Introduction to RH (Session 1 & 2) (1).pdf

Introduction to RH (Session 1 & 2) (1).pdf

1. Introduction to Reproductive Health

1
Shahnaz Shahid
Senior Instructor & Midwifery Programme
Coordinator

2. Sessions Objectives
By the end of the session learners will be able to:

1.Understand the concept of RH
2.Discuss women’s health and its relationship to
availability, accessibility and quality of care
3.Define maternal health and its indicators
4.Discuss the national and international initiatives in RH
5.Discuss health services available in Pakistan to support
maternal & child health
6.Integrate the role of a nurse midwife, community health
nurse and other health team members in RH care
7.Apply nursing process to the clients with reproductive
disorders



2

3. “is a state of complete physical, mental and social
well-being, and not merely the absence of
reproductive disease or infirmity, in all matters
relating to the reproductive system, its functions
and processes through out life”.
3
Reproductive Health (RH)
Source: UN. Report of the International Conference on Population and Development, Cairo, 5-13 September 1994. New York: United Nations, 1995: Sales No.
95.XIII.18.

http://www.un.org/popin/unfpa/taskforce/guide/iatfreph.gdl.html

4. 4
According to the definition RH includes, the ability to:

•reproduce
•have a satisfying, safe sex life, free from fear of pregnancy and
disease
•go through pregnancy and childbirth safely, with successful
maternal and infant survival and outcomes
•obtain information about and access to safe, effective and
affordable methods of family planning
•minimize gynecologic disease and risk throughout all stages of
life; and
•freedom to control reproduction

5. Reproductive Health Components
1.Promoting “Safe Motherhood”
2.Provision of high quality of family planning services
3.Infertility services
4.Elimination of unsafe abortion
5.Adolescent reproductive and sexual health
6.Promotion of healthy sexuality
7.Prevention and treatment of Sexually Transmitted Infections
(STI) / HIV / AIDS, other gynecological morbidities and RH
needs associated with menopause including reproductive tract
cancers
8.Discouragement of harmful practices
9.Gender equity
10.Accessibility to functional referral

5

6. Maternal Health
Maternal health includes matters related to care during
pregnancy, labour and postpartum period

The target population includes women, infants,
children and adolescents

It also encompasses children with special health care
needs


6

7. Maternal Morbidity Mortality??
7
Illness or death of women while pregnant or
within 42 days of termination of pregnancy,
irrespective of the duration and site of
pregnancy from any cause related to or
aggravated by pregnancy or its
management, but not from accidental or
incidental cause.

http://www.who.int/healthinfo/statistics/indmaternalmortality/en/

8. Key facts


•Every day, approximately nearly 830 women die from preventable causes

•99% of all maternal deaths occur in developing countries

•Every year, some 3 million girls aged 15 to 19 undergo unsafe abortions

•Young adolescents face a higher risk of complications and death as a result of
pregnancy

•Skilled care can save the lives of women and newborn babies

•Between 1990 and 2015, maternal mortality worldwide dropped by about
44%

•Between 2016 and 2030, as part of the Sustainable Development Agenda, the
target is to reduce the global maternal mortality ratio to less than 70 per
100 000 live births

http://www.who.int/mediacentre/factsheets/fs348/en/

9. Maternal Health Indicators in Pakistan
•The TFR in rural areas (4.2 births) is considerably higher than the rate in urban
areas (3.2 births)

•Overall, 35 % of married women are using a contraceptive method

•One in every 11 children die before reaching their 5
th
birthday

•The estimated IMR is 74 deaths/ 1,000 live births (one in every 14 children born
die before reaching their first birthday)

•73% of women consult a skilled health provider at least once for antenatal care

•64% of the last births are protected against neonatal tetanus

•52 % of births are delivered by a skilled health provider and 48 % take place in
health facilities.


(PDHS, 2012-13)

11. Issues in MCH Service Delivery
11

12. Health Care System in Pakistan
•There are an estimated 1022 public sector
hospitals within the country; of these:

 56 are tertiary level
 116 are district level hospitals
 whereas 850 are small hospitals

•Poor attitude towards patients and low
standards of care arise, because of failure to
introduce a culture of patient-centered
healthcare.

(Nishtar, 2006)

13. 13

1.What are the major causes of maternal deaths/
morbidities?

2.What are the contributing factors leading to maternal
death/ morbidity?


Food for Thought

14. 14

15. 15
Intervention for Major causes of Maternal Mortality

16. Availability, Accessibility, Acceptability and Quality of
Care and the Three Delays Model
http://www.unfpa.org/resources/setting-standards-emergency-obstetric-and-newborn-care

17. Socio cultural &
Economic Factor
Delay Decision
17
Gender
inequality
Low Literacy
Lack Empowerment
Delay in
Receiving Care
Lack of
Understanding
High Risk Pregnancies
• Young age (below 18)
• Primigravida
• Grand multigravida
• No family planning
• Poor out come in
• previous pregnancy
•Referrals
Cost
Capacity
Lack
Awareness
Resources
Human Material
Skill birth
attendant Delay in Reaching care
Cost

Accessibility?
Availability of
Transport
Cost
Health Care
System
Quality
Source : UNICEF (2012) Situation Analysis of children and women in Pakistan : National Report Available: http://www.unicef.org/pakistan/National_Report.pdf

18. Programs to Improve MCH in Pakistan
PAIMAN
(Pakistan
Initiative for
Mothers &
Newborns)
2006
Social
Action
Program
Nutrition
Project
HANDS
2002
Women
Health
Project
2000
Community Midwifery
Programme
Emergency Obstetric Care in
Hospital (EMOC)
1994; Reproductive Health projects
Lady Health Workers Program
1987; Safe Motherhood Initiative
1979 PHC Movement
National MCH Program; (800 BHU, RHC in Country ) Training of
Traditional Birth Attendants

19. Safe Motherhood

Safe motherhood means ensuring that all women
receive the care they need to be safe and healthy
throughout pregnancy and childbirth.

http://safemotherhood.org
1987 Initiative

20. 20

23. WHO Framework for Individual Family & Community Level
Intervention
Develop CAPACITIES to stay
healthy, make healthy decisions and
respond to obstetric and
neonatal emergencies Increase AWARENESS: of the
rights, needs and potential
problems related to maternal and
newborn health
Strengthen LINKAGES for social
support between women, men,
families and community
Improve QUALITY of care and of
health services and of their interactions
with women, men

24. Life Cycle Approach to Reproductive
Health
RH concerns increases during adolescence and
particularly for women during the reproductive
years

RH needs are therefore from “cradle to grave”

25. Reproductive Health: Life Cycle Approach
Stages in life
cycle
Health Issues Promotion, prevention,
Treatment, Rehabilitation
Perinatal
(28 wks of
Gestation –7
days after birth
Fetal death
Intra-uterine retardation
(low Birth weight &
prematurity)
Immunizable diseases.
Prenatal care.
Nutrition.
Immunization with tetanus
Toxoid.

26. Cont.…
Stages in life
cycle
Health Issues Promotion, prevention, Treatment,
Rehabilitation
Infancy
(Birth – 1
year)
abnormal
growth and
development
Malnutrition
Communicable
disease
Accidents
Child abuse
Care of mother & newborn (mother baby
care package)
Breast feeding
Immunization(EPI)
Growth monitoring (mile stones)
Nutrition, education & counseling
Oral rehydration therapy (ORT)
Chronic diarrheal diseases. (CDD)
Control of upper respiratory tract infection
Education and counseling on prevention
against accidents and abuse.

27. Cont.…
Stages in life
cycle
Health Issues Promotion, prevention, Treatment,
Rehabilitation
Child hood
(1 – 10 years)
Infectious
diseases.
Malnutrition.
Accidents and
injury
Child abuse.
Immunization (EPI)
Oral rehydration therapy (ORT)
Chronic diarrheal diseases. (CDD)
Acute respiratory tract infection (ARI)
control.
Growth monitoring.
Nutrition supplementation.
Parent’s counseling on normal growth &
development of a child.
Prevention against accidents and
abuse.

28. Cont.…
Stages in life
cycle
Health Issues Promotion, prevention,
Treatment, Rehabilitation
Adolescence
(11 – 21)
Unhealthy lifestyle
Early marriage
Unwanted pregnancy
Complication of teen
age pregnancy
Morbidity and mortality
due to early pregnancy
RTIs / STDs

Education on health lifestyles.
Nutrition and fertility awareness.
FP information and service.
Counseling on sexuality.
Treatment of RTIs and referral.

29. Cont.…
Stages in life
cycle
Health Issues Promotion, prevention, Treatment,
Rehabilitation
Adulthood /
reproductive
years
22 – 45
years
Unhealthy life style.
Nutritional problems
Menstrual
abnormalities.
Genital tract cancers.
Breast lumps.
Genital tract benign
tumors.
Excessive vaginal
discharge.
Premarital general
health.
Anemia.
Education on healthy life style.
Balanced diet. Calcium & Iron
Early detection, counseling and
treatment.
Screening, diagnosis & treatment.
Screening and counseling.
Early diagnosis and treatment.

Counseling, reassurance &
treatment of pathological discharge
Counseling and screening.

Early detection and treatment.

30. Cont.…
Stages in life
cycle
Health Issues Promotion, prevention,
Treatment, Rehabilitation
Adulthood /
reproductive
years
22 – 45
years
Pregnancy and related problems
Maternal mortality
& morbidity.
Complications of
abortions.
Fertility regulation
Infertility
Sexual abuse / harassment.
Harmful traditional
practices
RTIs /STDs /
HIV/AIDS
Maternal care
Nutrition
FP information and service.
Infertility diagnosis / referral
Counseling on sexuality.
Violence against women &
Violence against Men
RTIs, HIV/AIDS diagnosis &
management / referral

31. Cont.…
Stages in life
cycle
Health Issues Promotion, prevention,
Treatment, Rehabilitation
Post
Reproductive
Years
Female
(Menopause)
Sexual dysfunction.
Menopausal problems.
Osteoporosis.
Cancers of
reproductive tracts.
Depression
Counseling / assurance
Nutrition
Supportive care
Early diagnosis and treatment of
cancers

32. Cont.…
Stages in
life cycle
Health Issues Promotion, prevention,
Treatment, Rehabilitation
Male Male Sexual dysfunction
Depression
Cancer of reproductive
organs
Counseling / assurance
Nutrition
Supportive care
Early diagnosis and treatment
of cancers

33. Role of Nurse in RH

•Provide essential input to interdisciplinary programs that monitor,
anticipate, and respond to public health problems in population groups,
regardless of which disease or public health threat is identified

•Evaluate health trends and risk factors of population groups and help
determine priorities for targeted interventions

•Work with communities or specific population groups within the
community to develop public policy and targeted health promotion and
disease prevention activities

•Participate in assessing and evaluating health care services to ensure that
people are informed of programs and services available and are assisted in
the utilization of available services

•Provide health education, care management and primary care to individuals
and families who are members of vulnerable populations and high risk
groups

33

34. 34
References
Mahmood, N., N. Durr e, et al. (2000). "An Analysis of Reproductive Health Issues in Pakistan [with
Comments]. The Pakistan Development Review: 675-693.

Ministry of health of Pakistan. (2000). Women health & Right situation.

Nishtar, S. (2006). The Gateway Paper; Health System in Pakistan – a Way Forward. Islamabad, Pakistan:
Pakistan’s Health Policy Forum and Heartfile. Available from URL: http://www.heartfile.org/pdf/phpf-
GWP.pdf

Reproductive Health Data and Statistics Available: http://www.cdc.gov/reproductivehealth/data_stats/

Pakistan Demographic and Health Survey ([PDHS], 2006- 2007). Retrieved from
http://www.measuredhs.com/pubs/pdf/FR200/FR200.pdf

UNICEF. (2012). Situation Analysis of children and women in Pakistan : National Report Available:
http://www.unicef.org/pakistan/National_Report.pdf

http://www.unicef.org/infobycountry/pakistan_pakistan_statistics.html

www.safemotherhood.org

35. Thank You