Reproductive Health: An Overview

Shahida Abbasi
Nursing Instructor
PGCN
October, 2020
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 Sessions Objectives
By the end of the session learners will be able to:

1. Introduce concepts of Reproductive health

2. Discuss the women’s health and its relationship to
poverty, access and quality of care.
3. Define maternal health and its indicators.
4. Discuss health services available in Pakistan to support
maternal & child health
5. Discuss the national and international initiatives in RH
6. Integrate the role of a nurse midwife, community health
nurse and other health team members in reproductive
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health care.
 Reproductive Health
• Reproductive Health (RH) is a state of complete
physical, mental and social well-being, and not merely
the absence of reproductive disease or infirmity.

• RH deals with the reproductive processes, functions and

system at all stages of life.

• RH, 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.
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 Conti…

RH is the right of men and women

• Access to appropriate health care services that will

enable women to go safely through pregnancy and
childbirth – have a healthy Infant.
•
• Access to safe, effective, affordable and acceptable
methods of fertility regulation/ family size.

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 Components of RH
 Family planning
 Antenatal, safe delivery and post-natal care
 Prevention and appropriate treatment of infertility
 Prevention of abortion and management of the
consequences of abortion
 Treatment of reproductive tract infections;
 Prevention, care and treatment of STIs and
HIV/AIDS

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 Conti…
 Information, education and counselling as appropriate,
on human sexuality and reproductive health
 Prevention and surveillance of violence against
women, care for survivors of violence and other
actions to eliminate traditional harmful practices
 Appropriate referrals for further diagnosis and
management of the above.
 Infertility and sexual dysfunction
 Adolescent Reproductive and Sexual Health
 RH needs associated with menopause including
reproductive tract cancers
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 Maternal Health

• Maternal health involves health care needed during

pregnancy, labour and postpartum period.
• The target population includes women; Infants;
children and adolescents.
• It also encompasses children with special health care
needs.

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 Maternal Morbidity Mortality

Maternal Morbidity/ Mortality

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”

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 Maternal Deaths Causes

Direct Causes In direct Causes

Anemia
APH/PPH Malaria
Obstructed labor Heart Disease
Septic abortion Hepatitis

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 Case study why did Shazia die
Why did Shazia die?
Shazia is an 18 year old woman live in a village; her
mother passed away when Shazia was only 5 years old.
She was married 5 years back with Umar age 40 years.
Shazia’s father borrowed some money and was not able
to return in time, therefore in return Umar demanded to
wed Shazia. Umar was already married and had four
children.

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 Umar have abused his second wife Shazia . She would do all
household chores; and she would hardly get enough to eat. In
last five years she had been pregnant for 4 times; this is the
fifth time she is pregnant again. She also had two abortion for
which her husband have blamed and beaten her.
Few days back Shazia had spotting but she kept quite because
of fear. One day she went to fetch water from community tap;
on the way back she felt dizzy and fell down.
As the villagers passed by they noticed her; she was taken
home. The family did not take her to hospital because of lack
of interest in her health and the distance of hospital from
home. However they called village TBA who could not help
her; rather her condition got deteriorated by next morning and
1 she died.
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 Umar have abused his second wife Shazia . She would do all
household chores; and she would hardly get enough to eat. In last
five years she had been pregnant for 4 times; this is the fifth time
she is pregnant again. She also had two abortion for which her
husband have blamed and beaten her.

Few days back Shazia had spotting but she kept quite because of
fear. One day she went to fetch water from community tap; on the
way back she felt dizzy and fell down.

As the villagers passed by they noticed her; she was taken home.
The family did not take her to hospital because of lack of interest in
her health and the distance of hospital from home. However they
called village TBA who could not help her; rather her condition got
deteriorated by next morning and she died.

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 Factors Contributing to MMR
High Risk Pregnancies
• Young age below 18
• Primigravida
• Grand multigravida
• Poor out come in previous
pregnancy
• Maternal employment &
paternal unemployment
• Pregnancy with chronic
disease
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Poor Health Facilities
• Accessibility
• Affordability
• Poor quality of Care
• Insufficient Resources
(Human and material)
• Attitude of the skill
birth attendant
• Inappropriate treatment
• Delay in referrals
 Conti…
Social Issues
• Low literacy
• Lack of awareness about RH rights
• Gender inequality
• Women empowerment
• Lack of legislation to control quack
• Delays in decision making (three delays).
• Traditional methods for treating infertility and
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abortion.
 Maternal Mortality: Magnitude

Why does more

women die in
developing
countries?

15 Source: http://www.gendercide.org/ case_maternal

 “Three-Delays Model”

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 Three Delays Model
1. Delay in decision making to seek treatment
 Lack of understanding of complications
 Acceptance of maternal death
 Low status of women
 Socio-cultural barriers to seeking care
2. Delay in reaching health care facility
 Mountains, islands, rivers — poor
organization

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 Conti…
3. Delay in receiving care
 Unavailability of staff and supplies (blood,
lab test, Poorly trained personnel with
punitive/negative attitude
 Finances

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 Magnitude of the Problem
Maternal Mortality: A Global Tragedy
Annually, 585,000 women die of pregnancy related
complications
99% in developing world
1% in developed countries

Risk of dying from pregnancy-related

Complications is 45 times higher than that of her
counterparts in developed countries.

WHO, UNICEF, UNFPA update estimates (2000)

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 Conti…
 Pakistan - 6th most populous nation in the world
 MMR is 177/100,000 live births in Pakistan
 86% of women received ANC from a skilled provider
 51% of women had at least four antenatal care visits
 69% women were protected against neonatal tetanus
 69% of deliveries were conducted by skilled birth
attendants
 66% of deliveries took place in a health facility.
 44% women in rural areas and 75% in urban areas
delivered by SBA.
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PDHS 2017-18
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  62% of women reported having received a PNC
check-up.
 Under-5 mortality rate declined steadily from
112/1,000 live births to 74/1,000 live births in the
most recent 5-year period.
 Infant mortality decreased from 86 to 62 deaths per
1,000 live births.
 Though the neonatal mortality stagnated at 55 deaths
per 1,000 live births for nearly a decade, as reported
by 2006-07 PDHS and 2012-13 PDHS, it has
declined to 42 deaths per 1,000 live births.
PDHS 2017-18
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 MMR

 MMR is 177/100,000 live births in Pakistan

 3/100,000 live births in Greece
 4/100,000 in Austria
 5/100,000 in Japan
 6/100,000 in Germany
 7/100,000 in Canada
 9/100,000 live births in UK
PDHS 2017-18

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 Maternal Morbidity in Pakistan
Out of each 100 women having morbidity:
• Puerperal pyrexia 79.8 %
• Postpartum hemorrhage (PPH)16.5%
• Rupture uterus 11%
• Fistulae 4.2 %
• Only 22 % MCBA received professional
postnatal care for the last birth within 24
hours.

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 Maternal Health Situation Analysis in Pakistan
 50 % Receive Adequate Antenatal Care
 31 % Deliveries Conducted by skilled birth attendants.
 51 % Pregnant Receive Tetanus Immunization
 28% Receive Postnatal Care 40% deaths in postnatal
period
 Inaccessible health care facilities
 30 % Female Literacy

Source: Ministry of Health July 2005

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 MCH Care Delivery in Pakistan
70 % health is provided by private sector
 Quality is from Excellent to poor

30 % Government
 Free of cost
 Quality care poor/good
 Accessibility
 Strong infrastructure but functionally questionable

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 Pakistan Government Health Care System
Tertiary Teaching Hospital
University Hospital

24% female
Secondary
staff & 14%
District Hospital
female Drs.
Sub-district Hospital

20% not functioning

Rural Health Centre Facility-based care 58% female sanction post
not filled

Primary Family and

Basic Health Units Outreach Community
Packages

2LHVs & FHT

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Status of Health Care Personals in Pakistan (2001)

 Population per doctor 1, 552

 Population per nurse 3, 788
 Population per hospital bed 1, 518
 MCH centers 85
 Village based workers 13, 084
 Lady health visitors 4500

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 MCH Care Delivery Status in Pakistan
No linkage b/w community health
care and facility base personnel's
LHWs—PHC and family
planning hope to reduce the
gap

Missing referral chain among

Secondary and tertiary facility
and
Self referral makes
overcrowding Quality poor

Government & NGOs working on

new concept of
Community midwifes

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 Role of a nurse in RH
• Knowing the client /community and clinical
understandings of the health and illness experiences of
individuals and families within the population.
Assessment
• Equipped with knowledge and skills for appropriate
application
• Multidisciplinary approach to achieve assessment,
assurance and policy development.
• Three levels of care ???
• Advocacy of client/communities

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 Role of a nurse in RH

 Provide essential input to interdisciplinary programs

that monitor, anticipate, and respond to public health
problems in population groups.

 Evaluate health trends and risk factors of population

groups and help determine priorities for targeted
interventions.

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 Role of a nurse in RH
• Work with communities 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 RH
programs and services available and are assisted in the
utilization of available services.
• Provide health education, and primary care to individuals
and families who are at high risk groups.

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 International funded projects since Alma Ata
Initiative to improve RH
Declaration
Safe Motherhood Initiative
• Family health project
• Women Health Project
• Traditional Birth attendant training program
• Lady Health Worker program
• PAIMAN (Pakistan Initiative for Mothers and
Newborns).
• NMNCH Program

Aim of all the projects was to improve the maternal and

child Health in Pakistan

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 Initiative to improve RH
International initiatives

 Beijing Conference 1994

 Cairo Conference –ICPD 1995
 MDGs (MDG 5) Improving Maternal Health
2015 {one of the two target is to improve RH}
 Sustainable Development Goals October 2015

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 References
WHO Make every child and mother count (2005) . World Health Report 2005 Geneva

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

Salihu, H.M. Ray.A.M. (2004). The impact of maternal mortality in muslim using
traditional birth attendant’s and village midwifes. Journal of Obstetrics and gynecology,
24(1), 5-11.

WHO, UNICEF, “UNFPA, World Bank Group and United Nation Population Division.
Trends in maternal mortality: 1990-2015. Estimates by WHO, UNICEF.” (2015): 599-620.
URL: data.worldbank.org/indicator/sh.sta.mmrt

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 References
AbouZahr C, Wardlaw, T. Maternal Mortality in 2000: Estimates Developed by WHO,
UNICEF and UNFPA. Geneva: WHO; 2000. Available at: www.who.int/reproductive-
health/publications/maternal_mortality_2000/maternal_mortality_2000.pdf.

Bhutta, Z., Dewraj H. Gupta, i., Silva, H., Manandhar, D., Awasthi, Hossain, M., & Salam,
M, (2004) Maternal and child health: is ready to change in south Asia BMJ; 328, 816-819,

Betrán, A Wojdyla, D, Posner, S, Gülmezoglu M. (2005) National estimates for maternal

mortality: an analysis based on the WHO systematic review of maternal mortality and
morbidity. BMC Public Health. 5: 131. 1.

Begum , S., Aziz-un-Nisa, Begum., I. (2003). Alysis of maternal mortality in a tertiary care
hospital to determine causes and preventable factors
J Ayub Med Coll Abbottabad; 15 (2)

Donna, H., Danel, L., Isabella & Patricia, T. (2000). Maternal mortality rates, United States
and Canada, 1916–1997. Birth 27 (1), 4-11.

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