To GMPH Students

3 cr.hrs

BY:- NIGUSS CHERIE(MPH/RH, Assistant prof, PhD Candidate)

August, 2022
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Course Content/outline
o HISTORICAL DEVELOPMENT, CONCEPTS,
COMPONENTS AND POLICY PRIORITIES OF RH
o Reproductive health problems and interventions
o Maternal morbidity and mortality
o Maternal health service
o Family planning
o Child health problems and services
o Adolescents SRH
o Public health STI/HIV/AIDS
o Monitoring and evaluation of RH services

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Teaching and Learning Methods:

 Lecture/Discussion
 Seminar preparation and presentation
 Reading assignment( ART, PMTCT, HTC)
 Term paper/Project work preparation and presentation

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Assessment and student evaluation

 Seminar preparation and presentation

 Term paper/Project work
 Final written Examination

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 Learning Objectives
 Describe the historical development of RH
 Define reproductive health & related terms
 Explain objectives and enabling conditions of RH
 Identify components of reproductive health
 Explain sexual and reproductive rights
 Discuss the importance of RH for development
 Discuss national RH policies and strategies

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 Brain storm
What is the definitions , Similarity and
Difference between?

RH

FP /MCH

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 Introduction
 MCH is a comprehensive care given to mothers & children;
also defined as a broad & accepted meaning of:

• Promotive eg. Breastfeeding

• Preventive eg. Immunisation

• Curative & rehabilitative care.

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Comparison between MCH & RH
MCH RH
 Driven by demographic • Considerations for maternal
imperative health issues, & STD
 More on quantity rather than prevention & mgt.
quality. • More concerned with ability
 Exclusively for women. to make informed decisions.
 Served only married people. • Includes women, men, the
young, aged, refugees.

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WHY SPECIAL CARE FOR MOTHERS AND CHILDREN?

 Majority population 70% ( women are about 23% of the total

population and children under 15 years constitute about 47%
in developing countries)
 Vulnerable group of population
 Problems of mothers and children are intertwined
 Health problems are avoidable
 “Voiceless”
 Investment in to the future

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MCH in the old paradigm (before 1994)

Mainly focuses on:-

 MCH/FP
 Maternity Care
 Child Health Care
 Family Planning

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The UN International Conference on Population and
Development (ICPD), Cairo 1994
 In September 1994, Ethiopia participated in the ICPD, held in

Cairo, Egypt.

 The ICPD marked the beginning of the paradigm shift from the

concept of MCH & FP to RH

 Focuses on meeting the needs of individual throughout the life
cycle women and men rather than on achieving demographic
targets
 Recognition of the need to empower women
 Criticism of the over-emphasis on the control of female fertility
 Represented a major step forward in current thinking about
human sexuality and reproduction
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Reproductive health in the new
paradigm(Includes Old +the following)

1.Gender discrimination
2.Violence against women
3.Adolescent sexuality
4.Reproductive rights regarding marriage and childbearing
5.Gender equity and equality
6.Unintended pregnancy
7.Chronic complications of pregnancy and childbirth
8.Sexually transmitted diseases
9.HIV/AIDs
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 Three important elements behind the paradigm shift

1. Recognition of the needs of people in sexuality &

reproduction beyond fertility regulation.

2. The articulation & interpretation of the international

human rights treaties in terms of RSH

3. The advent of the HIV/AIDS pandemic

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 (International conference on population and
development(ICPD)
 Recognized the need for high quality & integrated service
address women's life cycle
 The need for gender equality equity & empowerment &
eliminating discrimination against women, girl child & be
free from violence & coercion
 Ensuring women's ability to control their own fertility
 The need for Men involvement & responsible & respectful
relation
 Articulation & foundation on reproductive & sexual right of
men & women
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 RH DEFINITION (ICPD 1994, Cairo)

Reproductive health is a state of complete physical, mental,

social well-being & not merely the absence of disease or
infirmity in all matters relating to the reproductive system &
to its functions & processes…
 The definition implies that people are able to have a
satisfying & safe sex life & that they have the capability to
reproduce & freedom to decide if, when, & how often to do
so.” (ICPD, PoA; 7.2)

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 Reproductive health
Reproductive health care : is defined as the constellation of methods,
techniques and services that contribute to reproductive health and well-being
by preventing and solving reproductive health problems.

Sexual Health: The capacity of individuals to enjoy a

satisfactory sexual life without risk, which does not
include procreation as an indispensable element.

 It also includes sexual health: the purpose of which is

the enhancement of life & personal relations, & not
merely counseling & care related to reproduction &
STDs.“

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 Sexual Health…
Three basic elements
 A capacity to enjoy and control sexual and reproductive
behaviors in accordance with social and personal ethics
 Freedom from fear, shame, guilt, false beliefs and other
psychological factors inhibiting sexual response and impairing
sexual relationship
 Freedom from organic disorders, diseases, and beneficiaries that
interfere with sexual and reproductive functions

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 Sexual and Reproductive rights
1. The right of all individuals, free of coercion, discrimination
and violence,
2. The highest attainable standard of sexual health, including
access to sexual and reproductive health care services;
3. Seek, receive, and impart information related to sexuality;
4. Sexuality education;
5. Respect for bodily integrity;
6. Choose their partner;
7. Decide whether or not to be sexually active;
8. Consensual sexual relations;
9. Consensual marriage;
10. Decide whether or not, and when, to have children;
11. Pursue a satisfying, safe and pleasurable sexual life.
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Enabling conditions for RH
 Empowering Women and Promoting Gender Equality and
Equity
 Eliminating Discrimination against the Girl Child
 Ensuring Male Responsibility and Participation:
 Achieving Universal Education:

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 OBJECTIVES OF RH
1. Ensure that comprehensive & factual information & a full
range of RH services, including FP are accessible, acceptable
& convenient for users

2.Enable support responsible voluntary decisions about child

bearing & methods of FP of their choice, as well as other

methods for regulation of fertility which are not against the law

& to have information, education & means to do so

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Objectives Cont’d
3. meet the changing sexual & RH needs over the life-

cycle & to do so in ways sensitive to the diversity of

circumstances of local communities

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COMPONENTS OF RH CARE
 Quality FP counselling, information, education, communication
& services

 prenatal, safe delivery & post natal care, including breast

feeding

 prevention & treatment of infertility

 prevention & management of complications of unsafe abortion

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Components Cont’d
 safe abortion services

 treatment of RTI/STIs & other conditions of the reproductive

system

 information & counselling on human sexuality, responsible

parenthood & SRH

 Encourage male involvement

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Components Cont’d
 Active discouragement of harmful practices, such as
FGM/C

 Referral for additional services related to FP,

pregnancy, delivery & abortion complications,
infertility, RTI/STDs & HIV/AIDS, & cancers of the
reproductive system

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 RH components & their
Relationships?

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Advantage of The Integrated Approach to RH Services

 It addresses a range of client reproductive health

needs
 It saves time and money for clients as services are
obtained during a single visit
 A single service provider may offer a range of
reproductive health services
 Clients gain confidence in the service provider
 Client satisfaction with and utilization of services
increases
 The coordination and cost effectiveness of services
are improved
 Opportunities to create client awareness of the
availability of other services increases.
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Challenges of the Integrated Approach
 Skills in different components
 Workload increased?
 Attitude and motivation of health workers
 Pressure to reach target in individual component(s)
 Monitoring and evaluation components
 Which components to integrate?

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Reproductive Health and Development
 Human beings are the centre of concern for sustainable
development,
 People are the most important and valuable resource of
any nation.
 They are entitled to a healthy and productive life in
harmony with nature,
 Countries should ensure that all individuals are given the
opportunity to make the most of their potential

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Reproductive Health and Development…
 Improving Reproductive Health of women, men and young
people substantially contributes to the advancement of a nation.

“Sexual and reproductive health is fundamental to the social

and economic development of communities and nations, and
a key component of an equitable society.”The

Lancet 2006

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 ETHIOPIA RH STRATEGY

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National RH strategy Selected Priority
Intervention Areas

1. The social and cultural determinants of women’s RH

2. Fertility, family planning, gender and age of first birth
3. Maternal and newborn health
4. HIV/AIDS
5. RH of young people
6. Reproduction Organ Cancers

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 Con’t….
 Each selected priority problems are analyzed
at 3 levels
 The “community” - the broader social and
cultural context of each health issue;
 The “system” - opportunities arising from the
delivery of health care services; and
 The “Policy” - the institutional and
normative frameworks within which decisions
are made

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 The situation of RH in Ethiopia
 Limited evidence due to small number of
studies
 But existing data show

 High rates of morbidity and mortality

 High fertility rates
 Poor health and social status of women
 Women lack access to health service due
to cultural, economic and geographic
reasons
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 Con’t….
 High rate of gender based violence

 Poor quality of health services

 Limited range of health services;

adolescents grossly missed
 Inequalities: gender, geographic and
economic
 High rate of Harmful traditional
practices: FGM and early marriage

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 Opportunities and Future Directions
 Government is embarking on the Health
Extension Program

 Accelerated expansion of PHC

 Decentralization

 Increased involvement of NGOs, civil

society, and the private sector

 Increased domestic manufacturing capacity

of supplies

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 Con’t….
 Enactment of the National Health policy that
stipulates delivery of health care services in a
decentralized and equitable manner

 The development and implementation of National

Reproductive Health Strategy

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 Con’t….
 Introduction of abortion guidelines in 2006

 The launching of the accelerated training of health

Professionals

 provision of training on clean and safe delivery for

health extension workers

 The Government has introduced a guideline to allow

women to receive free maternal health services.

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 Con’t….
 The launching of campaign on Accelerated Reduction of
Maternal and newborn death led by Africa Union

 The MDGs focusing on maternal heath and Child survival

 HSDP aiming to accelerate PHSC incorporating both RH

and Child survival strategy

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 Con’t….
 Realistic and appropriate investment in women’s education,
health and economic empowerment

 Male involvement and participation in Reproductive Health

issues and services

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 Challenges
 Inadequate Human resource for health:

 Limited access to quality of care

 Gender inequalities

 Weak intersectoral linkages

 Overall national resource constraints

(economic growth)

 Insufficient coordination of public and

private activities in the health sector
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 Con’t….
 Lack of adequate capacity to implement decentralized
health system at local level
 Widespread harmful and deep-rooted traditional practices
 Infrastructure problem
 Poor Health service utilization
 Week Health Management, supervision and Information
system
 Lack of Professional commitment to apply Service based
on standardization
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 The role of health professionals in addressing
RH problems and programs
 Creating Community awareness' on danger signs of
Pregnancy and birth preparedness

 Provision of F/P Methods/counselling

 Provision of focused ANC (Iron, TT, Rx and prevention of

malaria),

 Provision of Safe and clean delivery, postpartum care/Advice

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 Con’t….
 Strengthen the RH programme to promote multisectoral
involvement

 Develop appropriate plane for effective community

involvement and participation

 Maintain two way referral system

 Implementation framework with clearly defined

supervision, monitoring and evaluation mechanisms.

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 Con’t….
 Recognition of complications and early referral

 Education and community involvement to eliminate

HTP and Community Mobilization for better RH

 Registration and review of every birth and death

 Provide access to quality reproductive health

services, including skilled attendance at birth.

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 References
 National Reproductive Health Guideline

 National Health Policy Guideline

 Reproductive Health Lecture note

EDHS

National RH strategy

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