

TS
 Learning objectives
 To define reproductive health
 To know the historical development of RH
 Understand magnitude of RH problems
 Understand RH indicators and criteria for
selection of indicators
 Know the targets of reproductive health

TS
 Introduction
Definition of Reproductive
Health:
• It 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.
TS
 ….introduction

• According to the World Health Organization

(WHO), reproductive health means a total
well-being in all aspects of reproduction,

• i.e., physical, emotional, behavioral and social.

TS
 ……..CONT’D
• it means 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.

• It also includes access to information and services

on safe, effective, affordable and acceptable
contraceptive methods
TS
• Reproductive health is life-long, beginning
even before women and men attain sexual
maturity

• and continuing beyond a woman's child-

bearing years.

TS
Figure a: The reproductive life cycle
TS
• A woman's reproductive years, which typically
span almost four decades, can be divided in stages

1. Menarche to intercourse

2. Intercourse to marriage

3. Marriage to first birth

4. First birth to attainment of desired family size

5. Attainment of desired family size to menopause

TS
 Historical development of the
concept
During the 1960s, UNFPA established with a
mandate to raise awareness about population
“problems” and to assist developing countries
In 1972, WHO established Research,
development and Human Reproduction
(HRP),dealt on fertility regulation

TS
the 1994 ICPD has been marked as the key
event in the history of reproductive health.

Three elements are of particular importance.

The first was the growing strength of the

women’s movement and their criticism of the
over-emphasis on the control of female fertility

TS
A second key development was the advent of
the HIV/AIDS pandemic; suddenly it became
imperative to respond to the consequences of
sexual activity other than pregnancy

A third development, that brought a unity to

the others, was the articulation of the concept
of reproductive rights.
TS
Three rights in particular were identified:

The right of couples and individuals

The right to attain the highest standard of

sexual and reproductive health; and,

The right to make decisions.

TS
Development of Reproductive Health
Before 1978 Alma-Ata Conference

• Basic health services in clinics and health centers

Primary health care declaration 1978

• MCH services started with more emphasis on

child survival

• Family planning was the main focus for mothers

TS
Safe motherhood initiative in 1987

• Emphasis on maternal health

• Emphasis on reduction of maternal mortality

TS
Reproductive health, ICPD in 1994

⃝ Emphasis on quality of services

⃝ Emphasis on availability and accessibility

⃝ Emphasis on social injustice

⃝ Emphasis on individuals woman's needs and

rights
TS
 SDG and reproductive health
• World Summit, declare universal access to RH.

• SDGs have a relation to RH.

• Goal 3 and 5 .

• “Sexual and reproductive health is

fundamental to the social and economic
development of communities and nations, and
a key component of an equitable society.”
TS
TS
TS
 Magnitude of Reproductive Health
Problem
• The RH system provides not only a solution
measure to the population problem

• but it also contributes to the improvement of

individual health.

• It is most often equated with one aspect of

women’s lives; Motherhood.
TS
• Complications associated with various maternal
issues are indeed major contributors to poor
reproductive health among millions of women
worldwide.

• Half of the world’s women are 15 – 49 years of age.

• this group is highly vulnerable to problems related to

sexual intercourse, pregnancy, contraceptive side
effects, etc.
TS
• Death and illnesses from reproductive causes are
the highest among poor women.
• Ethiopia has one of the highest maternal mortality
in the world. it is estimated to be between 412
deaths per 100,000 live births.
• Currently the Contraception use in married
women is 36 % and about 22% women want to
use it.

TS
• Women in developing countries and economically
disadvantaged women in the cities of some
industrial nations suffer the highest rates of
complications from pregnancy, sexually
transmitted diseases, and reproductive cancers in
the world.

• Lack of access to comprehensive reproductive

care is the main reason so many women suffer and
TS
die.
• Most illnesses and deaths from reproductive
causes could be prevented or treated with
strategies and technologies well within reach of
even the poorest countries.
• Men also suffer from reproductive health
problems, most notably STIs.
• But the number and scope of risks is far greater
for women for a number of reasons.
TS
Many people in the world have no chance to enjoy
reproductive health due to such causes include:
Insufficient knowledge of human sexuality,

low-quality information and service on RH,

The spread of high-risk sexual behavior,

Discriminative social customs,

Negative attitudes toward women and girls, and

Limited empowerment of women and girls, etc.

TS
 Reproductive Health Care
• It is defined as the entire set of methods,
techniques and services that contribute to
reproductive health and

• its well being through prevention and solution

of various problems related to reproductive
health.

TS
 RH and reproductive Rights
Reproductive rights are part of human rights .
These rights are basic right of all couples and
individuals
To decide freely and responsibly the number,
spacing and timing of their children
To have the information and means to do so,
To attain the highest standard of sexual and
reproductive health. TS
 Rights……
In addition, it also includes their right:
• To make decisions concerning reproduction
free of discrimination, coercion and violence,
as expressed in human rights documents.
• To be informed and have access to safe,
effective, affordable and acceptable methods
of their choice for the regulation of fertility
which are not against the law,
TS
Men and women have the right
• To use appropriate health care services so that
women can enjoy safe pregnancy and delivery
and
• Access to appropriate health care services for
safe pregnancy and childbirth
• Provide couples with the best chance of having
a healthy infant
TS
 Right……
• A basic set of reproductive rights, including
rights to sexual and reproductive health is
implied by the rights recognized in international
human rights instruments.

• Promoting women’s human rights is an

essential part of improving women health.

TS
Sexual and reproductive Health Rights
In 2016, the Committee on Economic, Social and
Cultural Rights, UN Economic and Social Council
has articulated the right to Sexual and Reproductive
Health, as articulated in General Comment No. 22.
These rights include:
1. The Right to Life; Liberty and Security of the
Person;
2. The Right to Equality, and to be Free from all
Forms of Discrimination;
3. The Right to Privacy;
4. The Right to Freedom of Thought;
TS
 Rights ……
5. The Right to Information and Education;
6. The Right to Choose Whether or Not to Marry
and to Found and Plan a Family;
7. The Right to Decide Whether or When to Have
Children;
8. The Right to Health Care and Health Protection;
9. The Right to the Benefits of Scientific Progress;
10. The Right to Freedom of Assembly and Political
Participation; and
11. The Right to be Free from Torture and Ill
Treatment.
TS
The following populations are groups of priority
concern in reproductive health services.

These groups are:

• Women of childbearing age (15- 49 yrs old)

• Adolescents (both male and female)

• Under five years old children

TS
 Components of Reproductive
Health
1. Quality family planning services
2. Promoting safe motherhood: prenatal, safe
delivery and post natal care, including breast
feeding;
3. Prevention and treatment of infertility
4. Prevention and management of complications
of unsafe abortion;

TS
 …..Components
5. Safe abortion services, where not against the
law

6. Treatment of reproductive tract infections,

including sexually transmitted infections

7. Information and counseling on human

sexuality, responsible parenthood and sexual
and reproductive health
TS
 Components of….
8. Promotion of healthy sexual maturation

9. Active discouragement of harmful practices,

such as female genital mutilation and
violence related to sexuality and reproduction

10. Management of non infectious diseases

11. Functional and accessible referral

TS
Quality of care in Reproductive Health
• Quality of care in RH refers to the overall
effectiveness and appropriateness of health
care.

• It is about providing services that clients

want and includes effectively by the staff.

TS
The following are the elements of quality health
care:
• Promotion and protection of health
• Accessibility and availability of services
• Acceptability of services
• Technical competence
• Availability of essential supplies and equipment

TS
 Cont’d elements …..
• Quality of client provider interaction

• Adequate and relevant information and

counseling for clients

• Involvement of clients for decision-making

• Comprehensiveness of care and linkages to

other reproductive services

• Continuity of care and follow up

TS
The Integrated Approach to RH Services
 It addresses a range of client RH needs;
 saves time and money for clients as services
are obtained at single visit;
 A single service provider may offer a range of
RH services;

TS
 Clients gain confidence in the service provider;
 Client satisfaction with and utilization of
services increases; the coordination and cost
effectiveness of services are improved; and
 Opportunities to create client awareness of the
availability of other services increases.

TS
 Reproductive health indicators
• It summarize data which have been collected
to answer questions that are relevant to the
planning and management of RH programs.

• The indicators provide a useful tool to assess

needs, and monitor and evaluate program
implementation and impact.

TS
 Indicators …..
• Indicators are expressed in terms of rates,
proportions, averages, categorical variables or
absolute numbers.

• Evidence for monitoring: Reproductive health

indicators

• A health indicator is usually a numerical measure

which provides information about a complex
situation or event. TS
 Indicators……
1. Total fertility rate.
2. Contraceptive prevalence rate.
3. Maternal mortality ratio.
4. Percentage of mothers attended at least once
during pregnancy by skilled health personnel
(excluding trained and untrained traditional birth.
attendants) for reasons relating to pregnancy.
TS
5. Percentage of births attended by skilled health
personnel (excluding trained and untrained
traditional birth attendants).
6. Number facilities with functioning basic
essential obstetric care per 100,000 populations.
7.Prenatal mortality rate.

TS
8. Percentage of births of low birth weight(<2500
gm)
9. Positive syphilis serology prevalence in
pregnant women (15-24).
10.Number of facilities with functioning
comprehensive essential obstetric care per
500,000 populations.
TS
11.Percentage of obstetric and gynecology
admissions owing to abortion.
12.Reported prevalence of women with FGM.
13.Percentage of women of reproductive age
(15-49) at risk of pregnancy who report trying
for a pregnancy for two years or more.

14. Reported incidence urethritis in men (15-49).

TS
For example

• To understand the general health status of

infants in a country, the key indicators are
infant mortality rates and the proportion of
infants of low birth weight.

• Maternal health care quality, availability and

accessibility can be measured using maternal
mortality. TS
Criteria For Selecting Indicators
A good indicator has a number of important
attributes, and those are recommended by WHO:
1. To be useful
2. To be scientifically robust
3. To be representative
4. To be understandable
5. To be accessible
6. To be ethical
TS
RH and Defining Target Population

Rationale for Defining Target Population

• To set priority and deliver appropriate services

to high risk groups.

• To utilize resources efficiently,

• To determine the number of eligible for the

services,
TS
• To plan the type of services to be provided,

• To focus the efforts towards the target group,

• To measure / evaluate changes,

• To address equity in delivery of the health services

TS
 Estimation of the Eligible Population
Number (Target Groups) for RH

Knowing the no or estimate of the eligible for

RH is important for the following purposes.
• To plan usage targets for services
• To plan for supplies
• To assign service providers
• To monitor utilization of services
• To monitor coverage of the service
TS
The techniques to be utilized to estimate the eligible
for reproductive health should include:
- Deciding the catchments area for the reproductive
health service.
- Identify all kebeles in the catchments area;
- Prepare a sketch map of the catchments area,
- Divide the catchments area in to zones for ease
of operation
TS
Determining the number of the eligible population
from the total population in the catchment area.
 The methods for estimating the number of the
eligible could be;
By conducting census of the population in the
catchment area
By estimation of those eligible from the total
population using national, regional or district
standard figures.
TS
Thank you

TS,2015 EC