Reproductive health

1. Dr :Mohammed Ali Aljradey
MBBS ,MPH
Reproductive Health/MCH Course
14 March 2020 Reproductive Health 1
International University of Africa
Faculty of Medicine

2. 14 March 2020 Reproductive Health 2

3. Learning objectives:
 To define reproductive health
 Understand magnitude of RH problems
 Understand RH indicators
 Objectives / Contents of RH.
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4. Definition of Reproductive Health
• Reproductive health is defined as a state of
physical, mental, and social well-being in all
matters relating to the reproductive system,
at all stages of life.
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5. Components of RH
• Maternal Health (safe motherhood)
• Infant Health Care
• Family Planning
• Infertility
• Abortions
• STDs
• Harmful Practices
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6. CONT’D Components of RH
• Adolescent health
• Women Empowerment
• Menopausal care
• Male reproduction
• Reproductive Cancer
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8. 8
Maternal Mortality:
A Global Tragedy
Annually, 585,000
women die of pregnancy
related complications
99% in developing
world
~ 1% in developed
countries

9. 9
Global Maternal Death Watch
Every Minute
380 women become pregnant
190 women face unplanned or unwanted
pregnancy
110 women experience a pregnancy
related complication
40 women have an unsafe abortion
1 woman dies from a pregnancy-related
complication
Every Minute...

10. 10
Global Causes of Maternal Mortality
24.8
14.9
12.96.9
12.9
7.9
19.8
Hemorrhage 24.8%
Infection 14.9%
Eclampsia 12.9%
Obstructed Labor
6.9%
Unsafe Abortion
12.9%
Other Direct Causes
7.9%
Indirect Causes
19.8%

11. 11
Determinants of Maternal
Mortality
1. Age at child birth (Too Early, Too Late)
2. Parity (Too Many)
3. Too close pregnancies (Too Close)
4. Family size
5. Malnutrition
6. Poverty
7. Illiteracy
8. Ignorance and prejudices

12. 12
Determinants (cont)
9. Lack of maternity services
10. Shortage of health manpower
11. Delivery by untrained midwives
12. Poor environmental sanitation
13. Poor communication and transport
facilities
14. Social customs

13. 13
Three Delays Model
1. Delay in decision to seek care
– Lack of understanding of complications
– Acceptance of maternal death
– Low status of women
– Socio-cultural barriers to seeking care
2. Delay in reaching care
– Mountains, islands, rivers — poor organization
3. Delay in receiving care
– Supplies, personnel
– Poorly trained personnel with punitive attitude
– Finances

14. Pre-marriage Care
• History
• Clinical examination
• Laboratory investigation
• Treatment/control of existing diseases
• Immunization
• Counseling
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15. Raiymah – Yemen
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Antenatal Care

17. Antenatal Visits
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18. First visit
• History
• Physical examination
• Obstetrical examination
• Investigations ??
AIMS :
Treatment /control of existing diseases
Immunization
Health Education
Identify High Risk cases
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19. High Risk Cases
1. Elderly primi >30
2. Short statured primi ≤ 140 cm
3. Malpresentations (breach, transverse ..)
4. Antepartum haemorrahage
5. Pregnancy induced hypertension PIH
6. Twins, hydramnious
7. Bad obstetrical history
8. Elderly grand multiparas
9. Pregnancy associated with chronic diseases
10.Prolonged pregnancy >14 days of EDD
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20. On subsequent visits
• Physical examination (e.g. weight gain, BP)
• Laboratory tests
• Iron and Folic acid supplementation
• Immunization
• Health Education (mainly on nutrition,
delivery and referral system)
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21. Health education for pregnant women
• nutritional health education,
• personal hygiene and sanitation
• avoiding tobacco, alcohol and non-prescribed
drugs
• explaining minor complications of pregnancy
and childbirth
• avoidance of occupational hazards etc
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22. Immunization
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23. Intranatal Care
Safe delivery
• Clean
• Identification of childbirth complications
• Availability of referral system
• Availability of obstetrical emergency unit:
– Trained personnel
– Blood Bank
– Equipped theatre
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24. Postnatal Care
• Checking for infections
• Health education (encouraging breast feeding,
nutrition, FP, good parenting etc)
• Vaccination
• Rh immune globulin when indicated
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25. 25
Infant Health Care
a. Resuscitation of the newborn.
b. Early and exclusive breast feeding.
c. Management of infection (ophthalmia neonatorum
and cord infections).
d. Congenital abnormalities.
e. L.B.W and malnutrition management.
f. Weaning.
g. Safe and aseptic circumcision.
h. Immunization.

26. 11 Indicators on reproductive,
maternal and child health
Used for the purpose of monitoring progress
towards the goals of the Global Strategy.
1.Maternal mortality ratio( (MMR) is the ratio
of the number of maternal deaths during a
given time period per 100,000 live births
during the same time-period).
2.Under-five child mortality :Probability of
dying between birth and exactly five years of
age expressed per 1,000 live births.
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27. CONT’D Indicators of RH
3. Children under five who are stunted
4. Proportion of demand for family planning
satisfied (met need for contraception)
5. Antenatal care coverage (at least four times
during pregnancy)
6. Antiretroviral (ARV) prophylaxis among HIV
positive pregnant women to prevent HIV
transmission Skilled attendant at birth.
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28. CONT’D Indicators of RH
8. Postnatal care for mothers and babies within
two days of birth
9. Exclusive breastfeeding for six months (0–5
months)
10.Three doses of combined diphtheria-tetanus
pertussis (DTP3) immunization coverage (12–
23 months)
11.Antibiotic treatment for suspected
pneumonia
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30. FP
• Definition :
the practice of controlling the number of
children in a family and the intervals between
their births.
• Benefits to women’s health ???
• Family planning benefits children’s health ???
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31. FP
• Human Rights Rationale :It rests on the belief
that individuals and couples have a
fundamental right to control reproductive
decisions, including family size and the timing
of births.
• Family planning indirectly contributes to
children’s health, development and survival by
reducing the risk of maternal mortality and
morbidity
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32. Methods
1. Natural Method
A. Breast feeding
B. Abstinence
C. Withdrawal (Coitus
interrupts)
D. Calendar
methods(safe period)
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33. Methods
2. Artificial methods
A.Barrier methods
Diaphragm
Condom
B. Intra-uterine device (IUD)
C.Hormonal
Pills (combined , mono )
Implants
Injectable
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34. Methods
3. Surgical methods (Permanent) :
• Tubal ligation (ligating the oviduct).
• Vasectomy (ligating the sperm duct).
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35. LACTATION
• Advantages:
– Encourage infant nutrition
– Safe and available
• Disadvantages:
– High individual failure rates
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36. ABSTINENCE FROM SEX
• Advantages:
– Accessible, safe and reversible
– Acceptable to most religious groups
• Disadvantages:
– Requires strong motivation
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37. Barriers
cervical cap, diaphragm, male and female condoms
• Advantages:
– Provide protection against STDs
– Effective when combined with other methods
• Disadvantages:
– Require education and cooperation
– Not acceptable by some cultures
– Minimal risk of toxic shock
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38. Intrauterine devices (IUD)
• Advantages:
– Gives protection for years
– Effective
• Disadvantages:
– Perforation, infections, infertility
– Heavier menstrual flow
– Cost
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39. Combined Pills
(Estrogen-Progestron)
Advantages:
– Highly effective
– Generally safe and reversible
– Protect against anaemia, dysmenorrhea,
ovarian cysts and endometrial cancers
– Possibly protective against breast and ovarian
cancers
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40. • Disadvantages of combined pills:
– Major side effects (increase risk of cardiovascular
diseases
– Minor side effects (migraines, bleedings, phlebitis,
nausea)
– Needs regular prescription and use
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cont. combined pills

41. Progestin-only Pills
(minipills, injections and implants)
• Advantages:
– Effective
– It does not affect lactation
• Disadvantages:
– Irregular cycle
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42. VASECTOMY
• Advantages”
– Highly effective
– Easy to perform
• Disadvantages:
– Surgical complications
– Not accepted in many cultures
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43. TUBAL LIGATION
• Advantages:
– Highly effective
– Usually permanent
• Disadvantages:
– Surgical risks
– Cost
– Rare re-canalization
– Ectopic pregnancies
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45. STD/STI

46. Main STIs
• Bacterial e.g.
– Gonorrhea (Neisseria gonorrhoeae)
– Syphilis (Treponema pallidum)
• Fungal (Candidiasis)
• Viral:
– Hepatitis B
– HIV/AIDs
– Herpes simplex
• Parasites e.g. Crab louse (Pthirus pubis)
• Protozoal (Trichomonas vaginalis)

47. Prevention
• Moral and religious discussions
• Vaccines (Hepatitis B)
• Condoms
• Health Education

48. ADOLESCENT HEALTH

49. Introduction
• World Health Organization defines adolescents as
individuals between 10 and 19 years of age.
• Adolescents (ages 10 to 19) and young adults
(ages 20 to 24) make up 21 percent of the
population
• Environmental factors, including family, peer
group, school, neighborhood, policies

50. Why Is Adolescent Health Important?
• Adolescence is a critical transitional period
that includes the biological changes of
puberty and the need to negotiate key
developmental tasks, such as increasing
independence and normative
experimentation.

51. The Main Health Problems of Adults
• Homicide
• Suicide
• Motor vehicle crashes, including those caused by
drinking and driving
• Substance use and abuse
• Smoking
• Sexually transmitted infections, including HIV
• Teen and unplanned pregnancies
• Homelessness

52. Prevention and Control of Adolescent
Health Problems
• Primary:
–Health Education
–Immunization
–Control of drugs
–Control of weapons
–Measures to limit car accidents
• Secondary: Screening
• Tertiary: Rehabilitation

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54. 54
Harmful Traditional
Reproductive Health Practices

55. 55
• Early marriage
• Female Genital Cutting/Mutilation (FGM)
• Dietary and other restrictions during
pregnancy
• Heavy work during pregnancy
• Withholding colostrums from newborn
Harmful Traditional Reproductive
Health Practices

56. Female Genital Mutilation
• Definition : all procedures that intentionally
alter or cause injury to the female genital
organs for non-medical reasons.
• Socio-cultural causes .
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57. The Problem
• 140 million girls and women worldwide
currently living with consequences of FGM.
• It is carried out on young girls 1-15 years.
• In Africa an estimated 92 million have
undergone FGM.
4/24/2011 57Female Genital Mutilation

58. FGM in Sudan
• 1979 = 95% of women have undergone FGM.
- 1991, this percentage dropped to 90%. -
2009 80%
• Recent studies in Northern Sudan shows a
gradual drop in Northern Sudan < 70%
Sudan was the first country in Africa to outlaw
circumcision it in 1946
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59. Types of FGM
• Type 1: clitoridectomy, this is the partial or
total removal of the
• Type 2: excision, this is the partial or total
removal of the clitoris and the labia minora
• Type 3: infibulation, cutting and repositioning
the labia minora, or labia majora, sometimes
through stitching, with or without removal of
the clitoris (clitoridectomy).
• Type 4: This includes all other harmful
procedures14 March 2020 Reproductive Health 59

60. Types of FGM
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61. Immediate Complications
• severe pain
• excessive bleeding (haemorrhage)
• infections e.g., tetanus
• urinary problems
• wound healing problems
• injury to surrounding genital tissue
• shock
• death.
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62. Long-term consequences
• urinary problems
• vaginal problems (discharge, itching
• menstrual problems
• sexual problems (pain during intercourse,
• increased risk of childbirth complications
• need for later surgeries:
• psychological problems (depression, anxiety,
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63. Control of FGM
• Health Education
• Work within communities (declare their
support to end it)
• Political support to end FGM
• Wider international involvement to stop FGM
• Legislation
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64. ‫الطبي‬ ‫المجلس‬ ‫قوانين‬
•‫في‬ ‫وذلك‬ ‫اإلناث‬ ‫ختان‬ ‫بشأن‬ ً‫ا‬‫قرار‬ ‫السوداني‬ ‫الطبي‬ ‫المجلس‬ ‫أصدر‬
‫رقم‬ ‫جلسته‬(366)
•‫فيه‬ ‫جاء‬" :‫مجال‬ ‫في‬ ‫التخصص‬ ‫أهل‬ ‫من‬ ‫القضية‬ ‫حول‬ ‫لنقاش‬ ‫استماعه‬ ‫بعد‬
‫عددوا‬ ‫حيث‬ ،‫والدين‬ ‫الورع‬ ‫وأهل‬ ‫التقاة‬ ‫من‬ ‫وهم‬ ‫والتوليد‬ ‫النساء‬ ‫أمراض‬
‫وموت‬ ‫نزيف‬ ‫من‬ ‫اإلناث‬ ‫ختان‬ ‫عادة‬ ‫على‬ ‫يترتب‬ ‫وما‬ ،‫عليهم‬ ‫تمر‬ ‫التي‬ ‫الحاالت‬
‫ع‬ ‫والعضوية‬ ‫النفسية‬ ‫واآلالم‬ ،‫العملية‬ ‫تعقب‬ ‫التهابات‬ ‫أو‬ ،‫العملية‬ ‫أثناء‬،‫الزفاف‬ ‫ند‬
‫بعضها‬ ‫في‬ ‫الوفيات‬ ‫بعض‬ ‫لحدوث‬ ‫تؤدي‬ ‫الوالدة‬ ‫تعسر‬ ‫وعمليات‬..‫واستن‬ً‫ا‬‫اد‬
‫أنه‬ ‫األصولية‬ ‫للقاعدة‬(‫ضرار‬ ‫وال‬ ‫ضرر‬ ‫ال‬)‫التوص‬ ‫الطبي‬ ‫المجلس‬ ‫أصدر‬ ‫فقد‬‫ية‬
‫اآلتية‬:
•(‫باإلنسان‬ ‫يضر‬ ‫عمل‬ ‫أي‬ ‫بممارسة‬ ‫لألطباء‬ ‫يسمح‬ ‫ال‬..‫نسبة‬ ‫فيه‬ ‫أو‬
‫صوره‬ ‫بكل‬ ‫اإلناث‬ ‫ختان‬ ‫ذلك‬ ‫ويشمل‬ ‫ضرر‬.")
4/24/2011 Female Genital Mutilation 64

65. Infertility
• Def. : The couple’s inability to achieve pregnancy
after 1 year of unprotected intercourse.
• causes ( male , female , both )
• Prevention
example early and prompt treatment of
infections of genital tract
• Early diagnosis
• Referral (endocrineological centres)
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66. Abortion
 Definition
a procedure for terminating pregnancy
Unsafe abortion:
a procedure for terminating an unintended
pregnancy either by individuals without the
necessary skills or in an environment that does
not conform to minimum medical standards,
or both. (WHO)

67. Problem
68000 women die from complications of
unsafe abortion /each year all in developing
country
19 million women experience an unsafe
abortion worldwide each year
18,5mellion of these occur in developing
=59% of unsafe abortions in Africa are among
women aged 15 – 24 year

68. Types of Abortion
 Spontaneous.
Induced
- Legal (for medical reasons under medical
supervision)
- Illegal (unwanted pregnancy)

69. Abortion Hazards
 Early:
◦Hemorrhage.
◦Sepsis.
◦Uterine perforation.
◦Cervical injury.
◦Thrombo-embolism.
 Late :
◦Infertility.
◦Ectopic pregnancy.

70. Menopause
• Menopause – permanent physiological
cessation of menses
• Associated with decrease ovarian function,
some breast & genital organ atrophy
• Irregular menses, breast tenderness, mood
changes, hot/warm flashes, noc sweats, sleep
disturbances, gradual thinning of pubic hair,
shrinkage, fatigue, forgetfulness

71. CONT’D
Menopause
• Be sensitive to all possible side effects
• Tx – hormone therapy
• Psychological support and therapy
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72. Women Empowerment
I. Equality
II. Promotion of health
III. Women’s decision making
.
3/29/2011 Reproductive Health 72

73. Child Health Care
• U5
• Older children (school children and non-
school children:
– Rheumatic fever
– DM
– etc
3/29/2011 Reproductive Health 73

74. REPRODUCTIVE CANCERS

75. Main Reproductive Cancers
• Breast Cancers
• Cervical Cancers
• Uterus Cancers
• Ovarian Cancers
• Prostate Cancers (male )

76. The Problem
• Breast cancers 2-3% (incidence increase with
age)
• Breast Ca High morbidity among females in
developed countries and high mortality
among females in developing countries
• Cervical and Uterine cancers (1%) (higher
incidence among young women)
• 10% of men develop prostate cancer (deaths

77. Screening Tests
• Available screening tests:
– Mammogram x-ray test for breast cancer
– Pap smear test for cervical cancer
– Prostate
– Prostate Specific Antigen (PSA) for Prostate Cancer
• Breast Self Examination (BSE)
• Finding cancers within regular exams is
essential in early diagnosis

78. Q
• Which type of contraceptive pill is considered
acceptable for the first six weeks after birth
when breastfeeding?
A.combination birth control pills
B.triphasic birth control pills
C.high estrogen pills
D.progestin-only pills
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79. References :
• Park`s textbook of Preventive and Social
Medicine
• Reproductive Health FOR Health Science
Students Feleke Worku (MD) Samuel Gebresilassie
(MD)
• WHO web site
• Lecture notes
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