIs and HIV/AIDS
Harmful traditional
practice (FGM)
Family planning
Counseling in
RH
(Women
empowerment
and Male
involvement
Menopause
Adolescent
health
Infertility
Reproductive
cancers
(cervical and
breast)
Safe motherhood
RH components and prioritiesRH components and priorities

36.
SAFE MOTHERHOOD

37.
SAFE MOTHERHOOD
 Safe motherhood begins before conception with
proper nutrition and a healthy lifestyle. It
continues with appropriate prenatal care, the
prevention of complications when possible, and
the early and effective treatment of any
complications.
 The ideal results are pregnancy at term without
unnecessary interventions, the delivery of a
healthy infant, and a healthy postpartum period
in a positive environment that supports the
physical and emotional needs of the woman,
infant, and family.

38.
 Globally, the numbers remain staggering: each
year there are at least 3.2 million stillborn
babies, 4 million neonatal deaths and more than
half a million maternal deaths.
 The majority of these deaths are avoidable.
 HIV/AIDS and malaria in pregnancy are having
an impact on maternal mortality and could
reverse the progress that has been made.

39.
 A total of 11–17% of maternal deaths occur
during childbirth itself . While 50–71% occur in
the post-partum period.
 The time spent in labour and giving birth, the
critical moments when a joyful event can
suddenly turn into an unforeseen crisis, needs
more attention, as does the often-neglected post-
partum period.
 These periods account not only for the high
burden of post-partum maternal deaths, but also
for the associated large number of stillbirths and
early newborn deaths.

40.
 Very few developing countries have accurate data
on maternal and newborn deaths and
morbidities, and less than one developing country
in three reports national data on post-partum
care

41.
SAFEMOTHERHOOD INDICATORS
 ✦ Access/Use of Services Indicators
 Met Need for Essential Obstetric Care
 Unmet Obstetric Need
 Cesarean Section Rate
 Who delivers the woman, and where does birth
take place

42.
 Quality of care indicators
 Case Fatality Rate (and numbers ofmaternal
deaths)
 Referral Rates

43.
SAFE MOTHERHOOD INDICATORS IN
SUDAN
71% of pregnant women have
access to prenatal care services
Postnatal care is low at 18% and
SHHS 2006

44.
Coverage with village midwives is
52.4%
ANC/FP services are provided by 37.5%
of facilities.
Coverage of health facilities with
EmONC services 57%
RH Annual report 2008

45.
Delivery by trained personnel in the
northern part of the country
accounts for 57% of deliveries.
Institutional deliveries account for
14% of all births
Caesarian Section Rate has risen to
4.5%
SHHS 2006

46.
LOCAL SITUATION

47.
LOCAL SITUATION
o The country adopted PHC as the main
strategy to improve the health status of
individuals, families and communities , as
early as 1973
o
o In 1976 Sudan National Health Plan
implemented the PHC with MCH/FP as an
integral part and one of the main components

48.
THE OVER ALL OBJECTIVE OF NATIONAL
STRATEGY IN SUDAN :
Is to accelerate progress
toward meeting the
nationally set and
internationally agreed RH
targets and ultimately to
attain highest achievable
standard of RH for all
population

49.
 Focuses on the elements of the health system and the
basic core skills and abilities required in order for care
providers to be able to function effectively
 In 2001 – all states ministers of health and the Federal
minister signed the Sudan Declaration on Safe
motherhood. As the main target- Midwife for every
village
Making Pregnancy Safer initiative
(2001)
Making Pregnancy Safer initiative
(2001)

50.
WHERE WE ARE?WHERE WE ARE?
Sudan Household Survey- 2010
• Overall Maternal Mortality: 730 per 100,000 live
births

51.
 By the end of the childbearing period about one
in ten women have never given birth

52.
 The age-weighted proportion of female deaths
reported occurring during the exposure period for
pregnancy and post-delivery in Sudan in 2008
was 46 percent, with the highest percentage of
pregnancy and delivery related deaths occurring
between the ages of 20 and 24 years.
 Among states, the age weighted proportion of
maternal deaths out of all female deaths was
highest in North and South Darfur, Kassala,
White Nile, Blue Nile and South Kordofan (above
50 percent) and lowest in Northern, River Nile
and Gezira (below 30 percent).

53.
 In Sudan, maternal conditions during pregnancy affect
over one in three pregnant women (conditional on
surviving pregnancy) and complications during labor or up
to six weeks after delivery affect approximately one in
every two pregnant women .
 About 60 percent of perinatal deaths (including still births
and neonatal deaths from any cause, during the perinatal
period – 27 weeks of gestation to 28 days of life) are low
birth weight (less than 2,500 grams), birth asphyxia and
infection (neonatal sepsis, tetanus, congenital syphilis, HIV
infection) (Graham, Cairns et al. 2006).
 Death to the mother and baby is highly concentrated near
delivery, from the onset of labor or abortion to 48 hours
postpartum or post abortion, highlighting the need for
mothers to have professional care at the time of delivery.
Mortality among babies is directly linked to complications
experienced by mothers.

54.
 Among women of reproductive age with a
pregnancy in the two years prior to the
survey - skilled birth attendance (births attended
by a doctor, nurse midwife or village midwife)
covered 68 percent of live births between 2004
and 2006 and 73 percent between 2008 and 2010.
Across states, skilled birth attendance ranges
from a high of 99 percent in Northern to a low of
34 percent in West Darfur

55.
FAMILY PLANNING

56.
WHAT IS FAMILY PLANNING?
A way of living that is adopted by individuals and
couples in order to promote the health and welfare
of the family group
Practices that help to :
◦ Avoid unwanted pregnancy.
◦ Bring about wanted pregnancies.
◦ Regulate intervals between pregnancies.
◦ Control the time of birth in relation to parent ages.

57.
FAMILY PLANNING
 Among women having had a live birth in the two
years prior to the SHHS, in 2010, 23 percent in
urban areas did not want their last birth
compared to 14 percent in rural areas.
 In 2010, 29 percent of women in urban areas and
21 percent in rural areas did not want a future
pregnancy.

58.
 The use of modern contraception expanded from 7.8 to 19
percent between 2006 and 2010among women in urban
areas.
 For women in rural areas, use of modern contraceptive
increased from 3 to 5.6 percent between 2006 and 2010 and
the use of traditional methods remained at 1 percent.
 The most commonlyused methods for contraception in 2010
among couples using contraception were
 pills (73 percent),
 injectables(11 percent),
 lactational amenorrhea (5 percent)
 and periodic abstinence (4.5 percent).
 Less than 2 percent of women reported using male condoms
as a form of contraception.

59.
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