Chapter One: Basic Concepts of SRH, Hiv/Aids and Life Skills

CHAPTER ONE
BASIC CONCEPTS OF SRH,HIV/AIDS AND LIFE SKILLS
Friday, March 1, 2019 1

sexual and reproductive health……..
Objective:
At the end of this chapter students will be able to :
 Identify common SRH problems and their manifestations..
 Describe the relationship between gender and common SRH
problems.
 List common SRH Problems.
 Develop the skills to prevent sexual and reproductive health
problems,
Friday, March 1, 2019 NOV,12/2-17 2

Definition
• Reproductive health : is defined as” 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”.
• Reproductive health addresses the human sexuality and
reproductive processes, functions and system at all stages

of life so.”
Definition……
• and 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.”

Sexual health
Sexual Health:Sexual health is "a state of physical,

emotional, mental and social well-being in relation to
sexuality......
Sexual health requires a positive and respectful approach to

sexuality and sexual relationships , as well as the possibility of
having pleasurable and safe sexual experiences, free of
coercion, discrimination and violence."
The sexual health of young people
• Relationships and sex are very important to young people
• Young people 15 to 25 are at higher risk of sexually transmitted infection than
other age groups
• Many young people are at risk of getting pregnant without wanting to
• Young people can experience problems like regretted sex, sexual pressure and
sexual abuse
• Some young people experience more health problems than others (e.g. gay men,
children in care, drug-using youth, some ethnic minority groups, transgender young
people)
• Problems like sexually transmitted infections, unwanted pregnancy and sexual
abuse cost a lot to society and we need new, effective, good-value solutions which
appeal to young people
Target groups fo reproductive health……
• Estimation of the Eligible Population Number:
Knowing the number or estimate of the eligible for
reproductive health 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

Target population ……
• The target population of a service includes for whom the
• service is primarily or solely intended. These people
• may be of a certain age or sex or may have other
• common characteristics.
• a. Women of child-bearing age (15 – 49 years old)
• 1. pregnancy and child birth women alone are at risk of complications
from pregnancy and childbirth.

Target population ….
2. Women face high risks in preventing unwanted
pregnancy; they bear the burden of using and
suffering potential side effects from most
contraceptive methods, and they suffer from the
consequences of unsafe abortion.
3. Women are more vulnerable to contracting and
suffering complications of many sexually
transmitted infections including HIV/AIDS.
4. From the equity point of view, this population
group constitutes about 24% of the population;
which is a significant proportion.
5. Deaths and illnesses from reproductive causes
are highest among poor women everywhere.
Target population……
b. Adolescents (Both sexes)
1. Adolescents lack reliable reproductive health
information, and thus the basic knowledge to
make responsible choice regarding their
reproductive behavior.
2. In many countries around the world, leaders,
community members, and parents are reluctant

to provide education on sexuality to young men
and women for fear of promiscuity.
3. Many adolescents are already sexually active,
often at a very young age.
4. The reproductive health status of young people,

in terms of sexual activity, contraceptive use,
child bearing, and STIs lays the foundation for
the country’s demographic feature.
5. During adolescence normal physical
development may be adversely affected by
inadequate diet, excessive physical stress, or
pregnancy before physiological maturity is

Targets groups of RP….
6. Adolescents are at high risk to acquire infertility
associated with STIs and unsafe abortion
7. Conditions of work are designed for adults rather
than adolescents and put them at greater risk of
accidental injury and death.
8. Current health services are generally not
organized to fulfill the reproductive need anddemand of
adolescents.

Targets groups of RH….
C. Under Five Children
1. Children’s health is a base for healthy
adolescence and childbearing ages.
2. Proper health service for children serves to
increase the opportunities of women to have
contact with the health institution.
3. The health of children and women is inseparable
4. The morbidity and mortality of children in Ethiopia is one of the highest in the world.
5. Bearing high number of children has adverse consequences on health of the mother,
thegeneral income distribution and health status

Sexual and
Reproductive rights

Reproductive Rights
• The instruments of human rights enshrine
equality and the respect of all aspects of human
rights of citizens
• Sexual and reproductive rights include a broad
range of sexual and reproductive health issues,
which fall within the scope of twelve basic
human rights
• These basic human rights have been sourced
from four international human right treaties,
which have been ratified by a range of countries
worldwide
Reproductive right….
1. The right to life, which means among other
things that no woman’s life should be put at
risk by reason of pregnancy
2. The right to liberty and security of the person
which recognizes that no person should be
subject to female genital mutilation, forced
pregnancy, sterilization or abortion

3. The right to equality and to be free from all
forms of discrimination including in one’s
sexual and reproductive life
4. The right to privacy, meaning that all sexual

and reproductive health care services should
be confidential and all women have the right to
autonomous reproductive choices

5.The right to freedom of thought, which includes freedom
from restrictive interpretation of religious texts, beliefs
philosophies and customs as tools to curtail freedom of
thought on sexual and reproductive health care and other
issues
6. The right to information and education, as it relates to
sexual and reproductive health for all, including access to
full information on the benefits, risks, and effectiveness of
all methods of fertility regulations in order that all
decisions taken are made on the basis of full, free and
informed consent
7. The right to choose whether or not to marry, found
and plan a family
8. The right to decide whether or when to have children.

All persons have the right to decide freely and
responsibly on the number and spacing of their
children. This includes the right to decide whether or
when to have children and access to the means to
exercise this right

9. The right to health care and health protection which
includes the right of clients to the highest possible
quality of health care and the right to be free from
traditional practices which are harmful to health
10. The rights to the benefits of scientific progress,

which includes the right of sexual and reproductive
health service, clients to new RH technologies,
which are safe, effective and acceptable

11. The right to freedom of assembly and political
participation, which includes the right of all
persons to seek to influence communities and
governments to prioritize sexual and
reproductive health and rights
12. The right to be free from torture and ill
treatment including the rights of all women, men,
and young people to protection from violence,
sexual exploitation and abuse
Sexual Rights
• They include the right of all individuals to be free of
coercion, discrimination and violence to:
– the highest attainable standard of sexual health, including
access to sexual and reproductive health care services;
– seek, receive, and impart information related to sexuality;
– sexuality education;
– respect for bodily integrity;

SRs…continued
choose their partner;
decide whether or not to be sexually active;
consensual sexual relations;
consensual marriage;
decide whether or not, and when, to have children;
pursue a satisfying, safe and pleasurable sexual life.

Components of SRH services
 Quality family planning services.
 Promoting safe motherhood: prenatal, safe delivery and post natal

care, including breast feeding.
• Prevention and treatment of infertility.
 Prevention and management of complications of

unsafe abortion.
 Safe abortion services, where not against the

law.
• Treatment of reproductive tract infections, including sexually transmitted
infections.
• Information and counseling on human sexuality, responsible parenthood and

sexual and reproductive health. Active discouragement of harmful practices,
such as female genital mutilation and violence related to sexuality and
reproduction.
• Functional and accessible referral.
• The approach recognizes the central importance of

gender equality, men's participation and responsibility.

Youth friendly clinic services
• Youth friendly SRH services are services that effectively attract young
people, meet the varying needs of young people comfortably and
responsively and succeed in retaining these young clients for
continuing care.

…cont’d
• Services are said to be ‘youth friendly’ if they have
• policies and attributes that attract adolescents to the facility or program

• provide comfortable and appropriate setting for youth
• meet the needs of adolescents and are able to retain their adolescents for
follow up and repeat visits

Health clinic designed for adolescents
• Separate units for adolescents
• Outreach clinics with specially trained staff
• Mobile clinics
• Special hours
• Convenient and safe locations
• Youth-to-youth promotions
• Low or no-cost services

Effective programs for adolescents
Identify target group and needs
- Involve adolescents
- Work with community and parents
- Use materials designed by and for adolescents
- Make services accessible based on adolescent's preference
- Incorporate evaluation
Common RH Programs
• Providing information and services to adolescents

– The most basic needs of adolescents, regardless of culture, age, and
marital status, are for accurate and complete information about their
body functions, sex, safer sex, reproduction, and sexual negotiation
and refusal skills.
– Without information, adolescents are forced to make poorly

informed decisions that may have profound negative effects on their
lives.

…cont’d
• Contraception for adolescents

“Adolescents have the right to clear and accurate information about
contraceptive methods, including correct use, side effects, and how
to reach a health care provider with their concerns”

…cont’d
• HIV and STI services
• Prevention of early and unintended pregnancy
• School based sexuality education
– Doesn’t address the need of out of school adolescents

…cont’d
• SRH or life skill education in schools
• Mass media based behavior change and social marketing

interventions
• Programs to make RH services more youth friendly
• Community based non formal education programs

…cont’d
• Youth club/ organizations
• Livelihood programs to generate economic opportunities for youth
• Advocacy campaign to influential political and cultural leaders (

adults in general)
• Community mobilization Campaigns

Types of services addressed through YFS
• Information and Counseling on Reproductive and Sexual health issues
• Testing Services for HIV
• Management of STIs
• Testing service for Pregnancy, Antenatal care including PMTCT,

Delivery Service and Post natal Care

…cont’d
• Abortion and post abortion care
• Family Planning Service
• Condom Promotion and Provision
• Referrals

…cont’d
• reluctance to use service for fear of judgment or concerned about

having pelvic examination Providers reluctance to serve unmarried
adolescents
• Prohibition by law/policy to serve adolescents
• Adolescent's n

Components of successful adolescent
reproductive health programs
Reproductive health programs for adolescents tend to
be most successful when they:
1. Accurately identify and understand the group to be served;
2. involve adolescents in the design of the program;
3. work with community leaders and parents;

Family planning
Definition: FP is the means of having the number of children you
want when you want them.
the use of various methods of fertility control that will help

individuals (men and women) or couples to have the number of
children they want when they want them in order to assure the well
being of children and the parents.
preventing unwanted pregnancies by safe methods of prevention.

Contraceptive Methods
Refers to methods or ways by which unwanted pregnancy is
prevented.
Not all the methods are equally effective, safe or equally acceptable.
Therefore, individualization of contraceptive choice is important for

successful prevention of pregnancy

…cont’d
• Two broad categories
• Traditional/Natural Contraceptive Methods
• Modern Contraceptive Methods
1. Traditional Contraception Methods

• Lactational Amenorrhoea Method (LAM)
• Abstinence
• Coitus interrupts

…cont’d
Natural Contraception Methods
• Rhythm or calendar method
• Basal Body Temperature
• Cervical Mucus Method
• Sympto-thermal
3. Modern Contraceptive Methods

Hormonal Methods and
Non Hormonal

…cont’d
• Hormonal Methods
• Oral contraceptives(e.g pills)
• Injectables (e.g depo provera)
• Implants(e.g jadelle,norplant,sinoplants,implanon)
• Emergency Contraception
• ECPs – within 3 days
• Copper releasing IUDs – up to 5 days
• Non hormonal Methods

• IUDs
• Barrier Methods:condomes(male and female)
• Surgical

Calendar or rhythm method
This method is the most widely used of the periodic abstinence techniques. The calendar method is a
calculation-based approach where previous menstrual cycles are used to predict the ﬁrst and the last fertile
day in future men Box4.1 Advice to women using the calendar method
• For irregular cycles,identify the longest and the shortest cycles recorded over six to eight
cycles.
• . Subtract 18 from the shortest cycle(gives the ﬁrst day of the fertile phase). . Subtract 11
from the longest cycle (gives the last day of her fertile time). . Avoid sex,use a barrier
method, or use withdrawal during the fertile phase calculated strual cycle

…cont’d
• ,she tellsyou it comesregularly every 30 days. Calculate thefertile
period of your client andadvise herwhentoavoidsex in order to
preventpregnancy.
• Answer Regularcycle 30 - 14 = 16
Firstday of fertile phase 16 - 7=9
Last dayoffertilephase 16 +2=18
Therefore, herfertile periodisbetween the9th and18thdays,
andshe should avoidsex between these days of thecycle

Calendar or rhythm method
• Example 1 a woman's last six menstrual cycles were 28, 26, 29, 27, 29
and27days. Using this information, calculate and instruct her about
how to use the calendar method to prevent pregnancy.
• Answer . Her shortest cycleis26days. .
Her longest cycleis29days :
First day of her fertile phase is 26-18 = 8. .
Last dayofher fertile phase is 29 - 11 =18.
• Therefore, the fertile period of this client is between the8th–18th
days, so she should avoid sex during this period to prevent pregnancy

Reproductive health indicators
• A health indicator is usually a numerical measure which

• provides information about a complex situation or event.
• When you want to know aborut a situation or event and
• cannot study each of the many factors that contribute to
• it, you use an indicator that best summarizes the
• situation.

• 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

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

2.3. Reproductive Health Indicators for
Global Monitoring
• 1. Total fertility rate: 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.
2. Contraceptive prevalence (any method):

Percentage of women of reproductive age who
are using (or whose partner is using) a
contraceptive method at a particular point in
time.

Indicators contin…….
• 3. Maternal mortality ratio: The number of
• maternal deaths per 100 000 live births from
• causes associated with pregnancy and child
• birth.
• 4. Antenatal care coverage: Percentage of
• women attended, at least once during
• pregnancy, by skilled health personnel for
• reasons relating to pregnancy.

• 5. Births attended by skilled health personnel:
• Percentage of births attended by skilled health
• personnel. This doesn’t include births attended
• by traditional birth attendants.
6. Perinatal mortality rate: Number of perinatal
deaths (deaths occurring during late pregnancy,
during childbirth and up to seven completed days
of life) per 1000 total births.

7. Low birth weight prevalence: Percentage of
live births that weigh less than 2500 g
. 8 Prevalence of anaemia in women: Percentage
of women of reproductive age (15–49) screened
for haemoglobin levels with levels below 110 g/l
for pregnant women and below 120 g/l for non-
pregnant women.

Historical development of reproductive health
Historical development of RH
 During the 1960s, UNFPA established with a mandate to raise awareness
about population “problems” and to assist developing countries in addressing
them.
 The focus was “standing room only”, “population booms, demographic
entrapment” and scarcity of food, water and renewable resources.
 Concern about population growth (particularly in the developing world and
among the poor) coincided with the rapid increase in availability of
technologies for reducing fertility - the contraceptive pill became available
during the 1960s along with the IUD and long acting hormonal methods.

Historical ………..
• In 1972, WHO established the Special Program of Research, Development and
Research Training in Human Reproduction (HRP), whose mandate was focused
on research into the development of new and improved methods of fertility
regulation and issues of safety and efficacy of existing methods.
• Held the promise of being able to prevent recourse to abortion.
• Population policies with the focus of restraining population growth spread in
developing countries during the 1970s and 1980s and were supported by UN
agencies and a variety of NGOs of which international planned parenthood
federation (IPPF) is perhaps the most well known.

• The dominant paradigm was population growth and little was said
about other aspects like changes in population structure or in
patterns of migration.
• The 1994 ICPD has been marked as the key event in the history of RH.
• It followed some important occurrences that made the world to think
of other ways of approach to reproductive health.
• The impetus behind the paradigm shift that Cairo represents and that
has been reinforced in the recent special session of the UN General
Assembly include three elements of particular importance.

Historical…cont’d
1. The first was the growing strength of the women’s movement
and their criticism of the over-emphasis on the control of female
fertility - and by extension, their sexuality - to the exclusion of
their other needs.
2. A second was the advent of the HIV/AIDS pandemic; suddenly it
became imperative to respond to the consequences of sexual
activity other than pregnancy, in particular sexually transmitted
diseases.
3. A third was the articulation of the concept of reproductive
rights. An interpretation of international human rights treaties in
terms of women’s health in general and reproductive health in
particular gradually gained acceptance during the 1990s.
Historical…cont’d
Three rights in particular were identified:
 The right of couples and individuals to decide freely and
responsibly the number and spacing of children and to have the
information and means to do so;
 The right to attain the highest standard of sexual and reproductive
health; and,
 The right to make decisions free of discrimination, coercion or
violence.

1.2. 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
Safe motherhood initiative in 1987
• Emphasis on maternal health
• Emphasis on reduction of maternal mortality
Reproductive health, ICPD in 1994 • Emphasis on quality of services
• Friday,
EmphasisMarch 1, 2019
on availability and accessibility 60
Millennium Development Goals
• Goal 3 Promote gender equality and empower women
• Target 4 Eliminate gender disparity in primary and secondary
education, pref-
• Eraly by 2005, and in all levels of education no later than 2015.
• Goal 4 Reduce child mortality
• Target 5 Reduce by two-thirds, between 1990 and 2015, the under-
five mortality rate.

Millennium Development Goals
• Goal 5 Improve maternal health
• Target 6 Reduce by three-quarters, between 1990 and 2015, the
maternal mortality ratio.
• Goal 6 Combat HIV/AIDS, malaria and other diseases
• Target 7 Have halted by 2015 and begun to reverse the spread of
HIV/AIDS.
• Target 8 Have halted by 2015 and begun to reverse the incidence of
malaria
• and other major diseases.

Male Reproductive System
Adolescence
 Puberty
 Burst of hormones activate maturation of the gonads: testes
 Begins: 9 – 14 yrs of age
 Abnormally early = precocious puberty
 Delayed = eunuchoidism

General Physical Changes
 Enlargement of the external and internal genitalia

 Voice changes
 Hair growth
 Mental changes
 Changes in body conformation and skin
 Sebaceous gland secretions thicken/increase  acne

External Genitalia
 Gonads = testes
undescended by birth= cryptorchidsim
 Scrotum
 Penis

Testes
 Each testis is an oval structure about 5 cm long and 3 cm in diameter
 Covered by: tunica albuginea
 Located in the scrotum
 There are about 250 lobules in each testis. Each contains 1 to 4 -

seminiferous tubules that converge to form a single straight tubule, which
leads into the rete testis.
 Short efferent ducts exit the testes.
 Interstitial cells (cells of Leydig), which produce male sex hormones, are
located between the seminiferous tubules within a lobule.

scrotum
 consists of skin and subcutaneous tissue
 A vertical septum, of subcutaneous tissue in the center divides it into two

parts, each containing one testis.
 Smooth muscle fibers, called the dartos muscle, in the subcutaneous tissue
contract to give the scrotum its wrinkled appearance. When these fibers are
relaxed, the scrotum is smooth.
 the cremaster muscle, consists of skeletal muscle fibers and controls the
position of the scrotum and testes. When it is cold or a man is sexually
aroused, this muscle contracts to pull the testes closer to the body for
warmth.

SCROTAL STRUCTURE

Epididymis
• A long tube (about 6 meters) located along the superior and posterior
margins of the testes.
• Sperm that leave the testes are immature and incapable of fertilizing
ova. They complete their maturation process and become fertile as they
move through the epididymis. Mature sperm are stored in the lower
portion, or tail, of the epididymis
• spermatic cord
 contains the proximal ductus deferens, testicular
artery and veins, lymph vessels, testicular nerve,
cremaster muscle and a connective tissue covering.
Ductus deferens( vas deferens)
 a fibromuscular tube that is continuous with the epididymis.
 enters the abdominopelvic cavity through the inguinal canal and passes
along the lateral pelvic wall, behind bladder & toward the prostate gland.
Just before it reaches the prostate gland, each ductus deferens enlarges to
form an ampulla.
 Sperm are stored in the proximal portion of the ductus deferens, near the
epididymis

Ejaculatory Duct
 Each ductusdeferens, at the ampulla, joins the duct from the adjacent
seminal vesicle (one of the accessory glands) to form a short ejaculatory
duct.
 Each ejaculatory duct passes through the prostate gland and empties into
the urethra.

Urethra
 extends from the urinary bladder to the external urethral orifice at the tip of
the penis.
 It is a passageway for sperm and fluids from the reproductive system and
urine from the urinary system.
 divided into three regions: The prostatic urethra, the membranous urethra
& the penile urethra (also called spongy urethra or cavernous urethra)

Duct System
 Sperm cells pass through a series of ducts to reach

the outside of the body.
After they leave the testes, the sperm passes through
Epididymes,Ductus deferense,
ejaculatory duct, and urethra.

accessory glands
 are the seminal vesicles, prostate gland, and the

bulbourethral glands. These glands secrete fluids that
enter the urethra.
•

Seminal Vesicles
 glands posterior to the urinary bladder.
 Each has a short duct that joins with the ductus

deferens at the ampulla to form an ejaculatory
duct, which then empties into the urethra.
 The fluid is viscous and contains fructose,

prostaglandins and proteins.

Prostate
 a firm, dense structure about the size of a walnut that is located just inferior
to the urinary bladder.
 encircles the urethra as it leaves the urinary bladder.
 Numerous short ducts from the prostate gland empty into the prostatic
urethra. The secretions of the prostate are thin, milky colored, and alkaline.
They function to enhance the motility of the sperm.

Male Hormones
 Follicle-stimulating hormone (FSH) stimulates

spermatogenesis
 Interstitial Cell Stimulating Hormone (ICSH) stimulates the

production of testosterone
 testosterone stimulates the development of male

secondary sex characteristics & spermatogenesis.

Female Reproductive System

Adolescence
Puberty
Burst of hormones activate maturation of the gonads: ovaries
Begins: 8-13 yrs of age
Abnormally early = precocious puberty
Delayed =Primary Amenorrhea

Function of Female Reproductive System
• Produce sex hormones

• Produce functioning gamates [ova]
• Support & protect developing embryo
• For birth cana l

General Physical Changes
• Axillary & pubic hair growth
• Changes in body conformation [widening of hips, development of
breasts]
• Onset of first menstrual period [menarche]
• Mental changes

Major Organs
• Ovaries
• Fallopian tubes
• Uterus
• Cervix
• Vagina
• Accessory glands
• breasts

ovaries
• Each ovary is about the size and shape of an almond. In young women
the ovaries are about 1½ - 2 inches long, 1 inch wide & 1/3 inch thick.
After menopause they tend to shrink.
• they produce eggs (also called ova) every female is born with a
lifetime supply of eggs
• they also produce hormones:
Estrogen & Progesterone
Male Homolog = testes

fallopian tubes [uterine tubes]
• stretch from the uterus to the ovaries and measure about 8 to 13 cm
in length.
• range in width from about one inch at the end next to the ovary, to
the diameter of a strand of thin spaghetti.
• The ends of the fallopian tubes lying next to the ovaries feather into
ends called fimbria
• Millions of tiny hair-like cilia line the fimbria and interior of the
fallopian tubes. The cilia beat in waves hundreds of times a second
catching the egg at ovulation and moving it through the tube to the
uterine cavity.
• Fertilization typically occurs in the fallopian tube

uterus
• muscular organ in the upper female reproductive tract.
• The fundus is pear-shaped the upper portion of the uterus where
pregnancy occurs.
• The cervix is the lower portion of the uterus that connects with the
vagina and serves as a sphincter to keep the uterus closed during
pregnancy until it is time to deliver a baby.
• the uterus expands considerably during the reproductive process. the
organ grows to from 10 to 20 times its normal size during pregnancy

Uterus cont.………………
The main body consists of a firm outer coat of muscle
(myometrium) and an inner lining of vascular, glandular material
(endometrium).
The endometrium thickens during the menstrual cycle to allow
implantation of a fertilized egg.
Pregnancy occurs when the fertilized egg implants successfully into
the endometrial lining. If fertilization does not occur, the
endometrium sloughs off and is expelled as menstrual flow

endometrium
• Functional zone – layer closest to the cavity – contains majority of
glands. Thicker portion – undergoes changes with monthly cycle
• Basal zone – layer just under myometrium, attaches functional layer
to myometrial tissue, has terminal ends of glands. Remains constant

The Cervix
The lower portion or neck of the uterus.
• The cervix is lined with mucus, the quality and quantity of which is
governed by monthly fluctuations in the levels of the estrogen and
progesterone.
• When estrogen levels are low, the mucus tends to be thick and
sparse, hindering sperm from reaching the fallopian tubes. But when
an egg is ready for fertilization, estrogen levels are high, the mucus
then becomes thin and slippery, offering a “friendly environment” to
sperm
• at the end of pregnancy, the cervix acts as the passage through which
the baby exits the uterus into the vagina. The cervical canal expands
to roughly 50 times its normal width in order to accommodate the
passage of the baby during birth
The Vagina
• vagin = sheath
• a muscular, ridged sheath connecting the external genitals to the
uterus.
• functions as a two-way street, accepting the penis and sperm during
intercourse and roughly nine months later, serving as the avenue of
birth through which the new baby enters the world

External genitalia
• vulva—which runs from the pubic area downward to the rectum.
• Mons pubis or "mound of Venus" is the V-shaped area covered with hair
• Labia majora or "greater lips" are the part around the vagina containing two glands
(Bartholin’s glands)which helps lubrication during intercourse. Male Homolog = scrotum
• Labia minora or "lesser lips" are the thin hairless ridges at the entrance of the vagina,
which joins behind and in front. In front they split to enclose the clitoris
• The clitoris is a small pea-shaped structure (equivalent to penis in males ) It plays an

important part in sexual excitement in females. Male Homolog = penis

External genitalia
• The urethral orifice or external urinary opening is below the clitoris on the
upper wall of the vagina and is the passage for urine
• The introitus or opening of the vagina is separate from the urinary

opening (unlike males) and located below it.
• The hymen is a thin cresentic fold of tissue which partially covers the
opening of the vagina. medically it is no longer nsidered to be a 100% proof
of female virginity.

Mammary Glands [ breasts]
Present in both sexes - normally only functional in females
• Developmentally they are derived from sweat glands
• Contained within a rounded skin-covered breast anterior to the pectoral
muscles of the thorax
• Slightly below center of each breast is a ring of pigmented skin, the areola - this
surrounds a central protruding nipple
• Internally - they consist of 15 to 25 lobes that radiate around and open at the
nipple
• Each lobe is composed of smaller lobules- these contain alveoli that produce
milk when a women is lactating
• non-pregnant women - glandular structure is undeveloped - hence breast size
is largely due to the amount of fat deposits

Hormones and the menstrual cycle

The female hormones that control the cyclic growth and shedding of the endometrium are
estrogen and progesterone.
Estrogen and progesterone are produced by the ovaries. Estrogen causes the growth or
proliferation of the endometrium during the first 2 weeks of the menstrual cycle.
After ovulation, the ovary produces e progesterone

When does ovulation occur ?
• The timing of ovulation varies with the length of a woman's menstrual cycle.
• In the average 28 day menstrual cycle, the LH surge usually occurs between cycle days
11-13 and ovulation follows about 36-48 hours later, on or close to cycle day 14.
• Women with shorter menstrual cycle lengths tend to ovulate earlier and women with
longer cycle lengths tend to ovulate later than cycle day 14.
• Despite the variations in menstrual cycle length, the time from ovulation to the onset of
the next menstrual period is usually constant (2 weeks). This principle is the basis for the
use of ovulation calendars that take into account an individual's shortest and longest cycle
lengths

GENDER BASED VIOLENCE

Sexual and gender-based violence
If Development is not Engendered, it

is Endangered.
Definitions
Sex and Gender
• Gender
• Gender is a concept that describes the socially-constructed differences between females and
males throughout their life cycles. Gender, together with factors such as age, race and class,
influence, inter alia, the expected attributes, behaviour, roles, power, needs, resources,
constraints and opportunities for people in any culture. Gender is also an analytical tool that
allows us to achieve a better understanding of factors of vulnerability with a view to more
appropriately responding to need.
Sex
Sex describes the physical and biological differences between males and females. It is
determined biologically and cannot be changed (without surgical intervention).
Definitions
• Rape
Rape is physically forced or otherwise coerced penetration - even if slight – of the
vagina, anus or mouth with a penis or other body part. It also includes penetration of the
vagina or anus with an object. Rape includes marital rape and anal rape/sodomy. The
attempt to do so is known as attempted rape. Rape of a person by two or more
perpetrators is known as gang rape WHO (2002) World Report on Violence and Health.
Sexual exploitation
Sexual exploitation means any actual or attempted abuse of a position of vulnerability,
differential power, or trust, for sexual purposes, including, but not limited to, profiting
monetarily, socially or politically from the sexual exploitation of another. Some types of
forced prostitution can fall under this category.
Definitions
• Domestic violence
• Domestic violence is a term used to describe violence that takes place between
intimate partners (spouses, boyfriend/girlfriend) as well as between other family members.
• It is defined by WHO as behaviour by an intimate partner or ex-partner that causes

physical, sexual or psychological harm, including physical aggression, sexual coercion,
psychological abuse and controlling behaviours.

SEXUAL AND GENDER·BASED VIOLENCE SESSION 3: DIFFERENT FORMS OF SGBV
Definitions
• Forced marriage
• Forced marriage is the marriage of an individual against her or his will.
Child marriage
• Child marriage is a formal marriage or informal union before the age of 18
Sexual violence
Describes acts of a sexual nature committed against any person by force, threat
of force or coercion. Coercion can be caused by circumstances such as fear of
violence, duress, detention, psychological oppression or abuse of power. The
force, Friday,
threat March 1,of
2019 force or coercion can also be directed against another person. 114
Gender Equity
• If men and women are equal, they should be treated fairly, this
includes:
• The right of choice and security in marriage, right to land and
property,
• Reproductive rights, freedom from violence, etc.
However, in practice, gender equality and equity are often different
Social and economic structures and conditions, which disqualify
women from receiving the same treatment

Gender Identity and Gender Roles
• Gender identity – your personal sense of self as a man (boy) or a

woman (girl).
 Gender role – everything you feel, think, say and do that shows to
yourself and others that you are a man or a woman.
 Gender role stereotypes – oversimplified, rigid beliefs that all
members of a sex have distinct behavioral psychological and
emotional characteristics

Gender Roles
Three types:
• Reproductive roles- women’s biological capacity to give birth -assumes that child
rearing and household maintenance is women’s role
• Productive roles- informal economic activities considered not productive, yet
contributes to society
• Community roles-
Men usually dominate in leadership and political roles, whereas women usually
perform service oriented or cultural activities

Gender equality and gender equity
• Gender equality means the absence of discrimination, on the
basis of a person’s sex, in opportunities, in the allocation of
resources or benefits or in access to services
• Gender equity means fairness and justice in the distribution of
benefits and responsibilities between women and men and often
requires women-specific projects and programmes to end existing
inequities

GENDER PRIMER TOPICS
• Sex and gender
• Gender roles
• Diversity among women
• Women's issues
• Identifying discrimination

Introduction of the different types of GBV
GBV is categorised in four main types:

1.Physical violence: physical assault;
murder, physical harassment in public;
attempted murder; denied access to
medical treatment;, harmful traditional

Introduction to………
2.Sexual violence: Forced marriage; child marriage;

forced engagement; forced prostitution; rape; forced
sexual intercourse with husband; incest; sexual assault
and Female Genital Mutilation (FGM).

Introduction of the different types of GBV….
• 3.Psychological/emotional violence: denial of food or basic needs;
prevention of education, refusal to communicate; preventing
maternal contact with children; using children as threats; physical
threats to other family members; verbal insulting; threats to kill;
intimidation; restrictions on movement outside the home i.e. to visit
own family, talk to neighbours, etc; forced to divorce/ separate;
abandoned to own parents

Introduction of the different types of GBV
4.Other types of violence: Other traditional and cultural

practices i.e. honour killings; kidnapping; attempted kidnapping,
trafficking.

Female Genital Cutting (FGC)
• According to EDHS 2005 the prevalence of:-
• FGM is 74%
Female circumcision, also known as female genital cutting
(FGC) or female genital mutilation (FGM) consists of all
procedures that involve partial or total removal of the
external female genitalia or other injury to the female
genital organs whether for cultural or other non-therapeutic
reasons.
WHO classification of female genital
mutilation (FGM)
• No FGM: No evidence of any genital mutilation
• FGM I: Excision of the prepuce, with or without excision of part or all of the
clitoris
• FGM II: Excision of the clitoris with partial or total removal of the labia
minora.
• FGM III: Excision of part or all of the external genitalia and) stitching or
narrowing of the vaginal opening (infibulation)

Classification of FGM
• Type I: Partial or total removal of the clitoris and/or the prepuce
(Clitoridectomy).
• Type II: Partial or total removal of the clitoris and the labia minora,
with or without excision of the labia majora (Excision).
• Type III: Narrowing of the vaginal orifice with creation of a covering
seal by cutting and a positioning the labia minora and/or the labia
majora, with or without excision of the clitoris (Infibulation).
• Type IV: All other harmful procedures to the female genitalia for non-
medical purposes, for example: pricking, piercing, incising, scraping
and cauterization (Unclassified).
Effects of FGC
According to a WHO study (November, 2001- March,

2003), deliveries to women who have undergone FGM
are significantly more likely to be complicated by:-

Caesarean section, Bleeding due to genital
tear, episiotomy, extended maternal hospital
stay, infection,child death than deliveries to
women who have not had FGM

Root causes and contributing factors of Gender-based violence
• Contributing factors are those that perpetuate GBV/SGBV or increase risk

of GBV (family, community and state violence).
• Contributing factors do not cause GBV although they are associated with
some acts of GBV.

Root causes and contributing factors of
Gender-based violence
Some examples:
• Alcohol/drug abuse is a contributing factor - but not all drunks/drug
addicts beat their wives or rape women.
• War, displacement, and the presence of armed combatants are all
contributing factors, but not all soldiers rape civilian women.
• Poverty is a contributing factor, but not all poor women are
victimized by forced prostitution or sexual exploitation.
• Many contributing factors can be eliminated or significantly reduced

through preventive activities.

The Impact of GBV on children in the family
Children respond in different ways to the violence experienced in their family

environment.
Possible emotional and behaviour effects could be:
• Loss of self esteem and self confidence.
• Insecurity, fear and vulnerability

• Injury, disability, or death. STIs and HIV/AIDS.
• Injury to the reproductive system including menstrual disorders, infections, miscarriages, unwanted
pregnancies, unsafe abortions

Consequences of GBV/SGBV...
The consequences of GBV can be scattered into four main aspects:
• 1. Health
• 2. Emotional, social and psychological
• 3. Community and physical safety and security
• 4. Legal/justice system

Consequences of GBV/SGBV....
Emotional/Psychological:
Emotional damage including anger, fear and self-hate. Shame,
insecurity, loss of ability to function and carry out daily
activities.
Feelings of depression and isolation

Gender-based violence and the violation of
women‘s human rights
Consent
1. Consent means saying “yes,” agreeing to something. Informed
consent means making an informed choice freely and voluntarily by
persons in an equal power relationship

Gender-based violence and the violation of
women‘s human rights
2.Acts of gender-based violence occur without informed consent. Even

if she says “yes,” this is not true consent because it was said under
pressure - the perpetrator(s) used some kind of force to get her to say
yes

INTERVENTIONS
INTERVENTIONS OF GENDER BASED VIOLENCES.
(GBV)
• A.MEDICAL INTERVENTIONS: Find a safe environment away from the assailant
• Call a close friend or relative – someone who will offer unconditional support
• Seek medical care; do not change clothes, bathe, douche, or brush your teeth
until evidence is collected. A complete medical evaluation includes evidence
collection, a physical examination, treatment and/or counseling. You do not have
to do any part of this evaluation that you do not want to do

At the clinic
• History taking
• Head to toe examination
• Genito-anal examination
• Investigations for clinical management of the survivor
• Investigations carried out for evidence purposes
• Management of physical injuries
• Post exposure prophylaxis
• Pregnancy prevention
• Prophylaxis of STI’s including Hep B

Evidence carried out for investigative
purposes
• Urine analysis for epithelial celles
• ’’ ’’ ’’ pregnancy test
Vaginal swab for spermatozoa….
Blood test for HIV/AIDS and other STIs.

Management of physical injuries
Violated person must take Tetanus toxoid according to

the physicians order until completing the doses
If STIs suspected Prophylactic antibiotics drugs must be taken .
HepB future prevention :If liver diseases suspected hepatitis
prophylaxis should be given to the person

Post exposure prophylaxis
(PEP)

PEP

Pregnancy prevention

B,Psychosocial support measures
• Definition of psychosocial support
• The Psychosocial Framework of 2005 – 2007 of the International
Federation defines psychosocial support as “a process of facilitating
resilience within individuals, families and communities [enabling families to
bounce back from the impact of crises and helping them to deal with such
events in the future]. By respecting the independence, dignity and coping
mechanisms of individuals and communities, psychosocial support
promotes the restoration of social cohesion and infrastructure”
Basic principles
• Safety: Ensuring the safety of the survivor(s) and their families
• Confidentiality: Respecting the confidentiality of the survivor(s) and their families
• Respect: Respecting the wishes, choices, rights and dignity of the survivor(s)
• Non-discrimination: Ensuring non-discrimination in all service provision

C.Legal measures against
GBVs.
International instruments on women rights
• Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)
• Beijing Platform for Action
• MDGs 3
• UNSCR 1325
• UNSCR 1820, 1880, 1889
• Revised Penal Code of 1957
• In 2004, Ethiopia amended the Penal code of 1957 to further protect women’s rights, particularly
• attending to the issue of violence against them. The new code made sexual violence against women
and minors punishable by law and outlawed Harmful Traditional Practices (HTPs) such as female
genital mutilation (FGM), including the most extreme forms of the practice

Cont……
• punishable by six months imprisonment. It also proscribed early marriage and abductions,
• practices to which women and girls are especially vulnerable.
• Affirmative Action Policy
• The Ethiopian Constitution enshrines affirmative action for women, declaring in Article 35(3),
• “[t]he historical legacy of inequality and discrimination suffered by women in Ethiopia taken into
account, women, in order to remedy this legacy, are entitled to affirmative measures. The
• purpose of such measures shall be to provide special attention to women so as to enable them to
compete and participate on the basis of equality with men in political, social and economic life.
• .Article 89(7) also obligates the state to “ensure the
participation of women in equality with men in all economic
development endeavors.”

D.Women’s Empowerment
• :It is a means of strengthening women.
• Goal 3 Promote gender equality and empower women
• Target 4 Eliminate gender disparity in primary and secondary education,
preferably by 2005, and in all levels of education no later than 2015
• The Women’s Empowerment Principles were launched on 9 March 2010 in

celebration of International Women's Day at a day-long conference in New
York for business, civil society, Government academia and the UN to explore
the application of the Principles in various contexts. In brief, the Principles
are:

Women’s Empowerment Principles
1.Establish high-level corporate leadership for gender equality.
2.Treat all women and men fairly at work – respect and support human
rights and nondiscrimination.
3. Ensure the health, safety and well-being of all women and men
workers.
4. Promote education, training and professional development for
women
5. Implement enterprise development, supply chain and marketing
practices that empower women.
6. Promote equality through community initiatives and advocacy.
7. Measure and publicly report on progress to achieve gender equality
Femininity IS NATURE,NOT INFERIORITY


Chapter One: Basic Concepts of SRH, Hiv/Aids and Life Skills

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Chapter One: Basic Concepts of SRH, Hiv/Aids and Life Skills

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CHAPTER ONE

BASIC CONCEPTS OF SRH,HIV/AIDS AND LIFE SKILLS

Friday, March 1, 2019 1

Friday, March 1, 2019 NOV,12/2-17 2

• Reproductive health addresses the human sexuality and

reproductive processes, functions and system at all stages

Friday, March 1, 2019 4

Sexual Health:Sexual health is "a state of physical,

Sexual health requires a positive and respectful approach to

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4. The right to privacy, meaning that all sexual

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8. The right to decide whether or when to have children.

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10. The rights to the benefits of scientific progress,

Friday, March 1, 2019 21

– seek, receive, and impart information related to sexuality;

– respect for bodily integrity;

Friday, March 1, 2019 24

 Promoting safe motherhood: prenatal, safe delivery and post natal

• Prevention and treatment of infertility.

 Prevention and management of complications of

 Safe abortion services, where not against the

• Information and counseling on human sexuality, responsible parenthood and

• Functional and accessible referral.

• The approach recognizes the central importance of

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• policies and attributes that attract adolescents to the facility or program

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Identify target group and needs

- Work with community and parents

- Use materials designed by and for adolescents

- Make services accessible based on adolescent's preference

• Providing information and services to adolescents

– Without information, adolescents are forced to make poorly

Friday, March 1, 2019 31

• Contraception for adolescents

Friday, March 1, 2019 32

• HIV and STI services

• Prevention of early and unintended pregnancy

• School based sexuality education

– Doesn’t address the need of out of school adolescents

Friday, March 1, 2019 33

• SRH or life skill education in schools

• Mass media based behavior change and social marketing

• Programs to make RH services more youth friendly

• Community based non formal education programs

Friday, March 1, 2019 34

• Youth club/ organizations

• Livelihood programs to generate economic opportunities for youth

• Advocacy campaign to influential political and cultural leaders (

• Community mobilization Campaigns