This document discusses reproductive health. It begins by listing learning objectives about defining reproductive health, understanding its historical development and indicators. It then defines reproductive health and discusses how it addresses human sexuality, reproduction and systems across life stages. It discusses how men and women have rights to fertility regulation and healthcare. The document outlines the historical development of reproductive health from the 1960s onward. It discusses key organizations and documents that shaped the concept. It notes challenges in Somalia's reproductive health context and outlines common reproductive health program areas and UNFPA indicators. Overall, the summary captures the key topics, definitions and historical overview provided in the document.

2. Learning objectives:
 To define reproductive health
 To know the historical development of RH
 Understand RH indicators and criteria for
selection of indicators
 To understand the relationship of
reproductive health and gender
 Know the targets of reproductive health

3.  Reproductive health addresses the human
sexuality and reproductive processes,
functions and system at all stages of life and
implies that people are able to have “a
responsible, satisfying and safe sex life and
that they have the capability to reproduce and
the freedom to decide if, when and how often
to do so.”

4.  Men and women have the right to be informed
and have access to safe, effective, affordable and
acceptable methods of their choice for the
regulation of fertility which are not against the
law, and the right of access to appropriate health
care services for safe pregnancy and childbirth
and provide couples with the best chance of
having a healthy infant.
 Reproductive health is life-long, beginning even
before women and men attain sexual maturity
and continuing beyond a woman's child-bearing
years.

5.  Historical development of the concept It is
helpful to understand the concept and to
examine its origins.
 During the 1960s, UNFPA established with a
mandate to raise awareness about population
“problems” and to assist developing countries.
 Concern about population growth (particularly in
the developing world and among the poor)
coincided with the rapid increase in availability of
technologies for reducing fertility

6.  The contraceptive pill became available during the 1960s
along with the IUD and long acting hormonal methods.
 In 1972, WHO established the Special Program of
Research, Development and Research Training in Human
Reproduction (HRP), whose mandate was focused on
research into the development of new and improved
methods of fertility regulation and issues of safety and
efficacy of existing methods.
 Moreover, they held the promise of being able to prevent
recourse to abortion (generally practiced in dangerous
conditions) or infanticide.
 Population policies became widespread in developing
countries during the 1970s and 1980s and were supported
by UN Reproductive Health 4 agencies and a variety of
NGOs.

7.  The term “Reproductive Health “is most often equated
with one aspect of women’s lives; motherhood.
 Complications associated with various maternal
issues are indeed major contributors to poor
reproductive health among millions of women
worldwide.
 Half of the world’s 2.6 billion women are now 15 – 49
years of age.
 Without proper health care services, this group is
highly vulnerable to problems related to sexual
intercourse, pregnancy, contraceptive side effects,
etc.
 Death and illnesses from reproductive causes are the
highest among poor women everywhere

8. Three elements are of particular importance.
 The first was the growing strength of the women’s
movement and their criticism of the over-emphasis on the
control of female fertility - and by extension, their sexuality
- to the exclusion of their other needs.
 A second key development was the advent of the
HIV/AIDS pandemic; suddenly it became imperative to
respond to the consequences of sexual activity other than
pregnancy, in particular sexually transmitted diseases. But
perhaps more important, it became possible (and essential)
to talk about sex, about sexual Reproductive Health 6
relations outside of marriage as well as within it, and about
the sexuality of young people.

9.  A third development, that brought a unity to
the others, was the articulation of the concept
of reproductive rights.
 An interpretation of international human
rights treaties in terms of women’s health in
general and reproductive health in particular
gradually gained acceptance during the
1990s.

10.  The World Health Organization (WHO) and
UNICEF estimate that about 1% of women in
Somalia currently use a modern method of
contraception.
 Consequently, Somalia’s total fertility rate is
estimated to be one of the highest in the world,
at approximately 6.7 children per woman.
 Only 9.4% of births in this context occur in health
facilities, and the maternal mortality ratio in
Somalia is over 1,000 deaths per 100,000 live
births.
 Access to a range of existing reproductive health
services, such as ongoing contraceptive methods,
antenatal care, skilled birth attendants, and
postpartum care, is extremely limited.

11.  Abortion is severely restricted in Somalia and is
only legally permissible to save the woman’s life.
And Somalia remains one of the only countries in
the world yet to register a dedicated progestin-
only emergency contraceptive pill.
 Compared to other countries in the East African
region, Somalia remains an outlier with respect
to reproductive health indices and outcomes; use
of skilled birth attendants during childbirth and
modern contraceptive methods, for example, is
considerably higher in every country throughout
the region

12.  Quality family planning services
 Promoting safe motherhood: prenatal, safe
delivery and post natal care, including breast
feeding;
 Prevention and treatment of infertility
 Prevention and management of complications
of unsafe abortion
 Safe abortion services, where not against the
law

13.  Treatment of reproductive tract infections,
including sexually transmitted infections
 Information and counseling on human
sexuality, responsible parenthood and sexual
and reproductive health
 Active discouragement of harmful practices,
such as female genital mutilation and
violence related to sexuality and reproduction
 Functional and accessible referral

14.  There are sixteen reproductive health
indicators developed by the United Nation
Population Fund (UNFPA) are given below.
1. Total fertility rate
2. 2. Contraceptive prevalence (any method).
3. Maternal mortality ratio.
4. Antenatal care coverage
5. Births attended by skilled health personnel

15. 6. Availability of basic essential obstetric care
7. Availability of comprehensive essential
obstetric care
8. Perinatal mortality rate
9. Low birth weight prevalence
10. Prevalence of anemia in women
12. Percentage of obstetric and gynecological
admissions owing to abortion

16. 13. Reported prevalence of women with FGM
14. Prevalence of infertility in women
15. HIV prevalence in pregnant women:
Percentage of pregnant women
16. Knowledge of HIV-related prevention
practices:

17. It implies that
 Couples have the ability to reproduce and
regulate their fertility
 Women are able to go through pregnancy and
child birth safely
 Outcome of the pregnancy is successful in
terms of maternal and infant survival and well-
being and
 Couples are able to have sexual relations free
of the fear of pregnancy and of contracting any
disease

18.  The Life Cycle approach in Women's and
Men's Health:
Pre-birth Infancy Childhood
Adolescence Reproductive age Elderly

19. Rationale for Defining Target Population
 To set priority and deliver appropriate services to high
risk groups.
 To utilize resources efficiently, •
 To plan the type of services to be provided
 To address equity in delivery of the health services
The target population of a service includes for whom the
service is primarily or solely intended.

20. These people may be of a certain age or sex or may have
other common characteristics.
A. Women of child-bearing age (15 – 49 years old)
 Women alone are at risk of complications from
pregnancy and childbirth
 Women face high risks in preventing unwanted
pregnancy; they bear the burden of using and
suffering potential side effects from most
contraceptive methods, and they suffer from the
consequences of unsafe abortion.

21. B. Adolescents (Both sexes):
 Adolescents lack reliable reproductive health
information, and thus the basic knowledge to make
responsible choice regarding their reproductive
behavior
 During adolescence normal physical development
may be adversely affected by inadequate diet,
excessive physical stress, or pregnancy before
physiological maturity is attainted.

22. C. Under Five Children:
 children’s health is a base for healthy adolescence
and childbearing ages.
 Proper health service for children serves to increase
the opportunities of women to have contact with the
health institution.
 The health of children and women is inseparable

23. ANY QUESTION