WorkBook 1

Sexual and Reproductive Health concerning Midwifery

by [Name]

Course

Professor's Name

Institution

Location of Institution
Date
 WorkBook 2

Sexual and Reproductive Health concerning Midwifery

Introduction
Sexual and reproductive health has a significant interlinkage to midwifery as a

profession. Throughout the module, I gained critical insight into the key issues revolving around

the concept of sexual reproductive health. According to Østensen (2017), the holistic approach of

sexual and reproductive health adopted in the module enhanced my understanding of the

physical, social, and psychological aspects of sexual and reproductive health. The world health

organization defines sexual and reproductive health as a state of complete physical, mental, and

social well-being and not merely the absence of a disease or infirmity in all sex and reproductive

health matters. Four essential themes are pertinent as far as sexual and reproductive health is

concerned. The first issue is sexual health and sexuality, which addresses issues such as sexual

identity. The second theme concerns contraception concerning midwifery practice (Duran et al.,

2020). The third theme involves the management of STIs and HIV during pregnancy. Therefore,

aspects addressed in this essay include contraceptives, pregnancy and HIV management, STIs,

and other women who test positive for HIV. Stigma being a critical topic with regards to sexual

health will also be addressed; stigma is defined as an element of disgrace associated with a

particular trait, circumstance or person, in this case, it may be associated to a particular sexual

health circumstance such as HIV state.

Theme 1: Sexual health and sexuality

In this section, I intend to describe the interrelationship between sexual health, sexuality,

and midwifery. The world health organization recognizes the essential contribution that sexuality

has towards the attainment of sexual health. Physical, mental, and social aspects of women’s

sexuality, thus have a significant contribution towards the status of their sexual health (Szirom,
 WorkBook 3

2017). Concerning the physical element, women have been proven to undergo specific

physiological processes during the phase of their reproductive years (Işik & Yildirim, 2021).

According to the argument presented by Allen and Walter (2018), the acknowledgement of these

issues such as menstrual circle, birth, labour, and lactation among the midwives should influence

the decision that is to be made at various points when getting medical attention. In evaluating the

advantages and disadvantages of individual intervention, such sexual aspects of the women

should be prioritized to ensure that their sexual health is adequately preserved.

Sexuality is a diverse topic and consists of various types; people may change their

sexuality with time. It may also take time for people to figure out their sexuality. Different types

of sexuality include; bisexual, homo and heterosexual, and asexual. Heterosexual individuals are

attracted to the opposite sex; homosexual individuals are attracted to people of the same sex as

theirs. Bisexual individuals are attracted to both opposite and same-sex individuals, whereas the

asexual individuals experience limited to ultimately no sexual attraction (Kolak, 2017). To

achieve positive sexual health, it is essential for individuals to positively and positively approach

sexuality and sexual relationships and both encourage safe and pleasurable sexual experiences

and prevent violence, coercion, and discrimination (Höglund and Larsson, 2019. Sexual health is

an individual responsibility and that of the community, especially in relation to sexuality; the

community is responsible for promoting positive sexual health by respecting and appreciating

diversity and individual differences (World Health Organization, 2017). Therefore, midwives

should understand this concept and hence treat diverse patients with respect, care and

appreciation.

There is also the need for the creation of a conducive environment for women during the

delivery process. Women tend to feel secure when they deliver in a room that has some elements
 WorkBook 4

of privacy. Bohme (2017) specifically argues in support of the need to uphold privacy by stating

that the condition makes the women feel safe as they are going through the delivery process. A

safe environment has been associated with a reduction in the cases of birth complications.

Bohme (2017) privacy is an essential concept of women's sexuality as they are designed to feel

safe about their sexuality when their sexual issues are addressed privately. Thus, in a situation

where privacy is not upheld, such women may end up experiencing birth-related complications

that may affect the unborn babies and the women's lives.

The midwives should equally acknowledge the existence of specific cultural barriers that

may affect the delivery process. Cultural beliefs have been shown to affect how people make

specific interpretations about their lives. For instance, some women believe that the delivery

process is so private that the number of attending physicians must be reduced to ensure that the

whole process is conducted safely (Crooks, Baur and Widman, 2020). In such a case, the

midwives can reduce the number of people in the room to make the pregnant women confident

about the delivery process. Concerning the concept of cultural ideologies, some expectant

mothers are usually not proud of their sexuality due to specific cultures, such as that the husband

should only see a woman's reproductive parts. Such cultural ideologies may prevent the

expectant woman from embracing the delivery process as some may not motivate to push the

baby (Höglund and Larsson, 2019). Such harmful cultural ideologies necessitate the need to

practice health education before the entire process to protect the pregnant woman from the

harmful cultural ideologies that may harm the delivery process.

Generally, sexuality has a significant contribution towards the attainment of sexual and

reproductive health among women. The midwives should thus pay crucial attention to the

women’s sexuality due to its interlinkages to sexual health. The sexual health of a woman can
 WorkBook 5

extensively impact the delivery process. Therefore, a focus on the sexuality of the women has a

significant contribution towards the attainment of favorable health outcomes before, during, and

after the delivery process.

Theme 2: Contraception concerning midwifery practice

The use of contraception among women has been proven to enable them to gain more

control over their sexuality. These contraceptives make it possible for women to control the

number of children they opt to have and the appropriate spacing between each child. There exist

several benefits that have been shown to result from the proper use of contraception among

women. Höglund and Larsson (2019) state that contraception allows women to attain controlled

childbearing, reducing the economic challenge of high dependency in low-income cases. The

inability to regulate the number of children has made some women have several children even

when they do not have the financial ability to cater to the needs of these children. Thus, through

proper contraception, the challenge can be effectively addressed, leading to a significant

improvement in women's lives. Adequate spacing of children equally has some medical benefits

(Szirom, 2017). Women who appropriately space their children are less likely to develop birth-

related complications than their counterparts that give birth regularly. Women need to provide

themselves with enough time for their reproductive health to adjust before deciding whether to

have another child (Höglund and Larsson, 2019). Thus, the midwives need to participate in many

health educational programs meant to equip the women with the correct information that can

encourage them to make an appropriate decision about contraception. Such initiatives are

expected to have a positive effect on the attainment of proper health outcomes.

The nature of the women's information regarding the use of contraception is one crucial

challenge that needs to be addressed. A significant proportion of the women still uphold the
 WorkBook 6

existing myths and misconceptions regarding using these contraceptives (Höglund and Larsson,

2019). For instance, some women believe that contraception has been associated with the

development of cancer. As a result, some usually opt not to use them for fear of developing

cancer. The midwives need to conduct comprehensive health education to address the current

wrong information related to contraceptives (Höglund and Larsson, 2019). Successful

implementation of this comprehensive health education will equip the women with the

knowledge to make the right decisions concerning contraception.

The men's involvement in the family planning initiatives can equally go a long way in

promoting their use among women. Men are required to support the women in their attempt to

utilize the family planning services. Therefore, the midwives need to encourage the women to

attend such sessions with their husbands to enable them to understand the roles they need to play

to ensure that the women effectively utilize the different types of contraception available to them

(Höglund and Larsson, 2019).

Contraception prevents pregnancy by preventing egg production, keeping the sperm and

ovule apart, or stopping the combined sperm and egg from attaching to the womb's lining.

Various methods of contraception include; vaginal ring, diaphragms, contraceptive implant,

combined pills, and contraceptive injections (Karimian et al., 2018). Multiple factors to consider

for selecting the appropriate contraception include health, age, lifestyle, and side effects. The

mid-wives should consist of health education programs developed for women (Crooks et al.,

2020). Research also highlights that women spend the majority of their reproductive lifetime

preventing pregnancy compared to experiencing pregnancy; the choice of contraceptives may

also be challenging as there are various types, each with a set of drawbacks and advantages

(Naezer et al., 2017). Therefore, midwives need to be familiar with the range of contraceptives
 WorkBook 7

available within their locality and ways to guide women in choosing the most effective

contraception individually.

Theme 3: Management of STI’s and HIV during pregnancy

The management of STIs and HIV is a crucial role that needs to be conducted throughout

pregnancy. According to WHO (2017), these conditions have been proven to negatively affect

the health status of infants upon birth. For instance, in the case of HIV infection, the caregivers

must undertake the right medical interventions that would protect the unborn child from HIV

infection during delivery (World Health Organization, 2017). At the moment, there exist enough

policies that advocate for prior testing of pregnant women to establish their HIV status. In a

situation where the woman is usually proven to be positive, the caregivers usually put the

expectant woman through an appropriate medical intervention to reduce the chances of infections

(Østensen, 2017). In addition to that, some drugs are usually issued to lower the viral loads to

levels where they can not establish some infection to the infant. The midwives are required to

conduct a proper assessment of the pregnant woman to ensure that they do not go into labor

when they are not adequately prepared for such events. The midwives are thus required to

conduct a review of the medical history of the expectant woman to reduce the chances of mother-

child form of transmission (World Health Organization, 2017). Mother-to-child transmission has

been shown to harm the quality of life due to the adverse effects of HIV transmission on the

immune system. Therefore, midwives have a crucial role to play concerning the management of

HIV infections during pregnancy.

The management of STIs at various stages of pregnancy is another essential role that

needs to be undertaken by the midwives. STI's extensively affects the quality of life among

infants, mainly since cross infections can occur. As the baby passes through the birth canal
 WorkBook 8

during delivery, some of the pathogens responsible for the disease in question may come into

contact with the baby's skin (World Health Organization, 2017). Close contact may facilitate

some infections, especially since the baby's skin is usually not developed enough to prevent the

entry of these pathogens. STI's such as gonorrhea have been shown to cause blindness among

infants. As a result, specific health policies have been postulated to make it mandatory for an

expectant mother to be tested before the delivery (Pugsley, 2018). The midwives are required to

ensure that the assessment of the pregnant women who are just about to deliver also covers the

evaluation of whether they could be dealing with any form of STI. Also, the midwives need to

advocate to educate the pregnant women about some of the danger signs that they should observe

in case they suspect any form of sexually transmitted infection. Awareness about these

presentations of STIs will facilitate early detection to enable the affected parties to get early

medical intervention (Höglund and Larsson, 2019). Early medical interventions are bound to

protect unborn babies from infections that would adversely affect their health status.

The HIV test is conducted similar to all the other routine antenatal blood tests; these

include the rhesus factor, blood group, syphilis, and rubella tests, although one blood sample

may be used to achieve all the tests. A repeat test is conducted in the third trimester,

approximately before the 36th week of gestation, in cases where the results were initially

negative but the risks for acquiring HIV are increased (Mccann et al., 2019). There is an

approximately 25% chance that a child will be born HIV positive if the mother goes untreated.

Hence, the increased need for HIV testing during pregnancy is also essential in ensuring proper

physical health in the mother through treatment (Oren et al., 2018). Antiretroviral medicines

prevent HIV transmission from the mother to the child in cases of infected mothers; the

antiretroviral drugs dolutegravir and emtricitabine/tenofovir alafenamide fumarate

 WorkBook 9

(DTG+FTC/TAF) have been reported as the most effective HIV treatment currently available for

pregnant women with HIV/AIDs. Early treatment is also recommended for decreased viral load

in the blood during delivery. Midwives should also be educated on viral loads and their impact

on method of delivery; pregnant women with a viral load of fewer than 1000 copies/mL in 4-6

weeks due may have the option of vaginal delivery while a viral load of greater than or equals to

<1000 copies/mL only allows the choice of caesarian delivery.

Theme 4: Young people and sexual health

We reviewed the concept of young people and health during the module, where specific

insights came up. The sexual health of young people depends on several issues that should be

addressed from a holistic perspective. One specific challenge that has been shown to negatively

impact young people's sexual health is poor information. Reproductive health information is

expected to enable people to make informed choices regarding their lives (Riggs and

Bartholomaeus, 2018). Thus, issues such as sexual and reproductive health rights are expected to

make people adopt the right decision that does not violate the fundamental rights and freedoms

issued to young people. Awareness of these rights is bound to make young people more

confident about their lives in a manner that prevents them from associating with people who can

violate some of their sexual and reproductive health rights (Höglund and Larsson, 2019). The

protection of these young people from the mentioned sexual offenders through teaching on sex

and reproductive health rights is bound to positively affect the attainment of the fundamental

objectives.

My interactions with young people also enhanced my understanding of the role of

comprehensive sex education in attaining the proper sexual health outcomes. The primary

purpose of extensive education is to equip the audience with the correct information that can give
 WorkBook 10

them the chance to make the right choices. In line with the stated argument, comprehensive sex

education enhances people's understanding of their sexual health to enable them to live

meaningful lives that are free from any form of health issue. Comprehensive sex education

equally addresses the challenge of Gender among young people—a proper understanding of the

critical issues involved in Gender (Pugsley, 2018). Through adequate knowledge of the

acknowledgment of such gender differences, young people respect one another in a manner that

prevents them from subjecting their counterparts to different levels of discrimination which can

negatively affect their lives (Höglund and Larsson, 2019).

The adoption of health-seeking behavior can also have a positive effect on the attainment

of the desired outcomes. Most young people tend to engage in activities that can push them into

unplanned sexual activities (Allen and Walter, 2018). For instance, the use of drugs has been

shown to make young people engage in random sexual activities in a manner that leads to a surge

in infection rates. Thus, young people should be educated on some of the health-seeking

behavior they should encourage to prevent any form of unintended sexual activity. The adverse

implications of these involuntary sexual activities are profound as they can lead to unplanned

pregnancies, among other challenges (Østensen, 2017). Therefore, the midwives should ensure

that the healthcare needs of the young people are adequately catered for through the provision of

health education meant to equip them with the skills required for evidence-based decision-

making.

Various conditions emerge with the child's exposure to alcohol during the mother's

pregnancy, identified as fetal alcohol spectrum disorders (FASD). FASD has been reported to

cause most brain damage in children before birth; low birth weight and premature birth are also

other effects. Fetal alcohol syndrome varies from child to child, although its defects in any
 WorkBook 11

particular child are irreversible. Based on this information, midwives should be educated to

deliver sex education to teenagers and other members of the young population on the impacts of

drug abuse on both their unborn children as well as their health. Midwives should also insist on

the need for early diagnosis to reduce risks for long-term problems in children suffering fetal

alcohol syndrome.

Conclusion

The module has extensively enhanced my understanding of the interlinkages between

sexual reproductive health and midwifery as a medical practice. Sexual and reproductive health,

being part of the essential system in the body, requires the same medical attention that is needed

by other systems in the body. Physical, mental, and social aspects of women's sexuality have a

significant contribution towards the status of their sexual health. There is also the need for the

creation of a conducive environment for women during the delivery process. The midwives

should also acknowledge the existence of specific cultural barriers that may affect the delivery

process. Contraception, on the other hand, allows women to attain controlled childbearing,

reducing the economic challenge of high dependency in low-income cases. The nature of the

women's information regarding the use of contraception is one crucial challenge that needs to be

addressed. The midwives need to conduct comprehensive health education focused on addressing

the current wrong information related to contraceptives. The management of STIs and HIV is

also essential and needs to be taught throughout pregnancy. Young people’s sexual health is also

impacted by poor information; comprehensive sex education addresses the challenge among

various others among the young people on midwifery.

 WorkBook 12

References

Allen, M.S. and Walter, E.E., 2018. Linking big five personality traits to sexuality and sexual

health: A meta-analytic review. Psychological Bulletin, 144(10), p.1081.

Böhme, G., 2017. Midwifery as science: an essay on the relation between scientific and everyday

knowledge. In Society & Knowledge (pp. 373-392). Routledge.

Crooks, R.L., Baur, K. and Widman, L., 2020. Our sexuality. Cengage Learning.

Duffy, K., and Gillies, A. 2018. Supervision and assessment: The new nursing and midwifery

council standards. Nursing Management, 25(3).

Duran Aksoy, O., 2020. Assessing the Sexual Attitudes of Midwifery Students and Their

Opinions on Sexuality in People with Disabilities. Sexuality & Disability, 38(2).

From, T., 2017. Teaching gender?: sex education and sexual stereotypes (Vol. 21). Taylor &

Francis.

Höglund, B. and Larsson, M., 2019. Midwives' work and attitudes towards contraceptive

counseling and contraception among women with intellectual disability: focus

group interviews in Sweden. The European Journal of Contraception &

Reproductive Health Care, 24(1), pp.39-44.

Işik, K., & Yildirim, H. 2021. Psychometric Assessment of the Nursing and Midwifery Students'

Attitudes Towards Sexual Health Scale. Turkiye Klinikleri Hemsirelik

Bilimleri, 13(2).
 WorkBook 13

Karimian, Z., Azin, S.A., Javid, N., Araban, M., Maasoumi, R., Aghayan, S. and Khoie, E.M.,

2018. Reaching consensus: a review on sexual health training modules for

professional capacity building. Health promotion perspectives, 8(1), p.1.

Kolak, M., Jensen, C. and Johansson, M., 2017. Midwives’ experiences of providing

contraception counselling to immigrant women. Sexual & Reproductive

Healthcare, 12, pp.100-106.

McCann, E., Marsh, L. and Brown, M., 2019. People with intellectual disabilities, relationship

and sex education programmes: A systematic review. Health Education

Journal, 78(8), pp.885-900.

Naezer, M., Rommes, E. and Jansen, W., 2017. Empowerment through sex education?

Rethinking paradoxical policies. Sex Education, 17(6), pp.712-728.

Ören, B., Zengin, N., Yazıcı, S. and Akıncı, A.Ç., 2018. Attitudes, beliefs and comfort levels of

midwifery students regarding sexual counselling in Turkey. Midwifery, 56,

pp.152-157.

Østensen, M., 2017. Sexual and reproductive health in rheumatic disease. Nature Reviews

Rheumatology, 13(8), pp.485-493.

Pugsley, L., 2018. Focus groups, young people and sex education. In Gender and qualitative

research (pp. 114-130). Routledge.

Riggs, D.W. and Bartholomaeus, C., 2018. Transgender young people’s narratives of intimacy

and sexual health: implications for sexuality education. Sex Education, 18(4),

pp.376-390.
 WorkBook 14

World Health Organization, 2017. WHO technical brief: preventing HIV during pregnancy and

breastfeeding in the context of PrEP (No. WHO/HIV/2017.09). World Health

Organization.