REPUBLIC ACT NO.

10354 --- Responsible Parenthood & Reproductive Health Act of 2012 / Reproductive Health Law / RH Law
- a Philippine law that provided universal access to methods on contraception, fertility control, sexual education, and maternal care
in the Philippines
- TARGET POPULATION: Married Women of Reproductive Age (MWRA – 18 to 49) / WRA (15-49)

MILLENIUM DEV’T GOALS

To advance the health of women and children, gender equality, education, the environment, & global partnerships

1. END POVERTY AND HUNGER

2. ACHIEVE UNIVERSAL PRIMARY EDUCATION
3. PROMOTE GENDER EQUALITY AND EMPOWER WOMEN
4. REDUCE CHILD MORTALITY
5. IMPROVE MATERNAL HEALTH
6. COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES
7. ENSURE ENVIRONMENTAL SUSTAINABILITY
8. DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

STRATEGIES:

 Provision of Regular and Quality Maternal Care Services

Regular & quality prenatal care Provision of safe, delivery care

Prenatal counseling Provision of quality postpartum care

Proper schedule of follow-up must be followed:

1st postpartum visit: For home deliveries must be done w/in 24 hours after delivery
2nd postpartum visit: Done at least 1 week after delivery
3rd postpartum visit: Done 2-4 weeks thereafter

Attendants must be aware of the early signs, symptoms, & complications.

They should follow the 3 CLEANS: CLEAN Hands - CLEAN Surface - CLEAN Cord

 Improvement of the health personnel's capabilities on newborn care, midwifery thru trainings.
Note: All deliveries should be done in health care facilities ONLY

 Improvement on the quality of care at the First Referral Level

 Prevention of unwanted pregnancies through family planning services

 Prevention and management of STDS

 Promotion of Appropriate health practices

 Upgrade reporting services

 Mobilize political commitment and community involvement to provide support to basic health care delivery
MATERNAL CARE PROGRAM

BASIC EMERGENCY OBSTETRIC CARE (BEMOC)

= for every 125,000 population
= families to plan for child birth & upgrade technical capacities of HCP

COMPREHENSIVE EMERGENCY OBSTETRIC CARE (CEMOC)

= 1:150 population
= administer BT/Blood, newborn resuscitation, etc.

ESSENTIAL INTRAPARTUM NEWBORN CARE (EINC)

= a “simple cost-effective newborn care intervention” intended to enable improved neonatal & maternal care
= by changing childbirth practices, maternal & newborn deaths can be reduced significantly

ADMINISTRATIVE ORDER NO. 25 = UNANG YAKAP : Essential Intrapartum Newborn Care

WITHIN 30 MIN. AFTER 30 SEC.
-- immediate & thorough drying -- early skin-to-skin contact
-- provides warmth to the child -- establishes mother & child bonding
-- prevents hypothermia from setting in -- minimizes the risk of sepsis & hypoglycaemia

WITHIN 1-3 MIN. WITHIN 90 MIN.

-- properly timed cord clamping & cutting -- non-separation of the newborn & mother for early initiation of breastfeeding
-- prevents anemia and hemorrhage -- based onRA 7600 (BF Law/Rooming-in)

4 PILLARS / GUIDING PRINCIPLES OF THE PHILIPPINE FAMILY PLANNING PROGRAM (PFPP)

GENERAL OBJECTIVES:

Help couples and individuals to achieve their desired number, timing, & spacing of children through responsible parenthood.
To contribute in improving maternal, neonatal and child health, and nutrition (MNCHN) conditions.

1. Responsible Parenthood
= the will & ability to respond to the needs & aspirations of the family
= promotes the freedom of responsible parents to decide on the timing & size of their families in pursuit of a better life

2. Respect for Life

= the 1987 Constitution protects the life of the unborn from the moment of conception
= FP aims to prevent abortions thereby saving lives of both women and children

3. Birth Spacing
= proper spacing of 3-5 years from recent pregnancy enables women to recover from pregnancy and to improve their well-being,
 the health of the child, the rel. between husband and wife, & the rel. between parents and children

4. Informed Choice
= couples & individuals are fully informed on the different modern FP methods
= they decide & may choose the methods that they will use based on informed choice
= to exercise responsible parenthood in accordance with their religious and ethical values & cultural background
= subject to conformity with universally recognized international human rights.

FAMILY PLANNING
- the ability of individuals & couples to anticipate and attain their desired number of children and the spacing & timing of their births
- having the desired number of children using safe & effective modern methods when you want to have them

TYPES OF CONTRACEPTION:
NATURAL METHODS (temporary) / Behavioral Methods
= does not involve man-made devices & has no cost
= useful for proper timing & spacing of pregnancies; effective with self-control & discipline

 ABSTINENCE  BASAL BODY TEMPERATURE

- complete avoidance of sexual intercourse
- only 100% effective way to prevent pregnancy & STIs
 CALENDAR METHOD
- predicting fertility based on menstrual cycles
- charts prev. cycles to predict days of fertility & infertility
 STANDARD DAYS METHOD (SDM)
- for women with menstrual cycles bet. 26-32 days
- avoid unprotected sex on day 9-19; ovulation at day 14
-70-80% effective
- this is the lowest body temp. when at rest
- ovulation would raise the body temp. by ½ - 1 *F
- body temp. will drop if fertilization does not occur
 CERVICAL / SPINNBARKEIT MUCUS
- coincides with the day of ovulation in 80% of cases
- probability of conceiving a baby is highest on this day
 COITUS INTERRUPTUS / WITHDRAWAL
- removal of penis from vagina before ejaculation occurs
- not sufficient since it’s difficult to control
- sperm on legs or labia can still travel to the vagina
- 1/5 women still get pregnant

ARTIFICIAL METHODS

 HORMONAL METHODS (similar to estro. & progesto)

- pill, patch, vaginal ring, shots, implants, IUD, etc.
- add chemicals similar to hormones to stop ovulation & weaken the sperm
- the hormones thicken the cervical mucus; slow sperm; thin out the uterine lining to prevent implantation
SAFE PERIOD:
Based on process of ovulation & menstrual cycle, the safe period can be determined (time for coitus to be done).
This method is not suitable for those with irregular periods and changes in their menstrual cycle.

 BARRIER METHODS
- prevent the meeting of the sperm and egg

CONDOM SPERMICIDES
- a thin covering unrolled over an erect penis - cream, gel, foam, film, suppository, sponge
- doesn’t protect against STIs - chemicals that go in the vagina 10 mins. before sex
- may decrease male sensation & lubrication makes it - immobilize or kill sperms (1 hr. or 24 hrs. for sponge)
easy to break
IMPLANTABLE RODS
 IUD – Copper (lasts 10 years) / – Progestasert (1 yr.)
DIAPHRAGM
- along with spermicides, these are very effective
- has no risk or contraindication
- placed inside the vagina by professionals & requires
check-up
INTRAUTERINE DEVICE (IUDs)
- small, stringed plastic “T” inserted into the uterus
- stops / slows the sperm or egg; inserted during period
- can last for 5 years
- release synthetic progestin that changes cervical
mucus, FTs, & uterine lining

 CHEMICAL BARRIERS
- kill sperms & allow chemical contraceptives to prevent pregnancy
- foam tablet aerosols, cream, jelly, pastes, suppository, soluble films
 BIRTH CONTROL PILLS
- taken orally every day at about the same time, but requires prescription
- stops ovulation, thins uterine lining, thicken cervical mucus

 EMERGENCY CONTRACEPTION / MORNING AFTER PILL

- a pill or combination of pills taken after sex to prevent pregnancy
- contains a higher dose of the same hormones found in regular birth controls
- does not stop and existing pregnancy

 COMBINED PILLS
- pill has both estrogen & progesterone in very small doses
- inhibit ovulation by blocking gonadotropin from the pituitary gland
- progesterone thickens the cervical mucus to prevent the entry of sperms into the genital canal

 INJECTABLE CONTRACEPTIVES
- easier to administer, highly effective, irreversible, does not interfere with lactation, & no effect on the infant
- can cause abnormal uterine bleeding, genital malignancy, & breast cancer

 SUBDERMAL IMPLANTS
- NORPLANT = has 6 small silicon tubes w/ each containing 30mg of progestogen
- NORPLANT R2 = has 2 small rods
- both are placed under the arm skin & steadily diffuse steroids into the bloodstream for a period of 5 years

 SHOT / DEPO-PROVERA
- a long-acting hormonal injection given to women once every 3 months
- irreversible = once injected, the hormones remain in the woman for at least 3 months (w/ weight gain)

SURGICAL METHODS / STERILIZATION (Permanent & For 35+ y/o)

 VASECTOMY
- ligation of the vas deferens w/in 15-20 minutes
- more effective & has a faster and easier recovery compared to tubal ligation
- a small cut is made on both sides of the scrotum then about 1cm of the VD on either side in ligated, folded back, & sutured
- this does not affect sexual characteristics & sex life; it simply prevents the ejaculation of sperm

 TUBAL LIGATION / TUBECTOMY

- resects a small portion of FTs & ligates the resected ends
- tubes can also be closed with bands, clips, or electrocautery
- can be done through an abdominal (laparoscopy / mini laparotomy) or vaginal approach
- done after delivery, between deliveries, or after abortion
 ABORTION
- termination of pregnancy before the fetus becomes viable / before it’s able to live outside the womb
- period is fixed at 28 weeks when the fetus weighs 1kg
- can be spontaneous or induced