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REPRODUCTIVE
HEALTH
By ::: Amal Mohamed
 definition
 indicators
 Safe motherhood and its indicators
 Situation in Sudan
 Family planning

DEFINITON
Defined as a state of complete physical,
mental and social well-being and not
merely the absence of reproductiv...
 Reproductive health, therefore,
implies that people are able to
have a responsible, satisfying and
safe sex life and tha...
 Implicit in this are the right of men and women
to be informed of and to have access to safe,
effective, affordable and ...
 Comprehensive reproductive health care
includes:
 counseling, information, education, communication and
clinical servic...
 prevention and management of sexual violence;
active discouragement of harmful traditional
practices such as female geni...
REPRODUCTIVE HEALTH
INDICATORS
 During the 1990s, the official representatives of countries
worldwide attended international conferences (ICPD in
Cairo,...
 WHO's resulting set of 17 indicators covers the
main RH areas and represents the consensus
among international agencies ...
1- TOTAL FERTILITY RATE
 Total number of children a woman would have by
the end of her reproductive period if she
experie...
 calculated from age specific fertility rate
 date derived from : vital registration , population
censuses and populatio...
2- CONTRACEPTIVE PREVELANCE
RATE
 Percent of women of reproductive age (15-
49) who are using (or whose partner is
using)...
 Numerator: Number of women of
reproductive age at risk of pregnancy who
are using (or whose partner is using) a
contrace...
3- MATERNAL MORTALITY RATE
 Annual number of maternal deaths per 100,000
live births
 Maternal mortality is widely ackno...
 Maternal deaths are difficult to measure owing to many
factors, including their comparative rarity and context-
specific...
4- ANTENATAL CARE COVERAGE
 Percent of women attended at least once during
pregnancy, by skilled health personnel (exclud...
5- PERCENT OF BIRTH
ATTENDED BY SKILLED
HEALTH PERSONNEL
 Percent of births attended by skilled health
personnel (excludi...
source of data :
 vital statistics
 population based surverys
 Percent in Sudan is 57%>…
 This indicator is one of four mutually supportive
indicators in the minimum list measuring
maternal health service cover...
6- AVAILABILITY OF BASIC
ESSENTIAL OBSTETRIC
CARE
 Number of facilities with functioning basic
essential obstetric care p...
7- AVAILABILITY OF
COMPREHENSIVE ESSENTIAL
OBSTETRIC CARE
 Number of facilities with functioning
comprehensive essential ...
 health facility based survey
 population based survey (household)
8- PERINANTAL MORTALITY RATE
 Number of perinatal deaths (still births plus
early neonatal deaths) per 1,000 total births...
9- LOW BIRTH WEIGHT
PREVALENCE
 Percent of live births that weigh less than 2,500g
 One third of infant are born with a ...
10- POSITIVE SYPHLIS
SEROLOGY PREVELANCE IN
PREGNANT WOMEN
 Percent of pregnant women (15-24) attending
antenatal clinics...
11- PREVALENCE OF ANEMIA IN
WOMEN
 Percent of women of reproductive age (15-49)
screened for hemoglobin levels with level...
SOURCE OF DATA
 health facility based data
 special population survery
12-PERCENT OF OBSTETRICS AND
GYNECOLOGY ADMISSION OWING
TO ABORTION
 Percent of all cases admitted to service delivery
po...
13- REPORTED PREVALENCE OF
WOMEN WITH FGM
 Percent of women interviewed in a community
survey reporting having undergone ...
14-PREVALANCE OF INFERTILITY IN
WOMEN
 Percent of women of reproductive age (15-49) at
risk of pregnancy (not pregnant, s...
15- REPORTED INCIDENCE OF
URETHRITIS IN MEN
 Percent of men aged (15-49) interviewed in a
community survey reporting epis...
16- HIV PREVALENCE AMONG
PREGNANT WOMEN
 Percent of pregnant women (15-24) attending
antenatal clinics, whose blood has b...
17- KNOWLEDGE OF HIV
RELATED PREVENTION
PRACTICE
 Percent of all respondents who correctly identify
all three major ways ...
STIs and HIV/AIDS
Harmful traditional
practice (FGM)
Family planning
Counseling in
RH
(Women
empowerment
and Male
involvem...
SAFE MOTHERHOOD
SAFE MOTHERHOOD
 Safe motherhood begins before conception with
proper nutrition and a healthy lifestyle. It
continues wit...
 Globally, the numbers remain staggering: each
year there are at least 3.2 million stillborn
babies, 4 million neonatal d...
 A total of 11–17% of maternal deaths occur
during childbirth itself . While 50–71% occur in
the post-partum period.
 Th...
 Very few developing countries have accurate data
on maternal and newborn deaths and
morbidities, and less than one devel...
SAFEMOTHERHOOD INDICATORS
 ✦ Access/Use of Services Indicators
 Met Need for Essential Obstetric Care
 Unmet Obstetric ...
 Quality of care indicators
 Case Fatality Rate (and numbers ofmaternal
deaths)
 Referral Rates
SAFE MOTHERHOOD INDICATORS IN
SUDAN
71% of pregnant women have
access to prenatal care services
Postnatal care is low at...
Coverage with village midwives is
52.4%
ANC/FP services are provided by 37.5%
of facilities.
Coverage of health facilit...
Delivery by trained personnel in the
northern part of the country
accounts for 57% of deliveries.
Institutional deliveri...
LOCAL SITUATION
LOCAL SITUATION
o The country adopted PHC as the main
strategy to improve the health status of
individuals, families and c...
THE OVER ALL OBJECTIVE OF NATIONAL
STRATEGY IN SUDAN :
Is to accelerate progress
toward meeting the
nationally set and
in...
 Focuses on the elements of the health system and the
basic core skills and abilities required in order for care
provider...
WHERE WE ARE?WHERE WE ARE?
Sudan Household Survey- 2010
• Overall Maternal Mortality: 730 per 100,000 live
births
 By the end of the childbearing period about one
in ten women have never given birth
 The age-weighted proportion of female deaths
reported occurring during the exposure period for
pregnancy and post-delive...
 In Sudan, maternal conditions during pregnancy affect
over one in three pregnant women (conditional on
surviving pregnan...
 Among women of reproductive age with a
pregnancy in the two years prior to the
survey - skilled birth attendance (births...
FAMILY PLANNING
WHAT IS FAMILY PLANNING?
A way of living that is adopted by individuals and
couples in order to promote the health and wel...
FAMILY PLANNING
 Among women having had a live birth in the two
years prior to the SHHS, in 2010, 23 percent in
urban are...
 The use of modern contraception expanded from 7.8 to 19
percent between 2006 and 2010among women in urban
areas.
 For w...
THANK YOU
Reproductive health, safemotherhood & family planning
Reproductive health, safemotherhood & family planning
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Reproductive health, safemotherhood & family planning

primary health care course, master of community medicine university of Khartoum , batch 2

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Reproductive health, safemotherhood & family planning

  1. 1. REPRODUCTIVE HEALTH By ::: Amal Mohamed
  2. 2.  definition  indicators  Safe motherhood and its indicators  Situation in Sudan  Family planning 
  3. 3. DEFINITON Defined as a state of complete physical, mental and social well-being and not merely the absence of reproductive disease or infirmity. , in all matters relating to the reproductive system and to itsfunctionsand processes.[WHO]
  4. 4.  Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. .
  5. 5.  Implicit in this are the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and  the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
  6. 6.  Comprehensive reproductive health care includes:  counseling, information, education, communication and clinical services in family planning;  safe motherhood, including antenatal care, safe delivery care (skilled assistance for delivery with suitable referral for women with obstetric complications) and postnatal care, breastfeeding and infant and women’s health care; gynecological care, including prevention of abortion, treatment of complications of abortion, and safe termination of pregnancy as allowed by law;  prevention and treatment of sexually transmitted diseases (including HIV/AIDS), including condom distribution, universal precautions against transmission of blood borne infections, voluntary testing and counseling;
  7. 7.  prevention and management of sexual violence; active discouragement of harmful traditional practices such as female genital mutilation; and reproductive health programmes for specific groups such as adolescents, including information, education, communication and services
  8. 8. REPRODUCTIVE HEALTH INDICATORS
  9. 9.  During the 1990s, the official representatives of countries worldwide attended international conferences (ICPD in Cairo, the Fourth Women's Conference in WHO's Short List of Reproductive Health Indicators for Global Monitoring in Beijing) and endorsed a number of global goals and targets in the broad area of sexual and RH. This endorsement led to a proliferation of RH indicators on which countries were asked to report. Subsequently, the UN asked WHO to take the lead in organizing an interagency technical process to examine the issue of RH indicators and to reach consensus on a short list of indicators for global monitoring.
  10. 10.  WHO's resulting set of 17 indicators covers the main RH areas and represents the consensus among international agencies of the key indicators for international comparison, global monitoring, and follow-up to the international conferences.  The purpose of this set of indicators is to provide an overview of the RH situation at global and national levels. The objective is not to present a comprehensive set of indicators for program monitoring and evaluation. However, the data collected for reporting the indicators should be useful at the program management level
  11. 11. 1- TOTAL FERTILITY RATE  Total number of children a woman would have by the end of her reproductive period if she experienced the currently prevailing age-specific fertility rates throughout her childbearing life
  12. 12.  calculated from age specific fertility rate  date derived from : vital registration , population censuses and population based surveys  In sudan TFR is 5.9%
  13. 13. 2- CONTRACEPTIVE PREVELANCE RATE  Percent of women of reproductive age (15- 49) who are using (or whose partner is using) a contraceptive method at a particular point in time  .. Children born within 2 years of an elder sibling are 60% more likely to die in infancy than are those born more than 2 years after their sibling. (Cleland, J et al. Contraception and Health www.thelancet.com; July 10, 2012).
  14. 14.  Numerator: Number of women of reproductive age at risk of pregnancy who are using (or whose partner is using) a contraceptive method at a given point in time  Denominator: Number of women of reproductive age at risk of pregnancy at the same point in time  data collection method : population based data survey  Rate in Sudan is 11% prevelance was 20% in rural and 3 % in urban areas
  15. 15. 3- MATERNAL MORTALITY RATE  Annual number of maternal deaths per 100,000 live births  Maternal mortality is widely acknowledged as a general indicator of the overall health of a population, of the status of women in society and of the functioning of the healt system. It is therefore useful for advocacy purposes, in terms both of drawing attention to broader challenges faced by governments and of safe motherhood.  Is 509 per 100,000 live births in Sudan
  16. 16.  Maternal deaths are difficult to measure owing to many factors, including their comparative rarity and context- specific factors such as reluctance to report abortion- related deaths, problems of memory recall and lack of medical attribution.  source of data :  - vital registration  - health facility based data ( could be over or under estimated )  population based survery *** ( main source in many developing countries )
  17. 17. 4- ANTENATAL CARE COVERAGE  Percent of women attended at least once during pregnancy, by skilled health personnel (excluding trained or untrained traditional birth attendants), for reasons relating to pregnancy.  At least one visit is 68.9% at least four visits 47.1% [Global Health Observatory Data Repository- WHO]
  18. 18. 5- PERCENT OF BIRTH ATTENDED BY SKILLED HEALTH PERSONNEL  Percent of births attended by skilled health personnel (excluding trained or untrained traditional birth attendants)  Numerator: Number of pregnant women attended, at least once during their pregnancy, by skilled personnel for reasons related to pregnancy during a fixed period  Denominator: Total number of live births during the same period
  19. 19. source of data :  vital statistics  population based surverys  Percent in Sudan is 57%>…
  20. 20.  This indicator is one of four mutually supportive indicators in the minimum list measuring maternal health service coverage. The other three indicators are: “antenatal care coverage”, “availability of basic essential obstetric care” and “availability of comprehensive essential obstetric care”.  In combination, these indicators measure progress towards the goal of providing all pregnant women with antenatal care, trained attendants during childbirth, and referral facilities for high-risk pregnancies and obstetric emergencies
  21. 21. 6- AVAILABILITY OF BASIC ESSENTIAL OBSTETRIC CARE  Number of facilities with functioning basic essential obstetric care per 500,000 population
  22. 22. 7- AVAILABILITY OF COMPREHENSIVE ESSENTIAL OBSTETRIC CARE  Number of facilities with functioning comprehensive essential obstetric care per 500,000 population
  23. 23.  health facility based survey  population based survey (household)
  24. 24. 8- PERINANTAL MORTALITY RATE  Number of perinatal deaths (still births plus early neonatal deaths) per 1,000 total births  Neonatal mortality is 31 per 1000 live births
  25. 25. 9- LOW BIRTH WEIGHT PREVALENCE  Percent of live births that weigh less than 2,500g  One third of infant are born with a low birth weight in Sudan [UNICEF]
  26. 26. 10- POSITIVE SYPHLIS SEROLOGY PREVELANCE IN PREGNANT WOMEN  Percent of pregnant women (15-24) attending antenatal clinics, whose blood has been screened for syphilis, with positive serology for syphilis  Data collected by sentinel survelliance
  27. 27. 11- PREVALENCE OF ANEMIA IN WOMEN  Percent of women of reproductive age (15-49) screened for hemoglobin levels with levels 11g/dl for pregnant women, and 12g/dl for non-pregnant women  57.7% in Sudanese pregnant women in 2005
  28. 28. SOURCE OF DATA  health facility based data  special population survery
  29. 29. 12-PERCENT OF OBSTETRICS AND GYNECOLOGY ADMISSION OWING TO ABORTION  Percent of all cases admitted to service delivery points providing in-patient obstetric and gynecological services, which are due to abortion (spontaneous and induced, but excluding planned termination of pregnancy)
  30. 30. 13- REPORTED PREVALENCE OF WOMEN WITH FGM  Percent of women interviewed in a community survey reporting having undergone FGM  Sudan is 88%  Nigeria 27%  Egypt is 91% (highest total number)  Somalia 98% highest prevelance rate
  31. 31. 14-PREVALANCE OF INFERTILITY IN WOMEN  Percent of women of reproductive age (15-49) at risk of pregnancy (not pregnant, sexually active, non-contracepting, and non-lactating) who report trying for a pregnancy for two years or more  Proportion of women who has their first birth at 18 in 2008 is 17%
  32. 32. 15- REPORTED INCIDENCE OF URETHRITIS IN MEN  Percent of men aged (15-49) interviewed in a community survey reporting episodes of urethritis in the last 12 months
  33. 33. 16- HIV PREVALENCE AMONG PREGNANT WOMEN  Percent of pregnant women (15-24) attending antenatal clinics, whose blood has been screened for HIV and who are sero-positive for HIV
  34. 34. 17- KNOWLEDGE OF HIV RELATED PREVENTION PRACTICE  Percent of all respondents who correctly identify all three major ways of preventing the sexual transmission of HIV and who reject three major misconceptions about HIV transmission or prevention
  35. 35. STIs and HIV/AIDS Harmful traditional practice (FGM) Family planning Counseling in RH (Women empowerment and Male involvement Menopause Adolescent health Infertility Reproductive cancers (cervical and breast) Safe motherhood RH components and prioritiesRH components and priorities
  36. 36. SAFE MOTHERHOOD
  37. 37. SAFE MOTHERHOOD  Safe motherhood begins before conception with proper nutrition and a healthy lifestyle. It continues with appropriate prenatal care, the prevention of complications when possible, and the early and effective treatment of any complications.  The ideal results are pregnancy at term without unnecessary interventions, the delivery of a healthy infant, and a healthy postpartum period in a positive environment that supports the physical and emotional needs of the woman, infant, and family.
  38. 38.  Globally, the numbers remain staggering: each year there are at least 3.2 million stillborn babies, 4 million neonatal deaths and more than half a million maternal deaths.  The majority of these deaths are avoidable.  HIV/AIDS and malaria in pregnancy are having an impact on maternal mortality and could reverse the progress that has been made.
  39. 39.  A total of 11–17% of maternal deaths occur during childbirth itself . While 50–71% occur in the post-partum period.  The time spent in labour and giving birth, the critical moments when a joyful event can suddenly turn into an unforeseen crisis, needs more attention, as does the often-neglected post- partum period.  These periods account not only for the high burden of post-partum maternal deaths, but also for the associated large number of stillbirths and early newborn deaths.
  40. 40.  Very few developing countries have accurate data on maternal and newborn deaths and morbidities, and less than one developing country in three reports national data on post-partum care
  41. 41. SAFEMOTHERHOOD INDICATORS  ✦ Access/Use of Services Indicators  Met Need for Essential Obstetric Care  Unmet Obstetric Need  Cesarean Section Rate  Who delivers the woman, and where does birth take place
  42. 42.  Quality of care indicators  Case Fatality Rate (and numbers ofmaternal deaths)  Referral Rates
  43. 43. SAFE MOTHERHOOD INDICATORS IN SUDAN 71% of pregnant women have access to prenatal care services Postnatal care is low at 18% and SHHS 2006
  44. 44. Coverage with village midwives is 52.4% ANC/FP services are provided by 37.5% of facilities. Coverage of health facilities with EmONC services 57% RH Annual report 2008
  45. 45. Delivery by trained personnel in the northern part of the country accounts for 57% of deliveries. Institutional deliveries account for 14% of all births Caesarian Section Rate has risen to 4.5% SHHS 2006
  46. 46. LOCAL SITUATION
  47. 47. LOCAL SITUATION o The country adopted PHC as the main strategy to improve the health status of individuals, families and communities , as early as 1973 o o In 1976 Sudan National Health Plan implemented the PHC with MCH/FP as an integral part and one of the main components
  48. 48. THE OVER ALL OBJECTIVE OF NATIONAL STRATEGY IN SUDAN : Is to accelerate progress toward meeting the nationally set and internationally agreed RH targets and ultimately to attain highest achievable standard of RH for all population
  49. 49.  Focuses on the elements of the health system and the basic core skills and abilities required in order for care providers to be able to function effectively  In 2001 – all states ministers of health and the Federal minister signed the Sudan Declaration on Safe motherhood. As the main target- Midwife for every village Making Pregnancy Safer initiative (2001) Making Pregnancy Safer initiative (2001)
  50. 50. WHERE WE ARE?WHERE WE ARE? Sudan Household Survey- 2010 • Overall Maternal Mortality: 730 per 100,000 live births
  51. 51.  By the end of the childbearing period about one in ten women have never given birth
  52. 52.  The age-weighted proportion of female deaths reported occurring during the exposure period for pregnancy and post-delivery in Sudan in 2008 was 46 percent, with the highest percentage of pregnancy and delivery related deaths occurring between the ages of 20 and 24 years.  Among states, the age weighted proportion of maternal deaths out of all female deaths was highest in North and South Darfur, Kassala, White Nile, Blue Nile and South Kordofan (above 50 percent) and lowest in Northern, River Nile and Gezira (below 30 percent).
  53. 53.  In Sudan, maternal conditions during pregnancy affect over one in three pregnant women (conditional on surviving pregnancy) and complications during labor or up to six weeks after delivery affect approximately one in every two pregnant women .  About 60 percent of perinatal deaths (including still births and neonatal deaths from any cause, during the perinatal period – 27 weeks of gestation to 28 days of life) are low birth weight (less than 2,500 grams), birth asphyxia and infection (neonatal sepsis, tetanus, congenital syphilis, HIV infection) (Graham, Cairns et al. 2006).  Death to the mother and baby is highly concentrated near delivery, from the onset of labor or abortion to 48 hours postpartum or post abortion, highlighting the need for mothers to have professional care at the time of delivery. Mortality among babies is directly linked to complications experienced by mothers.
  54. 54.  Among women of reproductive age with a pregnancy in the two years prior to the survey - skilled birth attendance (births attended by a doctor, nurse midwife or village midwife) covered 68 percent of live births between 2004 and 2006 and 73 percent between 2008 and 2010. Across states, skilled birth attendance ranges from a high of 99 percent in Northern to a low of 34 percent in West Darfur
  55. 55. FAMILY PLANNING
  56. 56. WHAT IS FAMILY PLANNING? A way of living that is adopted by individuals and couples in order to promote the health and welfare of the family group Practices that help to : ◦ Avoid unwanted pregnancy. ◦ Bring about wanted pregnancies. ◦ Regulate intervals between pregnancies. ◦ Control the time of birth in relation to parent ages.
  57. 57. FAMILY PLANNING  Among women having had a live birth in the two years prior to the SHHS, in 2010, 23 percent in urban areas did not want their last birth compared to 14 percent in rural areas.  In 2010, 29 percent of women in urban areas and 21 percent in rural areas did not want a future pregnancy.
  58. 58.  The use of modern contraception expanded from 7.8 to 19 percent between 2006 and 2010among women in urban areas.  For women in rural areas, use of modern contraceptive increased from 3 to 5.6 percent between 2006 and 2010 and the use of traditional methods remained at 1 percent.  The most commonlyused methods for contraception in 2010 among couples using contraception were  pills (73 percent),  injectables(11 percent),  lactational amenorrhea (5 percent)  and periodic abstinence (4.5 percent).  Less than 2 percent of women reported using male condoms as a form of contraception.
  59. 59. THANK YOU

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