This document discusses reproductive health and rights. It defines reproductive health according to the ICPD Cairo conference in 1994. Reproductive health includes physical, mental and social well-being related to reproductive functions. The document also discusses reproductive rights as outlined in international agreements, including the right to decide family planning and access to reproductive health services. Denying these rights can negatively impact maternal and child health.

1. Konsep Dasar & Hak-hak
Reproduksi
MK. Dasar-dasar Kesehatan Reproduksi
TM 2
Eri Wahyuningsih
Jurusan Kesehatan Masyarakat
UNSOED

2. 2
Definisi (ICPD Cairo, 1994)
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 related to the reproductive system and to its functions
and processes.
(Keadaan sejahtera fisik, mental dan sosial secara utuh, yang tidak semata-
mata bebas dari penyakit atau kecacatan, dalam semua hal yang berkaitan
dengan sistem reproduksi, serta fungsi dan prosesnya)
Bacaan tambahan:
https://www.unfpa.org/news/explainer-what-icpd-and-why-does-it-matter

3. 3
Pasal 71
1) Kesehatan reproduksi merupakan keadaan sehat secara fisik,
mental, dan sosial secara utuh, tidak semata-mata bebas dari
penyakit atau kecacatan yang berkaitan dengan sistem, fungsi,
dan proses reproduksi pada lakilaki dan perempuan.
2) Kesehatan reproduksi sebagaimana dimaksud pada ayat (1)
meliputi:
a. saat sebelum hamil, hamil, melahirkan, dan sesudah
melahirkan;
b. pengaturan kehamilan, alat konstrasepsi, dan kesehatan
seksual; dan
c. kesehatan sistem reproduksi.
3) Kesehatan reproduksi sebagaimana dimaksud pada ayat (2)
dilaksanakan melalui kegiatan promotif, preventif, kuratif, dan
rehabilitatif.
Definisi menurut UU RI No. 36 Tahun 2009:

4. 4
International Conference on Population and
Development (ICPD), Cairo, 5-13 Sept. 1994 
Program of Action
Essential message :
Population issues are development issues  poverty
reduction, women’s empowerment, economic growth,
changing lifestyle
Latar Belakang

5. 5
Ruang Lingkup
Pendekatan siklus hidup (life-cycle approach) 
Indonesia: Empat komponen prioritas Kesehatan
Reproduksi, yaitu:
1.Kesehatan Ibu dan Bayi Baru Lahir
2.Keluaga Berencana
3.Kesehatan Reproduksi Remaja
4.Pencegahan dan Penanganan Penyakit Menular
Seksual, termasuk HIV/AIDS.

6. 6
Pelayanan KesPro  terpadu, berkualitas, memperhatikan
hak reproduksi perorangan.
Pelayanan Kesehatan Reproduksi Esensial (PKRE), mencakup:
• Kesehatan Ibu dan Bayi Baru Lahir
• Keluaga Berencana
• Kesehatan Reproduksi Remaja
• Pencegahan dan Penanganan Penyakit Menular Seksual,
termasuk HIV/AIDS.
Pelayanan Kesehatan Reproduksi Komprehensif (PKRK),
mencakup:
• PKRE (4 aspek)
• Pelayanan Kesehatan Reproduksi bagi Usia Lanjut

7. 7
Pendekatan Siklus Hidup
Memperhatikan
kekhususan
kebutuhan
penanganan
sistem reproduksi
pada tiap fase
kehidupan, serta
kesinambungan
antar fase

9. 9
Pendekatan Siklus Hidup
1
2
2
2
2
2
3
4
5
Konsepsi (Ibu
hamil & Janin)
Bayi Baru Lahir
Bayi
menyusu ASI
Excl & Ibu
menyusui
BAYI
ANAK (Balita)
ANAK (Usia Sekolah)
REMAJA
USIA SUBUR
USIA TUA

10. 10
Faktor-faktor Berpengaruh
1.Kemiskinan
2.Kedudukan perempuan dalam keluarga dan
masyarakat
3.Akses ke fasilitas kesehatan yg memberikan
YanKesPro belum memadai
4.Kualitas YanKesPro kurang memadai

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1. Kemiskinan
Masy di bwh garis kemiskinan  menghambat akses
YanKes  kesakitan, kecacatan, kematian
2. Kedudukan perempuan dlm keluarga & masy.
Ditentukan oleh: sosek, budaya, nilai2 masy  perlakuan
diskriminatif, a.l :
 Di-nomor 2-kan, ex: pemberian mkn sehari2, pendidikan,
kerja, kedudukan
 Terpaksa menikah muda krn tekanan ekonomi
 Keterbatasan dlm pengambilan keputusan utk dirinya,
ex: pilih alkon, pilih yankes, kendali aset keluarga
 Tingkat pendidikan rendah

12. 12
3. Akses ke fasilitas kesehatan yg memberikan YanKesPro
belum memadai, a.l karena:
 Jarak cukup jauh & sulit dicapai
 Kurang info ttg kemampuan fasilitas kesehatan
 Keterbatasan biaya
 Tradisi yg menghambat pemanfaatan tenaga & fasilitas
kesehatan
4. Kualitas YanKesPro kurang memadai, a.l krn:
 YanKes yg kurang memperhatikan kebutuhan klien
 Kemampuan fasilitas kesehatan yg kurang memadai.

13. 13
Contoh Permasalahan KesPro
1. AKI dan AKB masih tinggi
2. Anemia pd ibu hamil
3. KEK pd ibu hamil
4. Cakupan plynn KB masih rendah
5. Partisipasi pria dlm KB masih rendah
6. Ibu hamil dg keadaan “4 Terlalu” masih tinggi

14. 14
KEGIATAN OPERASIONAL KESPRO
ICPD 1994  Lokakarya Nasional Kesehatan Reproduksi, Mei
1996 :
1. Definisi Kesehatan Reproduksi:
Keadaan sejahtera fisik, mental dan sosial secara utuh, yang
tidak semata-mata bebas dari penyakit atau kecacatan,
dalam semua hal yang berkaitan dengan sistem reproduksi,
serta fungsi dan prosesnya

15. 15
2. Ruang Lingkup Kespro, meliputi:
a. Kesehatan ibu dan bayi baru lahir
b. KB
c. Pencegahan & penanggulangan infx saluran
reproduksi, trmasuk HIV/AIDS
d. Pencegahan & penanganan infertilitas
e. Kanker pd usia lanjut & osteoporosis
f. Berbagai aspek KesPro lain, a.l: kanker leher rahim
3. PKRE
4. PKRK

16. 16
Kebijaksanaan & Strategi Nasional Program
KesPro
4 Kebijaksanaan  berdasar paradigma baru:
1. Mengutamakan kepentingan klien dg memperhatikan
hak reproduksi, kesetaraan & keadilan gender
2. Menggunakan pdkt siklus hidup dlm menangani mslh
kespro
3. Memperluas jangkauan YanKesPro scr proaktif
4. Meningkatkan kkualitas hidup masy mll YanKesPro
berkualitas.
7 Strategi

17. 17
7 Strategi Pelaksanaan Kebijaksanaan:
1. Meningkatkan upaya advokasi & komitmen politis
2. Menyediakan YanKesPro terpadu
3. Meningkatkan kualitas YanKesPro
4. Mengembangkan upaya kespro dg prioritas sesuai dg
masalah spesifik daerah
5. Menerapkan program kespro mll keterlibatan program,
sektor dan pihak terkait
6. Meningkatkan kesetaraan da keadilan jender
7. Meningkatkan penlitian & pengumpulan data berwawasan
jender yg berkaitan dg kespro.

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Target Nasional Program KesPro
1. Kesehatan ibu dan bayi baru lahir
 AKI = 125 per 100.00 kelahiran hidup
 AKB = 35 per 1000 kelahiran hidup
 Cakupan akses ANC (K1) = 95%
 Cakupan pertolongan persalinan o/ nakes = 90%
 Proporsi penanganan komplx/kasus obstetri min. 80%
 Cakupan plynn nifas = 90%
 Prevalensi anemia bumil = 35%
 Prevalensi BBLR = 5%
Target yg akan dicapai pd th 2010 adalah:

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2. KB
 Cakupan KB pd PUS = 70%
 Prevalens “4 Terlalu” = 50%
 Penurunan angka komplikasi KB
 Penurunan angka drop-out peserta KB
3. Penanggulangan PMS termasuk HIV/AIDS
 Prevalensi Gonorrhoea di kelompok resti <10%,
prevalensi siphilis <1%
 Prevalensi infx HIV di kelompok resti <1%

20. 20
4. Kesehatan Remaja
 Penurunan prevalensi anemia pd remaja, mjd 20%
 Cakupan YanKes remaja mll jalur sekolah = 85%, mll jalur
luar sekolah min. 20%
 Penurunan prevalensi permasalahan remaja scr umum
5. KesPro Usia Lanjut
 Cakupan yankes kpd usia lanjut min. 60%
Prioritas upaya peningkatan YanKesPro:
1. Meningkatkan mutu YanKesPro yg sudah tersedia
2. Menambah jenis YanKesPro yg belum ada

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HAK-HAK
REPRODUKSI

22. 22
RH & Human Rights
United Nations Charter (1945) :
Achieve international cooperation in ... promoting and
encouraging respect for human rights & for fundamental
freedoms for all without distinction as to race, sex,
language, or religion.
United Declaration of Human Rights (1948) :
Common standard of achievement for all peoples and
nations for ensuring fundamental political, social,
economic, and cultural rights and freedoms

23. 23
1970:
1. The International Convenant on Civil & Political
Rights (Political Convenant)
2. The International Convenant on Economic, Social &
Cultural Rights (Economic Right Convenant)
UN General Assembly (1979) :
States must act to eliminate violations of women’s rights
whether by private person, groups, or organizations.

24. 24
The Convention on The Rights of the Child (1989) :
 Ratified by nearly all countries: rights for children and
reaffirmed the right to family planning services
 Compels states to confirm that they are making an effort to
realize its goals, which include:
1. Ensuring appropriate prenatal & postnatal health care
for mothers
2. Abolishing traditional practices prejudicial to the health
of children
3. Protecting children from sexual exploitation & abuse
4. Giving children access to information they need for their
social, spiritual, and moral well-being, and physical &
mental health.

25. 25
ICPD Cairo 1994:
Reproductive Health embrace certain human rights
recognized in national and international legal and human
rights documents:
1. The right of couples and individuals to decide freely and
responsibly the number and spacing of their children, and
to have the information and means to do so
2. The right to attain the highest standard of sexual and
reproductive health
3. The right to make decision free of discrimination, coercion,
or violence.
Fundamental basis for government & community-supported
policies & programmes in the area of RH, incl. sexual health &
family planning

26. 26
RH & Sexual health is a right for both men &
women
Goal:
to achieve universal access to RH information and
services by the year 2015

27. 27
Sexual & Reproductive Rights
The current international understanding of sexual &
reproductive rights includes the rights to:
1. Reproductive & sexual health as a component of overall
lifelong health
2. Reproductive decision-making, including choices in marriage,
family formation & determination of the number, timing and spacing of
one’s children; & the right to the information & the means to exercise
those choices
3. Equality & equity for women and men to enable individuals
to make free and informed choices in all spheres of life, free from
gender discrimination
4. Sexual & reproductive security, including freedom from sexual
violence & coercion, and the right to privacy.

28. 28
Components of Reproductive & Sexual Rights
The UNFPA, WHO, and the International Planned Parenthood
Federation (IPPR)  protection of reproductive & sexual rights
a central focus.
What are these rights, and what do they entail:
1. The right to survival/ right to life; abrogated by maternal
mortality
2. The right to liberty and security of the person; abrogated
by FGM, compulsary sterilization, criminalitation of contraception,
among others
3. The right to the highest attainable standard of health
4. The right to family planning
5. The right to marry and found a family

29. 29
6. The right to a private and family life; abrogated by state or
community interference in the decision of whether or when to have
children
7. The right to the benefits of scientific progress; including
qyality contraception
8. The right to receive and impart information and the
freedom of thought
9. The right of women to education
10.The right to non-discrimination of the basis of sex
11.The right to non-discrimination of the basis of age;
abrogated when young people are denied information & confidentiality
about RH services.

30. 30
Effect of denying sexual & reproductive
rights
1. 585.000 women, every minute, die, each year from causes
related to pregnancy
2. About 200.000 maternal death each year result from lack or
failure of contraceptive services
3. 120-150 million women who want to limit or space their
pregnancies are still without the means to do so effectively
4. At least 75 million pregnancies each year (out of total 175
million) are unwanted; they result in 45 million abortions and
over 30 million live births
5. 70.000 women die each year as a result of unsafe abortion:
an unknown number suffer from infection & other health
consequences

31. 31
6. 1 million people die each year from reproductive tract
infections, incl sexually transmitted diseases (STDs) other
than HIV/AIDS. There are an estimates 333 million new
cases of STDs per year
7. 6 out of 10 women in many countries have a STD. All face
a higher risk of infertility, cervicalcancer, or other serious
health problems
8. 3,1 million people in 1996 were infected by the HIV which
leads to AIDS
9. 120 million women have suffered from FGM, another 2
millinon are at risk each year.

32. 32
Meeting people’s needs for RH care and
family planning
Reduced fertility rates and slow population
growth around the world

33. 33
Programme of Action  Guiding
Principles:
1. The principal aim of population goals & policies is to
improve the quality of life of all people
2. Population policies should be consistent with national
sovereignty & legislation, and with national development
priorities, ensuring respect for religious, ethical, and cultural
diversity, in conformity with universally recognized human
rights
3. Gender equity & ensuring women’s ability to control their
own fertility are cornerstone of population programmes.
States should ensure, on a basis of equality of men and
women, universal acces to health services, including to
sexual and RH services.

34. 34
4. Everyone has right to education for the full development of
their human dignity and potential, and for the strengthening
of respect for their human rights and fundamnetal freedoms,
including those relating to population and development, with
particular attention to women & girls
5. All service providers should safeguard the principles of
informed free choice by providing comprehensive, factual
information on a full range of save and effective methods.
Their aim should be to support responsible, voluntary
decisions about child-bearing and methods of regulation of
fertility to meet the changing health needs over the life cycle
6. Services should protect and promote the rights to privacy &
confidentiality.

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7. Population goals and policies should be defined in terms of
unmet need for information and services. Government
should not impose incentive scheme or demographic goals
on family planning providers in the form of quotas or targets
for the recruitment of clients. Any form of coercion has no
part to play in family planning programmes.
8. Everyone is entitled to all the rights and freedoms set forth in
teh Universal Declaration of Human Rights, including rights
to health and education, without distinction of any kind, such
as race, sex, language, religion, national or social origing,
property, birth or other status.

36. 36
Hak Reproduksi di Indonesia
Definisi:
Setiap org, baik laki-laki maupun perempuan (tanpa
memandang perbedaan kelas sosial, suku, umur, agama,
dll), mempunyai hak yg sama utk memutuskan secara
bebas & bertanggung jawab (kpd diri, keluarga & masy)
mengenai jumlah anak, jarak antar anak, serta utk
menentukan waktu kelahiran anak & di mana akan
melahirkan.

37. 37
Pasal 72
Setiap orang berhak:
a. menjalani kehidupan reproduksi dan kehidupan seksual yang
sehat, aman, serta bebas dari paksaan dan/atau kekerasan
dengan pasangan yang sah.
b. menentukan kehidupan reproduksinya dan bebas dari diskriminasi,
paksaan, dan/atau kekerasan yang menghormati nilai-nilai luhur
yang tidak merendahkan martabat manusia sesuai dengan norma
agama.
c. menentukan sendiri kapan dan berapa sering ingin bereproduksi
sehat secara medis serta tidak bertentangan dengan norma
agama.
d. memperoleh informasi, edukasi, dan konseling mengenai
kesehatan reproduksi yang benar dan dapat
dipertanggungjawabkan.
UU RI No. 36 Tahun 2009:

38. 38
1. Setiap org berhak memeperoleh standar yankespro terbaik
 penyedia: yankespro berkualitas, memperhatikan
kebutuhan klien  menjamin keselamatan & keamanan
klien
2. Perempuan & laki-laki, sbg pasangan atau individu, berhak
memperoleh informasi lengkap ttg seksualitas, kespro &
manfaat serta efek samping obat2an, alat & tindakan medis
yg digunakan utk mengatasi mslh kespro
3. Hak memperoleh plynn KB yg aman, efektif, terjangkau, dpt
diterima, sesuai dg pilihan, tanpa paksaan, & tdk melawan
hukum
4. Perempuan berhakmemperoleh yankes yg dibutuhkannya,
yg memungkinkannya sehat & selamat dlm mjlni kehamilan
& persalinan, serta memperoleh bayi yang sehat
Penjabaran Praktis:

39. 39
5. Hub suami isteri didasari penghargaan thdp pasangan
masing2, & dilakukan dlm situasi & kondisi yg diinginkan
bersama, tanpa unsur pemaksaan, ancaman, & kekerasan
6. Remaja, laki2 & perempuan, berhak memperoleh informasi
yg tepat & benar ttg reproduksi remaja, shg dpt berperilaku
sehat & mjlni kehidupan seksual yg bertgjwb
7. Laki2 & perempuan berhak mdpt informasi yg mudah
diperoleh, lengkap, & akurat ttg PMS termasuk HIV/AIDS.
Derajat KesPro Masyarakat

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Matur nuwun.