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CORE MATERIALS Ml 13

REPRODUCTIVE HEALTH IN THE WORKPLACE

I. BRIEF DESCRIPTION

Industrial and technological developments and the increasing use of chemicals

can have an impact on reproductive health, especially for women workers.

The reproductive health program in the workplace is one of the strategic efforts to reduce maternal
and child mortality in accordance with the Millennium Development Goals (MDGs) targets.

II. LEARNING OBJECTIVES

General purpose

After attending this session the participants were able to understand reproductive health efforts in

workplace.

Special purpose

After this session participants will be able to:

1. Know the background of reproductive health efforts in the workplace.

2. Explain the meaning and scope of reproductive health.

3. Explain the risk factors that affect the reproductive health of workers.

4. Describe some reproductive health disorders that can occur in

worker.

5. Explain reproductive health efforts in the workplace.

6. Knowing the role of various parties in reproductive health efforts in place

Work.

III. POINTS OF DISCUSSION

1. Background on reproductive health efforts in the workplace.

2. Definition and scope of reproductive health.

3. Risk factors that affect the reproductive health of workers.

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4. Reproductive health problems that can occur in workers.

5. Reproductive health efforts in the workplace.

6. The role of various parties in reproductive health efforts in the workplace.

IV. TEACHING MATERIALS

1. Hand out material on reproductive health in the workplace

V. STEPS AND PROCESSES

1. The facilitator introduces himself (5 minutes).

2. The facilitator explains the purpose and objectives of the material briefly (5 minutes).

3. The facilitator explores participants' knowledge about reproductive health on the spot

work (10 minutes).

4. The facilitator delivers material on reproductive health in the workplace (60

minute).

5. The facilitator provides opportunities for participants to express opinions and

or questions (5 minutes).

6. The facilitator summarizes the material that has been given (5 minutes).

VI. MATERIAL DESCRIPTION

A. BACKGROUND

In an effort to increase Indonesia's Human Development Index (IPM), then

one of the health development policies is more directed to improve

quality of human resources to be more resilient, independent, and qualified,

as well as being able to compete in the face of increasingly tight free competition in Indonesia

globalization era. One of the strategic efforts to improve the quality of human resources

Indonesia starts from the fetus in the womb, therefore the mother/woman who

healthy is expected to give birth to a healthy generation as well.

Women and men who work, both in the formal and informal sectors, are often exposed to various risk

factors that have the potential to threaten their health, including reproductive health. Reproductive health

disorders that occur, can be in the form of fertility disorders, disorders of pregnancy or malignancy.

The magnitude of the problem resulting from exposure in the workplace is difficult to estimate

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assessed, only a fraction of the more than 60,000 chemicals used in industry
has been investigated for its toxicity to reproductive health. Exposure to toxic substances
on reproductive health is estimated to occur most frequently in women
who work in the manufacturing and health sectors as a result of using solvents
organic. In developing countries the main problem is caused by
pesticides and other industrial chemicals.

Many employment sectors are predominantly occupied by women workers

because it has several properties such as; conscientious, patient, easy to manage or not
protests a lot, has manual skills and is often willing to pay less
than men. Female workers are generally of reproductive age (15-
45 years) where women of reproductive age constitute a group
vulnerable society. In the United States women are working at the time
her first pregnancy reached 64.5%.

Working women generally have a double workload, they are burdened to add to or become
the main source of family income, have the burden of doing household chores and taking
care of their children and sometimes their parents. Because women have a risky
physiological condition,
so if women work in risky places it will have an impact
on reproductive health.

Women workers in Indonesia are like women in general in their age

reproductive health problems include: the prevalence of anemia in women of reproductive
age is 26.8%, anemia in pregnant women is 40.0%,
so that it will result in women of reproductive age easily suffering from illness and
it is possible that if you are pregnant you will have a high risk of giving birth and giving birth to a
generation that is malnourished as well (Ministry of Health, 2003).

The average body size of all women is smaller than men. Workplace
and work equipment generally designed for male workers, including tools
self protection. Work in the workplace and use work tools that don't work
accordingly causes women to be more susceptible to interference
occupational health.

Women have more body fat which causes it

tolerance to hot ambient temperatures becomes lower, however
to cold temperatures to be higher. According to NIOSH ambient temperature for men

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25.5oC, while for women 24.4oC. In addition, the potential for storage
fat-soluble toxic substances are higher.

Law no. 7 of 1984 is the ratification of the 1979 UN convention

concerning the elimination of all forms of discrimination against women, where
Article 11 states the right to health protection and
Occupational safety including protection for the function of continuing descent.

B. DEFINITION AND SCOPE

1. Definition of reproductive health

Reproductive health is a state of physical, mental and social well-being

as a whole, not merely free from disease or disability in all
matters relating to the reproductive system, as well as its functions and processes
(International Conference on Population and Development (ICPD), Cairo 1994).

2. The scope of reproductive health

• Maternal and Child Health

• Family Planning
• PP ISR, HIV/AIDS
• PP complications of abortion

• Adolescent Reproductive Health

• PP Infertility

• Old age reproductive health

C. RISK FACTORS ON REPRODUCTIVE HEALTH

1. Factors outside of work
• Age, nutrition, exercise, chronic disease
• Sexually Transmitted Infections (STIs)

• Reproductive Tract Infection (ISR)

• Genetic disorders
• Drug use
• Cigarettes, alcohol and coffee

• Social support
• Income
• Health insurance, etc

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2. Hazards in the workplace

• Physical

• Chemistry

• Biology

• Ergonomics

• Psychosocial

3. Special conditions

• Pregnancy

• Labor, and others

D. REPRODUCTIVE HEALTH DISORDERS THAT MAY OCCUR TO WORKERS

1. Pre-Conception and Conception:

Decreased fertility and menstrual abnormalities can be caused by abnormalities in the hypophyseovarium

relationship. This condition is caused by:

• Physical factors: hard work & overtime (excessive activity)

• Psychological factors: Stress

• Hazardous chemicals: benzene, xylene, styrene, trichloroethane,

tetrachlorethylene

• Heat pressure: specifically in males interfere with the process of spermatogenesis

2. Pregnancy:

• Fetal death can be caused due to health problems of pregnant women

• Several studies found that the occurrence of spontaneous abortion because

exposure to hazardous chemicals (organic solvents), radiation, psychological stress

• Fetal defects are defects in the fetus, after exposure to radiation/

hazardous chemicals and malnutrition

• Cancer can result from exposure to radiation and hazardous chemicals

• Health Problem: malnutrition, viral and bacterial infections, psychological stress.

3. Breastfeeding

Some chemicals show can get into breast milk, among others

Polychlorinated Biphenyls, Polybrommated Biphenyls, Chlor Hydrocarbon Aliphatic Perchlorethylene, Hg, Pb.

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4. Post Christmas Effects

Chemicals can be associated with the occurrence of neurological disorders in the fetus and
increase the incidence of neurological disorders in children.

E. REPRODUCTIVE HEALTH EFFORTS IN THE WORKPLACE

In protecting workers from reproductive health hazards in the workplace efforts
the efforts made are as follows:
1. Reproductive Health Service Program
a. Before Conception
Reproductive health services before the conception period are primarily promotive
and preventive for both female and male workers. Promotive is aimed at increasing
knowledge about reproductive health and preparing to become healthy parents.
The reproductive health service programs implemented are:

ÿ Promotion and education about reproductive health

ÿ Knowledge of hazards in the workplace that affect the
reproductive health and its management.
ÿ Counseling Sexually Transmitted Infections and Reproductive Tract Infections.
ÿ Knowledge of nutrition, nutritional status, nutritional intake and balanced nutrition on
worker.
ÿ Periodic health checks.

ÿ Utilization of iron tablets to treat anemia caused by

Fe deficiency.
ÿ Provision of TT immunization to female workers when they become candidates
bride.

b. During Pregnancy

Pregnant women who work apart from getting health problems

also generally have a higher risk of getting a hazard on the spot
Work. Reproductive health services in the workplace, are promotive,
preventive, curative and rehabilitative, namely:

ÿ Promotion and education about reproductive health and development

fetus.
ÿ Administrative arrangements related to ergonomic issues that can
interfere with pregnancy, such as working too long standing, lifting

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heavy loads, night shifts, overtime work, and others

ÿ Improved knowledge of workplace hazards

of pregnancy and its management.

ÿ Placement in a healthy and safe workplace

affect the health of pregnant women and fetal development.

ÿ Pregnancy examination at least 4 times during pregnancy.

ÿ Promotion and education about the nutrition of pregnant women.

ÿ Obtain blood supplement tablets.

ÿ Obtain KIA book.

ÿ Following the Birth Planning Program with Prevention

Complications (P4K).
ÿ Obtain guarantees for giving birth at a health facility.

Obtain guarantees for handling if complications occur in the mother

and baby.
ÿ Obtain maternity leave.
c. Postpartum

Several reproductive health services provided to postnatal mothers, prioritized for the health of mothers

and their babies are:

ÿ Family planning services (KB).

ÿ Providing opportunities for mothers to give breast milk exclusively by providing a lactation room / milk

expressing room.

ÿ Providing Vit. A high dose in postpartum mothers.

ÿ Providing opportunities to care for infants or toddlers during work breaks by establishing a day care

center at the workplace.

ÿ Knowledge of hazards in the workplace that may affect the mother

and the baby.

ÿ Providing counseling to mothers may or may not breastfeed because

certain exposures from the workplace; such as exposure to organic solvents,

mercury, lead and cadmium, etc.

2. Workplace Protection Program ( Occupational Health Program)

a. Perform workplace hazard identification of risky exposures

on reproductive health. Workplace hazard identification activities can

conducted through walk through surveys and discussions with workers.

Hazard identification is carried out on all activities or positions or materials

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chemicals that have the potential to cause reproductive disorders. Through the Department
and job descriptions can give an idea of the workload, existence
exposure to hazardous materials and possible reproductive health problems
which he may suffer. Identification can also be developed from
list of chemicals used in a production process to results
end. All identification results must be communicated and documented
well.
b. Measuring the work environment that affects health
reproduction.

c. Conduct a work risk assessment in the workplace which can be disruptive

reproduction health. Assessment of reproductive health risks in the workplace,
carried out through exposure measurement, evaluation of dose response and risk
characteristics. Accuracy of hazard identification, exposure assessment and risk classification
is the starting point of health promotion and disease prevention programs.
d. Control workplace risks that can harm health
reproduction. Control of the work environment that poses a risk to health
reproduction namely:

e. Elimination, removing work processes, tools or chemicals

harmful substances that can cause problems with reproductive health.
• Substitution, replacing work processes, tools or chemicals
harmful substances that can cause problems with reproductive health.
• Engineering control / Engineering Control, perform engineering engineering
against tools/machines that may cause health problems
reproduction. This control contains two aspects, namely technical aspects
production and work environment aspects. On the technical aspect of production,
Control can be done by isolating or
control it remotely. Aspects of the work environment
prioritizing the security of the work environment instead
to the material, for example by making a good ventilation system
to reduce pollutant concentrations.
• Administrative/administrative control, making arrangements for worker placement,
working hours, rest hours, overtime, work shifts for workers who are at risk/
vulnerable to reproductive health such as pregnant workers, workers with
workplace risks that can interfere with reproductive health (radiation, extreme
temperatures, chemicals
dangerous, etc.).

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• Legislative control in the form of implementation of laws and regulations

valid invitation. Several regulations have been issued
relating to reproductive health in the workplace are;
arrangements for maternity leave rights, menstrual breaks, sick breaks,
determination of maximum values of exposure to toxic substances, regulation
industrial waste management as well as environmental sanitation and hygiene.

• Provision of appropriate personal protective equipment.

• Education about knowledge of hazards in the workplace that can

affect reproductive health and its management. Effort
Health education is aimed at educating workers to be capable
help himself to live a healthy life by emphasizing on aspects
prevention.

F. ROLE OF VARIOUS PARTIES IN REPRODUCTIVE HEALTH EFFORTS IN

WORKPLACE

In the implementation of reproductive health services in the workplace,

requires the involvement of various related sectors that each has
role. The roles of these sectors are:

1. Health Service Unit in Company Clinic Workplaces

The Health Service Unit at Work has a role in the implementation of reproductive
services and occupational health services in a complete manner. Clinics in the workplace
can coordinate and cooperate with local regional health centers in providing reproductive
health services. Company clinics are required to report the number of visits and service
coverage of the reproductive health program every month to the local regional health
center.
2. Health Center

Puskesmas as the regional technical implementation unit within the Health Office
districts/cities carry out operational technical tasks for occupational health and
reproductive health programs based on the authority granted by the district/city health
office through individual health efforts and
area-based public health. The health center is responsible
reproductive health problems in the region are obliged to coordinate
and fostering reproductive health programs in workplaces in the region
it works. The health center is authorized to receive health activity reports
reproduction for workers of all health care units in place

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work/clinical company in the region.

3. BKKM (Community Occupational Health Center)
Receiving medical referrals and community health referrals related to
reproductive health services for workers.
4. The hospital accepts medical referrals related to health services
reproduction.

5. The Health Service has the following roles:

• Mobilize regional, cross-sector related professional organizations, the business world and
trade unions to obtain support in the delivery of reproductive health services in
workplaces in their working areas.
• Conduct technical guidance and facilitation of the implementation of health services
reproduction at work.
• Apply general health requirements and reproductive health
especially in various workplace environments.
• Organizing capacity building through technical and skills training for reproductive health
services in the workplace.
• Strive for the availability of financial support, facilities and infrastructure, guidelines
as well as occupational health and reproductive health tools to support
implementation of reproductive health efforts in the workplace.
6. Department of Labor
• Carry out the development of occupational health norms (outside the technical scope
medical) as part of K3 norms in accordance with applicable laws and regulations
applicable (coordinating with the local Health Office)
• Supervision (including law enforcement) of implementation
the obligation of employers in providing reproductive health services to workers in the
context of protecting occupational health norms.
• Carry out health hazard data collection in the workplace in coordination with
Public health Office.

• Completion of cases of reproductive health disorders in accordance with

mechanism in the applicable laws and regulations
Empowering Jamsostek advisory doctors and medical examiners

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