COMMUNITY HEALTH

NURSING-II
• By:
• ANWAR ALI MALIK,
• BSN (G) M.ED, MPH
• V.PRINCIPAL
• HIMAS CON
• malikstar2000@gmail.com
• 03333398310
 Reproductive Health
• Reproductive health is defined as” A state of
complete physical, mental, and social wellbeing
and not merely the absence of disease or
infirmity, in all matters related to the
reproductive system and to its functions and
process”.

• This definition is taken and modified from the

WHO definition of health.
• Reproductive Health addresses the human
sexuality and reproductive processes, functions
and system at all stages of life.

• It means that people are able to have “a

responsible, satisfying and safe sex life, they have
the capability to reproduce and the freedom to
decide if, when and how often to do so.”

• Men and women have the right 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.
• Reproductive Health...

• They have the right of access to appropriate

health care services for safe pregnancy and
childbirth and, provide couples with the best
chance of having a healthy infant.

• Reproductive health is life-long, beginning

even before women and men attain sexual
maturity and continuing process till woman's
child-bearing years (i,e 15 to 49).
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;
5. Safe abortion services, where not against the law;
6. Treatment of Reproductive Tract Infections
RTI, including sexually transmitted STI infections
including HIV/AIDS.
7. Information and Counseling on human
sexuality, responsible
parenthood/fatherhood/motherhood and
Sexual and Reproductive health;
8. Active discouragement of harmful practices,
such as female genital mutilation (circumcision)
and violence related to sexuality and
reproduction;
9. Functional and accessible referral.
 MOTHER & CHILD HEALTH CARE (MNCH)
• It is a branch of public health, which is
planned for health supervision of the mother
and child, not only physical but mental and
emotional health.
• AIMS:
• Making available the best possible care for
women during pregnancy, labour and
puerperuim.
• Best possible care to childen while they are
growing and are valnurable.
 OBJECTIVES OF MNCH SERVICES
 Improve the health of mother and child.
 To reduce maternal mortailty and morbidity.
 To reduce birth rate.
 to reduce infant mortality and morbidity.
 To decrease prenatal deaths.
 To reduce death rate.
 To ensure birth registration.
 To study and obtain information regarding women
education, family income, environment nd psychological
status.
 To promote the reproductive health, physical and
physiological development of child and adolscent in
family.
 COMPONENTS OF MNCH
 Antenatal Care
 Intranatal Care
 Postnatal Care
 Infant Care
• under five years
• Immunization.
• Nutritional disorders
 Training Programs.
 Health Education.
 MATERNITY CYCLE
• The stages in maternity cycle are;
• Fertilization
• Antenatal care (care of mother during
pregnancy)
• Intranatal care (cae of mother during child
birth and also of child care)
• Postnatal care (care of mother after
delivery)
• Inter-conceptional peroid (the time period
between pregnancy).
CAUSES OF MATERNAL MORTALITY
1. MAIN CAUSES:
 Haemorrhage (21%) ;due to abortion, ectopic
pregnancy, placenta previa, placenta abruption, and post
partum hemorrhage, rupture of uterus due to obstructed
labour, retained plaenta and membranes.
Hypertensive disease (19%); of pregnancy or eclampsia
or pregnancy induced hypertension.
Purperal sepsis or infection elsewhere.
Anemia in pregnancy.
Pulomonary embolism and amniostic fluid embolism.
Malnutrition.
Anaesthesia accidents i,e cardaic arrest, inhalation of
gastric contents.
2. CONTRIBUTORY CAUSES:
Death due to pre-existing diseases, which gets
aggaravated by pregnancy e.g. heart disease.

3. BIOLOGICAL FACTORS: Age, parity, social class.

4. SOCIAL FACTORS: Birth interval, literacy, family size,

delivery by untrained Dai or BTraditional birth attendants.
HEALTH REALTED PROBLEMS ACROSS A WOMEN’S LIFETIME
There are divided as:
1. INFANCY & CHILDHOOD(0-9 YEARS);
 Sex selection.
 genital mutilation.
 Disciminatory nutrition.
2. ADOLSCENCE (10-19 YEARS);
 Early childbearing.
 Unsafe abortion.
 STD’s, and AIDS.
 Under nutrition and micronutrients.
 substance abuse.
3. REPRODUCTIVE YEARS (20-44 YEARS);
 Unplanned pregnancy.
 Unsafe abortion.
 STd’s, and AIDS.
 pregnancy omplications.
 Malnutrition, especially iron deficiency anaemia.
4. POST- REPRODUCTIVE YEARS (ABOVE 45 YEARS);
 Cardiovascular diseases.
 Gynaecological disturbances.
 Osteoporosis.
 osteoarthritis.
 diabetes.
5. LIFE TIME HEALTH PROBLEMS;
 Gender violence.
 Certain occupation and environmental health hazards.
 Depression.
MEASURES TO REDUCE MMR:

Birth Spacing/ Reproductive Health

1. Discourage early marriages
2. Legislative measures
3. Providing incentives for smaller families
4. Spread awareness
5. Women empowerment
6. Eradicate poverty
7. Education
8. Integrated health, population & nutrition
services
9. Easy and cheap availability of contraceptives
10. Development
• In societies where women are poor, illiterate, and
politically powerless, high rates of reproductive illnesses
and deaths are the normal.

• Ethiopia has one of the highest maternal mortality in the

world; it is estimated to be between 566 – 1400 deaths
per 100,000 live births.

• Ethiopia has one of the highest maternal mortality in the

world; it is estimated to be between 566 – 1400 deaths
per 100,000 live births
 Magnitude (Burden) of Reproductive Health
Problem in World
• The term “Reproductive Health “is most often consider
with one aspect of women’s lives; motherhood.
• Complications associated with various maternal issues
are indeed major contributors to poor reproductive
health among millions of women worldwide.
• Half of the world’s 2.6 billion women are now 15 – 49
years of age.
• Without proper health care services, this group is highly
vulnerable to problems related to sexual intercourse,
pregnancy, contraceptive side effects, etc.
• Death and illnesses from reproductive causes are the
highest among poor women everywhere.
 Annual 9,500 Annual 0.5
maternal million children
Maternal & Child Mortality (Pakistan Demographic and Health
deaths deaths
Survey 2017-18)

306
249
Maternal deaths per
100,000 live births

211
178
140

2000 2005 2010 2015 2019

Maternal Mortality
Source: UNIA estimates and PDHS 2017-18 Child Mortality
 Breakdown of Deaths (2019)
Disease Groups for RMNCH & CD Number of deaths
Maternal & Neonatal disorders 265,947
Respiratory infections & TB 131,272
Enteric infections 101,485
Nutritional deficiencies 14,630
HIV/AIDS & sexually transmitted 8,874
infections
Neglected tropical diseases & malaria 7,109
Other infectious diseases 55,039
SOURCE: IHME 2019

TOTAL
TOTALRMNCH & CD
Injuries 584,359
85,346 (38.9%)
(5.6%)

TOTAL Non-Communicable Diseases 830,172 (55.3%)

Total Annual Deaths (2019): 1,499,877

 Maternal Care
Institutional Deliveries (2017- Modern CPR (2017-18)
18) Punjab: 27%
Punjab: 69% Sindh: 24%
Sindh: 72% KP: 23%
KP:
AJK: 62%
62% AJK: 19%
GB: 62% GB: 30%
Islamabad: 84% Islamabad: 35%
Balochistan:35% Balochistan:14%
Source: PDHS 1991, 2007, 2013, 2018
 Child Health Care
EPI Coverage (2017-18)
Punjab: 80%
Sindh: 49%
KP: 55%
Balochistan: 29%
AJK: 75% Highest number
GB: 57% (84 in 2020) of
Islamabad: 68% Polio cases in
the World
66%
Source: PDHS 1991, 2007, 2013, 2018

54% ARI cases

47%
67.1 million new
35% cases
28%

6% 5% 4% Diarrheal
PDHS
All Baic1990-91
Vaccines PDHS 2006-07 2012-13
No Vaccine cases
2017-18 49.4 million
new cases
Addressing determinants of health - Inter-sectoral
Policies
The Way Forward
In Pakistan half of GENDER
the RMNCH EMPOWERMENT

related burden
can be reduced
through inter-
sectoral policies,
which demand
collaboration
with other
sectors and
partners
 Spending in Health in Pakistan
 Requirement: US$
80% of 271(Rs. 76,693) per
80% of preventive &
curative primary person per year to
healthcare healthcare achieve (The Lancet)
services services
 Per capita health
expenditure: US$ 45
(Rs. 4,688)
 Per capita government
1 % of GDP
health expenditure:
2 % of GDP
US$ 15
 Total health
expenditure ratio to
Spending on GDP: 3%
Health
 Top Ten Burden & Risks (2019)
Cause of Death Premature Years Lost with Risk
Deaths Disability
1 Neonatal 1 Malnutrition
disorders 1 Neonatal 1 Dietary Iron (MCH)
disorders deficiency
2 Ischemic heart 2 Air pollution
disease 2 Ischemic heart 2 Depressive
disease disorders 3 High systolic BP
3 Stroke
3 Lower 3 Headache
4 Diarrheal respiratory 4 Dietary risks
disorders
disorders infections
4 Low back pain 5 Tobacco
5 Lower 4 Diarrheal
respiratory disorders 5 Other MSK 6 Unsafe WASH
infections 6 Gynaecological
5 Tuberculosis 7 High fasting
diseases plasma glucose
SOURCE: IHME 2019

6 Tuberculosis 6 Stroke
7 Diabetes
7 COPD 7 Congenital 8 High body-mass
defects 8 Age related index
8 Diabetes Hearing loss Behavioural

8 Cirrhosis 9
Environmental
High LDL
Metabolic
9 Chronic kidney 9 Neonatal cholesterol
9 Typhoid & disorders
disease Paratyphoid
10 Anxiety 10 Kidney
10 Cirrhosis 10 Chronic kidney dysfunction
disorders
disease
 Key Challenges
 Weak Governance in health
sector
 Low Financial allocation for health
(1% of GDP in public sector)
 Inadequate Access to ‘Universal
Health Coverage’ and Quality of
care
 Crises in Health workforce
 Frequent Health emergencies
 Addressing determinants of
health
 Harnessing research and
Towards Good Health & Happiness of A

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