21/05/2007

KESEHATAN REPRODUKSI
Pemeliharaan dan perawatan
k
kesehatan
h t serta
t d
dampaknya
k
pada
d
kesehatan reproduksi

RH Outlook 2003
RH Library
Sumber dari Depkes

21/05/2007

Millenium Development Goals

(United Nation)- 2015
1
1.
2.
3.
4.
5.
6.
7.
8.

Menghapus kemiskinan dan kelaparan

Pendidikan untuk semua orang
Promosi kesetaraan gender
Penurunan angka kematian anak
Meningkatkan kesehatan ibu
Memerangi HIV/AIDS, malaria dan penyakit
l i
lain
Menjamin kelestarian lingkungan
Kemitraan global dalam pembangunan

RUANG LINGKUP KES-PRO

1
1.
2.
3.

4.
5.
6.
7.

Kesehatan Ibu dan Anak

Keluarga Berencana
Pencegahan dan penanggulangan Infeksi
Saluran Reproduksi(ISR), termasuk IMSHIV/AIDS
Pencegahan dan Penanggulangan
Komplikasi Abortus
Kesehatan Reproduksi Remaja
Pencegahan dan Penanganan Infertilitas
Kanker pada Usia Lanjut dan Osteoporosis

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Definisi SEHAT Kesehatan

Reproduksi (ICPD Kairo ,1994)

Suatu keadaan sejahtera fisik , mental

dan sosial secara utuh, tidak sematamata bebas dari penyakit atatu
kecacatan dalam semua hal yang
berkaitan dengan sistem reproduksi,
serta fungsi dan prosesnya .

KESEHATAN IBU DAN ANAK

21/05/2007

Kesehatan ibu dan anak

AKI Indonesiaan /100.000

/100 000 kelahiran
hidup :

1986
1992
1994
1995
1997
2003

450
421
390
373
334
307

Worldwide, it is estimated that 515,000

women die yearly from complications of
pregnancy and childbirthabout one woman
every minute.
Some 99 percent of these deaths occur in
developing countries, where a woman's
lifetime risk of dying from pregnancy-related
complications is almost 40 times higher than
that of her counterparts in developed
countries.

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Figure2

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Safe Motherhood Initiatives

The SMI
SMI's
s target has subsequently been adopted
by most developing countries. Under the Safe
Motherhood Initiative, countries have
developed programs to reduce maternal
mortality and morbidity. The strategies
adopted to make motherhood safe vary among
countries and include:
providing family planning services;
providing postabortion care;
promoting antenatal care;
ensuring skilled assistance during childbirth
improving essential obstetric care; and
addressing the reproductive health needs of
adolescents.

Essential Obstetric Care

Ensuring access to essential obstetric care is
especially important in reducing maternal
deaths. Basic essential obstetric care (also
called basic emergency obstetric care) at the
health center level should include at least:
parenteral antibiotics;
parenteral oxytocic drugs;
p
parenteral sedatives for eclampsia;
p ;
manual removal of placenta;
manual removal of retained products; and
assisted vaginal delivery.

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Comprehensive essential
obstetric care
Comprehensive essential obstetric
care services at the district
hospital level (first referral level)
should include all of the above,
plus:
surgery
anesthesia
blood transfusion

Ten years after: Key

lessons learned

recognizing
g
g that every
yp
pregnancy
g
y faces risks;;
increasing access to family planning services;
improving the quality of antenatal and postpartum care;
ensuring access to essential obstetric care (including
postabortion care);
expanding access to midwifery care in the community;
training and deploying appropriate skilled health
personnel (e.g. midwives);
ensuring
e
su g a continuum
co t uu o
of ca
care
e co
connected
ected by effective
e ect e
referral links, and supported by adequate supplies,
equipment, drugs, and transportation; and
reforming laws to expand women's access to health
services and to promote women's health interests.

21/05/2007

Ten years after: Key

lessons learned

Strong political commitment.

Involving national and local leaders and other
key parties .
Involving community members.
Training and deploying a range of health care
providers at appropriate service delivery levels
help increase access to maternal health
p
y life-saving
g services.
services,, especially
Effective communication between health care
providers at both the community level and the
district (first-referral).
Community education about obstetric
complications and when and where to seek
medical care is important.

Besarnya AKI bisa ditanggulangi

dengan meningkatkan:

Kesadaran perilaku hidup bersih dan

sehat
Status gizi dan status kesehatan ibu
Penyediaan akses terhadap pelayanan
Kes-Pro
Kes
Pro dan hak
hak-hak
hak reproduksi untuk
usia lanjut
Gender Development Index

21/05/2007

Peningkatan peran serta masyarakat

dalam penanganan kesehatan dan hak
reproduksi
Human Development Indeks (HDI)
Gender Empowerment Measure (GEM)
Buta huruf 15-45 tahun
Wajib belajar 9 tahun

ANTENATAL CARE W.H.O.

Birth Planning
Danger Signs

Perdarahan
Pre eklampsia/eklampsia
Perut nyeri
Pernapasan sesak
Panas

Emergency Preparedness and Complication

readiness
Social Support

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RECOGNITION

REFERRAL

RESPONSIVENESS

KELUARGA BERENCANA

10

21/05/2007

KELUARGA BERENCANA
Total Fertility Rate 1967
1967-1970
1970 : 5,5
55

SDKI 1995-1997 : 2,8

SDKI 2002-2003 : 2,6

Contraceptive Prevalence Rate :

1987 : 48 %

1997 : 57%

2002 : 60,3%
KB pria rendah : 4,4 %

Unmeet need (pasangan usia subur yg

seharusnya harus pakai KB namun tidak
memakai alat KB):
1997 9,7%
2002 8,6%
Diharapkan 2004 turun jadi 6,5%

11

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65% ibu hamil menderita 4 terlalu :

Terlalu
Terlalu
Terlalu
Terlalu

muda
tua
sering
banyak

Hal ini menujukkan bahwa masih banyak PUS

yg perlu
l ber
b KB
Hal ini menyebabkan unwanted pregnancy
illegal abortion AKI meningkat

Major issues in delivering high-quality,

cost-effective family planning services in
low-resource settings.

Increasing access to family planning

Overcoming medical barriers
Guidelines and indicators
Logistics and contraceptive quality assurance
Infection prevention
Interpersonal communication and counseling
Information, education, and communication
(IEC) activities

12

21/05/2007

Major issues in delivering high-quality,

cost-effective family planning services in
low-resource settings.

Training and performance improvement

Supervision
Quality improvement strategies
Integrated services
Financial management and sustainability
Policy making
Advocacy

PENCEGAHAN INFEKSI MENULAR

SEKSUAL (termasuk HIV / AIDS)

13

21/05/2007

Penelitian terbatas
Jakarta Utara (1997)- 312 klien KB:
Prevalensi ISR 24,7%

Klamydia 10,3% , trichomonas 5,4% ,

gonore 0,3%

Surabaya 599 perempuan hamil :

Infeksi
f
herpes simpleks 9,9%, klamidia
8,2%, trikomonas 4,8%, GO 0,8% dan
sifilis 0,7%

Base-line survey (1999)

42% remaja tahu HIV/AIDS

24% remaja tahu IMS
55% remaja mengetahui proses kehamilan
53% remaja tak tahu sama sekali bahwa
berhubungan sex mengakibatkan kehamilan
45% remaja beranggapan HIV/AIDS dpt
disembuhkan
42% beranggapan orang yg nampak sehat
tak mungkin mengidap HIV/AIDS

14

21/05/2007

Diperkirakan th 2002 90-130 ribu orang

HIV di Indonesia
Kumulatif sampai Juni 2005 infeksi HIV
3.740 AIDS 3.358
Kelompok berisiko tinggi waria penjaja
seks
k
Tidak hanya penjaja seks dan
langganan , pengguna NAPZA juga

Although AIDS is incurable, the

transmission of HIV is preventable.

increase people's
people s awareness and knowledge of
HIV/AIDS and how to protect against it;
create an environment where people can
openly discuss safer sexual and drug-injecting
practices and ways to adopt them;
provide services such as access to affordable
condoms and clean injection equipment, HIV
testing, and treatment for reproductive tract
i f ti
infections
(RTIs)
(RTI ) iincluding
l di
sexually
ll
transmitted infections (STIs).
help people acquire the skills they need to
protect themselves and their partners;
reform laws to protect people's health and
expand their access to health services.

15

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Prevention

Knowledge alone is not enough. People need

skills, support, and motivation to change their
behavior and avoid HIV infection.
The same prevention approach will not work in
every setting. Risk and vulnerability vary in
every society, and it is not always possible to
find and work with all vulnerable groups.
Although targeting specific groups is
important, complementary efforts to reach the
general populationespecially young people
are equally essential to HIV prevention.
Political leadership and support are critical to
an effective response to the HIV/AIDS
epidemic.

Prevention

Working with young people is key to HIV

prevention efforts. Effective approaches
include:

HIV/AIDS life-skills education;

communications programs involving mass media;
condom access;
voluntary
l t
counseling,
li
testing,
t ti
and
d referral
f
l services;
i
management of STIs;
participation of parents and other adults; and
strategies to strengthen the social and economic
status of young people.

16

21/05/2007

Care and Support

Collaboration with local organizations

g
and
agencies can help enhance a project's visibility
and effectiveness.
By allowing more channels for entry to care
and support services, integration of services
with local institutions and community groups
(e.g., religious institutions, hospitals, local
health facilities, schools) help maximize use of
scarce resources and skills and increase
access.
Promotion of community- and home-based
care as part of a continuum of care is
important in efforts to control the AIDS
epidemic.

Care and Support

Collaboration with hospital-based services can facilitate

continuity of home-based care and support services.
Involving community members (including people with
and affected by HIV/AIDS, local leaders, traditional
healers, families members, women's groups) in the
planning and implementation of services is integral to a
project's success and helps ensure sustainability of
services.
Community members and volunteers,
volunteers especially people
with HIV/AIDS, can be trained and supported to provide
project services and play a vital role in educating their
peers and caring for people with HIV/AIDS (Kerrigan,
1999).

17

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KESEHATAN REPRODUKSI
REMAJA

Survei Depkes 1995/1996

Remaja 13-19
13 19 th di Jabar dan Bali ,
terdapat kehamilan remaja 7% dan 5%
Kehamilan Tidak Dikehendaki (Pradono
1997 N=1310) :

61% usia 15-19 th

12,2% melakukan pengguguran

7,2% ditolong dokter/bidan , 10,2% oleh

dukun, 70,4% tanpa pertolongan

18

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Kehamilan Remaja

Dampak fisik,
fisik kesehatan mental dan
emosi, keadaan ekonomi dan
kesejahteraan sosial dalam jangka
panjang thdp remaja , keluarga ,
bangsa

Masalah KesPro Remaja

Perilaku berisiko
Kurangnya akses pelayanan kesehatan
Kurangnya informasi yg benar dan dapat
dipertanggung jawabkan
Banyak informasi salah tanpa tapisan
Termasuk masalah IMS HIV/AIDS
Tindakan kekerasan seksual
K h
Kehamilan
il
dan
d
persalinan
li
muda
d usia
i (AKI ,
AKB naik)
Kehamilan tak dikehendaki umur<20 th (
resiko 2-4 x AKI dp ibu berusia 20-35 th

19

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Penyebab mendasar

Rendahnya pendidikan remaja

Kurangnya ketrampilan petugas
kesehatan
Kurangnya kesadaran semua pihak
akan pentingnya penanganan
kesehatan remaja

Lesson learned

Key strategies for reaching and serving youth

include:
- developing youth-friendly services;

- involving youth in program design, implementation, and

evaluation;
- training providers to attend to the special needs and
concerns of adolescents;
- encouraging community advocacy efforts to support youth
development and promote positive adolescent health
behaviors;
- implementing programs that provide complete and accurate
sexual health information; and
- incorporating skills-building exercises into youth programs to
help young people improve their self-esteem, develop their
communication skills about sexuality, and strengthen their
ability to negotiate safer sexual practices.

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KESEHATAN REPRODUKSI
USIA LANJUT

Sensus penduduk 2000 :

Wanita > 50 th : 15,5 juta
Pria > 55 th : 14,2 juta
Statistik :
Th 2002 wanita
it menopause 30,3
30 3 juta
j t
Laki2 andropause 24,7 juta

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Masalah

Wanita kekurangan estrogenestrogen banyak keluhan

,kualitas hidup turun.
Meningkatnya nyeri tulang dan sendi
Nyeri sanggama
Jantung koroner
Keganasan
Dementia
Gangguan produktivitas

Depending on the resources available,

appropriate services for older women may
include:

Counseling
g on diet,, exercise,, and other elements of a
healthy lifestyle to prevent cardiovascular disease and
osteoporosis.
Treatment of reproductive tract and urinary infections,
uterine prolapse, fistulas, and other gynecological
disorders.
Screening and treatment for cervical cancer and breast
cancer
Counseling on menopause and alleviation of symptoms
Medical management of women at high risk for
fractures, cardiovascular disease, and breast cancer.
Support services for older women caring for family
members infected with HIV and for grandchildren
orphaned by the disease

22

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Pada laki laki :andropause

Penurunan hormon androgen dan
testosteron
Impotensi
Keluhan tulang dan sendi
Pembesaran kelenjar
Kanker kelenjar prostat

GENDER DAN KEKERASAN

PADA PEREMPUAN

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To address these concerns, gender-sensitive

family planning and reproductive health
programs have broadened their understanding of
needed services to ensure access to:

information about sexuality (including the effect of

contraceptive methods on sexual satisfaction), and counseling
on personal sexual problems
advice on how women can negotiate sexual matters with their
partners and gain greater control over their sexual lives;
sexual education and youth-friendly health services for
adolescents
screening for common mental illnesses, such as depression
and anxiety, followed by appropriate treatment or referrals;
services
i
(or
( appropriate
i t referrals)
f
l ) for
f victims
i ti
off violence
i l
and
d
trafficking, including medical treatment, legal advice,
sanctuary, and psychological counseling
community-based programs that address gender issues,
including sexual double standards, folk beliefs about sex and
reproduction, and women's right to control their own bodies
activities that involve men in reproductive health issues and
programs as clients, partners, and gatekeepers

Providers who are sensitive to

gender and sexuality issues:

consistently treat female clients with respect;

collect
ll t information
i f
ti
about
b t a client's
li t' sexuall partners,
t
practices, and problems to help determine their health
and family planning needs;
help clients assess their STI risks;
determine how much control clients have over their
sexual lives and, when appropriate, suggest a
contraceptive method that can be used without their
partner's knowledge, offer to talk to the client's partner,
or teach the client how to negotiate sexual matters;
query clients about their situation, including the
possibility of domestic violence and trafficking; and
look for signs of STIs, evidence of physical and sexual
abuse, and damage from FGM during physical exams.

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25