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Comprehensive Introduction to Family and Reproductive Health Concepts

Explore definitions, components, characteristics, and determinants of family health alongside reproductive health principles, strategies, and services in Ethiopia for improved well-being.

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By: Firehiwot H. (MPH RH) Nov, 2022 Introduction to Family Health
Learning Objectives At the end of this session the student is expected to:  Define family and family health  List and discuss the major components of family health  Discuss the characteristics of healthy family  Discuss importance of family health  Discuss the determinants of family health
Definition of Family What is family?  A group of two or more persons related by birth, marriage, or adoption and residing together in a household  It is a smallest social unit  A basic structure of society centered about replacement  Every family is unique and it is affected by every aspect of community life
Types of family  Nuclear family: a family consisting of a married couples and their children; the children can be born or adopted  Extended family: a nuclear family plus collateral kinship  consisting of parents like father, mother, and their children, nieces, nephews, aunts, uncles, cousins, grandparents etc.  Joint family: a family consisting of two or more married couples staying together with children
Definition of Family Health Health : a state of complete physical, mental and social well-being and not merely/only the absence of disease and infirmity (WHO, 1958)  Family Health: a state of positive interaction between family members which enables each members of the family to enjoy optimum physical, mental, and social well being  Is part of community health  Is a unit of health care
Major components of family health  Reproductive health Safe motherhood (family planning, antenatal care, obstetric care, post natal care, abortion care and control of STI/HIV/AIDS) Nutritional deficiencies, LBW RTIs  Infertility Adolescent health (suicide, depression, STIs)
Major components of family health … Child health Child bearing, rearing Child health services: nutrition, immunization, Growth monitoring Mortality and morbidity of children Social health problems of children: Child abuse , street children, child labour , Juvenile delinquency, and battered baby syndrome
Major components of family health …  Gender issues in family: Girls trafficking, Gender mainstreaming, Female Genital Mutilation , female feticide (sex-selective abortion)  Aging: Problems of ageing, active ageing  Mental health: situation of mental health, its causes and prevention, National mental health policy
Characteristics of healthy family  A healthy family is a stress effective family in that such a family is able to function at its fullest capacity, and is able to cope with demands of daily life  Commitment : A family is like an organism, with life and vitality. It is made of many interdependent parts. For the family to survive, those interdependent parts (different roles in the family) must work together, coordinate, and be supportive of each other  Togetherness: the family should spend time together in such activities as playing games, taking family vacations, and celebrating birthdays together  Appreciation: high degree of mutual admiration and appreciation between members of families for their job plays important role to have healthy family
Characteristics of health family…  Good communication: Good communication creates a sense of belonging, reduces frustration, reduce redundancy, and enhances marital relationships  Spiritual well-being: When family members share a common faith, it reassures their mutual support, and tends to be more patient, forgiving, and broadly accepting of each other Our differences in faith create distance between us  Coping with crisis and stress : Healthy families are able to face reality and creatively, systematically, and rationally overcome crises together, family members must depend on each other’s mutual trust and interdependence
Importance of family health  Aside from disease cures, it offers a variety of activities and programs for disease prevention, rehabilitation, and health promotion for all family members  It is more than the sum of these members’ individual health because it considers their interactions with one another as well as the family’s human, biological, and physical environment  It can be described using specific markers such as demographics, genetics, physical, mental, and social health, socioeconomics, and culture  Many health issues emerge and are treated at this level, and women, in particular, are primary health care providers everywhere  As a result, it serves to bridge the gap between individual health and community/public health
The determinants of family health  Income and Social Status: Healthy families are those in societies which are prosperous and have an equitable distribution of wealth  Education: Health status a family improves with level of education , Effective education for children and lifelong learning for adults are key contributors to health and prosperity of the family  Employment and Working Conditions: unemployment, stressful or unsafe work are associated with poorer health outcome  Social Support Networks: Support from families, friends and communities helps families to solve problems, associated with better health outcome
The determinants of family health…  Social Factor : Availability of resources to meet daily needs, Social norms and attitudes, such as discrimination ,Exposure to crime, violence  Physical Environments: an exposure to toxic substances and other physical hazards and , contaminants of air, water, food and soil can cause a variety of adverse health effects  Health Services: Lack of access, or limited access, to health services greatly impacts an individual’s health status  Genetics: Hereditary disease such as sickle-cell anemia, hemophilia, heart disease, and cystic fibrosis Carrying the gene, which increases risk for breast and ovarian cancer
The determinants of family health…  Lifestyle/ individual behaviors: Dietary practice, physical activity , Hygiene , alcohol consumption , cigarette smoking , and other drug use plays a role in family health outcomes  Gender: Gender based domestic violence, male dominating societies, lack of women participation in health decision making process will affect greatly on overall concept of healthy family  Culture: Marginalization, stigmatization, loss or devaluation of language and culture and lack of access to culturally appropriate health care and services badly affect the family health
Introduction to Reproductive Health(RH) By: Firehiwot H.(MPH RH) Nov, 2022
Learning Objectives At the end of this session the learners will be able to: Define RH Discuss the concept and principles of RH Discuss the components of RH Discuss reproductive health strategy of Ethiopia Discuss youth friendly health services
Definition of RH RH is a “state of complete physical, mental & social wellbeing & not merely the absence of disease or infirmity, in all matters related to reproductive systems & to its functions & process (ICPD,1994) RH encompasses three main points : 1. Sexual health 2. Reproductive freedom (access to information, methods and services in reproductive health matters) and 3. Safe motherhood.(safe pregnancy, safe childbirth and healthy children)
Sexual Health  A state of physical, emotional, mental, and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity  It includes a positive and respectful approach to sexuality and sexual relationships that are free of coercion, discrimination, and violence Sexuality? Sensuality; enables us to feel good about how our bodies look and feel and what they can do Sexualization?
Sexuality It is a central aspects of humanity which includes:  Sex  Gender identities and roles  Sexual orientation  Sexual pleasure  Sexual intimacy and Reproduction  Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships Sensuality:Awareness and feeling with one’s own body and other people’s bodies, especially the body of a sexual partner: – Sensuality enables us to feel good about how our bodies look and feel and what they can do
Concept and principles of RH Reproductive health implies A responsible, satisfying and safe sex life Successful maternal and infant survival Freedom to control reproduction Ability to minimize gynecological disease throughout life
Women and men have the right: To be informed and have access to safe, effective, affordable and acceptable Family Planning services To have access to appropriate health care services that enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant
The concept of reproductive health is based on the equality between men and women Human health, especially women’s right is central to reproductive health Reproductive health service is a means to realize reproductive health The definition of RH is not merely about reproduction It must be viewed as three interconnected domains:-  Universal rights,  Women’s empowerment, and  Health service provision
Reproductive health strategy of Ethiopia  Proposed Goal 3 of SDG aims to “ensure healthy lives and promote well-being for all at all ages.”  Sub target 3.7 states by 2030, ensure universal access to sexual and reproductive health services, including information and education, and the integration of reproductive health into national strategies and programs  Ethiopia revised national reproductive health strategy after the adoption of SDG
Reproductive health strategy of Ethiopia…  The goal of this strategy is to improve the reproductive health of Ethiopian women, men newborns, adolescents and youth  Primary impact targets by 2020 Reduce the (MMR) from 353 to 199 per 100,000 live births Reduce the (NMR) from 28 to 10 per 1,000 live births Reduce stillbirth rate from 18 to 10 per 1000 births Reduce HIV infection rate among infants born to HIV-positive mothers from 11% to < 2% Reduce the (TFR) from 4.1 to 3 children per woman  The national RH strategy is structured based on the HSTP strategic map and contains 22 strategies under 12 strategic objectives
RH Strategies 216-2020 Strategic objectives Strategies Improve Equitable Access to Quality RH Services 1-11 Enhance Good Governance 12 Improve Regulatory System 13 Improve Logistics and Supply Chain Management 14 Improve Community Participation and Engagement 15 Improve Resource Mobilization Enhance use of Technology and Innovation Social determinants 16 Improve Research and Evidence for Decision Making 17 Enhance use of Technology and Innovation Social determinants 18 Development and Management of Human Resource for Health 19 Improve Health Infrastructure 20 Enhance Policy and Procedures 21 Address social determinants of RH 22
 Increasing access, creating demand and improving utilization of quality family planning (FP) services  Improving the prevention, investigation and management of infertility.  Improving access to and utilization of essential maternal and neonatal health (MNH) services at all levels of the health care delivery system.  Improving the quality of basic and comprehensive emergency obstetric and newborn care (EmONC) services at health centers and hospitals.  Strengthen maternal death surveillance and response (MDSR) and perinatal death review (PDR) system to address quality of care for maternal and perinatal health.  Increase access to sexual and reproductive health (SRH) information, education and health services  Promote a safe and supportive environment, multi-sectorial collaboration and participation in policy and program development  Strengthen the integration of STI/HIV prevention, detection and treatment in the RMNAYH services  Reduce the incidence and associated morbidity and mortality of reproductive organ cancers (ROCs) in both women and men  Improve the pelvic organ prolapse (POP) detection, management and prevention capacity at different levels  Ensure provision of sexual and reproductive health services in emergency affected areas
 Enhance coordination and effective monitoring of RH programs  Improve the standards of premises, products, practice and professionals for appropriate provision of RH/EmONC services  Improve capacity and coordination of logistics and supply chain management for increased availability of RH commodities  Improve community engagement in RH program with particular focus on men and young boys  Improve resource mobilization, allocation and utilization for MNH  Improving use of research and evidence for decision-making for better RH care  Improving use of technologies and innovation for better RH outcomes  Improve availability, motivation and retention of compassionate, respectful and competent RH care providers across all regions and all levels of health facilities. Performance targets by 2020:  Improve health infrastructure as per norms for proper RH service delivery  Ensure availability and implementation of enabling policy environment for the RH services.  Improving advocacy and partnership to improve women’s decision making power on RH matters.  Advocating for the enforcement of the implementations of the legal frameworks that protect and advance women’s RH rights, including harmful traditional practices elimination.
Youth friendly health services Learning Objectives At the end of this session the learners will be able to:  Define YFS  Discuss implementation strategies of YFS  Discuss characteristic features of YFS  Discuss the barriers of YFS
YFS…  Youth refer to people aged between 15 and 24 years  Are characterized by unique physical, psychological, social, and emotional changes that put their life at high risk.  They account for 22 % of the total population of Ethiopia  Designed to address the barriers faced by youth in accessing high-quality sexual and reproductive health (SRH) services.  The services include counseling, family planning, Voluntary Counseling and Testing (VCT) and treatment of Sexually Transmitted Infections (STIs)
YFS…  YFS: represent an approach which brings together the qualities that young people demand, with the high standards that have to be achieved in the best public services.  YFS are: Accessible, acceptable and appropriate for youth ,In the right place, at the right time and at the right price , Comprehensive because they deliver an essential package of services  Equitable and do not discriminate against any sector of youth on grounds of gender, ethnicity, religion, disability, social status or any other reason  Reach out to those who are most vulnerable and those who lack services  Effective because they are delivered by trained and motivated health care providers
Characteristics of YFS Providers  Well trained  Demonstrate respect and concern for young people  Knowledgeable of normal adolescent development  Have the skills to diagnose and treat common conditions  Have access to the correct drugs and supplies, Know where to refer youth  Respect the confidentiality and privacy
Strategies for Implementing YFS Service provider must see the person (the client) not the problem Training and staff support Making the service facilities acceptable Confidentiality and Privacy Services that are acceptable to the local communities Involving youth
Characteristics of YFS 1.Youth friendly policies that:  Fulfill the rights  Address the special needs of different sectors of the population  Avoid discrimination  Pay special attention to gender factors  Guarantee privacy and confidentiality  Ensure affordability to young people 2. Youth friendly procedures to facilitate:  Easy and confidential registration of clients, retrieval and storage of records  Short waiting time and (where necessary) swift referral  Consultation with or without an appointment
3. Youth friendly health care providers who are:  Technically competent  Have interpersonal and communication skills  Motivated and supported  Non-judgmental  Devote adequate time to clients or patients  Provide information and support to enable adolescent’s voluntary and informed choices 4. Youth friendly support staff who are:  Understanding and considerate, treating all youth clients with equal care and respect  Competent, motivated and well supported
5. Youth friendly health facilities that:  Provide a safe environment at a convenient location  Have convenient working hours  Offer privacy and avoid stigma  Provide information and education material 6. Youth involvement in planning, implementing and evaluating YFS so that they become:  Well informed about the services and their rights  Encouraged to respect the rights of others  Involved in service assessment and provision
7.Community involvement and dialogue to:  Promote the value of SRH for youth  Encourage parental and community support 8. Community based outreach and peer-to-peer services to increase coverage and accessibility 9. Appropriate and comprehensive services that: Address each youth's physical, social and psychological health and development needs  Provide a comprehensive package of SRH care and referral to other relevant services  Do not carry out unnecessary procedures (i.e. doing unnecessary pelvic exam)
Barriers  Structural barriers, such as laws and policies requiring parental or partner consent, distance from facilities, costs of services and/or transportation, long wait times for services, inconvenient hours, lack of necessary commodities at health facilities, and lack of privacy and confidentiality.  Sociocultural barriers, such as restrictive norms and stigma around adolescent and youth sexuality; inequitable or harmful gender norms; and discrimination and judgment by communities, families, partners, and providers.  Individual barriers, such as incomplete or incorrect knowledge of SRH, including myths and misconceptions around contraception; limited self-efficacy and individual agency; constrained ability to navigate internalized social and gender norms; and lack of access to information about what SRH services are available and where to seek services.
Adolescent sex education  Adolescence (10-19) is a period of transition from childhood to adulthood  it is a period of dynamic change marked by profound physical, emotional, mental & social changes, and health risk behaviors  From all the stages of the adolescent’s growth, the most intense is the increase of sexual urge and the new and often mysterious emotions and thoughts accompanying them  Conducive time for transferring knowledge, information and skills about sexuality, relationships, marriage, and future life (most of them are in schools)  Adolescent are exposed to many challenges that need to be handled carefully
Adolescent sex education…  Sexual and reproductive health problems are the second common causes of adolescent morbidity and mortality.  Why do they engage in health risk behaviors? 1. Adolescents take risks because they lack knowledge. 2. Adolescents engage in health risking behaviors because they think they are not vulnerable  So to prevent the conscience of health risk behaviors adolescent sex education is very important.
Why to Adolescents?  Sex education should be provided to all. However, our resources are limited. Priority is given to adolescents because:  They have a maximum sex drive.  They form a high risk group.  They are eager to get information because of the physical and physiological changes.  Their common sources of information (misinformation) are their friends, blue films and pornographic literature.  They are easily influenced and therefore likely to go astray and land in problems of unmarried motherhood, abortions, STD/HIV infections, sexual abuse.  They are going to be the responsible citizens of tomorrow.
Adolescent sex education…  Sex education is the provision of information about bodily development, sex, sexuality, and relationships, along with skills-building to help young people communicate about and make informed decisions regarding sex and their sexual health.  Comprehensive sexuality education (CSE) has been defined as “rights-based and gender-focused approach to sexuality education, whether in school or out of school”  Comprehensive sexuality education enables young people to protect and advocate for their health, well-being and dignity by providing them with a necessary toolkit of knowledge, attitudes and skills.
Comprehensive sexuality education (CSE) helps to  Avoid negative health consequences  Communicate about sexuality and sexual health  Understand healthy and unhealthy relationships  Understand, value, and feel autonomy over their bodies  Respect others’right to bodily autonomy  Protect adolescents success
Approaches of CSE  Family based  Peer based  School based  Social media based  Community and religious leaders Elements of CSE  Positive sexualities and resect full relationships  SRH related concerns and practices  Young peoples rights, participation and agency  Gender equality and power relationships
The reproductive life cycle  Reproductive Life cycle is the developmental stages that occurs during an sexually reproducing organism life time
Life cycle approach in reproductive health Actions, both positive and negative, taken at one stage in a woman’s life can and will affect her throughout her life women’s health needs have been addressed through maternal and child health programs, focusing primarily on narrow aspect of their lives women’s health is now being viewed holistically – as a continuum of care that starts before birth and progresses cumulatively throughout her life Life cycle approach defines women's life time health problems
A life cycle approach in reproductive health examines how biological, behavioral and social factors throughout life, and across generations, act independently, cumulatively and interactively to influence reproductive health This lifecycle approach extends beyond women’s reproductive role to encompass women’s health at every stage and in every aspect of their lives Through this approach, other health issues affecting women that were previously overlooked, or thought not to exist, have become more apparent
Infancy & childhood (0-9 yrs.)  Sex selection  Genital mutilation  Discriminatory nutrition  Discriminatory health care  Behavior  Aggression/violence  Education
Adolescents (10-19 yrs.)  Early child bearing  Abortion  STIs/AIDs  Under nutrition- macro &micro  Rising trend of substance abuse  Acne  Physiological changes in the body  Secondary sex characteristics  Aggression  Violence/abuse  Gender discrimination
Reproductive Years (20-44 yrs.)  Unplanned pregnancy  STIs/AIDs  Abortion  Pregnancy complications  Malnutrition  Pregnancy  Child bearing and rearing  Contraception  Abuse and violence
Post-Reproductive years (45 + yrs.)  Cardio-vascular diseases  Gynecological cancers  Osteoporosis  Osteoarthritis  Diabetes  Cancers  Sexual dysfunction  Sub fertility/infertility  STD/HIV  Menopause
Population dynamics  A population is defined as a group of individuals of the same species living and interbreeding within a given area  Population dynamics is the branch of life sciences that studies the size and age composition of populations as dynamical systems, and the biological and environmental processes driving them (such as birth and death rates, and by immigration and emigration)  Population dynamics: Variation among populations due to birth and death rates, by immigration and emigration
Measures of fertility  Crude Birth Rate (CBR)  Child Women Ratio (C/W Ratio)  General Fertility Rate (GFR)  Age-specific Fertility Rates (ASFRs)  The Total Fertility Rate (TFR)  Gross Reproduction Rate (GRR)  Net Reproduction Rate (NRT)
08/20/2026 The most important measures of fertility include: 53 A. Crude Birth Rate (CBR)  The crude birth rate indicates the number of live births (children born alive) per 1000 mid year population in a given year. CBR = Number of live births in a year X 1000 Total mid – year population  It is high for population of the developing countries and low for those of the developed ones.  Based on CBR values Fertility  High fertility Rate = > 30/1000  Medium fertility rate = 20-30/1000  Low fertility rate = < 20/1000
08/20/2026 The most important measures of fertility include: 54 B. Total Fertility Rate (TFR)  The Total Fertility Rate is the average number of children that would be born to a woman throughout her life time or her child bearing age (15-49 years).  The TFR is one of the most useful indicators of fertility, because it gives the best picture of how many children women are having currently.  The TFR sums up in a single number the age specific fertility rates of all women at a given point in time.  Total fertility rate also varies widely between populations in the world.  It is higher for developing countries than developed ones.
08/20/2026 Fertility cont… 55  AGE SPECIFIC FERTILITY RATE: # Live births to females of given age group in a year X1000 Mid year female population in the same age group  TOTAL FERTILITY RATE: 5(f(15 - 19) + f(20 -24)+...+ f(45 -49) 1000  Where f = Age Specific Fertility  5 is the multiplier used since each of these age groups represent a 5 year span.  TFR in simple terms, indicates the number of children the average women will have during her lifetime
08/20/2026 General fertility rate 56  The general fertility rate of a population over a given time period measures the ratio of the number of live births over that time period to the number of women who are in their childbearing years during that time period GFR = # Live births in a year Mid year Female ages 15 – 49 Gross Reproduction Rate (GRR)  GRR is the average number of daughters that would be born to a woman throughout her child bearing age (15-49 years), if she were to pass through all her child bearing age. GRR =TFR X Female Male + Female births
Measures of Mortality  Death is the permanent disappearance of all evidence of life at any time after live birth has taken place CDR = No of deaths observed in a population in a year X1000 Population at risk of dying IMR = No of death of children < 1 year in a year X 1000 Total live births during that year  It is considered to be a sensitive indicator of the health status of a community, because it reflects the socio-economic condition of the population; like:  level of education,  environmental sanitation  adequate and safe water supply  communicable diseases, provision of health services
Under 5 mortality rate <5MR = No of deaths of children <5 yrs in a year X 1000 Total number of children < 5 years of age Age-specific mortality rates  Thus, death rates can be calculated for specific age groups, in order to compare mortality at different ages. ASMR = total death in a specified age group X 1000 Total population in the same specified age group
Maternal Mortality Ratio It is the number of women who die as a result of complications of pregnancy or childbearing in a given year per 100,000 live births in that year. MMR= (Number of maternal deaths / Number of live births) X 100,000 What is the maternal mortality ratio of Ethiopia? What is the Under 5 mortality ratio of ethiopia
Maternal Mortality Rate Number of deaths due to maternal causes per 1,000 women of reproductive ages MMr = NO of deaths due to maternal causes/ NO of women of 15-49) X 1000 Note: Maternal mortality ratio is more widely used What is the MMr of Ethiopia?
Maternal health services Learning objectives At the end of this session the students is expected to: Define maternal health Discus causes and consequences of maternal mortality and morbidity Discus about maternal health in Ethiopia Determinants of maternal Health services in Ethiopia Discuss safe motherhood initiatives Discuss three delay model, that determines maternal health outcomes Discuss Maternal health & the sustainable development goals
Introduction  According to (WHO) maternal health refers to the health of women during pregnancy, childbirth and the postpartum period  Maternal mortality is so high because maternal death and disability is a tragedy that has no single cause or solution.  In 2020, the global maternal mortality ratio was 152 deaths per 100,000 live births.  Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth  94% of all maternal deaths occur in low and lower middle- income countries.  Sub-Saharan Africa alone accounted for roughly two-thirds (196 000) of maternal deaths, while Southern Asia accounted for nearly one-fifth (58 000).
 The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 000 live births in developed countries  There are large disparities between countries, but also within countries, and between women with high and low income and those women living in rural versus urban areas.  The risk of maternal mortality is highest for adolescent girls under 15 years old and complications in pregnancy and childbirth is a leading cause of death among adolescent girls in developing countries
Trends of maternal mortality per 100,000 live births EDHS 2005-2016
Causes and consequences of maternal mortality and morbidity Maternal Mortality: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
Maternal morbidity: Any deviation, subjective or objective, from a state of physiological or psychological well being of women. Late maternal death: the death of a woman from direct or indirect obstetric causes, more than 42 days, but less than one year after termination of pregnancy
Causes of Maternal Mortality Direct Causes  Obstetric complications of pregnancy, labour and puerperium • Hemorrhage • Hypertensive disease (pre-eclampsia and eclampsia) • Infection and sepsis • Obstructed labor • Abortion • Others (embolism, anesthesia)  Includes interventions, omission, and incorrect treatment
 Indirect cause  Previous existing diseases or disease that develops during pregnancy and which was not due to direct obstetric causes, but was aggravated by the physiological effects of pregnancy Malaria Anemia DM HBV HIV Cardiovascular disease etc.
World wide causes of maternal mortality
Causes of maternal mortality in Ethiopia in 2013
Burden of Disease  Infertility  Uterine prolapse  Infection  Incontinence  Nerve damage  Pain during intercourse
Determinants of Maternal Health Outcomes Three delay model 1. Delay in deciding to seek care – Failure to recognize signs of complications – Failure to perceive severity of illness – Cost consideration – Negative experience with health system – Transportation difficulties
2. Delay in reaching care  Lengthy distance to a facility  Conditions of roads  Lack of available transportation 3. Delay in receiving appropriate care  Uncaring attitudes of providers  Shortages of supplies and basic equipment  Non-availability or poor skills of health personnel
The Safe Motherhood Initiative  Safe motherhood is women’s ability to have a safe and healthy pregnancy and delivery
The global Safe Motherhood Initiative was launched in 1987 to improve maternal health and cut the number of maternal deaths in half by the year 2000 It was seen as a major milestone in the race to reduce the burden of maternal mortality throughout the world, particularly in developing countries Gave greater visibility to the hidden inequity of maternal ill-health comprehensive understanding of the roots and causes of the unacceptable charge of MM in developing countries Put maternal MM at the forefront of international public health issue
Interventions on reduction of maternal mortality focused on the three areas Reduction of the likelihood that a woman will become pregnant Reduction of the likelihood that a pregnant woman will experience a serious complication of pregnancy or childbirth; Reduction of the likelihood of death among women who experience complications
Key strategies to reduce maternal mortality Prevention of complications (Maternity care ) Prevention of pregnancy (FP) Prevention of death (EOC)
Essential Services for Safe Motherhood 1. Community education on safe motherhood 2. Prenatal care 3. Skilled assistance during childbirth 4. Care for obstetric complications 5. Postpartum care 6. Post-abortion care 7. Family planning 8. RH education and services for adolescents
Four pillars of safe Motherhood 1. Family Planning: individuals and couples have the information and services to plan the timing, number and spacing of pregnancies; 2. Antenatal Care: to prevent complication where possible & ensure that complications of pregnancy are detected early & treated appropriately; 3. Safe Delivery: to ensure that all birth attendants have the knowledge, skills & equipment to perform a clean & safe delivery & provide postpartum care; 4. Essential Obstetric Care: to ensure that essential care for high- risk pregnancies and complications is made available to all women who need it
ANTENATAL CARE (ANC) ANC is a care given to pregnant women with the aim of improving the maternal and perinatal out come All pregnant women should have a minimum of four antenatal visits (at least 20 minutes duration each) for: Prevention, Early detection and Management of complications
Objective of ANC healthy pregnancy  A healthy outcome for mother and newborn  Promotion of physical, mental and social health
Benefits of Antenatal Care Used as an opportunity to provide information to women and their families about:  Danger signs and symptoms during pregnancy and delivery Developing an appropriate delivery/birth plan, based on the woman's history and health status  Unique opportunity for early diagnosis and treatment of problems like:  Maternal problems: anemia, vaginal bleeding, preeclampsia/eclampsia, infection Fetal problems: Abnormal fetal growth or movement, abnormal fetal position HIV, syphilis, malaria, malnutrition
Models of ANC Traditional (Risk) Approach  It is not rational Emphasis of visits is on frequency and numbers of visits, rather than on essential goal-directed elements of each visit Emphasis on risk screening Identifying women who would face problems through history taking, physical and laboratory examination
Focused (Goal Directed) Approach FANC: is a care routinely provided to all pregnant women from screening to intensive life support provided to any woman while pregnant and up to delivery. “Having one or more visits with a trained person during pregnancy” can detect early signs of disease or risk factors and timely intervention
Approach of FANC An approach of ANC that emphasizes:  Individualized care  Client-centered  Fewer but comprehensive visits  Disease detection, not risk  Care by a skilled provider
Goals of FANC  Early detection and treatment of problems and complications  Prevention of complications and disease  Birth preparedness & complication readiness  Health promotion Focused ANC Visit Schedule For The Healthy Client Four visit • FIRST <16 Weeks-30min • SECOND 24-28 Wks-20 min • THIRD 30-32 Wks.- 20 min • FOURTH 36-40 wks.- 20 min
The new ANC contact schedule  As per the 2016WHO recommendation, Ethiopia is replacing the previous four-visit FANC model with the new ANC eight-contact model. In order to reduce perinatal mortality and improve the pregnancy experience of women, a minimum of eight contacts is required
Recommended Elements of ANC  Birth preparedness:  Planning for a skilled attendant, Counseling danger signs of pregnancy Complication readiness: Planning for emergency funds, transport, blood donor, designated decision-maker Counseling/service provision Family planning, nutrition, mother-to-child transmission of HIV/AIDS
ANC by skilled provider from EDHS 2005-2019  EDHS 2005- 28  EDHS 2011- 34  EDHS 2016- 62  EDHS 2019-74 Had 4 and above ANC visit  EDHS 2005- 6  EDHS 2011- 11  EDHS 2016- 20  EDHS 2019- 28
Institutional delivery The proportion of births occurring in health facilities in the area  A key strategy to ensure skilled care during childbirth is to that all births take place in health facilities in which obstetric complications can be treated when they arise The situation in Ethiopia  EDHS 2005- 5  EDHS 2011- 10  EDHS 2016- 26  EDHS 2019- 48
Intra-partum care Intra-partum care : care that a woman receives during labour and delivery and it has the potential to affect the woman herself, both physically and emotionally, and the health of her baby in the short and longer term Aims Clean and safe delivery  Recognition, early detection and management of complications at health center or hospital The five cleans in delivery care Clean hands Clean delivery surface Clean perineum Clean cord cutting Clean environment
Skilled birth attendance The skilled attendance is defined as a process through which a woman is provided with adequate care during labor, delivery, and the postpartum period Skilled attendance depends on;  The presence of a skilled care provider/ Most maternal deaths are due to a failure to get skilled help in time for delivery complications
 The enabling environment 1. Availability of drugs and supplies 2. Availability of functioning referral system 3. Awareness and readiness of the community for utilizing skilled care 4. Supporting policy and political commitment
Birth attended by a skilled provider 2005-2019 EDHS 2005- 6 EDHS 2011-10 EDHS 2016- 28 EDHS 2016- 28 EDHS 2019- 50
Postpartum care The postpartum period refers to the first six weeks after childbirth. This is a joyous time, but it’s also a period of adjustment and healing for mothers. A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery. Thus, prompt postnatal care (PNC) for both the mother and the child is important to treat any complications
Maternal care  Includes Management of complications at health center or hospital (for example, hemorrhage, sepsis and PHT)  Promotion and support to breastfeeding and management of breast complications)  Information and services for family planning  STD/HIV prevention and management  Tetanus toxoid immunization  Postnatal Health Check for Mothers EDHS 2016- 17 EDHS 2019- 34
Newborn care Resuscitation  Prevention and management of hypothermia  Early and exclusive breastfeeding  Prevention and management of infections including cord infections Recording of birth weight and referral of newborn Immunizations and growth monitoring Postnatal Health Check for Newborns  EDHS 2016- 13  EDHS 2019- 35
Maternal health & the SDGs The Sustainable Development Goals (SDGs) establish a transformative new agenda for maternal health SDG 3 Target 3.1, aims to ending preventable maternal mortality; and reduce the global MMR to less than 70 per 100 000 live births by 2030 Target 3.7, aims to ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs by 2030
Determinants of maternal Health services in Ethiopia No physical access High costs Poor information Cultural preferences Lack of decision-making power by women Poor quality of care Delays in referring women from community health facilities to hospitals
HIV/AIDS and Reproductive Health  HIV, the virus that causes AIDS, has become one of the world’s most serious health and development challenges since the first cases were reported in 1981.  Approximately 84 million people have become infected with HIV since the start of the epidemic  Today, there are approximately 38 million people currently living with HIV, and tens of millions of people have died ofAIDS-related causes since the beginning of the epidemic. .