This document discusses reproductive health in Nepal. It defines reproductive health as a state of complete physical, mental and social well-being in all matters relating to the reproductive system. The scope of reproductive health is wide, covering all life stages and including family planning, safe motherhood, newborn care, prevention and management of abortion complications, and prevention/management of reproductive infections and diseases. Reproductive health services in Nepal are provided through various levels of the health system according to established protocols. The national health policy prioritizes improving reproductive health and reducing fertility rates.

1. REPRODUCTIVE HEALTH
(RH)
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2. INTRODUCTION
 Reproductive health is the crucial part of the
overall health and is central to human
development.
 It is important component of general health
and is prerequisite for social , economic and
human development.
 According to WHO reproductive and sexual
health accounts for 20% of the global burden
for ill health for women and 14% for
men.(Reproductive health strategy-WHO)
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3.  The concept of reproductive health was
introduced at the International conference on
population and development (ICPD) at Cario,
in 1994 and later on it was accepted by WHO.
 In the ICPD program of action , Reproductive
health was first defined by the WHO and was
endorsed by the UN General Assembly and
by Beijing Declaration.
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4. Cont…
 This program of action endorses a new
strategy which emphasizes the
numerous linkage between population
and development and focus on meeting
the needs of individual women and men
rather than or achieving demographic
targets.
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5. Definition
 Reproductive Health is defined as a state of
complete physical, mental and social well being
and not merely absence of disease and infirmity
in all matters relating to the reproductive system
and to its function s and its process.
 Reproductive Health therefore implies that people
are able to have a 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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6. Cont….
 Implicit in this last condition are the right of men
and women to be informed of and to have access
to safe, effective, affordable and acceptable
methods of family planning of their choice as well
as other method of their choice of regulation of
fertility, which are not against the law, and the
right of access to appropriate health care services
that will enable women to go safely through
pregnancy and childbirth and provide couple with
best chance of having healthy infant.
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7. Cont…
 In line with the above definition of Reproductive
Health ‘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.’ It also includes sexual health, the purpose
of which is the enhancement of life and personal
relations and not merely counseling and care related
to reproduction and sexually transmitted disease.
( program of action in ICPD, document A/CONF
(71/13,paragraph 7.2)
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8. Scope/Components
 The scope of
Reproductive Health
is wide.
 It covers the all stage
of life.
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9. Reproductive health within the context of
Primary Health Care, includes the following
essential components:
1. Family planning; counseling, information,
education, communication and
services(emphasizing the prevention of
unwanted pregnancies)
2. Safe motherhood; education and services
for healthy pregnancy, safe delivery and
postnatal care including breast feeding.
3. Care of the newborn
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10. 4. Prevention and management of complication s of
abortion
5. Prevention and management of RTI, STDs,
HIV/AIDS and other reproductive health
condition.
6. Information, education and counseling as
appropriate on human sexuality, Reproductive
Health and responsible parenthood for
individuals, couples and adolescent
7. Prevention and management of sub fertility and
8. Life cycle issues including breast cancer, cancer
of the reproductive system and care of the
elderly.
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11. National Health Policy and
Strategies
The Nepal Reproductive Health strategy lists the
following Reproductive Health issues as priorities
in its Integrated Reproductive Health Package:
 Family planning
 Safe motherhood
 Child health (new born care)
 Prevention and management of
complications of abortion
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12. Cont…
 Reproductive Tract Infection/Sexually
Transmitted Disease/ Human Immuno-
Deficiency Virus/ Acquired Immunodeficiency
Syndrome.
 Prevention and management of subfertility.
 Adolescent reproductive health.
 Problems of elderly women (i.e. uterine,
cervical and breast cancer treatment) at the
tertiary level or the private sector.
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13. Cont….
 Each of the interventions is implemented
through the health institutions. The sub health
post is the first contact point for the basic
health care and referral services. But in actual
practice SHPs are the referral centers of the
FCHV as well as community based activities
such as PHC outreach clinics. Each level
above SHPs is a referral point in the
hierarchical networks.
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14. Cont…
 Reproductive Health Services are provided
throughout the country under the directives of
DoHs which has the responsibility of delivering
preventive and curative health services and
promotional activities.
 Family Health Division of DoHs is responsible in
implementing RH strategies and programs.
 Logistic Management division of DoHs is
responsible for procurement, warehousing and
distribution of Reproductive Health commodities
including supplies and equipment
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15. CONT…..
 Reproductive Health is not a new program , but
rather a new approach which seeks to strengthen
the existing Safe Motherhood, Family planning,
HIV/AIDS, STD, Child Survival and Nutrition
Program with a holistic life cycle approach.
 This calls for strengthening inter-divisional
linkages within the Department of Health Services
as well as between other sectors e.g. education,
women and development, local development and
the legal/justice system.
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16. Cont…..
 Gender perspectives and empowerment of
women will be built into all relevant program
areas.
 National Reproductive Health policies is well
inline with the policies adopted in National
Health Policy (1991) and second long term
Health Plan (1997-2017) which aims at
reducing infant, child and maternal morbidity
and mortality and reducing total fertility rate.
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17. Cont…
 The new health Policy and Second Long Term
Health Plan place emphasis on community
involvement, increasing access through PHC,
Out reach, Sub Health Posts , Health Posts,
Primary Health Care centers and Districts
Hospital, as well as establishing functional referral
mechanisms between different levels.
 Furthermore due emphasis is placed on
strengthening management capacity including
planning, monitoring/ supervision and
performance review/evaluation.
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18. Cont…..
Against this background , the following strategies
have been adopted for the effective and efficient
provision of quality Reproductive Health Services
in Nepal;
 Implement the ‘Integrated Reproductive Health
Package’ at hospital, PHC Center, Health Post
and Sub-Health Posts as well as through Primary
Health Care Outreach, FCHVs/ Mothers groups
and other community and family level activities
based on standardized clinical protocols and
operational guidelines;
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19. Cont….
 Enhance functional integration of
Reproductive Health activities carried out by
different divisions;
 Emphasize advocacy for the concept of
Reproductive Health including the creation of
an enabling environment for inter-and intra-
sectoral collaboration;
 Review and develop IEC materials to support
all levels of intervention including rumour
countering message.
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20. Cont…
 Review and update the existing training curricula
of various health workers to include missing
Reproductive Health components;
 Ensure effective management systems by
strengthening and revitalizing existing committees
at various levels;
 Develop a national RH research strategy which
outline research priorities and work plans based
on information requirements of policy makers,
planners, managers and service providers;
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21. Cont…
 Construct/ upgrade appropriate service delivery
and training facilities at the National, Regional,
District and Health Post level;
 Institutional strengthening through structured
Planning, Monitoring/ supervision and
Performance review;
 Develop an appropriate RH program for
adolescents;
 Support for national experts/consultants; and
 Promote inter-sectoral and multisectoral co-
ordination.
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22. Reproductive Health Services
Protocol at Different Levels
Level of Intervention for integrated RH package:
 Family / Decisional makers level
 Community level
 Sub-Health post/ Health Post level
 Primary Health Care center level
 District Level
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23. Family Level
S
N
Services Activities
1. Family
Planning
I. Identification of
necessity
II. Keeping information of
various places or
organization providing
the facilities of family
planning
2. Safe
motherhood
I. Identification of female
being pregnant
II. Identification of danger
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24. 3. Care of the
newborn
I. Proper care of the
newborn
II. Identification of
complication in the
newborn and
immediately taking for
treatment in health
centers
III. Immunization as per the
schedule
4. Prevention
and
management
of
complication
I. Information regarding
complications and signs
of abortion
II. Information regarding
centers providing
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25. 5. Prevention and
management
of
RTI/STD/HIV/A
IDS
1. Encourage use of condom
2. Information and seeking
help regarding infection in
reproductive organs and
other various sexually
transmitted disease
6. Prevention
and
management
of sub-fertility
cases
1. Identify subfertility
2. Treatment of subfertility in
the related health
institution by the couple
7. Adolescent
reproductive
health
1. Activities related to Family
Life Education like:
Having talk among
parents and children
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26. Providing adequate nutrition to the
adolescent especially to girls
Education to girls
8. Problem of
elderly
women i.e.
uterine
cervical and
breast
cancer
treatment at
the tertiary
level or in
the private
sector
1. Identify the problem
related to reproductive
organs
2. Keeping information
regarding respective
institute that can provide
information regarding
these matters
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27. COMMUNITY LEVEL
1. Family
Planning
1. Information , counseling and
education regarding adolescent
boy and girl, man and women
regarding sexual behavior and
gender equality
2. Distributing family planning
device at community level
through health worker, volunteer,
mothers group, family planning
worker and various NGOs
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28. 3. Giving counseling regarding
various other family planning
method
Information and education regarding
lactional amenorrhea
4. Making arrangement for
redistribution of condom and pills
2
.
Safe
motherhood
1. Education and counseling
regarding nutrition, family
planning, adequate rest,
exercise.
2. Providing information regarding
danger signs
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29. 3. Identification of danger
signs like rupture of membrane
for more than 12 hours,
prolapse of cord and excessive
bleeding
3. New born
Care
Counseling regarding :
•Health of new born baby
•keeping baby warm
•Immediate breast feeding
•Encourage breast feeding
•Immunization as per schedule
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30. 4. Prevention and
management of
complication of
abortion
1. Counseling regarding
prevention of
unplanned pregnancy,
family planning and
provision for
distribution of condom
and pills.
2. Identification of
abortion and signs of
complication of
abortion
3. Referred to health
facilities where
facilities are available
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31. 5. Prevention and
management of
RTI/STD/HIV/AID
S
1. Counseling
regarding safe sex
2. Distribution and
encourage the use
of condom
3. Information,
Education and
counseling regarding
safe sex and gender
equality
4. Education and
counseling regarding
infection to
reproductive organs
STI/HIV AIDS
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32. 6. Prevention and
management of
sub-fertility
cases
Information regarding
prevention an treatment
of subfertility
Referral of subfertility
couple to health
institution and provide
adequate required help
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33. 7. Adolescent
reproductive health
1. Education and counseling
regarding sexual
behavior and gender
equality
2. Creating awareness
regarding danger of early
age pregnancy
3. Family life
education.(same as
above)
8. Problem of elderly
women i.e. uterine
cervical and breast
cancer treatment
1. Identify the problem
related to reproductive
organs
2. Keeping information
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34. Sub Health Post/ Health Post Level
1.` Family
Plannin
g
1. Monitoring community based activities
2. Provision of pills, condom and depo
3. Provision of facility of IUCD in the
health institution where there are
related health workers
4. Counseling and referral for permanent
family planning method
5. Counseling, management and referral
of side-effect of related family planning
method and appropriate counseling
regarding change of family planning
method
6. Increasing the availability of other
family planning method 6/18/2022
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35. 2. Safe
motherhood
1. 4th ANC visit for each pregnancy
2. Delivery facilities and use of
partograph, oxytocin and hands for
placenta delivery
3. Identification of danger signs and
complication and immediate
referral
4. Perform episiotomy and perineal
tear,
5. Treatment of malaria according to
national guidelines
6. Treatment of postnatal mothers of
sepsis
3. Care of
newborn
1. Treatment of infection of infant
2. Manage to prevent gonococcal eye
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36. 4. Prevention
and
managem
ent of
complicati
on of
abortion
1. Identification of abortion by minor
physical examination
2. Resuscitation, IV drip and refer
3. Counseling regarding emergency
contraceptive method
5. RTI/STD/H
IV/AIDS
1. Identify, manage and refer white
discharge, lower abdominal pain,
ulcer of reproductive organs, swelling
of testes and groin region
2. Inform spouse and refer
3. Encourage and distribute condom
4. Advertisement, education and
information regarding various method
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37. 6. Prevention
and
management
of subfertility
cases
Same
7 Adolescent
reproductive
health
1. Make available of pills and
condom
2. Provide ANC, natal PNC and
newborn care according to
national standard
3. Conduct health education( family
life clinic)
4. School health program
5. Identify reproductive health
problem and refer 6/18/2022
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38. Primary Health Care Center Level
1. Family
Planning
1. Provide the facilities of Minilap,
permanent method of family
planning for male
2. Provide other method of family
planning method as per the
nation guidelines
3. Management and treatment of
complication
4. Facilities of postmortem
5. Provide the facilities of long
term temporary family planning
method and management of
side effects and complication
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39. 2
.
Safe
motherhood
Start I/V drip and first dose of
antibiotics prior to referral for
complications
Provide with the facility of forceps
delivery, vacuum delivery
3.
Care of the
newborn
Keep baby warm, resuscitation
and breast feeding and treatment
of newborn baby as per the
national guidelines
4.
Prevention and
management of
complication
and abortion
Start the required treatment like
antibiotics, IV drip, use of oxytocin,
uterus evacuation for less than 3
months abortion, refer for more
than 3 months abortion, use of
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40. 5. RTI/STD/HIV/AI
DS
•Treatment of STD according to
signs and symptoms
•Treatment of STI and STD
•Encourage and distribution of
condom
6. Prevention and
management of
sub fertility
cases
• Treatment of sub fertility,
semen analysis and referral
with appropriate counseling
to health centers having the
facilities
7. Adolescent
reproductive
health
•Treatment of STD
•Special attention to be given to
early age pregnant mothers
during their ANC, natal and PNC
period 6/18/2022
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41. District Level
1
.
Family
Planning
Same +Provision and expansion of
facilities of permanent family planning
method like minilap,
laproscopy,vasectomy facilities and
facilities of semen analysis
2
.
Safe
motherhoo
d
Treatment of maternal sepsis
Treatment of high risk mothers
Treatment of serious complication during
natal period, facilities of anesthesia, C/S
and provision of blood transfusion if
available
Treatment of referred case
Provide with the facility of forceps
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42. 4. Prevention
an
managemen
t of
complication
of abortion
Uterus evacuation for abortion
done within 2nd trimester
Treatment of complication of
abortion
Provide local/general
anesthesia
Cure of complication like
septicemia, peritonitis and
renal failure and referral of the
case to the appropriate health
center
5. RTI/STD/HI
V/AIDS
Treatment of disease based
on signs and symptoms and
laboratory investigations 6/18/2022
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43. Education, Information
and counseling regarding
the prevention of above
mentioned condition
6. Prevention an d
management of
sub fertility
cases
Cure and treatment of
subfertilityand if required
referral of case to better
center
7. Adolescent
reproductive
health
Same
8. Problem of Same 6/18/2022
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44. Indicators of Reproductive
Health
 Women empowerment indicators: literacy
rate of female, % of working female, Average
age of marriage of female, ratio of Female
volunteer providing health related services,
No. of adolescent female going school
 Health Service Delivery Indicators:
Contraceptive prevalence rate, % of women
with at least one ANC visit, % of women
receiving Postnatal and natal services,% of
delivery by trained health workers,,% of
pregnant women receiving TT-2
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45. IMPACT INDICATORS
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45
 Total fertility rate and age specifice fertility
rate.
 Maternal mortality rate.
 Perinatal mortality rate.
 Neonatal mortality rate.
 Infant mortality rate.
 CYP (couple year of protection.

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 Number of neonatal tetanus(NNT)
cases.
 LBW rate per 1000 live births.
 Anemia in pregnant women.
 STI prevalence

47. WOMENS EMPOWERMENT
INDICATORS
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 Literacy rate of women as compared to
man
 Percentage of women gainfully
employed.
 Age of women at first marriage
(Average).
 Number and percentage of women
health care providers by level of care.
 No. of women trained as health
volunteers.

48. CYP
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 Express the number of year for which a couple
will be protected from being pregnant by modern
contraceptive method providing during the year.
 VSC=13CYP
 Implant=5 CYP
 IMPLANT=3CYP
 IUCD=8CYP
 13 pills cycle=1CYP
 4 doses Depo=1CYP
 150 condom=1CYP

49. Some important
Indicators(2066/67)
 BCG coverage= 94.5%
 DPT3 coverage=81.6%
 Polio 3 Coverage=83.3%
 Measles coverage=86.4%
 TT2 and TT2+ coverage=78.4%
 Antenatal first visit= 87.4%
 Institutional delivery= 28.5%
 Postnatal first visit= 49.7%
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50. REFERENCES
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 Reproductive Health Program;Operational
Management Guidelines;For HP/SHP ;Family
Health Division ,Ministry of health;Government of
Nepal
 Annual Report, Department of health services
2066/67;Government of Nepal; Ministry of health
and population; Department of Health Services
Kathmandu
 Tuitui Roshani; Suwal S.N; Manual of midwifery
Antepartum and gyanecological nursing’2009;6th
edition;vidyarthi pustak bhandar;page No:457-
460
 URL:http://www.undp.org.np/mdg

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