FACTORS AFFECTING

REPRODUCTIVE HEALTH

Misra Abdulahi (PhD)

 Outline
 Introduction
 Reproductive Health problems
 Impacts of expanding and improving
RH services
 Factors affecting Reproductive Health
 Towards universal access to SRH
Learning objectives

At the end of the class, students will be able to

 State Reproductive Health problems
 Describe the impacts of expanding and improving RH services
 Discuss factors affecting Reproductive Health service
 Depict areas of action towards universal access to SRH
 Introduction

Comprehensive definition of Sexual and Reproductive Health: 

is a state of physical, emotional, mental and social well-being in

relation to all aspects of sexuality and reproduction, not merely the
absence of disease, dysfunction or infirmity. 
 Introduction...
Achieving SRH relies on realizing SRHR
• Have their bodily integrity, privacy and personal autonomy respected
• Freely define their own sexuality - sexual orientation, gender identity,
expression
• Decide whether and when to be sexually active
• Choose their sexual partners
• Have safe and pleasurable sexual experiences
• Decide whether, when and whom to marry
• decide whether, when and by what means and children to have
• Have access over their lifetimes to the information, resources, services and
support necessary to achieve all the above, free from discrimination, coercion,
exploitation and violence
 Introduction...
SRH service packages
• Comprehensive sexuality education
• Counseling and services for a range of modern contraceptives
• ANC, childbirth and PNC, including EONC
• Safe abortion services and treatment of complications of unsafe abortion
• Prevention and treatment of HIV and other STI
• Prevention, detection, immediate services and referrals for cases of SGBV
• Prevention, detection and management of ROC, esp. cervical cancer
• Information, counseling and services for subfertility and infertility
• Information, counseling and services for sexual health and well-being
 Reproductive Health Problems

Out of 923 million WRA in LMICs who want to avoid having a pregnancy

218 million have an unmet need for modern contraception

The unmet need is disproportionately high for adolescents aged 15–19 (43%),
compared to WRA (24%)

Each year, 111 million unintended pregnancies occur in LMICs

35 million women have abortions in unsafe conditions

 RH problems...
Each year in LMICs, 127 million women give birth annually
• 50 million make fewer than four antenatal care visits
• 31 million do not deliver in a health facility
• 16 million do not receive the care they need following a major obstetric complication
• 13 million have newborns who do not receive needed care for complications
• 299,000 women die from causes related to pregnancy and childbirth
Each year worldwide
• >350 M men & women need treatment for one of the four curable STIs
• nearly 2 million people become newly infected with HIV
• approximately 266,000 women die from cervical cancer
• nearly 1 in 3 women experience IPV or non-partner sexual violence.
Worldwide, 4·3 billion people of reproductive age - inadequate SRH services
Impacts of expanding and improving services

Evidence shows that access to SRH services 

• Saves lives
• Improves health and well-being
• Promotes gender equality
• Increases productivity and household income
• Multigenerational benefits by also improving children’s health and
well-being
Impacts of expanding and improving services

if all women who want to avoid

pregnancy use modern if all mothers and newborns if all women infected with STIs
contraceptives and all pregnant received recommended care get effective and timely treatment
women receive standard care

Unintended pregnancies, Cases of PID and infertility

unsafe abortions and Newborn deaths would caused by chlamydia or
maternal deaths drop by drop by two-thirds gonorrhea would be
about two-thirds  eliminated 

New HIV infections

among babies < six weeks
would drop by almost
nine-tenths
What are factors that affect Reproductive Health
services?
 Factors affecting Reproductive Health

A number of factors affect the existence and use of RH services

Evidence highlights that these factors operate at different linked levels

Understanding - identifying areas where interventions are needed  

The attainment of RH is not limited to interventions by the health sector alone -

needs the collective effort of every sectors
Factors affecting SRH
Public policy-level
Policy and structural factors

Organizational
institutions and their structure and processes
for operation

Community
Community and social norms

Interpersonal
family, husband, friend

Intrapersonal
individual
characteristics
and behaviours
 Individual-level factors

Residence Age  Education level

Employment Household
Marital status
status wealth/poverty

Access to Family
television/radio environment
 Individual-level ...

Autonomy on movement
Financial autonomy
Knowledge on SRHR
Previous health experiences or current health status
 Interpersonal factors

Knowledge level of partner/family

Support of partner in decision making
Level of a couple’s communication on SRHR
Attitude of extended family/mother in law
Financial dependence on partner
Sexual coercion and IPV
Partners or peer influence (for adolescents mostly)
 Community-level factors

Gender norms justify male dominance in decision making

Existence of effective community groups--social cohesion

Cultural values
Men participation in RH issues
Stigma and community judgment on premarital sex
Religious beliefs
 Organization-level factors
Affordable reproductive health care services

Accessible - Physical and financial accessibility

Acceptable reproductive health care services
Referral for complications and emergencies

Health information campaigns

Logistic management system for FP and other commodities

Quality reproductive health care services

Institution…– other sectors

Other related sectors 

 Education - Schooling for girls
 Transportation - Roads and vehicles
 Water and sanitation
 Food availability
 Power supply, communications
 Legal  frameworks – laws and regulations

Policy-level The manner in which revenue is raised for women

determinants
The amount of budget allocated for SRH

The share of expenditures devoted to public

services to reduce the burden of women
Approaches to financing, payments and incentives

The methods of consultation with stakeholders

Representing women in different decision making

positions.
 Health systems strengthening 

Multisectoral collaboration 

Towards Stakeholder engagement 

Supporting legislative and regulatory frameworks to enable individuals to

universal achieve their SRHR goals

access to Inclusive SRHR policy and strategies

SRH  Progressive realisation - Monitoring and evaluation are crucial.

laws and regulations that guarantee full and equal access to sexual and
reproductive health care, information and education.

The use of information technology to promote SRHR information promote

male engagement on sexual and reproductive health issues 
References

www.thelancet.com/commissions/sexual-and-reproductive-health-and-rights
GUTTMACHER Institute. ADDING IT UP Investing in Sexual and Reproductive Health
in Low- and Middle-Income Countries 2019
WHO. Universal health coverage and sexual and reproductive health and reproductive
rights 2021
Programme of Action the International Conference on Population and Development. 20th
Anniversary Edition 2014