Reproductive Health and its status in Nepal .pdf

It is presented on the reproductive health, related indicators and its present status in Nepal

1. Reproductive Health and its
Status in Nepal
Presented by;
Ramesh Bhatta (Associate Prof)
Principal, Yeti Health Science Academy
3/11/2025 Presented by: Associate Prof. Ramesh Bhatta 1

2. Definition of Reproductive Health and its Principles
•Reproductive health is the absolute physical, mental and social well being
related to the reproductive system throughout the life cycle.
•Reproductive health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity, in all matters relating to the
reproductive system and to its functions and processes. Reproductive health
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 (WHO).
•Reproductive health refers to the condition of male and female reproductive
systems during all life stages. These systems are made of organs and hormone-
producing glands, including the pituitary gland in the brain. Ovaries in females
and testicles in males are reproductive organs, or gonads, that maintain health
of their respective systems. They also function as glands because they produce
and release hormones.
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3. •Good sexual and reproductive health is a state of complete physical, mental
and social well- being in all matters relating to the reproductive system.
•It implies that people are able to have a satisfying and safe sex life, the
capability to reproduce and the freedom to decide if, when, and how often to
do so.
•To maintain one’s sexual and reproductive health, people need access to
accurate information and the safe, effective, affordable and acceptable
contraception method of their choice.
•They must be informed and empowered to protect themselves from sexually
transmitted infections. And when they decide to have children, women must
have access to skilled health care providers and services that can help them
have a fit pregnancy, safe birth and healthy baby.
•Every individual has the right to make their own choices about their sexual and
reproductive health.
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4. •It is recognized that RH is a crucial part of overall health and is central to
human development which affects every body; it involves intimate and
highly valued aspects of life.
•It is a reflection of health in infancy, childhood and adolescence, it also
sets the stage for health beyond the Reproductive years for both
women and men and has pronounced effects from one generation to
another
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5. Guiding Principle of Reproductive health developed by ICPD:
•Empowerment of women
•Promote men’s participation in RH/FP
•Involve women, Women’s organization
•Integrated services
•Assure highest level of quality of care
•Available effective methods of FP
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6. Components of RH
1.Safe motherhood
2.Family planning
3.Child health
4.Prevention and management of complications of abortion
5.RTI/STI/HIV/AIDS
6.Prevention and management of sub fertility
7.Adolescent reproductive health
8.Problems of elderly women
9.Gender based violence
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7. 1. Safe motherhood program have six components, which are also called six pillars of safe
motherhood. These should be implemented in integrated approach especially through primary
health care approach;
a.Family Planning: It ensure that individuals and couples have the information and services to
plan the timing, number, and spacing of pregnancies.
b.Antenatal Care:Screen risk factors in order to prevent complications where possible, and to
ensure that complications of pregnancy are detected early and treated appropriately.
c.Obstetric Care: To ensure that all birth attendants have the knowledge, skills, and equipment
to perform a clean and safe delivery, and to ensure that emergency care for high-risk
pregnancies and complications is made available to all women who need it.
d.Postnatal Care: Toensure that postpartum care is provided to mother and baby, including
lactation assistance, provision of family planning services, and managing danger signs.
Postnatal check-ups, the first in 24 hours of delivery at the health facility, the second on the
third day at home, third on the seventh to fourteenth at home and fourth on the 42 days
after delivery at health facility.
e.Post abortion Care: To prevent complications where possible and ensure that complications
of abortion are detected early and treated appropriately; to refer other reproductive health
problems; and to provide family planning methods as needed.
f.STD/HIV/AIDS Control: To screen, prevent, and manage transmission to baby; to assess risk
for future infection; to provide voluntary counseling and testing; to encourage prevention;
and where appropriate to expand services to address mother to child transmission.
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8. 2. Family Planning (FP)
•FP has been enshrined as a fundamental right in the constitution and included
in the basic health service package under the Public Health Service Act 2075.
•
The Safe Motherhood and Reproductive Health Act 20752, Safe Motherhood
and Reproductive Health Regulation 2077, 15th National Plan (2076/77-
2080/81, Safe Motherhood and Newborn Roadmap (2076-2087) has
emphasized the availability and accessibility of right-based FP services.
•The strategic focus involves ensuring access and utilization of high-quality,
client-centered FP services, particularly targeting underserved populations and
achieving SDG targets.
•Efforts are directed towards reducing contraceptive discontinuation, scaling up successful innovations, generating evidence, and linking FP services with
delivery and demand generation interventions.
•FP information and services are disseminated through government channels,
social marketing, non-government organizations (NGOs), and the private
sector.
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9. •Access to services in remote areas is facilitated through satellite clinics, visiting
providers, and mobile camps.
•Sterilization services are available at static sites and through scheduled outreach
services. Private and commercial outlets, including clinics, pharmacies, and hospitals
also contribute to the comprehensive availability of FP services
•Objective of FP program in Nepal: To improve the health status of all people through
informed choice on accessing and utilizing client centered quality voluntary FP services.
•Specific objectives: To increase access to and the use of quality FP services that are
safe, effective, and acceptable to individuals and couples (increasing access in rural and
remote places with focus on marginalized people with high unmet need, postpartum
and post-abortion women and partner of labourmigrants and adolescents)
•To increase contraceptive use, reduce unmet need for FP, unintended pregnancies, and
contraceptive discontinuation.
•To create an enabling environment for increasing access to quality FP services to men
and women including adolescents.
•To increase the demand for FP services by implementing strategic behavior change
communication activities.
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10. 3. Child health: Basically focus on reducing , neonatal mortality, infant
mortality, under-five mortality , increase immunization and improving child
nutrition.
4. Prevention and management of complications of abortion
•In Nepal abortion was legalized in 2002, and now is under basic health
service package
•It is important to recognize sign and symptoms of abortion and know
where to seek help, getcounselling on prevention of unwanted pregnancy,
and post abortion FP.
•
Safe Abortion Service users 2079/80 (93,463). Among these cases, the share of medical abortion is more
than that of surgical abortion.
•Among total medical abortion 5.70 % done among <20 years women and 6.9%total surgical abortion were done among <20 years women.
•The legal age of marriage is 20 years; this data depicts either premarital conception or early marriages leading to abortion.
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11. 5. RTI/STI/HIV/AIDS
•Sexual health is an integral component of reproductive health and refers to the
ability to have a safe and satisfying sexual life. This implies the absence of
sexually transmitted diseases, sexual dysfunctions and sexual violence.
•
Prevention of STIs includes condom use, vaccination(e.g., against human
papillomavirus –HPV) and education about safe sexual practices. Treatment
for STIs should be accessible and effective to reduce the spread and associated
complications.
•Sex education provides people with the knowledge and skills to make
informed decisions about their sexual lives. This includes information about
anatomy, reproduction, contraception, and STD prevention.
•Recognizing RTI/STD symptoms and seek care, treat both partners in the case
of infection is important.
•Sexuality and gender education and counselling, Condom promotion and
distribution should be done.
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12. 6. Prevention and management of sub-fertility/ Infertility
•The terms subfertility and infertility are often used interchangeably but they
aren’t the same thing. Infertility is the inability to conceive naturally after one
year of trying. Subfertility, on the other hand, is where the possibility of
conceiving naturally exists, but it takes longer than average. In infertility, the
likelihood of conceiving without medical intervention is unlikely.
•The causes of subfertility are similar to the causes of infertility:
•The ability to reproduce is a central aspect of reproductive health. Subfertility
and infertility can affect both men and women and may have physical, genetic,
hormonal or environmental causes.
•Diagnosing infertility involves a series of tests to identify the underlying cause.
Treatments may include medications, surgery, artificial insemination, and
assisted reproductive techniques such as in vitro fertilization (IVF).
•Infertility is affecting 13-15% of couples in Nepal.
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13. •Assisted Reproductive Technology (ART) is a advance technique to help
couple with subfertility. ART involved handling either eggs or embryos
outside the body, which are of several types;
•
In vitro fertilization (IVF): An egg is removed from the ovary and fertilized
with sperm in the laboratory, The fertilized egg is placed in the uterus to
settle and grow a baby. It is most frequently used method.
•Intracytoplasmic sperm injection (ICSI): This is valuable for male factor
infertility. A doctor injects a single sperm into a mature egg.
•Zygote intrafallopian transfer (ZIFT) or Gamateintrafallopian transfer
(GIFT):Gametes or fertilized eggs are placed in the fallopian tube.
•Egg and sperm donation:You may need this if you are not producing
healthy sperm or eggs.
•Embryo donation: Unused embryos created by a couple during subfertility
treatment can be donated to other sub fertile couples.
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14. 7. Adolescent reproductive health
•Adolescents aged 10 to 19 make up 24% (6.4 million) of Nepal’s population.
•17% of girls aged 15- 19 are already mothers or pregnant.
•Only 14.2% of currently married adolescents use modern contraceptives.
•National adolescent Health and Development Strategy (2018) is developed to
promote adolescent sexual and reproductive health.
•Adolescent reproductive health is critical to their future development and well-
being. Adolescents face unique challenges related to puberty, initiation of
sexual activity, and the risk of unintended pregnancy and STIs.
•
Reproductive health education and services should be accessible and appropriate for adolescents. This includes comprehensive sexuality education
,
access to contraception, and confidential health care.
•Some of the recent activities conducted by government are expansion of
adolescent friendly health facilities, certification of adolescent friendly health
facilities.
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15. 8. Problems of elderly women
•Senior Citizens Act, 2063, defines senior citizens (Elderly) as individuals aged 60
and above
•
Nepal is currently undergoing a demographic transition characterized by an
increase in life expectancy. This shift is accompanied by a noticeable rise in the proportion of elderly individuals within the overall population.
•According to 2021 census, elderly population constitute 10.21% of the total population.
•Focus should be on timely identification of RH problems, health promotion (prevention and management of uterine prolapse) and treatment.
•Reproductive health issues among the elderly population primarily includeconcerns related to sexual function
, sexually transmitted infections (STIs),
pelvic floor dysfunction, and hormonal changes, with women experiencing
menopause and men facing potential issues with erectile dysfunction, all of
which can significantly impact quality of life.
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16. 9.Gender Based Violence (GBV)
•GBV is an umbrella term for any harmful act that is perpetrated against a person’s will
and that is based on socially ascribed (gender) differences between males and females.
•Around the world, GBV has a greater impact on women and girls than on men and
boys.
•The terms "gender-based violence" (GBV) and "violence against women" (VAW) are
often used interchangeably, since most gender-based violence is perpetrated by men
against women.
GBV includes:
•Sexual violence, including rape, sexual abuse, sexual exploitation and forced prostitution
•Domestic violence
•Forced and early marriage
•Harmful traditional practices such asfemale genital mutilation, honourcrimes, widow inheritance
•Trafficking
•The nature and extent of specific types of GBV vary across cultures, countries and
regions.
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17. •The Convention on the Elimination of all forms Discrimination Against
Women (CEDAW)notes that violence against women includes sexual,
physical, and psychologicalviolence in the:
•Family:such as battering, sexual abuse of children, female genital
mutilation/cutting, and rape;
•Community:such as sexual abuse, sexual harassment and intimidation,
trafficking, and forced prostitution
•State:such as poorly drafted or unenforceable laws for violence against
women, law enforcement agents who violate women, the lack of facilities
and education for prevention and treatment of women exposed to violence,
the sanctioning and reinforcement of unequal gender relations.The state’s
indifference and neglect in creating opportunities for women in regard to
employment, education, participation and access to social services also
support gender-based violence.
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18. •GBV violates human right and affects sexual and reproductive health. It restrict
choices and decision making of those who experience it, affect their right across
their life cycle to access SRH information and services.
Consequences of GBV
•Thephysical consequencesrange from relatively minor injuries to severe
injuries leading to death or permanent disabilities; unintended pregnancies;
unsafe and complicated abortion; adverse pregnancy outcomes, including
miscarriage, low birth weight and fetal death; sexually transmitted infections,
including HIV; pelvic inflammatory disease, infertility, chronic pain syndromes;
urinary tract infections.
•Psychological consequencesinclude: anxiety disorders, including post-traumatic
stress disorder (PTSD); depression; feelings of inferiority; inability to trust; fear; increased substance use and abuse; sleep disturbances; eating disorders; sexual dysfunction; and suicide.
•Impact on thesocial healthof the individual and the community in terms of
stigma, isolation and rejection (including by husbands and families); losses in women’s income potential; interrupted education of adolescents; and homicide.
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19. Goal 3:Ensure healthy lives and promote well-being for all at
all ages. (SDG goal)
•3.1By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
•3.2By 2030, end preventable deaths of newborns and children under 5 years of age, with all
countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and
under-5 mortality to at least as low as 25 per 1,000 live births.
•3.3By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases
and combat hepatitis, water-borne diseases and other communicable diseases.
•3.4By 2030, reduce by one third premature mortality from non- communicable diseases
through prevention and treatment and promote mental health and well-being.
•3.5Strengthen the prevention and treatment of substance abuse, including narcotic drug
abuse and harmful use of alcohol.
•3.6By 2020, halve the number of global deaths and injuries from road traffic accidents.
•
3.7By 2030, 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.
•3.8Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable essential
medicines and vaccines for all.
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20. •3.9By 2030, substantially reduce the number of deaths and illnesses from hazardous
chemicals and air, water and soil pollution and contamination.
•3.AStrengthen the implementation of the World Health Organization Framework
Convention on Tobacco Control in all countries, as appropriate.
•3.BSupport the research and development of vaccines and medicines for the
communicable and noncommunicable diseases that primarily affect developing
countries, provide access to affordable essential medicines and vaccines, in
accordance with the Doha Declaration on the TRIPS Agreement and Public Health,
which affirms the right of developing countries to use to the full the provisions in the
Agreement on Trade Related Aspects of Intellectual Property Rights regarding
flexibilities to protect public health, and, in particular, provide access to medicines for
all.
•3.CSubstantially increase health financing and the recruitment, development, training
and retention of the health workforce in developing countries, especially in least
developed countries and small island developing States.
•3.DStrengthen the capacity of all countries, in particular developing countries, for
early warning, risk reduction and management of national and global health risks.
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21. RH Indicators
•Indicators are markers of health status, service provision or resource
availability, designed to enable the monitoring of service performance or
program goals.
•Monitoring is a process of comparison, across populations or geographical
areas, to highlight differentials or to detect changes over time (to measure
progress) between reality and goals.
•Goals or objectives are an essential component in quantifying the aims of
health-related policies, programs and services. At the national and
international levels, an indicator must be able to “measure progress”
towards agreed goals.
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22. Basis for developing RH Indicators
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23. Indicators for global monitoring of Reproductive Health
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24. •Total Fertility Rate (TFR): Total number of children a woman would have by
the end of her reproductive period if she experienced the currently prevailing
age-specific fertility rates throughout her childbearing life.
•Contraceptive Prevalence Rate (CPR): Percent of women of reproductive age
(15-49) who are using (or whose partner is using) a contraceptive method at a
particular point in time.
•Maternal Mortality Ratio (MMR): Annual number of maternal deaths per
100,000 live births.
•Antenatal Care Coverage: Percent of women attended at least four times
during pregnancy, by skilled health personnel for reasons relating to
pregnancy
•Percent of Births Attended by Skilled Health Personnel: Percent of births
attended by skilled health personnel.
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25. •Availability of Basic Essential Obstetric Care: Number of facilities with
functioning basic essential obstetric care per 500,000 population
•Availability of Comprehensive Essential Obstetric Care: Number of facilities
with functioning comprehensive essential obstetric care per 500,000 population
•Perinatal Mortality Rate (PMR): Number of perinatal deaths per 1,000 total
births
•Low Birth Weight Prevalence: Percent of live births that weigh less than 2,500g
•Positive Syphilis Serology Prevalence in Pregnant Women: Percent of pregnant
women (15- 24) attending antenatal clinics, whose blood has been screened for
syphilis, with positive serology for syphilis.
•Prevalence of Anemia in Women: Percent of women of reproductive age (15-
49) screened for hemoglobin levels with levels 110g/l for pregnant women, and
120g/l for non- pregnant women
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26. •Percent of Obstetric and Gynecological Admissions Owing to Abortion: Percent of
all cases admitted to service delivery points providing in- patient obstetric and
gynecological services, which are due to abortion (spontaneous and induced, but
excluding planned termination of pregnancy)
•Reported Prevalence of Women with FGM: Percent of women interviewed in a
community survey reporting having undergone FGM
•Prevalence of Infertility in Women: Percent of women of reproductive age (15- 49)
at risk of pregnancy (not pregnant, sexually active, non- contracepting, and non-
lactating) who report trying for a pregnancy for two years or more
•Reported Incidence of Urethritis in Men; Percent of men aged (15- 49) interviewed
in a community survey reporting episodes of urethritis in the last 12 months
•HIV Prevalence among Pregnant Women: Percent of pregnant women (15- 24)
attending antenatal clinics, whose blood has been screened for HIV and who are
sero-positive for HIV.
•Knowledge of HIV- related Prevention Practices: Percent of all respondents who
correctly identify all three major ways of preventing the sexual transmission of HIV
and who reject three major misconceptions about HIV transmission or prevention.
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27. Status of RH indicators in Nepal
SnIndicators Status
1.Percentage of Institutional delivery 83 (FY 2079/80)
2.Percentage delivered by a skilled provider80.1 (NDHS, 2022)
3.Unmet need of FP 21%(NDHS, 2022)
4.Adolescent pregnancy rate (Teenage pregnancy)14% (NDHS, 2022)
KarnaliProvince (21%), MadheshProvince (20%), lowest in Bagmati
Province (8%)
5.Unmet need for FP –adolescent 31% (NDHS, 2022)
6.Met need for family planning
All methods: 57%
Modern methods: 43%
Traditional method: 15%
Modern methods include (female sterilization, male sterilization, IUCD,
injectables, implants, pill, male condom, emergency contraception,
lactational amenorrhea method (LAM) and other modern method)
7.Maternal mortality ratio 151/100000 live births
8.Prevalence of Anemia in Women (15-49 yrs) 34(NDHS, 2022)
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28. Trends in Use, need and Demand for Family Planning (% of currently married
women age 15-49)
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29. Sn Indicator Status
9. Total Fertility Rate 2.1 (NDHS, 2022)
10. ANC coverage (4+ ANC visit) 81% (NDHS, 2022)
11. Under five mortality rate 33 (NDHS, 2022)
12. Infant mortality rate 28 (NDHS, 2022)
13. Neo-natal mortality rate 21 (NDHS, 2022)
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30. Child Mortality Indicators
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32. Reproductive Health Morbidity
•Reproductive Health Morbidity means any health condition adversely
impacting the reproductive system as a result of reproduction, pregnancy,
abortion, labor and sexual behavior, and also refers to pelvic organ
prolapse, obstetric fistula, infertility, cervical cancer, breast cancer as well
as any other similar health conditions that affects the reproductive functioning
.
•Cervical cancer, breast cancer, obstetric fistula, pelvic organ prolapses, and infertility are among the prioritized RH morbidities.
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33. Status of RH morbidity services of FY 2079/80
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34. Status of ANC visit as per Protocol
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35. Deliveries conducted by SBA and Skilled
Health Personnel
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36. PNC coverage as per protocol
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38. Modern mix method acceptors (FY 2079/80)
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39. Modern Contraceptive Prevalence Rate (mCPR) (2079/80)
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40. Causes of Maternal death reported in FY 2079/80
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42. Concept of Cairo Conference 1994 (International Conference on
Population and Development (ICPD)
•The International Conference on Population and Development (ICPD) was
held in Cairo in 1994 marked the acceptance of a new paradigm in addressing
human reproduction and health.
•It transformed global thinking on population and development issues.
•179 governments adopted the ICPD Program of Action. It affirmed that
inclusive sustainable development is not possible without prioritizing human
rights, including reproductive rights; empowering women and girls; and
addressing inequalities as well as the needs, aspirations and rights of
individual women and men.
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43. •For the first time, it focused on the needs of women empowerment, and
the emergence of an evolving discourse about the connection between
human rights and health, linking health with social justice and respect for
human dignity.
•It focused on access to comprehensive reproductive health care,
including voluntary Family Planning, safe pregnancy and childbirth
services, and the prevention and treatment of sexually transmitted
infections.
•It also recognized that reproductive health and women’s empowerment
are intertwined, and that both are necessary for the advancement of
society.
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44. •Women’s reproductive capacity was transformed from an object of population
control to a matter of women’s empowerment to exercise personal autonomy
in relation to their sexual and reproductive health within their social, economic
and political contexts.
•
Women’s health in general, and their sexual and reproductive health in particular, are determined not only by their access to health services
but by
their status in society and pervasive gender discrimination. The ICPD thus
suggests the human rights of women, their right to personal reproductive
autonomyand to collective gender equality as a primary principle in the
development of reproductive health and population programs.
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45. In 2019, in marking ICPD25, the Government of Nepal committed to the
following at the Nairobi Summit:
•
Achieving the three zeros: zero unmet need for family planning, zero
preventable maternal deaths, and zero gender-based violence, including
harmful practices.
•Investing in young people including their health and well- being by ensuring
that they are able to exercise their reproductive rights through upscaling
adolescent-friendly services and comprehensive sexuality education.
•Ensuring basic humanitarian needs of affected populations, including for
sexual and reproductive health care and gender-based violence prevention
and response, are addressed in humanitarian contexts.
•Putting in place financing policies, instruments and structures to ensure full
implementation of the International Conference on Population and
Development, Program of Action, and Sustainable Development Goals.
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46. Beijing Conference and Platform of action,1995
•The Fourth World Conference on WomeninBeijing, Chinawas the important conferences on women.
•It was marked as a significant turning point for the global agenda for gender equality aimed at
securing the equality of women with men in law and in practice
•More than 17,000 participants attended the conference, including 6,000 government delegates at the
negotiations, more than 4,000 accredited NGO representatives.
•The conference marked a significant turning point for the global agenda for gender equality.
TheBeijing Declaration and Platform for Action, was adopted by 189 countries. Main agenda was for
women’s empowerment thatis now considered the key global policy document on gender equality.
It has set12 critical areas of concern:
1. Women and poverty 2. Education and training of women3. Women and health
4. Violence against women5. Women and armed conflict 6. Women and the economy
7. Women in power and decision-making 8. Institutional mechanism for the advancement of
women
9. Human rights of women10. Women and the media11. Women and the environment
12. The girl-child
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47. •The Platform for Action is an agenda for women’s empowerment.
•It aims at removing all the obstacles to women’s active participation in all
spheres of public and private life through a full and equal share in
economic, social, cultural and political decision-making. This means that
the principle of shared power and responsibility should be established
between women and men at home, in the workplace and in the wider
national and international communities.
•Equality between women and men is a matter of human rights and a
condition for social justice and is also a necessary and fundamental
prerequisite for equality, development and peace. A transformed
partnership based on equality between women and men is a condition for
people centered sustainable development. A sustained and long-term
commitment is essential, so that women and men can work together for
themselves, for their children and for society to meet the challenges of
the twenty-first century.
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48. •Women’s empowerment and their full participation on the basis of equality in
all spheres of society, including participation in the decision-making process
and access to power, are fundamental for the achievement of equality,
development and peace;
•Equal rights, opportunities and access to resources, equal sharing of
responsibilities for the family by men and women, and a harmonious
partnership between them are critical to their well-being and that of their
families as well as to the consolidation of democracy;
•Eradication of poverty based on sustained economic growth, social
development, environmental protection and social justice requires the
involvement of women in economic and social development, equal
opportunities and the full and equal participation of women and men as agents
and beneficiaries of people- centered sustainable development;
•The explicit recognition and reaffirmation of the right of all women to control
all aspects of their health, in particular their own fertility, is basic to their
empowerment;
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49. •Local, national, regional and global peace is attainable and is inextricably linked with
the advancement of women, who are a fundamental force for leadership, conflict
resolution and the promotion of lasting peace at all levels;
•It is essential to design, implement and monitor, with the full participation of
women, effective, efficient and mutually reinforcing gender-sensitive policies and
programs, including development policies and programs, at all levels that will foster
the empowerment and advancement of women;
•The participation and contribution of all actors of civil society, particularly women’s
groups and networks and other non- governmental organizations and community-
based organizations, with full respect for their autonomy, in cooperation with
Governments, are important to the effective implementation and follow-up of the
Platform for Action;
•The implementation of the Platform for Action requires commitment from
Governments and the international community. By making national and international
commitments for action, including those made at the Conference, Governments and
the international community recognize the need to take priority action for the
empowerment and advancement of women.
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50. Reproductive Right of Women
•Reproductive rights means, having access to sexual and reproductive
healthcare and autonomy in sexual and reproductive decision-making -are
human rights; they are universal, indivisible, and undeniable. These rights are
founded upon principles of human dignity and equality, and have been
enshrined in international human rights documents. Reproductive rights
embrace core human rights, including the right to health, the right to be free
from discrimination, the right to privacy, the right not to be subjected to
torture or ill- treatment, the right to determine the number and spacing of
one's children, and the right to be free from sexual violence.
•Reproductive rights also include the right to the highest standards of sexual
and reproductive healthcare.
•When these rights are denied to women, the rights of all people everywhere
are threatened. Working to protect reproductive rights emphasizes the
equality and dignity of women, and the universality of human rights.
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51. Reproductive rights are central to individuals control over time and these rights are founded on a
number of international agreements, including human right documents;
•The Universal Declaration of Human Rights
•International Covenant on Economic, Social and Cultural Rights
•International Covenant on Civil and Political Rights
•The Convention on the Elimination of all forms of Discrimination Against Women
(CEDAW)
•Convention on the Elimination of all forms of Racial Discrimination (CERD)
•The Convention Against Torture
•International Conference on Population and Development (ICPD) Program of
Action
•The Beijing Platform for Action
•The Rome Statute of the International Criminal Court:
•The Vienna Declaration and Program of Action
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52. Reproductive Right of Women
•Reproductive rightsarelegal rightsand freedoms relating
toreproductionandreproductive healththat vary amongst countries around the
world.TheWorld Health Organizationdefines reproductive rights as;
Reproductive rights rest on the recognition of the basic right of all couples and
individuals to decide freely and responsibly the number, spacing and timing of
their childrenand to have the information and means to do so, and the right to
attain the highest standard of sexual and reproductive health. They also include the
right of all to make decisions concerning reproduction free of discrimination, coercion
and violence.
•Reproductive rights may include some or all of the following:right to abortion;birth
control; freedom fromcoerced sterilizationand contraception; the right to access
good-qualityreproductive healthcare; and the right toeducation and accessin order
to make free and informed reproductive choices.Reproductive rights may also
include the right to receiveeducationaboutsexually transmitted infectionsand
other aspects of sexuality, right tomenstrual healthand protection from practices
such asfemale genital mutilation.
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53. Rights included in the Safe Motherhood and Reproductive health Act, 2018
Right to reproductive health:
•Each woman and adolescent have the right to obtain education, information,
counseling and service relating to sexual and reproductive health.
•Each person have the right to obtain service, counseling and information relating to
reproductive health.
•Each woman have the right to safe motherhood and reproductive health. Each
woman have the right to determine the number or spacing of children.
•Each person have the right to contraceptive information and usage.
•Each woman have the right to obtain abortion services, in accordance with this Act.
•Each woman have the right to nutritious, balanced diet and physical rest during the
antenatal, postnatal and reproductive health morbidity
•Each woman have the right to essential counseling, obstetric care, and postpartum
contraceptive services from a birth attendant.
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54. Rights, Safe Motherhood and Reproductive health Act, 2018………………….
•Each woman have the right to obtain emergency obstetric care, basic emergency
obstetric care, comprehensive emergency obstetric care, new born essential
care and new born emergency care.
•Each person have the right to affordable, acceptable and safe reproductive
health services as needed during different stages of their lifecycle.
•Every person have the right to reproductive health services of their choice.
Right to seek family planning services:
•Each person have the right to obtain information, make choice and seek other
services related to family planning.
•The prescribed family planning services should be sought from the prescribed
health institution.
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55. 3/11/2025 Presented by: Associate Prof. Ramesh Bhatta 55

56. Rights, Safe Motherhood and Reproductive health Act,2018……….
Right to maternity leave:
•A woman working in a government, non-government or private organization or
institution will have the right to paid maternity leave for a minimum period of
ninety- eight days before or after childbirth.
•In case the maternity leave referred is not sufficient, a pregnant woman, with the
recommendation of an expert physician shall have the right to leave without pay
for a maximum period of up to one year.
•Government, non-government or private organization or institution will make
necessary arrangement for working women to breastfeed their infant during
office hours for a period of up to two years from their birth. Even in cases of still
birth or death of an infant after birth, the pregnant woman will be entitled to
leave referred in sub-section.
•A male staff of government, non-governmental or private organization or
institution shall get paternity leave with remuneration for 15 days before or after
the child delivery of his wife.
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57. Rights, Safe Motherhood and Reproductive health Act,2018……….
Rights for seeking safe abortion: A pregnant woman shall have the right to seek safe
abortion under the following conditions:
•Up to twelve weeks of pregnancy with the consent of a pregnant woman;
•Up to twenty-eight weeks of pregnancy with the consent of the concerned woman, if
in the opinion of a licensed physician that if an abortion is not performed, there may
be danger to the life of a pregnant woman or her physical or mental health may
deteriorate or a child born will be impaired
•Up to twenty-eight weeks of pregnancy with the consent of the pregnant woman in
case the conception is a result of rape or incest,
•Up to twenty-eight weeks of pregnancy with the consent of the woman who is
infected with virus that deteriorates immune system (HIV) or suffering from any similar incurable disease,
•Up to twenty-eight weeks of pregnancy with the consent of the pregnant woman, if
in the opinion of the health service provider involved in the treatment, due to fetal impairment the fetus is likely to become non- viable or unlikely to survive after birth
or become deformed due to any genetic disorder or any other reason
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58. Rights, Safe Motherhood and Reproductive health Act,2018……….
Confidentiality to be maintained:
•A listed health institution or listed health service provider shall maintain the
confidentiality, of information and documents, relating to reproductive health
counseling and services provided to a pregnant woman.
•Disabled-friendly service:Family planning, reproductive health, safe
motherhood, safe abortion, emergency obstetric care and newborn care,
reproductive health morbidity, shall be adolescent and disabled friendly.
•Discrimination prohibited:No one shall be discriminated in their right to access
services, including family planning, reproductive health, safe motherhood, safe
abortion, emergency obstetric care and newborn care, reproductive morbidity,
menstrual care on the ground of origin, religion, color, caste, ethnicity, sex,
community, occupation, business, sexual and gender identity, physical or health
condition, disability, marital status, pregnancy, creed, state of being suffering
from any disease or infected with virus or vulnerable to such infections, state of
reproductive morbidity, personal relationship or any other such grounds.
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59. National RH Policies and Strategies
•National health Policy 2019, has included; In accordance with the concept
of health across the lifecycle, health services around safe motherhood,
child health, adolescence and reproductive health, adult and senior citizen
shall be developed and expanded;
This policy has further included;
•Safe motherhood and reproductive health services shall be made of good quality,
affordable and accessible.
•Health services targeted to vulnerable age groups such as maternal- infant health,
child health, adolescent health, adult health and geriatric health shall be
strengthened and professional midwifery and nursing services shall be expanded.
•In view of social determinants that affect women’s health, special programs shall be
implemented in coordination with concern stakeholders
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60. National RH Policies and Strategies……………
•In order to strengthen safer motherhood and reproductive health, skilled birth
attendants shall be arranged in all wards.
•Abortion service shall be made qualitative and effective as per the law.
•Health services related with infertility shall be gradually extended to the state
level
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61. National RH Policies and Strategies………………
National Reproductive Health Strategy, 1998 has included following points;
•Implement the ‘Integrated Reproductive health Package’ at hospital, PHC center,
Health Posts as well as through PHC outreach, TBAs, FCHVs/Mother groups and
other community and family level activities based on standardized clinical protocols
and operational guideline
•Enhance functional integration of RH activities carried out by different divisions.
•Emphasize advocacy for the concept of Reproductive Health including the creation
of an enabling environment for inter and intra- sectoral collaboration
•Review and develop IEC materials to support all levels of intervention including
rumor countering message
•Review and updates the existing training curricula of various health workers to
include missing RH component
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62. •Ensure effective management system by strengthening and revitalizing
existing committees at various levels
•Develop a national RH research strategy which outlines research priorities
and work plans based on information requirements of policy makers,
planners, managers and service providers
•Construct/upgrade appropriate service delivery and training facilities at the
national, regional, district and health post level
•Institutional strengthening through structured planning,
monitoring/supervision and performance review
•Develop an appropriate RH program for adolescents
•Support for national experts/consultants and
•Promote inter-sectoral and multi- sectoral coordination.
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63. RH service at different level
•Family/Decision makers’ level
•Local level/Health Facility Level
•Provincial level
•Federal level
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64. Family level: Decision making (delay in decision making at family level contribute in
maternal mortality). Similarly timely decision making and support in other components
of RH, e.g.
•In the promotion of proper nutrition, immunization and creating healthy environment at home.
•Knowledge on FP and its appropriate use.
•Identification and recognition of danger signs during pregnancy, provide nutritious diets and rest
during pregnancy and post-partum period, encourage utilization of ANC/ PNC, birth preparedness
and arrangement of fund and transport, registration of maternal-neo-natal death
•Identification of danger signs and complications related to newborn and seek care from
appropriate health institution. Complete immunization as per schedule
•Know about the appropriate place to get abortion service, and also possible complication related
with abortion
•Recognize symptoms of abortion and seek timely care from appropriate place and trained health
worker.
•Know about the STIs/STDs and follow the appropriate preventive measures, Promote the use of
condom.
•Identify about the infertility condition and seek appropriate care from trained health worker.
•Identify the reproductive health problems of elderly and seek timely and appropriate care.
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65. •Community level/Local level/ health facility level:
•Increasing the accessibility, availability and utilization of the RH services
•Support deprived, marginalized community in utilization of service
•Support to create adolescents and disable friendly RH services
•Support health workers to enhance their capacity to provide effective RH service
•Provide IEC materials to the targeted population
•Maintain the death registry and encourage the community peoples to register the
maternal and neo-natal/ infant/ child deaths.
•Promote the PHC-ORC service to reach the unreached population
•Make the services and commodities uninterrupted and easily available at the Health
facilities
•Establish appropriate referral mechanism
•Establish appropriate record keeping system at the health facility (if possible establish
EPR system)
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66. •Provincial level and Federal level
•Make supportive policy to address the need general as well as specific
population.
•Ensure the regular supply of commodity at local and community level
•Ensure the deputation of sufficient number of trained service providers
at the health facilities as per service demand.
•Support in capacity building of the health workers involved in providing
RH services.
•Develop necessary IEC materials
•Develop updated training manuals and protocols based on the national
and international evidences.
•Regular monitoring, supervision and support
•Conduct advocacy on various issues related with RH
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67. For further strengthening the RH program
•In-service orientation and training to improve the coverage and quality of
RH service among the managers and service providers.
•Advocacy and IEC materials to provide concept of Reproductive health
(life cycle approach)
•Management including planning, monitoring, supervision, performance
review and evaluation.
•Quality assurance for RH services
•Reproductive health research to identify TH priorities
•Ensuring sufficient logistic and equipment
•Collaboration with NGOs and private sector
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68. For further strengthening the RH program………….
•Ensure access, availability, affordability and quality health services: Safe and accessible
reproductive health services (safe abortion, maternal health services, pre-natal care, emergency
obstetric care, safe delivery and post-natal care, skilled birth attendants, maternity leave etc.) are
needed and services should be guaranteed throughout the life-cycle.
•Ensure appropriate reproductive education, information and services to all age groups: Provide
necessary package of sexual and reproductive health information and services. Ensure youth-
friendly approaches that respect the right to confidentiality as well as specific approach to address
the needs of older women.
•Increase awareness regarding SRHR: Awareness raising in community through engagement of
people from different groups. Involve male members, elders, community leaders, traditional and
religious leaders etc.
•Ensure proper implementation of relevant laws and policies: Focus on the timely and effective
implementation of laws that guarantee women their social, cultural, economic, civil and political
rights while protecting SRHR of vulnerable groups (adolescents, unmarried young women and
mothers, widows, single mothers, migrants, indigenous communities and those belonging to
ethnic or sexual minorities, sex workers, and people living with HIV).
•Minimize and affectively address the GBV(providing women and girls with effective protection,
access to justice)
•SRH needs to be dealt with through multi-sectoral approach
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