SEXUAL AND REPRODUCTIVE HEALTH LECTURE - Copy - Copy - Copy.pptx

Sexual and reproductive health lecturer, it included all types of reproductive health issues and policies

1. SEXUAL AND REPRODUCTIVE HEALTH DR KWAKU ASAH-OPOKU 25/05/2023

2. OUTLINE OF PRESENTATION Introduction Definition of Reproductive Health(RH) Components of Reproductive Health Indicators For Reproductive Health Reproductive health and gender issues Conclusion

3. INTRODUCTION “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” - World Health Organization

4. INTRODUCTION Reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for women, and 14% for men.“(WHO) Unmet needs for sexual and reproductive health deprive women of the right to make "crucial choices about their own bodies and futures“.(UNFPA)

5. INTRODUCTION

6. DEFINITION OF REPRODUCTIVE HEALTH A state of complete physical, mental, and social well being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and to its functions and process” . (ICPD 1994)

7. Reproductive health, therefore, 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.”

8. Implicit in this last condition are the right of men and women to be informed [about] and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of birth control which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant

9. THE CURRENT SEXUAL AND REPRODUCTIVE HEALTH (ICPD) PARADIGM SHIFT Focus on micro concerns on the individual level as compared to the population level Focus on comprehensive reproductive health services instead of just family planning Move into an integrated system instead of a top down approach on policies Move from a technology based directive approach to a rights based approach that focuses on the link between human rights and health. Involves decentralised managers and providers as well as community involvement

10. Definition Sexual Health involves “ The integration of the physical, emotional, intellectual and social aspects of the sexual being in ways that are positively enriching and that enhance personality, communication and love. Every person has the right to receive sexual information and to consider sexual relationships for pleasure as well as for procreation

11. Question: Based on your current understanding of reproductive health, what should be the approach to managing a young lady who presents to the family planning unit for contraception?

12. The lifecourse approach to reproductive health

13. INDICATORS OF REPRODUCTIVE HEALTH WHO has a set of 17 indicators for RH which cover the main service areas of RH Rationale for these indicators: To provide an overview of the RH situation at global and national levels

14. INDICATORS OF REPRODUCTIVE HEALTH The indicators are: 1. Total fertility rate : It can be interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the current observed age-specific rates. GMHS 2017-TFR=3.9 (4.7 Rural, 3.9 Urban).

15. 2. Contraceptive Prevalence Rate (CPR): % of women of reproductive age (15-49) who are using (or whose partner is using) a contraceptive method at a particular point in time

16. 3. Maternal Mortality Ratio (MMR): Annual number of maternal deaths per 100,000 live births

17. Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Indirect obstetric death is maternal death resulting from previously existing disease or disease that developed during pregnancy and that was not due to direct obstetric causes, but that was aggravated by physiological effects of pregnancy

18. Data sources and collection methods For most countries, there are three main sources of data with which to calculate the maternal mortality ratio: vital registration health facility-based data population-based surveys or surveillance.

19. Recommended data collection methods 1. RAMOS (reproductive-age mortality surveys) seek to identify and classify all female deaths in the reproductive period, using both traditional and untraditional sources of information to find deaths, such as cross-sectional household surveys, continuous population surveillance, hospital and health- centre records and key informants.

20. 2. The sisterhood method This may overcome large sample size requirements by interviewing adult respondents about the survival of all their sisters, thereby yielding information on many woman-years at risk for each household visit. 3. Confidential enquiries into maternal deaths

21. 4.Antenatal Care Coverage

22. 5. Births attended to by skilled health personnel

23. 6. Facilities with basic obstetric care per 500,000 population 7. Facilities with comprehensive obstetric care per 500,000 population

24. Essential Obstetric Care Two types: basic essential obstetric care and comprehensive essential obstetric care. Basic essential obstetric care (also called basic emergency obstetric care) at the health centre level should include at least: - Parentral antibiotics Parentral oxytoxic drugs Anticonvulsants for eclampsia Manual removal of placenta Removal of retained products Assisted vaginal delivery

25. Comprehensive essential obstetric services at district hospital (first referral level) should include all of the above, plus: – Obstetric Surgery(Caesarean section) Blood transfusion

26. WHO recommends that there should be at least four BEOC and one CEOC facilities for every 500,000 population.

27. INDICATORS OF REPRODUCTIVE HEALTH 8 . Perinatal deaths: fetal or early neonatal deaths per 1,000 total births

28. 9. Low birth weight: babies weighing less than 2,500 grams

29. 10. Positive for syphilis Percent of pregnant women (15-24) attending antenatal clinics, whose blood has been screened for syphilis, with positive serology for syphilis

30. INDICATORS OF REPRODUCTIVE HEALTH 11. Prevalence of anemia Percent of women of reproductive age (15-49) screened for hemoglobin levels with levels 11.0g/dl for pregnant women, and 12.0g/dl for non-pregnant women 12. Health facility admissions due 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) Prevalence of female genital cutting/mutilation Percent of women interviewed in a community survey reporting having undergone FGC 14. Infertility 15. Urethritis (in men) Percent of men aged (15-49) interviewed in a community survey reporting episodes of urethritis in the last 12 months 16. HIV prevalence among women Percent of pregnant women (15-24) attending antenatal clinics, whose blood has been screened for HIV and who are sero -positive for HIV 17. Knowledge of HIV 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

31. INDICATORS OF REPRODUCTIVE HEALTH These indicators can be found in Demographic and Health Surveys World Health Organization FP2020 United Nations Human Development Index Country studies, surveys, censuses

32. COMPONENTS OF REPRODUCTIVE HEALTH Safe motherhood Deals with initiatives practices and protocols that assist in achieving conception, going through pregnancy and childbirth, delivery of a healthy infant in the best of health.

33. COMPONENTS OF REPRODUCTIVE HEALTH Safe motherhood Family planning Antenatal care Obstetric care Postnatal care Post-abortion care Sexually Transmitted Infection/HIV control

34. COMPONENTS OF REPRODUCTIVE HEALTH Community education on safe motherhood Prenatal care and counseling, including the promotion of maternal nutrition Skilled assistance during childbirth Care for obstetric complications, including emergencies Postpartum care Post-abortion care and, where abortion is not against the law, safe services for the termination of pregnancy Family planning counseling, information and services Reproductive health education and services for adolescents

35. COMPONENTS OF REPRODUCTIVE HEALTH 2.Family planning Family planning refers to the planning of when to have children and the use of birth control. It allows individuals and couples to anticipate and have their desired number of children, and to achieve healthy spacing and timing of their births. Family planning is achieved through use of contraceptive methods and the treatment of involuntary infertility

36. Contraception: Voluntary or deliberate prevention of pregnancy Types Natural and Modern Hormonal and non-hormonal Short acting and long acting Reversible and Permanent

37. COMPONENTS OF REPRODUCTIVE HEALTH Modern forms include oral contraceptive pills; implants; injectables ; patches;

38. COMPONENTS OF REPRODUCTIVE HEALTH vaginal rings diaphragms Intrauterine Contraceptive Devices(IUDs) male and female condoms vasectomy female sterilisation

39. COMPONENTS OF REPRODUCTIVE HEALTH Natural family planning methods Standard days method Calendar Rhythm methods Two day method Cervical mucus method Basal body temperature method

40. COMPONENTS OF REPRODUCTIVE HEALTH Natural family planning Symptothermal method Lactational Amenorrhoea method Withdrawal method

41. COMPONENTS OF REPRODUCTIVE HEALTH 3. Prevention and management of unsafe abortion and post abortion care Unsafe abortion is the procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards or both(WHO 1992) Worldwide, unsafe abortions account for 13 % of maternal deaths(WHO 1997)

42. COMPONENTS OF REPRODUCTIVE HEALTH Safe abortion services, as provided by law, need to be available, provided by well trained health personnel, supported by policies, regulations and a health systems infrastructure, including equipment and supplies, so that women can have rapid access to these services”(WHO 2003)

43. COMPONENTS OF REPRODUCTIVE HEALTH Post abortion care Five elements of post abortion care Community and service provider partnerships for prevention of unwanted pregnancies and unsafe abortion Counselling Treatment Contraceptive and family planning services Reproductive and other health services

44. COMPONENTS OF REPRODUCTIVE HEALTH Comprehensive abortion care=safe abortion care+ post abortion care

45. COMPONENTS OF REPRODUCTIVE HEALTH 4. Prevention and management of Reproductive Tract Infections (RTIs), including Sexually Transmitted Infections (STIs) and HIV/AIDS The specific objectives include Prevention and control of reproductive tract infections Prevention and control of sexually transmitted infections To diagnose and treat reproductive tract infections To prevent transmission of HIV To manage and support people living with HIV/AIDS

46. COMPONENTS OF REPRODUCTIVE HEALTH 5. Prevention and management of infertility The objectives include Prevention of infertility Treatment of infertility Promotion of social support for infertile couples

47. Effects ACCOG Meeting at Pentecost Convention Centre March 2014 More than 1500 couples

48. COMPONENTS OF REPRODUCTIVE HEALTH 6. Prevention and management of cancers of the female and male reproductive system, including the breast The objectives include Detection of early cancers of the reproductive system Treatment of cancers of the reproductive system Management of terminally ill reproductive tract cancer patients

49. COMPONENTS OF REPRODUCTIVE HEALTH 7. Responding to the concerns about menopause and andropause (male climacteric) The objectives include Creation of awareness and response to the concerns about symptoms and signs of menopause and andropause Provision of appropriate management of clients with bothersome menopausal symptoms

50. COMPONENTS OF REPRODUCTIVE HEALTH 8. Discouragement of harmful traditional practices and gender based violence that affect the reproductive health of women and men Female genital mutilation/Cutting Pregnancy related food taboos Ritual servitude eg Trokosi The objectives are To manage victims of harmful traditional practices To rehabilitate victims To create public awareness on the dangers of harmful traditional practices

51. COMPONENTS OF REPRODUCTIVE HEALTH To integrate prevention and management of harmful traditional practices into the curricula of pre-service health training institutions To build capacity for the management of victims of harmfulpractices .

52. Trokosi

53. Female Genital Mutilation(FGM)/ Female genital cutting(WHO 1997) FGM comprises all procedures that involve partial or total removal of the female external genitalia and or injury to the female genital organs for cultural or any other non-therapeutic reasons Globally approximately 200 million women and girls who are alive have been mutilated. 8000 are mutilated each day One female is mutilated every 10 seconds(WHO 1994)

54. FGM is mostly carried out on young girls between in fancy and age 15 years Treatment of the health complications of FGM in 27 high prevalence countries is estimated to cost 1.4billion USD per year and projected to rise to 2.3 billion USD by 2047 if action is not taken.(WHO 2022)

55. Overall prevalence of female genital mutilation in Ghana is 4%(UNICEF 2013).

56. Classification of FGM Type I:Excision of the prepuce with or without excision of part, or all, of the clitoris Type II: Excision of the prepuce and clitoris together with partial or total excision of the labia minora Type III: Excision of part or all of the external genitalia and stitching or narrowing of the vaginal opening(infibulation) Type IV:Unclassified Pricking, piercing or incision of the clitoris and or labia

57. Stretching of the clitoris and or labia Burning of the clitoris and surrounding tissues Scraping( angurya cuts) of the vaginal orifice or cutting( gishiri cuts) Introduction of corrosive substances into the vagina

58. Reasons for FGM Traditional reasons Sociological reasons Psychosexual beliefs Hygiene Economic

59. Complications of FGM Physical Short term: Severe pain, Shock, Haemorrhage, tetanus, sepsis, urine retention, ulceration of the genital region, HIV infection Long term: Cysts and abscesses on the vulva, urinary incontinence, keloid formation, painful sexual intercourse, recurrent urinary tract infections, increased risk of maternal death and still birth. Sexual consequences Mental and social complications)

60. Question: How can the menace of FGM be stopped in Ghana?

61. The law on female Genital Mutilation in Ghana-Criminal Code-1960(Act 29)- FGM second degree felony and liable to conviction of not less than 3 years Enforcing the legislation Advocacy Education of all Poverty alleviation Health promotion On FGM into routine Antenatal care ANC and postnatal care

62. Mens groups and womens groups as agents of change Engagement of chiefs, opinion leaders etc on FGM and its effects

63. 9. Information and counselling on human sexuality, responsible sexual behaviour, responsible parenthood, preconception care and sexual health

64. Gender and reproductive health Sex refers to biological and physiological attributes of that identify a person as male or female Gender refers to the economic, social and cultural attributes and opportunities associated with being male or female in a particular social setting at a particular point in time. Gender equality means equal treatment of women and men in laws and policies, and equal access to resources and services within families, communities and society at large

65. Gender and Reproductive health Gender equity means fairness and justice in the distribution of benefits and responsibilities between women and men. It often requires women-specific programmes and policies to end existing inequalities.

66. City for All Women Initiative (CAWI), Ottawa

67. Gender discrimination refers to any distinction, exclusion or restriction made on the basis of socially constructed gender roles and norms which prevents a person from enjoying full human rights. Gender stereotypes refer to beliefs that are so ingrained in our consciousness that many of us think gender roles are natural and we don’t question them. Gender bias refers to gender based prejudice; assumptions expressed without a reason and are generally unfavorable.

68. Reproductive Health and Gender Gender mainstreaming : the incorporation of gender issues into the analysis, formulation, implementation, monitoring of strategies, programs, projects, policies and activities that can address inequalities between women and men Gender analysis is a research tool that helps policy makers and program managers appreciate the importance of gender issues in the design, implementation, and evaluation of their projects.

69. Conclusion Reproductive Health is very important as a channel for good sexual health and also forms the basis of development. The RH Indicators indicate a wide disparity between developed and developing countries There is the need for improvement in Reproductive health services

70. References "Reproductive Health Strategy" . World Health Organization. Retrieved 2018-04-24 "Sexual reproductive health" . UN Population Fund. ICPD Programme of Action, paragraph 7.2. Save the Children, 2012, Every woman’s right: How family planning saves children’s lives Ghana Statistical Service (GSS) Ghana Health Service (GHS), and Macro International,. Ghana Maternal Health Survey 2017. GSS, GHS, and Macro International, Calverton, Maryland, USA