OUR LADY OF FATIMA UNIVERSITY

College of Pharmacy

MODULE 7:
PHARMACIST IN FAMILY HEALTH
Part 1 of 2
PHPP 311 - Week 6 (Day 1 of 6)
 UNIT OUTCOMES

At the end of this module, the students should be able to:

◉  Describe the definition, importance and scope of family
heath
◉  Describe the definition, importance, scope and promotion of
maternal health
◉  Describe the definition, importance and scope of
reproductive heath
◉  Identify the different programs involved in improving maternal
and reproductive health.
2
 UNIT OUTLINE
Topic 1. Family Health Topic 3. Reproductive Health
a. Definition a. Definition
b. Importance b. Scope
c. Scope c. Promotion
Topic 2. Maternal Health Topic 4: Programs of DOH on
a. Definition Family Health
b. Scope
c. Promotion
d. Programs
3
 CHECKLIST

◉  Read unit outcomes and unit objectives

◉  Read course guide prior to class attendance
◉  Proactively participate in discussions
◉  Watch videos related to the topic
◉  Participate in discussion board (Canvas)
◉  Answer and submit course unit tasks
NOTES

TOPIC 1:
FAMILY HEALTH
 THE FAMILY UNIT

FAMILY
○  Is usually a group of two or more
people related by marriage,
common agreement, birth, or
adoption who reside together in the
same household, and may consist
of one, two, or more generations.
Tulchinsky, T. (2018). The New Public Health. Elsevier Academic Press.

6
 THE FAMILY UNIT

◉  The family is the basic social support unit in virtually all

human societies, providing the basis for childbearing
and child rearing.

◉  It has important roles in stability of basic physiological

and psychological needs as well as the economic
basis of the members of the unit.

7
 THE FAMILY UNIT

◉  The family provides the key environment for the

emotional needs, socialization, mutual help, and
nurturing needed by adults as well as children.

8
 THE FAMILY UNIT

◉  The family unit includes people living together, engaged

in sexual relations, in fertility, and in rearing of children
through the many stages of development before they
reach independent adulthood.

◉  It also includes caring for elderly parents and relatives,

as well as maintaining close contact with adult siblings
and children, themselves in the process of childbearing
and child rearing
9
 NUCLEAR FAMILY

◉  Typically includes a male and female couple related by

marriage, or living together by common consent, with or
without children.

10
 EXTENDED FAMILY

◉  Multigenerational and consists of the nuclear family

and relatives of both parties, whether or not they are
living in close geographic proximity.
◉  The extended family provides a broader basis of mutual
support.
◉  Multigenerational families consisting of single,
divorced, or widowed women with children are now
common, in association with high divorce rates,
single parenthood, and increasing longevity,
especially for women.
11
 IMPORTANCE OF FAMILY HEALTH

◉  The family structure provides an important foundation

for physical and emotional health of the individual
and the community.

◉  Marital and family status and interactions among family

members affect each person’s health and the well-being
of the community and nation.

12
 IMPORTANCE OF FAMILY HEALTH

◉  The family exists and functions within the context of

cultural, economic, legal, and social patterns unique
to each society, with important commonalities of the role
of the family in health.

○  However, each person is a unique individual who passes

through life stages with changing health needs and support
systems not only in the family, but also in peer groups and
society more widely.

13
 SCOPE OF FAMILY HEALTH

◉  Family health issues relate to phases involving fertility

and pregnancy, infancy, childhood, adolescence,
adulthood, and old age as well as the relationships
among family members.

◉  Each phase has specific health risks in which

prevention and other health services play an important
role.
14
 SCOPE OF FAMILY HEALTH

◉  No single population group is isolated from another.

Poor pregnancy outcome affects mother, child, family,
and the community.

◉  The family of the person who is chronically ill, injured, or

killed at work or on the road suffers economically,
emotionally, and socially.

15
 SCOPE OF FAMILY HEALTH

◉  The public health and medical

care systems must be sensitive to
the special needs of the family by
providing appropriate health
promotion, disease prevention,
medical care, and support
programs for each member of the
family and the family as a whole.

16
 TOPIC 2:
MATERNAL HEALTH

17
 MATERNAL HEALTH

◉  Women’s health issues relate to their many roles: as family

caregivers, individuals, workers, wives, grandmothers, mothers,
and daughters.
◉  These demand lifelong responsibilities for knowledge, self-care,
and family leadership in health-related issues, such as nutrition,
hygiene, education, exercise, safety, fertility, child care, and care of
the elderly.
◉  Changes in social roles of women create extra demands and risks
in health.

18
 GLOBAL SITUATION ON MATERNAL HEALTH

◉  According to WHO, about 810 women die from

pregnancy- or childbirth-related complications every
day. 94% of all maternal deaths occur in low and lower
middle-income countries.

Source:https://www.who.int/health-topics/maternal-health#tab=tab_3

19
 GLOBAL SITUATION ON MATERNAL HEALTH

◉  Most maternal deaths are preventable, as the health-

care solutions to prevent or manage complications are
well known.

◉  All women need access to antenatal care in

pregnancy, skilled care during childbirth, and care
and support in the weeks after childbirth.

20
 GLOBAL SITUATION ON MATERNAL HEALTH

◉  Maternal health and newborn health are closely

linked. It is particularly important that all births are
attended by skilled health professionals, as timely
management and treatment can make the difference
between life and death for both the mother and the
baby.

21
 WHO ON MATERNAL HEALTH

◉  The World Health Organization (WHO) is supporting

countries to deliver integrated, evidence-based and
cost-effective care for mothers and babies during
pregnancy, childbirth and the postpartum period.

◉  Investing in health systems – especially in training

midwives and in making emergency obstetric care
available round-the-clock – is key to reducing maternal
mortality.
22
 WHO ON MATERNAL HEALTH

◉  WHO is working with individuals, families and communities to

improve maternal and newborn health defining concepts, values
and guiding principles, presenting strategies, settings, and priority
areas for intervention such as midwifery.

◉  While the rate of skilled care during childbirth has increased from
58% in 1990 to 73% in 2013, mostly due to increase in facility-
based births, giving birth in a health facility does not equate with a
safe birth.

23
 WHO ON MATERNAL HEALTH

◉  In response to this situation, WHO and UNICEF

launched a Network for Improving Quality of Care for
Maternal, Newborn and Child Health IN 2017, to cut
preventable maternal and newborn illness and deaths,
and to improve every mother’s experience of care.

24
 FERTILITY

◉  Fertility is the natural potential and ability to conceive

and have children through normal sexual activity.

◉  Infertility is defined as inability to conceive after a year

of regular intercourse without use of contraceptives.

25
 FERTILITY

◉  Proper nutrition, communicable disease control,

and education ensure that females reach the age of
fertility physically and intellectually prepared for
childbirth and child rearing.

26
 FERTILITY

◉  Literacy for women contributes to improved infant

survival rates.
○  The literate mother has a greater ability to address
health issues, using written materials instead of
depending solely on community traditions, and is
better able to cope with the complexities of a health
care system.
○  Greater education is also likely to lead to a better
chance of employability and greater family income.
27
 PUBLIC HEALTH CONCERNS OF FERTILITY

◉  Provision of birth control along with prenatal, delivery,

and post-pregnancy care are among the central roles of
any health care service.

◉  High levels of maternal mortality of the past in the

industrialized countries are still present in developing
countries.

28
 PUBLIC HEALTH CONCERNS OF FERTILITY

◉  Traditions of high fertility rates, unattended

deliveries, unsafe practices of traditional birth
attendants (TBAs) and female genital mutilation (in
some cultures) greatly contribute to the poor health
status of women in developing countries.

29
 PUBLIC HEALTH CONCERNS OF FERTILITY

◉  In many societies, infertility is a problem associated with

significant personal distress and social stigma. Sexually
transmitted infections (STIs) are a major cause of
infertility so that prevention and treatment of STIs are
important aspects of managing infertility.

30
 PUBLIC HEALTH CONCERNS OF FERTILITY

◉  Treatment of infertility is associated with high cost, not

only in expenditures, but also in emotional trauma.

31
 PUBLIC HEALTH CONCERNS OF FERTILITY

◉  Modern services to treat infertility, including stimulation

of ovulation, in vitro fertilization, and surrogate
parenting, raise many ethical and financial issues.
◉  Despite these and other problems of multiple births and
high rates of very low birth weight infants with
associated perinatal and developmental problems,
infertility treatment is very much a part of modern health
care systems.
32
 FAMILY PLANNING

◉  Family planning allows people to attain their desired

number of children and determine the spacing of
pregnancies.

◉  It is achieved through use of contraceptive methods and

the treatment of infertility.

◉  World Health Organization (2018). Family Planning/Contraception.

https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
33
 BENEFITS OF FAMILY PLANNING / CONTRACEPTION

◉  Promotion of family planning – and ensuring access to

preferred contraceptive methods for women and
couples – is essential to securing the well-being and
autonomy of women, while supporting the health and
development of communities.

34
 BENEFITS OF FAMILY PLANNING / CONTRACEPTION

1. Preventing pregnancy-related health risks in women

2. Reducing infant mortality
3. Helping to prevent HIV/AIDS
4. Empowering people and enhancing education
5. Reducing adolescent pregnancies
6. Slowing population growth

35
 MATERNAL MORTALITY AND MORBIDITY

◉  A maternal death as defined by the WHO is death of a

woman while pregnant or within 42 days following
termination of pregnancy from any cause related to or
aggravated by the pregnancy or its management, but
not from accidental or incidental causes.

36
 MATERNAL MORTALITY AND MORBIDITY

◉  Maternal deaths are subdivided into two groups:

1. Direct—deaths resulting from obstetric
complications of the pregnant state;

2. Indirect—deaths resulting from preexisting disease

or conditions not directly due to obstetric causes.

37
 WHY DO WOMEN DIE?

◉  Women die as a result of complications during and

following pregnancy and childbirth.
◉  Most of these complications develop during pregnancy
and most are preventable or treatable.
◉  Other complications may exist before pregnancy but are
worsened during pregnancy, especially if not managed
as part of the woman’s care.

38
 WHY DO WOMEN DIE?

The major complications that account for nearly 75% of all

maternal deaths are:
1.  severe bleeding (mostly bleeding after childbirth)
2.  infections (usually after childbirth)
3.  high blood pressure during pregnancy (pre-
eclampsia and eclampsia)
4.  complications from delivery
5.  unsafe abortion.
39
 HOW CAN WOMEN’S LIVES BE SAVED?

◉  Severe bleeding after birth can kill a healthy woman

within hours if she is unattended.
○  Injecting oxytoxics immediately after childbirth
effectively reduces the risk of bleeding.

◉  Infection after childbirth can be eliminated if good

hygiene is practiced and if early signs of infection are
recognized and treated in a timely manner.

40
 HOW CAN WOMEN’S LIVES BE SAVED?

◉  Pre-eclampsia should be detected and appropriately managed

before the onset of convulsions (eclampsia) and other life-
threatening complications.
○  Administering drugs such as magnesium sulfate for pre-
eclampsia can lower a woman’s risk of developing eclampsia.

○  To avoid maternal deaths, it is also vital to prevent unwanted

pregnancies. All women, including adolescents, need access to
contraception, safe abortion services to the full extent of the
law, and quality post-abortion care.

41
 WHY DO WOMEN NOT GET THE CARE THEY NEED?

The main factors that prevent women from receiving or seeking care during
pregnancy and childbirth are:
◉  poverty
◉  distance to facilities
◉  lack of information
◉  inadequate and poor quality services
◉  cultural beliefs and practices.
To improve maternal health, barriers that limit access to quality maternal
health services must be identified and addressed at both health system and
societal levels.

42
 WHO RESPONSE

◉  Improving maternal health is one of WHO’s key priorities.

◉  WHO works to contribute to the reduction of maternal
mortality by:
○  increasing research evidence
○  providing evidence-based clinical and programmatic
guidance
○  setting global standards
○  providing technical support to Member States on
developing
○  implementing effective policy and programs.
43
 WHO RESPONSE

As defined in the “Ending Preventable Maternal Mortality

Strategy”, WHO is working with partners in supporting countries
towards:
◉  addressing inequalities in access to and quality of
reproductive, maternal, and newborn health care services;
◉  ensuring universal health coverage for comprehensive
reproductive, maternal, and newborn health care;

44
 WHO RESPONSE

◉  addressing all causes of maternal mortality, reproductive

and maternal morbidities, and related disabilities;
◉  strengthening health systems to collect high quality data in
order to respond to the needs and priorities of women and
girls; and
◉  ensuring accountability in order to improve quality of care
and equity.

45
 MATERNAL HEALTH SERVICES

MATERNAL HEALTH SERVICES IN THE PHILIPPINES

(Based on The Philippines Health System Review Health
Systems in Transition Vol. 8 No. 2 2018 of WHO):

◉  It is the policy of the government that all pregnant women be

delivered in a health facility such as a health center or a
hospital.
◉  PhilHealth accredits these birthing facilities for them to be
eligible for the maternity care package.

link:https://apps.searo.who.int/PDS_DOCS/B5438.pdf
46
 MATERNAL HEALTH SERVICES

◉  All pregnant women are required to undergo at least

four antenatal visits; be delivered by a skilled birth
attendant at a properly equipped facility; and undergo
postpartum care.

47
 MATERNAL HEALTH SERVICES

◉  An RHU with the capacity to handle normal deliveries is

called a BEmONC facility while district hospitals and
provincial hospitals capable of handling complicated
deliveries are designed as CEmONC.

○  Rural Health Unit (RHU)

○  Basic emergency obstetric and newborn care (BEmONC)
○  Comprehensive Emergency Obstetrics and Newborn Care
(CEmONC)

48
 MATERNAL HEALTH SERVICES

◉  This approach has led to an increase in facility-based

deliveries from 63% (2011) to 77% (2013) to 86%
(2015) in the devolved public system.

49
 MATERNAL HEALTH SERVICES

◉  A big difference in facility-based deliveries between the

rich and the poor is observed.
◉  For the lowest quintile, facility-based delivery is at 33%,
while for the highest quintile, it is 91% (Philippine
Statistics Authority and ICF International, 2014).
◉  This rich–poor gap reduced over time as NDHS 2017
reports facility-based delivery of 58.4% among the
lowest quintile (Philippine Statistics Authority and ICF
International, 2018).
50
 MATERNAL HEALTH SERVICES

◉  A 2014 maternal health study undertaken by an

academic institution in the Eastern Visayas post-
Typhoon Yolanda (Haiyan) showed that the rate of
facility-based deliveries was 83%, even higher than
the pre-Typhoon Yolanda figure of 80%; although
figures for prenatal care (80%) and postpartum care
(60%) did not change significantly pre- and post-
Typhoon Yolanda.
○  These results show corroborating evidence of improved maternal
health services in this poor region (Ramirez C et al., 2016).
51
 MATERNAL HEALTH SERVICES

◉  The maternal mortality ratio (MMR) has remained at a

high level over the past 25 years.
◉  In 2010, the official government figure was 162 maternal
deaths per 100 000 live births.
○  To achieve the maternal mortality target for the
MDGs, this figure had to be reduced to 52 but this
target was not achieved.

52
 MATERNAL HEALTH SERVICES

◉  There is some evidence which suggests that even if

facility-based deliveries have increased, maternal
deaths now occur in the birthing facilities because
mothers arrive there too late and the facilities are ill-
equipped to handle cases of difficult labour where the
mother is already exhausted and has lost blood
excessively (Garilao E, 2016).

53
 TOPIC 3:
REPRODUCTIVE
HEALTH

54
 REPRODUCTIVE HEALTH

◉  Reproductive Health is a condition in which the

reproductive functions and processes are accomplished
in a state of complete physical, mental and social well-
being.

55
 REPRODUCTIVE HEALTH CARE

Reproductive Health Care (according to the DOH) includes:

● Family Planning Services, counseling and information
● Prenatal, postnatal and delivery care
● Nutrition and health care for infants and children
● Treatment for reproductive tract infections & STDs
● Management of abortion-related complications

56
 REPRODUCTIVE HEALTH CARE

● Prevention and appropriate treatment for infertility

● IEC on human sexuality, reproductive health,
responsible parenthood
● Male involvement
● Adolescent reproductive health
● Management and treatment of reproductive cancers
● Services to victim/survivors of Violence Against Women

57
 13 SEXUAL REPRODUCTIVE HEALTH RIGHTS

1. The Right to Life

This means, among other things, that no woman’s life should be put at risk by
reason of pregnancy, gender or lack of access to health information and
services. This also includes the right to be safe and satisfying sex life.
2. The Right to Liberty and Security of the Person
This recognizes that no woman should be subjected to forced pregnancy,
forced sterilization or forced abortion.
3. The Right to Equality, and to be free from all Forms of Discrimination
This includes, among other things, freedom from discrimination because of
one’s sexuality and reproductive life choices.

58
 13 SEXUAL REPRODUCTIVE HEALTH RIGHTS

4. The Right to Privacy

This means that all sexual and reproductive health care services should be
confidential in terms of physical set-up, information given or shared by the
clients, and access to records or reports.
5. The Right to Freedom of Thought
This means that all sexual and reproductive health care services should be
confidential in terms of physical set-up, information given or shared by the
clients, and access to records or reports.
6. The Right to Information and Education
This includes access to full information on the benefits, risks and effectiveness
of all methods of fertility regulation, in order that all decisions taken are made
on the basis of full, free and informed consent.
59
 13 SEXUAL REPRODUCTIVE HEALTH RIGHTS

7. The Right to Choose Whether or Not to Marry and to Found and Plan
a Family
This includes the right of persons to protection against a requirement to marry
without his/her consent. It also includes the right of individuals to choose to
remain single without discrimination and coercion.
8. The Right to Decide Whether or When to Have Children
This includes the right of persons to decide freely and responsibly the number
and spacing of their children and to have access to related information and
education.
9. The Right to Health Care and Health Protection
This includes the right of patients to the highest possible quality of health care,
and the right to be free from harmful traditional health practices.
60
 13 SEXUAL REPRODUCTIVE HEALTH RIGHTS

10. The Right to the Benefits of Scientific Progress

This includes the right of sexual and reproductive health service of
clients to avail of the new reproductive health technologies that are
safe, effective, and acceptable.

11. The Right to Freedom of Assembly and Political Participation

This includes the right of all persons to seek to influence communities
and governments to prioritize sexual and reproductive health and
rights.

61
 13 SEXUAL REPRODUCTIVE HEALTH RIGHTS

12. The Right to be Free From Torture and Ill-Treatment

This includes the rights of all women, men and young people to protection
from violence, sexual exploitation and abuse.

13. The Right to Development

This includes the right of all individuals to access development opportunities
and benefits, especially in decision-making processes that affect his/her life.

62
 REPRODUCTIVE RIGHTS

◉  Reproductive rights embrace certain human rights that

are already recognized in national laws, international
laws and international human rights documents and
other consensus documents.

◉  Recognition of the basic rights of all couples and

individuals to decide freely and responsibly the number,
spacing and timing of their children and to have the
information and the means to do so.
63
 REPRODUCTIVE RIGHTS

◉  Right to attain the highest standard of sexual and

reproductive health.

◉  It also includes their right to make decisions concerning

reproduction free of discrimination, coercion and
violence, as expressed in human rights documents.

64
 SEXUAL HEALTH

◉  Healthy sexual development

◉  Equitable and responsible relationships and
sexual fulfillment, and
◉  Freedom from illness, disease, disability,
violence and other harmful practices related to
sexuality.

65
 SEXUAL RIGHTS

◉  Decide freely and responsibly on all aspects of their

sexuality, including protecting and promoting their
sexual and reproductive health.
◉  Be free from discrimination, coercion or violence in her
sexual lives and in all sexual decisions; and
◉  Expect and demand equality, full consent, mutual
respect and shared responsibility in sexual relationships

66
 DIFFERENCE BETWEEN SEX AND GENDER

SEX GENDER

Primarily refers to physical attributes-body

Is the composite of attitudes and behavior of
characteristics notably sex organ which are
men and women (masculinity and femininity)
distinct in majority of individuals.

Is learned and perpetuated primarily through:

Is biologically determined – by genes and
the family, education, religion (where
hormones media; thus it
dominant) and is an acquired identity

Is relatively fixed/constant through time and Because it is socialized, it may be variable

across cultures through time and across cultures.

67
 WHY IS THERE A NEED FOR GR-RB INTEGRATED
REPRODUCTIVE HEALTH SERVICES?

◉  The reality shows that health providers, with all their technical
knowledge and skills, are not necessarily equipped with a
gender perspective or with an integrated approach to
reproductive health services.
◉  RH being intensely personal and requiring a high degree of
privacy as well as associated with strongly held beliefs and the
subject of social, religious, ethical, political and legal structures,
need services that recognize these factors.
◉  RH is also significantly affected by behaviors of sexual partners
that bear directly on an individual’s choices, health status and
treatment outcomes.
68
 WHY IS THERE A NEED FOR GR-RB INTEGRATED
REPRODUCTIVE HEALTH SERVICES?

◉  There is a need for health providers to address the different areas of

reproductive health care in a more integrative manner, taking into
consideration what the elements have in common and the linkages among
them.

◉  Service providers need to view and approach the clients’ reproductive

health need in a holistic manner, thus requiring the health provider to be
technically adept as well as gender-sensitive, client-oriented, interactive
and empowering.

69
 WHY IS THERE A NEED FOR GR-RB INTEGRATED
REPRODUCTIVE HEALTH SERVICES?

◉  Clients normally seek RH service for one presenting symptom/complaint

such as one aspect of maternal and child health services (pre-natal and
post-natal care, immunization, nutrition) or family planning, delayed
menstruation, painful urination or post-abortion care.

◉  Health providers tend to focus on the presented need or problems

expressed during a client visit. Although they may be aware that such
particular need presented by the client may have come from other needs
or concerns that contribute to their primary problem, they may fail to
identify underlying and other important related needs and problems.

70
 WHY IS THERE A NEED FOR GR-RB INTEGRATED
REPRODUCTIVE HEALTH SERVICES?

◉  This results to missed opportunities of addressing sexual and

reproductive health (SRH) related and other important issues that
clients fail or may be constrained to express due to fear, shame or
lack of knowledge.

◉  Thus, opportunities for health education and addressing potentially

life threatening consequences of unmet SRH problems such as
sexually transmitted infections (STIs), violence and high-risk
pregnancies are neglected.

71
 RECALL

◉  What are the ◉  Enumerate the ◉  What are the main

benefits of family complications that factors that prevent
planning? account for women from
maternal deaths receiving/seeking
care during
pregnancy and
child birth?
 REFERENCES:

◉  Tulchinsky, T. (2018). The New Public Health. Elsevier Academic

Press
◉  World Health Organization, Regional Office for South-East Asia
(2018). Health Systems in Transition. Vol-8, Number-2. The
Philippines Health System Review.
◉  World Health Organization (2019). Maternal Health
◉  World Health Organization (2019). Maternal Mortality.

106
 REFERENCES:

◉  World Health Organization (2018). Family Planning/Contraception.

https://www.who.int/news-room/fact-sheets/detail/family-planning-
contraception
◉  International Pharmaceutical Federation, 2013. FIP Statement of
Policy on the effective utilization of pharmacists in improving
maternal, newborn and child health (MNCH). Available at:
www.fip.org/statements

107
 REFERENCES:

◉  Department of Health
○  https://www.doh.gov.ph/health-programs
○  https://www.doh.gov.ph/family-planning
○  https://www.doh.gov.ph/newborn-screening
○  https://www.doh.gov.ph/national-safe-motherhood-
program
○  https://www.doh.gov.ph/unang-yakap

108
 Thanks!

ANY QUESTIONS?

You can find me at:

110