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Reproductive health and family planning module
- 1. A SKILL MODULE ON REPRODUCTIVE HEALTH AND FAMILY PLANNING MY HEALTH IS MY WEALTH! DEVELOPED BY: Lakshmi Bhardwaj Megha Verma Harina Kaur Oberoi Department Of Development Communication Extension and Journalism
- 2. OBJECTIVES OVERALLOBJECTIVEOFTHE SESSIONS: Thesessionsaimtospread awarenessabouttheimportance reproductivehealthandfamily planning. SPECIFICOBJECTIVES: 1)Toincreaseknowledgeaboutthe currentreproductivehealthstatus ofafemale. 2)Tohighlightthevariousmyths prevalentinthesocietyrelatedto reproductivehealthandfamily planningandtheimportanceof contraceptives. 3)Toshareinformationaboutthe variousmeasurestakenupbythe governmenttoensureproperfamily planningamongstthecitizens. "The emphasis must be not on the right to abortion but on the right to privacy and reproductive control." - Ruth Bader Ginsburg TARGETAUDIENCE: Females(20- 45yearsofage) RATIONALE Witharapidincreaseinthe numberofmedicalcasesrelated towomenreproductivehealth, highmaternalmortality,STDs,HIV AIDS,UnwantedPregnanciesand Abortions,itisneedofthehour tobreakstereotypesand suggest safepracticeswhich canensurebetterreproductive healthamongstwomenleadingto adeclineinthenumbersofcases reportedinsurveysandresearch. OTHERDETAILS: DURATION:3days NUMBEROFPARTICIPANTS:20 perbatch
- 3. S C H E D U L E . DAY SESSION SESSION NAME OBJECTIVEDURATION DETAILS AND LOGISTICS 1 1 Hello World! 45 Minutes ( 10:30 AM- 11:15 AM) At the end of this session participants would get to know each other through ice breaking activities. DETAILS: Ice breaker through interaction LOGISTICS: Large pieces of paper, markers and colourful balloons TEA BREAK (11:15 AM - 11:30 AM) 22 How Healthy Am I? To develop knowledge and understanding of issues related to sexual and reproductive health and provide suggestions to the same. DETAILS: Powerpoint presentation along with audience engagement through interactive question answers sessions in between. LOGISTICS: PPT, Projector Screen and Laptop 2 Hours (11:30 AM- 01:30 PM)
- 4. S C H E D U L E . DAY SESSION SESSION NAME OBJECTIVEDURATION DETAILS AND LOGISTICS 2 1 The Diseases I See! 3 Hours ( 10:30 AM- 01:30 PM) To spread awareness about the diseases related to reproductive health and its consequences . DETAILS: Flow chart and Discussion LOGISTICS: Flow charts , white board and markers LUNCH BREAK (01:30 PM - 02:00 PM) 22 Is it safe for me? To spread knowledge about contraceptives and help the participants identify them.. DETAILS: Flash Cards, and Discussion LOGISTICS: White board , flash cards and markers . 3 Hours (02:00 PM- 04:00 PM)
- 5. S C H E D U L E . DAY SESSION SESSION NAME OBJECTIVEDURATION DETAILS AND LOGISTICS 3 1 The Government That Cares! 3 Hours ( 10:30 AM- 01:30 PM) To tell participants the various schemes and initiatives by the government. DETAILS: Powerpoint presentations and Discussion LOGISTICS: , powerpoint presentation, projector, white screen LUNCH BREAK (01:30 PM - 02:00 PM) 23 I Will Plan My Family! To tell the participants about the importance and benefits of Family Planning. DETAILS: Roleplay Activity &Discussion LOGISTICS: White Board for writing discussion pointers. 3 Hours (02:00 PM- 04:00 PM)
- 6. BUDGETING MATERIAL AMOUNT (INR) PROJECTOR 20,000 LAPTOP CHAIRS TABLES SPEAKER STATIONARY 700 500 30,000 6,000 1,200 MIC 1,000 MISC, 2,000 TOTAL 61,400
- 8. SESSION 2:  How Healthy Am I? Objective: To develop knowledge and understanding of issues related to sexual and reproductive health and provide suggestions to the same. Method: Powerpoint presentation along with audience engagement through interactive question answers sessions in between. Material:  PPT, Projector Screen , Laptop, Projector Duration: 2 Hours Steps: Start with Yes/No questions followed by powerpoint presentation Background Information: Major Topics in this chunk are as follows: ⢠What is Reproductive Health? ⢠Global Indicators of Reproductive Health ⢠Program Components of Reproductive Health ⢠Safe Motherhood ⢠Effective Strategies and Interventions to Achieve Safe Motherhood // There are various definitions of reproductive health, out of whichsome focus predominantly on the physiological and fertility aspects, and others more holistic in their view.  DAY 1
- 9. The WHO International Conference on Population and Development, held in Cairo in 1994, arrived at a consensus view of reproductive health that was endorsed by 165 countries. We have adapted their definition for use in this education module.  The rather broad definition was made more explicit by spelling out specific implications and components of reproductive health. The definition suggests that reproductive health encompasses: # The ability to reproduce and freedom to control reproduction # The ability to go through pregnancy and childbirth safely, with successful maternal and infant survival and outcomes. # The ability to obtain information about and access to safe, effective and affordable methods of family planning # The ability to have a satisfying, safe sex life, free from fear of pregnancy and diseases and the ability to minimize gynecologic disease and risk throughout all stages of life. # To be informed of safe, effective, affordable and acceptable methods of fertility regulation. # To have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice. # To have access to appropriate health care services that will enable women to go through pregnancy and childbirth safely, and provide couples with the best chance of having a healthy infant.Â
- 10. # Reproductive health is a state of complete physical, mental and social well-being, and not merely the absence of reproductive disease or infirmity. Reproductive health deals with the reproductive processes, functions and system at all stages of life. # Reproductive health is a crucial part of general health and a central feature of human development.  It is a reflection of health during childhood, and crucial during adolescence and adulthood, sets the stage for health beyond the reproductive years for both women and men, and affects the health of the next generation.  The health of the newborn is largely a function of the mother's health and nutrition status and of her access to health care. # At each stage of life individual needs differ. However, there is a cumulative effect across the life course Ĺ events at each phase having important implications for future well-being.  Failure to deal with reproductive health problems at any stage in life sets the scene for later health and developmental problems. It is  an important component of general health it is a prerequisite for social, economic and human development. # The highest attainable level of health is not only a fundamental human right for all, it is also a social and economic imperative because human energy and creativity are the driving forces of development.  Such energy and creativity cannot be generated by sick, tired people, and consequently a healthy and active population becomes a prerequisite of social and economic development.Â
- 11. Importance of Reproductive Health ⢠Reproductive health is a human right stated in international law. ⢠Reproductive health plays an important role in morbidity, mortality and life expectancy. ⢠Reproductive health problems are the leading cause of ill health and mortality amongst females worldwide
- 12. SESSION 1: The Diseases I See! Objective:  To spread awareness about the diseases related to reproductive health and its consequences. Methods : Flow charts  and Interactive Discussion Materials required ; Flow charts , white board and markers Duration : 3 hours For this session, the trainer will : ⢠Ask the participants about the diseases that they know and how they spread ⢠Tell how these can be cured and prevented ⢠Use flow charts for visual reference. Background Information: Topics which are cover in this session are as follows: 1. Diseases  related with reproductive health for male and female both 2. Curable diseases 3. How diseases spread # Reproductive system diseases or any of the issues related to the reproductive system include abnormal hormone production by the ovaries or the testes or by other endocrine glands, such as the pituitary, thyroid, or adrenals. Such diseases can also be caused by genetic or congenital abnormalities, infections, tumours, or disorders of unknown cause. DAY 2
- 13. # DISEASES IN WOMEN: Pelvic Inflammatory Disease (PID) The abdominal cavity in women, unlike in men, is susceptible to infections and inflammation because it is open to the external environment through the reproductive tract. There is the possibility of bacteria entering via the vagina and travelling up the uterine tubes, thereby causing inflammation. Any infection that follows this path can cause PID. Repeated instances of inflammation can block the uterine tubes and cause infertility. 2. Prolapsed Uterus The uterus is held above the vagina by ligaments with the cervix (on the uterus) extending to the upper vagina. This support is important to prevent the cervix from sliding out through the vaginal opening, or called prolapsed uterus. Any such prolapse can only be rectified after surgery. 3. Sexually Transmitted Diseases (STDs) Sexually transmitted diseases in women can cause further complications and other female reproductive system diseases like PID. Infections such as chlamydia, syphilis, gonorrhea and genital herpes, if left untreated, will lead to inflammation of the pelvis. PID can scar the fallopian tubes increasing the chances of infertility or ectopic pregnancy where the egg is implanted in the fallopian tube after fertilization.
- 14. 4. Uterine Fibroids Sometimes it is possible that tumors grow in the muscular wall of the uterus; however, these tumors are not cancerous. They are called uterine fibroids and can cause increased urination, pain in the lower back, heavy bleeding and pain during the menstrual period, pain during intercourse, miscarriages and infertility. Surgery and pain relief methods are used to treat this condition. The Centers for Disease Control and Prevention (CDC) state that around 20 percent of women younger than 50 years of age develop such tumors. 6. Polycystic Ovary Syndrome This syndrome is caused when the ovaries produce high levels of a particular class of hormones, namely androgens. This increase in hormone levels can hamper the ovulation process and lead to cysts on the ovaries. It can also cause infertility by affecting the release of the ovarian egg in the menstrual cycle. Some symptoms are hair loss, acne, pain in the pelvic region, oily skin, and increases in facial or body hair growth. There is no cure for this female reproductive system disease yet, but the hormone production can be controlled and skin cleared up with hormone therapy.
- 15. 7. Female Infertility Difficulty in conceiving a child after trying for a considerable period of time can indicate infertility. Irregularities in the duration of the menstrual cycle or its absence can indicate a lack of ovulation. The reasons for infertility are varied and can be caused by other female reproductive system diseases. Ovulation disorders such as irregularities in the production of hormones or problems in the ovary account for 25% of infertility cases. Endometriosis, damage to the fallopian tubes, the uterine tubes or cervix can also cause infertility. There are different methods to induce pregnancy such as with fertility drugs, surgery or a way to assist the fertilization of the egg. 8. Â Ovarian Cysts The two ovaries in a woman are used to develop and mature the ova during the menstrual period. It is possible for cysts to form on the external or internal surface of the ovaries. These cysts are filled with fluid and are not particularly harmful. This happens frequently and generally disappears over time without the need for any treatment. However it is possible in some cases for these cysts to become a serious problem with the occurrence of ovarian torsion or rupture. It is important to schedule regular check-ups of the pelvis to help identify harmful cysts at an early stage.
- 16. 9. Ovarian Cancer This type of cancer starts within the ovaries and can propagate inside the pelvis and abdomen. Some symptoms are constipation, regular urination urges, pain in the pelvic region, loss of weight and abdominal bloating. The chances of occurring are higher in people who have a family history of Lynch syndrome, breast or ovarian cancer. Though it is difficult to detect, it is easier to treat the cancer when it is confined to the ovaries. The treatment depends on the factor causing it. Techniques to enhance genital stimulation, reduce pain during intercourse, promote physical familiarity and distract the partner can be used to remedy the situation. Â
- 17. Reproductive tract infections or RTI's are infections of the genital tract. They affect both women and men. # Some RTIs (such as syphilis and gonorrhoea) are sexually transmitted, but many are not. # In women, overgrowth of endogenous microorganisms normally found in the vagina may cause RTI (Eg: yeast infection, bacterial vaginosis). # Medical interventions may provoke iatrogenic infection in several waysâendogenous organisms from the vagina or sexually transmitted organisms in the cervix may be pushed during a transcervical procedure into the upper genital tract and cause serious infection of the uterus, fallopian tubes and other pelvic organs. # Organisms from outside the body can also be introduced into the upper genital tract during medical procedures if infection control is poor. In men, sexually transmitted infections are much more common than endogenous or iatrogenic infections.
- 18. SESSION 2: Is it safe for me? Objective: To spread knowledge about contraceptives and help the participants identify them. Methods : Using of flash cards and interaction between trainees and trainers , question and answer Material required: Flash cards , white board , markers and samples Duration: 2-3 hours For this session, the trainer will : # Ask the participants that what are contraceptives and how are they used. # To tell the importance of regular check ups # Use of flash cards to explain the various contraceptive measures. Background Information:  Topics covered in this session are as follows ; 1. Contraceptives 2. How it is used while sexually intercourse 3. Regular check up of male and female both DAY 2
- 21. D A Y 3 SESSION 1: The Government That Cares! Objective:  To tell participants the various schemes and initiatives by the government. Methods : Powerpoint presentations and interaction between trainees and trainer Materials required : Powerpoint presentation, Projector, projector screen Duration : 2 hours For this session, the trainer will : # Ask participants about the information they know about the government schemes. # To tell them why these schemes are beneficial to the people with the help of references mentioned in the presentation. # The presentation includes all the schemes with general information about the same. Background Information: Topics that will be covered in this session are as follows ; 1. Different programs of government and their usefulness 2. Spreading awareness about the schemes in an effective way. Â
- 22.     Adolescent Friendly Health Clinics (AFHCs) # Through AFHC, counselling and curative services are provided at primary, secondary and tertiary levels of care on fixed days and fixed time with due referral linkages. #Commodities such as Iron & Folic Acid tablets and non- clinical contraceptives are also made available in the clinics for the adolescents. # Counselling services for adolescent on important health areas such as nutrition, puberty, RTI/STI prevention and contraception and delaying marriage and child bearing are being provided through recruitment and training of dedicated counsellors. #Commodities available at AFHC:- a) Weekly Iron & Folic Acid Supplementation & Albendazole b) Sanitary napkins c) Contraceptives d) Medicines #Counselling on nutrition, menstrual disorders, personal hygiene, menstrual hygiene, use of sanitary napkins, use of contraceptives, sexual concerns, depression, sexual abuse, gender violence, substance misuse and promoting healthy behavior to prevent non communicable diseases
- 23. Â Â Â Â Â Â Â Â Â Â Curative Services available at AFHC: #Treatment of severe malnutrition # Treatment of common RTI/STI problems # Treatment of menstrual disorders # Treatment for sexual concerns of males and female #Â Mental health service/management of depression # Treatment of non-communicable diseases and other common ailments # Management of injuries related to accidents and violence # Management of substance misuse # Treatment of non-communicable diseases like hypertension, stroke, cardio-vascular diseases and diabetes # To delay first pregnancy and decrease teenage pregnancies and meet contraceptive needs of adolescents is an important mandate of the Adolescent Health Programme. # Counselling on contraception and provision for emergency contraceptives and reversible contraceptives to prevent unwanted pregnancy and to delay teenage pregnancy will be provided at the AFHC.
- 24. Scheme for Promotion of Menstrual Hygiene among Adolescent Girls in Rural India The scheme aims at ensuring that adolescent girls in the target group have adequate knowledge and information about menstrual hygiene and the use of sanitary napkins are made available to the along with environment safe disposal mechanism that is are readily accessible. The scheme has been launched as part of the Adolescent Reproductive and Sexual Health (ARSH). Supply of sanitary napkins in 107 districts initially is being done in a Central supply mode, wherein sanitary napkins are being supplied by the Government of India. The supply of sanitary napkins in the remaining 45 districts is to be done through Self Help Groups (SHG), wherein SHGs are to manufacture the sanitary napkins that are to be sold to adolescent girls. National Health Mission National Health Mission (NHM) was launched by the government of India in 2013 subsuming the National Rural Health Mission and National Urban Health Mission. It was further extended in March 2018, to continue till March 2020. Some of the major initiatives under National Health Mission (NHM) are as follows: Accredited Social Health Activists Community Health volunteers called Accredited Social Health Activists (ASHAs) have been engaged under the mission for establishing a link between the community and the health system. ASHA is the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services in rural areas. ASHA Programme has increased the utilization of outpatient services, diagnostic facilities, institutional deliveries and inpatient care.
- 25. . Janani Suraksha Yojana (JSY) JSY aims to reduce maternal mortality among pregnant women by encouraging them to deliver in government health facilities. Cash assistance is provided to eligible pregnant women for giving birth in a government health facility. Large scale demand side financing under this scheme has brought poor households to public sector health facilities on a scale never witnessed before. Janani Shishu Suraksha Karyakram (JSSK) Moving in the direction of universal healthcare, Janani Shishu Suraksha Karyakarm (JSSK) was introduced to provide free to and fro transport, free drugs, free diagnostic, free blood, free diet to pregnant women who come for delivery in public health institutions and sick infants up to one year. Rashtriya Bal Swasthya Karyakram (RBSK) A Child Health Screening and Early Intervention Services has been launched in February 2013 to screen diseases specific to childhood, developmental delays, disabilities, birth defects and deficiencies. The initiative will also provide free treatment including surgery for health problems diagnosed under this initiative. Mother and Child Health Wings (MCH Wings) With a focus to reduce maternal and child mortality, dedicated Mother and Child Health Wings with 100/50/30 bed capacity have been sanctioned in high case load district hospitals and CHCs which would create additional beds for mothers and children.
- 26. D A Y 3 SESSION 2: I Will Plan My Family! Objective:  To tell the participants about the importance and benefits of Family Planning. Methods : Roleplay activity and interaction between trainees and trainer Materials required : White Board and markers Duration : 3 hours For this session, the trainer will : # Ask participants about the information they know about the way they are planning their family and write the pointers on the white board. # Play roleplay games Background Information: Family planning is an important strategy in promoting maternal and child health. # It improves health through adequate spacing of births and avoiding pregnancy at high risk maternal ages. # Even if there is no reduction in the family size of individual couples, delaying child bearing will bring about a decline in fertility and population growth rate.Â
- 27. # Lack of adequate information and ignorance are key factors militating against family planning practices. #Many potential informational barriers exist to contraceptive use.Women must be aware of the methods available. They must know where supplies of these methods can be obtained and they must know how to use the method they choose. #Â Each year an estimated 500,000 women die of complications due to pregnancy, child bearing or unsafe abortion. #Â In some areas of the country, one in five women report having experienced an unwanted conception, of these 58% had an abortion and an additional 9% attempted unsuccessfully to end the pregnancy. #Â It is estimated that about 25% of women who have abortion in Delhi experience serious complications. #Â Adoption of family planning measures will reduce unwanted pregnancies and criminal abortions to the minimum. # Pregnancy is the main reason that women in the reproductive age group die at a higher rate than men. # Most maternal deaths occur among poor women who live in remote rural areas and have difficult access to hospital.
- 28. Family Planning refers to enlarging the size of the family up to a limit in accordance! With the size of income of a family. The small size will improve the standard of living' of the family. Thus, it implies to have children by choice not by chance, by design and not by accident. In simple words, acceptance of small family norm and of less number of children is the thrust of family planning programme. Importance of Family Planning in India Importance Family planning programme is beneficial not only to individual but also to the whole society. The main advantages of the programme are as under: 1. Benefit to the Children: The slow growth of population due to family planning programme will be beneficial for the children. A fall in birth rate will reduce immediately! The number of children. This instrument reduces the number of dependents on the working people. This will create an environment where in children will be better looked after, better fed and better cared for. 2. Benefit to the Parents: The family planning has favourable effect on the health of the parents. With less number of children, they will be able to raise the standard of living of the family. Thus Family Planning is necessary for better health, long, happy and prosperous life of the mother. The Family Planning will also result in better upkeep and education of the children.
- 29. 3. Benefit to the Society: The family planning is beneficial both for the individual and the society. Since the family planning will result in improving the standard of living of the citizens, the quality of human factor will improve and the society becomes better. 4. Benefit to the Nation: The family planning is necessary for the welfare of the whole nation. The family planning will ultimately result in the economic development of the country. As a consequence of a reduction in the population growth, there will be rise in the per capita income. The addition to the per capita income can be a source of additional saving and therefore of capital formation. Over a period of time, the reduction in the population growth will favourably affect the supply of labour, in the sense that the increase in the rate of labour supply will be cut down. In such a situation the phenomena of unemployment will automatically disappear..
- 30. N O T E S .Â