This document discusses reproductive health issues and conventions. It begins by outlining common reproductive health issues such as harmful practices, unwanted pregnancy, and STDs. It then discusses the International Conference on Population and Development and its goals of guiding principles. The document goes on to define reproductive health and discuss related concepts such as reproductive rights. It also examines indicators of reproductive health like fertility, life expectancy, and perinatal mortality. Overall, the document provides an overview of key topics in reproductive health.

1. Sanjeev Kumar Shah
National Open College
Sanepa, Lalitpur
11/27/20181
Unit: VII Reproductive Health
Issues and Conventions

2. Reproductive Health Issues and Conventions
 Common reproductive health issues: Harmful
practices, unwanted pregnancy, unsafe abortion,
reproductive tract infections including sexually
transmitted diseases and HIV/AIDS, gender-
based violence, infertility, malnutrition and
anemia, and reproductive tract cancers.
- International Conference on Population and
Development (ICPD)
o Goals of ICPD
o Guiding principles of ICPD
11/27/20182

3. Reproductive health
Concept
 The word "Reproductive Health" implies both men
and women. Men are partners in reproduction and
sexuality. Men's reproductive health and their
behaviors impact on women's reproductive health and
children's well-being and society as well
 Reproductive health can be defined as the state of
physical, mental and social well-being in all matters
relating to the reproductive system, its functions and
processes.
 It implies that people are able to have a safe and
satisfying sex life, capability to reproduce and the
freedom to decide when and how often to do so.
(http://www.who.int/topics/reproductive_health/en/).
11/27/20183

4. Contd..
 This definition 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.
 Men and women have the right to be informed
and to have access to safe, effective, affordable
and acceptable methods of family planning of
their choice that are not against the law.
11/27/20184

5. Contd..
 Lot of attention have been given to RH by many
countries after the world population conference in
1974, as population grew rapidly in developing
countries.
 Reproductive health issues have been strongly
addressed after the International Conference on
Population and Development (ICPD) held at
Cairo in 1994.
 Reproductive health is a bilateral subject with
parallel need of male and females.
11/27/20185

6. Contd..
 Reproductive health is a universal concern, but is
of special importance for women particularly
during the reproductive years.
 However, men also demand specific
reproductive health needs and have particular
responsibilities in terms of women's reproductive
health because of their decision-making powers
in some reproductive health matters.
 Reproductive health is a fundamental
component of an individual’s overall health status
and a central determinant of quality of life
11/27/20186

7. Principle of RH
 As per ICPD, RH has following main principles
 Putting people at centre
 RH as new approach
 Individual choice promote prosperity
 Women rights
 Participation and partnership
11/27/20187

8. life cycle perspective for reproductive
health.
 Reproductive health is a crucial feature of healthy
human development and of general health. It may
be a reflection of a healthy childhood, is crucial
during adolescence, and sets the stage for health
in adulthood and beyond the reproductive years
for both men and women.
 Reproductive life span does not begin with sexual
development at puberty and end at menopause
for a woman or when a man is no longer likely to
have children. Rather, it follows throughout an
individual’s life cycle and remains important in
many different phases of development and
maturation. 11/27/20188

9. Contd..
 At each stage of life, individual reproductive
health needs may differ. However, there is a
cumulative effect across the life course, and each
phase has important implications for future well-
being.
 An inability to deal with reproductive health
problems at any stage in life may set the scene
for later health problems. This is known as the life
cycle perspective for reproductive health.
11/27/20189

10. Rights in RH
 There is a long history of recognizing
reproductive health among the essential human
rights. Acknowledgements of reproductive health
from a human rights perspective are embedded in:
 The Universal Declaration of Human Rights, 1948;
 The Convention on the Elimination of All Forms of
Discrimination Against Women, 1979;
 The programme of Action, from the International
Conference on Population and Development, Cairo
1994;
 and the Platform for Action at the Fourth World
Conference on Women, Beijing 1995.
11/27/201810

11. Contd..
Three rights in particular were identified:
 The right of couples and individuals to decide
freely and responsibly the number and spacing
of children and to have the information and
means to do so;
 The right to attain the highest standard of sexual
and reproductive health; and,
 The right to make decisions free of
discrimination, coercion or violence.
11/27/201811

12. Rights contd..
Other rights are as,
 the right to health in general
 the right to reproductive choice
 the right to receive reproductive health services
 the right of men and women to marry and found
a family
 the right of individuals to make reproductive
decisions free of discrimination, coercion and
violence
 the right of the family to special protection
 and sometimes, concepts of special rights in 11/27/201812

13. Importance of Reproductive Health
 Support to understand the 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 women’s ill health and mortality
worldwide. So study of RH support to minimize
the problems
 Supports to deal with reproductive health
problems at any stage in life may set the scene
for later health problems
11/27/201813

14. Development of Reproductive Health
 Before 1978 Alma-Ata Conference
 Basic health services in clinics and health centers
 Primary health care declaration 1978
 MCH services started with more emphasis on child
survival
 Family planning was the main focus for mothers
 Safe motherhood initiative in 1987
 Emphasis on maternal health
 Emphasis on reduction of maternal mortality
 Reproductive health, ICPD in 1994
 Emphasis on quality of services
 Emphasis on availability and accessibility
 Emphasis on social injustice
 Emphasis on individuals woman's needs and
rights
11/27/201814

15. Contd..
 Millennium development goals and
reproductive health in 2000
 MDGs are directly or indirectly related to health
 MDG 4, 5 and 6 are directly related to health, while
MDG 1,2,3, and 7 are indirectly related to health
 World Summit 2005, declared universal access
to reproductive health
 “Sexual and reproductive health is fundamental
to the social and economic development of
communities and nations, and a key component
of an equitable society.” lancet-2006
11/27/201815

16. Components of Reproductive Health
 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;
 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 11/27/201816

17. Global Indicators of RH
 Fertility
 Life Expectancy
 Perinatal Mortality
 Low birth weight
 Maternal Mortality
11/27/201817

18. Fertility
 Fertility is a measure of the average number of
births women in a society have.
 Fertility influences the rate of natural growth of a
population. It is impacted by couples’ ability to
control reproduction and by infant survival.
 To replace itself, a population must have a fertility
rate of 2.1 children per woman
 There has been a marked decline in fertility and
increase in life expectancy in developed countries
of the world.
 Fertility rates continue at high levels in many less
developed countries, particularly in Africa and
Asia. 11/27/201818

19. Life expectancy
 Life expectancy is the number of years a newborn
baby can expect to live if current mortality trends
continue.
 It is a common indicator of the overall health and
socio-economic wellbeing of a society.
 Life expectancy is heavily influenced by infant
and maternal mortality.
 Life expectancy has lengthened markedly over
the 20th century, in large part due to
improvements in health care, preventive
measures, sanitation and nutrition.
 There remain marked disparities in life
expectancy between genders, countries and
regions of the world,
11/27/201819

20. Factors affecting to LE
 The factors that noticeably affect life expectancy
are
 poverty,
 environmental and occupational exposures,
 Individual risk factors such as smoking, obesity,
 Access to health care,
 Disease spread such as AIDS.
11/27/201820

21. Perinatal mortality
 Perinatal mortality is a significant indicator of the
health status of pregnant women and their
newborns.
 Perinatal deaths are infant deaths that occur
within the first week of life and stillbirths.
 Of the 4 million babies that die each year during
the first month of life, 3 million of them die in the
last trimester of pregnancy or during the first
week of life, considered the perinatal period.
11/27/201821

22. Contd..
 Ninety-eight percent of early childhood deaths
occur in the developing regions of the world.
 6.3 million perinatal deaths occur worldwide
each year, of which 3.3 million are stillbirths
and 1/3rd of stillbirths occur during delivery.
 Deaths during delivery are closely related to
place of delivery and care at delivery.
 In developing countries, approximately 40% of
deliveries take place in a health facility;
 57% or less occur under the care of a skilled
birth attendant.
11/27/201822

23. Causes of Perinatal Mortality
 Causes of Perinatal Mortality
 poor maternal health or nutritional status
 inadequate care during pregnancy
 poor management of complications during
 pregnancy or delivery
 preterm birth
 unsanitary delivery
 maternal infections, such as malaria or syphilis
 neonatal tetanus
11/27/201823

24. Low birth weight
 Low birth weight is infant weight of less than 2500
grams at birth.
 20 million low birth weight infants are born each year
around the world.
 96% of low birth weight infants are born in developing
countries. ( Asia, with 77 million annual births, has the
greatest number of births of any region in the world.
 There the incidence of low birth weight is also the
highest in the world; 18.3% of infants born in Asia are
low birth weight.
 More than half of the low birth weight infants in the
region are born in India.
 The incidence of low birth weight in Africa, ranging
from approximately 12% to 16%, varies relatively little
11/27/201824

25. Figure of LBW
 Number and Percent of Births that are Low Birth weight
WORLDWIDE 20,629,000 15.5 %
Africa 4,320,000 14.3 %
Asia 14,195,000 18.3 %
Europe 460,000 6.4 %
Latin Am./Carribean 1,171,000 10.0 %
North America 343,000 7.7 %
 More developed countries 916,000 7.0 %
 Less developed countries 19,713,000 16.5 %
 Least developed countries 4,968,000 18.6 %
 Source: UNICEF and WHO. Low birth weight. Country, Regional and Global
Estimates,2004.
11/27/201825

26. Causes of LBW
 The major causes of LBW are directly related to
 maternal health,
 nutrition,
 disease and other conditions during pregnancy
11/27/201826

27. Magnitude of Reproductive Health
Problems
 1/5th of the world wide Borden of illness and
premature death 1/3rd of the illness and death
among women is in reproductive age.
 Problem related to pregnancy and childbearing
present the measure portion of healthy year of life
lost to women of reproductive age.
 One women die/minuet due to the pregnancy
related causes. This adds up to more than ½ million
mothers lost each year.
 Every year at least 70,000 women die of
consequence of unsafe abortion and many more
suffer complications.
 It is estimated that one out of every 11 babies in
developing countries die during the first period of life.
This adds up to 10.7 million infant death. Similarly 4
million children between 1-5 year die every year. 11/27/201827

28. Contd..
 Six out of 10 women in many countries have sexually
transmitted diseases. One million people die each year as a
result of RTI other than HIV/AIDS.
 For women aged between 15-45 years in developing countries
the second highest burden of disease ( after maternal
morbidity and mortality) comes from STD and they account for
nearly 15% of all health lost in this age. There are an
estimated 333 million new cases of STD per year
 Rape and other forms of sexual violence are increasing
though many rape are unreported because of stigma and
trauma associated with them and lack of sympathetic
treatment from legal system
 2 million girls between the age 5-15 are introduced into the
commercial sex market each year
 Study of domestic violence suggests that widespread in most
societies. It is a frequent cause of suicide among women and
murder. 11/27/201828

29. Major RH problems
 Perinatal and Maternal death
 Neonatal, infant and child death
 Teen age and high risk pregnancy
 Low birth weight
 Illegal abortion
 RTI, STD and HIV/AIDS
 Adolescent health problems
 Infertility
 Elderly health problems
 Female Genital mutilation
 Sex selective abortion
 Rape
 Gender based violence
11/27/201829

30. RH issues in Nepal
 Family planning
 Safe motherhood
 Adolescent RH
 Neonatal Health
 HIV/AIDS
 Infertility
 Abortion care
 Elderly women
 Gender based violence
 Sex selective abortion
 Marital rape
 Female dignity and right
11/27/201830

31. Approaches to address the RH
problems
 Initiation of Safe motherhood program
 Improve the institutional delivery services
 Increasing the prenatal service accessibility
 Proper care of new born, neonates and infants
 Early diagnosis and treatment of STD and HIV
AIDS and infertility
 Improvement of social inclusion and Gender
equality
 Reduction of teen age pregnancy and unsafe
abortion
 Awareness on reducing Female genital mutilation
and sex selective abortion
 Care of adolescent and elderly women 11/27/201831

32. 11/27/201832
In vitro fertilization

33. Meaning and concept
11/27/201833
 In vitro fertilization or fertilization (IVF) is a process
by which an egg is fertilized by sperm outside the body: in
vitro ("in glass").
 The term in vitro, from the Latin meaning in glass, is
used, because early biological experiments involving
cultivation of tissues outside the living organism from
which they came, were carried out in glass containers
such as beakers, test tubes, or Petri dishes.
 Today, the scientific term in vitro is used to refer to any
biological procedure that is performed outside the
organism in which it would normally have occurred, to
distinguish it from an in vivo procedure, where the tissue
remains inside the living organism within which it is
normally found.

34. Contd..
11/27/201834
 The process involves monitoring and stimulating
a woman's ovulatory process, removing an ovum
or ova (egg or eggs) from the woman's ovaries
and letting sperm fertilize them in a liquid in a
laboratory.
 The fertilized egg (zygote) is cultured for 2–6
days in a growth medium and is then implanted in
the same or another woman's uterus, with the
intention of establishing a successful pregnancy.
 IVF techniques can be used in different types of
situations. It is a technique of assisted
reproductive technology for treatment of infertility.

35. Contd..
11/27/201835
 IVF techniques are also employed in gestational
surrogacy, in which case the fertilized egg is
implanted into a surrogate's uterus, and the resulting
child is genetically unrelated to the surrogate.
 In some situations, donated eggs or sperms may be
used. Some countries ban or otherwise regulate the
availability of IVF treatment, giving rise to fertility
tourism, but it restrictions on to single females,
lesbians and surrogacy arrangements.
 Due to the costs of the procedure, IVF is mostly
attempted only after less expensive options have
failed.

36. History of IVF
11/27/201836
 The first successful birth of a "test tube baby", Louise
Brown, occurred in 1978. Louise Brown was born as a
result of natural cycle IVF where no stimulation was
made.
 Robert G. Edwards, the physiologist who developed
the treatment, was awarded the Nobel Prize in
Physiology or Medicine in 2010.
 With egg donation and IVF, women who are past their
reproductive years or menopause can still become
pregnant.
 Adriana Iliescu held the record as the oldest woman
to give birth using IVF and donated egg, when she
gave birth in 2004 at the age of 66.
 After the IVF treatment many couples are able to get
pregnant without any fertility treatments

37. Medical uses
11/27/201837
 IVF may be used to overcome female infertility
where it is due to problems with the fallopian
tubes, making fertilization in vivo difficult.
 It can also assist in male infertility, in those cases
where there is a defect in sperm quality; in such
situations intracytoplasmic sperm injection (ICSI)
may be used, where a sperm cell is injected
directly into the egg cell.
 This is used when sperm has difficulty
penetrating the egg, and in these cases the
partner's or a donor's sperm may be used.
 ICSI is also used when sperm numbers are very
low.

38. Contd..
11/27/201838
 IVF treatment is appropriate in cases of
unexplained infertility for women that have not
conceived after 2 years of regular unprotected
sexual intercourse.
 IVF is also considered suitable in cases where
any of its expansions is of interest, surrogacy
where the woman providing the egg isn't the
same who will carry the pregnancy to term

39. Success rates
11/27/201839
 IVF success rates are the percentage of all IVF procedures
which result in a favorable outcome. Depending on the
type of calculation used, this outcome may represent the
number of confirmed pregnancies, called the pregnancy
rate, or the number of live births, called the live birth rate.
 The success rate depends on variable factors such as
maternal age, cause of infertility, embryo status,
reproductive history and lifestyle factors.
 Maternal age: Younger candidates of IVF are more likely to
get pregnant. Women older than 41 are more likely to get
pregnant with a donor egg.[3]
 Reproductive history: Women who have been previously
pregnant are in many cases more successful with IVF
treatments then those who have never been pregnant.[3]
 Due to advances in reproductive technology, IVF success
rates are substantially higher today than they were just a
few years ago.

40. Contd..
11/27/201840
 A 2012 summary compiled by the Society for
Reproductive Medicine which reports the average IVF
success rates in the United States per age group
<35 35-37 38-40 41-42
Pregnancy rate 47.6 38.9 30.1 20.5
• In 2006, Canadian clinics reported an average
pregnancy rate of 35%.
• A French study estimated that 66% of patients
starting IVF treatment finally succeed in having a
child .

41. Complications
11/27/201841
 Multiple births: The major complication of IVF is the
risk of multiple births. Multiple births are related to
increased risk of
 pregnancy loss,
 obstetrical complications,
 prematurity,
 and neonatal morbidity with the potential for long term
damage.
 LBW: Recent evidence also suggest that singleton
offspring after IVF is at higher risk for lower birth
weight for unknown reasons.
 Spread of infectious disease: chronic disease like
HB, HIV/AIDS

42. €ontd..
11/27/201842
 Other risks to the egg provider/retriever
 A risk of ovarian stimulation is the development of
ovarian hyper-stimulation syndrome, This results in
swollen, painful ovaries.
 In moderate cases, ovaries swell and fluid accumulated
in the abdominal cavities and may have symptoms of
heartburn, gas, nausea or loss of appetite.
 During egg retrieval, there’s a small chance of bleeding,
infection, and damage to surrounding structures like
bowel and bladder as well as difficulty in
 breathing, chest infection, allergic reactions to medication
 Ectopic pregnancy may also occur if a fertilized egg
develops outside the uterus, usually in the fallopian tubes
and requires immediate destruction of the foetus.
 Birth defects: A review in 2013 came to the result that
infants resulting from IVF have a relative risk of birth
defects of 1.32 (95% confidence interval 1.24–1.42)
compared to naturally conceived infants

43. Thank You
11/27/201843