1.Reproductive health

Unit 3: REPRODUCTIVE
HEALTH (RH)
Reproductive health is the crucial part of the
overall health and is central to human
development.
It is important component of general health
and is prerequisite for social, economic and
human development.
4/6/2021 1

Reproductive health and development
• UNFPA works to ensure sexual and
reproductive health and rights remain at the
very centre of development.
• The International Conference on Population
and Development draws a clear connection
between reproductive health, human rights
and sustainable development.
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• When sexual and reproductive health needs
are not met, individuals are deprived of the
right to make crucial choices about their
own bodies and futures, with a cascading
impact on their families’ welfare and future
generations.
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 And because women bear children, and also
often bear the responsibility for nurturing
them, sexual and reproductive health and
rights issues cannot be separated from gender
equality. Cumulatively, the denial of
these rights exacerbates poverty and gender
inequality.
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Evolution timeline
Year EVENT
1970 Family planning programms
1980s Womens’ health movement
1994 Concept of RH in ICPD
conference- accepted and first
defined by WHO
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Year EVENT
1965 Family planning – public policy
(private sectors-1958)
1968 Family Planning and MCH
Programme
1988 STI and AIDS
1998 Safe Motherhood Policy
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 The concept of reproductive health was introduced
at the International conference on population and
development (ICPD) at Cario, in 1994 and later on it
was accepted by WHO.
 In the ICPD program of action , Reproductive health
was first defined by the WHO and was endorsed by
the UN General Assembly and by Beijing
Declaration.
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This program of action endorses a new
strategy which emphasizes the numerous
linkage between population and development
and focus on meeting the needs of individual
women and men rather than or achieving
demographic targets.
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4/6/2021 9
But a new approach that integrated the existing safe
motherhood, f/p, HIV/AIDS, STIs, child survival, PAC and
adolescent reproductive health programme with a holistic
life cycle approach
RH is not a new
programme.

Reproductive health is a state of complete
physical, mental and social well-being and not
merely the absence of disease or infirmity, in
all matters relating to the reproductive system
and to its functions and processes.
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Reproductive health therefore implies that
 people are able to have a 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.
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Implicit above last condition are
the rights of men and women to be informed
and to have access to safe, effective,
affordable and acceptable methods of family
planning of their choice, as well as other
methods of their choice for regulation of
fertility which are not against the law, and
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 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.
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Definition
 It is defined as constellation of methods, techniques
and services that contribute to reproductive health
and well-being by preventing and solving
reproductive health problems.
 Maternal and perinatal health,
 family planning,
 preventing unsafe abortion,
 prevention and treatment of sexually transmitted
diseases and
 promoting sexual health.
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 It also includes sexual health,- the purpose of
which is the enhancement of life and personal
relations and not merely counseling and care
related to reproduction and sexually
transmitted disease.
(program of action in ICPD, document A/CONF
(71/13,paragraph 7.2)
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Important human rights related to RH
The right to lead a responsible and satisfied sexual life
Right to reproduce and freedom to decide when, and
how often to do so
Right of women to have choices and access to, safe,
effective, affordable and acceptable methods of family
planning of their choice.
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 The right of access to appropriate health care
services that will enable women to go safely
through pregnancy and child birth and provide
couples with the best chance of having a healthy
infant.
 In addition to these, it also includes gender equity
and equality, empowerment of women and the
provision of universal access to appropriate health
services over the life cycle.
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Scope/Components
 The scope of
Reproductive Health is
wide.
 It covers the all stage of
life.
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Reproductive health within the context of Primary
Health Care, includes the following essential
components:
1. Family planning; counseling, information, education,
communication and services(emphasizing the
prevention of unwanted pregnancies)
2. Safe motherhood; education and services for healthy
pregnancy, safe delivery and postnatal care
including breast feeding.
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3. Care of the newborn
4.Prevention and management of complications
of abortion
5. Prevention and management of RTI, STDs,
HIV/AIDS and other reproductive health
condition.
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6. Information, education and counseling as appropriate
on human sexuality, reproductive Health and
responsible parenthood for individuals, couples and
adolescent.
7. Prevention and management of sub fertility and
8. Life cycle issues including breast cancer, cancer of the
reproductive system and care of the elderly.
4/6/2021 23

Indicators of Reproductive Health
Service Delivery Indicator
Availability of service delivery statistics of
various RH services, analysis and utilization of
these records at local level for program
planning, monitoring and performance review.
Percentage of eligible couple who had access to
FP service.
Contraceptive prevalence rate
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 Percentage of pregnant woman who had antenatal
care at once
 Percentage of deliveries attended by trained
personnel
 Percentage of mother receiving postnatal care
 Percentage of newborn receiving newborn care
 Number of health facilities providing EMONC by
type of health facilities.
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 Percentage of high risk maternity and STI cases
managed and referral.
 Percentage of pregnant mother who are anemic and
received iron folate.
 Percentage of pregnant who received TD at least
two doses.
 Essential newborn care
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Quality care indicator
 Percentage of updating and regular supply
and utilization of drugs, equipments etc
 Availability and condition of physical
facilities.
 Percentage of follow up visits
 Percentage of satisfied clients.
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 Family planning users continuation rate
 Percentage of eligible clients converting from a
spacing method to a permanent.
 Percentage of mother who had at least four antenatal
visit
 Availability and adherence of RH guidelines and
protocols regarding different elements of RH at
different level
 Regular updating of knowledge and skills of service
providers.
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Impact Indicators
 Total fertility rate and
age specifice fertility rate.
 Maternal mortality rate.
 Perinatal mortality rate.
 Neonatal mortality rate.
 Infant mortality rate.
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 CYP (couple year of
protection
 Number of neonatal
tetanus(NNT) cases.
 LBW rate per 1000
live births.
 Anemia in pregnant
women.
 STI prevalence

Woman empowerment indicators
 Literacy rate of women as compared to man
 Percentage of women gainfully employed.
 Age of women at first marriage (Average).
 Number and percentage of women health care
providers by level of care.
 No. of women trained as health volunteers.
 Adolescent girl at school.
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20 Sep 2018
Unit 3: Sexual and
REPRODUCTIVE
HEALTH (RH)
Heera KC
Msc. Nursing(Maternal Health )BPKIHS
PBN 2nd yr Co-ordinator, Birat Health College
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Guiding principle of Reproductive
health developed by ICPD
• Empowerment of women
• Involve women, women’s organization
• Promote men’s participation in RH/FP
• Assure highest level of quality of care
• Integrated services
• Make available effective methods of FP.
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Cont…
 Reproductive Health - provided under directives of
DoHs - delivering preventive and curative health
services and promotional activities.
 Family Health Division - implementing RH strategies
and programs.
 Logistic Management division -for procurement,
warehousing and distribution of Reproductive Health
commodities including supplies and equipment
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• National Reproductive Health policies – in line with
policies adopted in
National Health Policy (1991) and
second long term Health Plan (1997-2017)
• which aims at reducing infant, child and maternal
morbidity and mortality and reducing total fertility
rate.
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RH strategies-1998
1. Implement the ‘Integrated Reproductive Health
Package’ at hospital, PHC Center, Health Post and
Sub-Health Posts as well as through Primary Health
Care Outreach, FCHVs/ Mothers groups and other
community and family level activities based on
standardized clinical protocols and operational
guidelines;
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2. Enhance functional integration of
Reproductive Health activities carried out by
different divisions;
3. Emphasize advocacy for the concept of
Reproductive Health including the creation of
an enabling environment for inter-and intra-
sectoral collaboration;
4. Review and develop IEC materials to support
all levels of intervention including rumour
countering message. 4/6/2021
36

5. Review and update the existing training
curricula of various health workers to include
missing Reproductive Health components;
6. Ensure effective management systems by
strengthening and revitalizing existing
committees at various levels;
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7. Develop a national RH research strategy which
outline research priorities and work plans based on
information requirements of policy makers,
planners, managers and service providers;
8. Construct/ upgrade appropriate service delivery and
training facilities at the National, Regional, District
and Health Post level;
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9. Institutional strengthening through structured
planning, Monitoring/ supervision and Performance
review;
10. Develop an appropriate RH program for
adolescents;
11. Support for national experts/consultants; and
12. Promote inter-sectoral and multisectoral co-
ordination.
4/6/2021 39

क
े
क
े
Reproductive
Health Services कस्लार्इ
सुरक्षित
मातृत्व
पररवार
नियोजि
िवजात
शििु
ककिोर
ककिोरी
HIV र
योि रोग
नििन्ताि
दम्पती सेवा
सुरक्षित
गर्इपि
उमेर ढल्क
े का
महिला
लैंगगक
हििंसा
40
स्वस्थ नेपाल, समृध्द नेपाल

Integrated reproductive health package
1. Family planning
2. Safe motherhood
3. Child health (new born care)
4. Prevention and management of complications of
abortion
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5. Reproductive Tract Infection/Sexually Transmitted
Disease/ Human Immuno-Deficiency Virus/ Acquired
Immunodeficiency Syndrome.
6. Prevention and management of subfertility.
7. Adolescent reproductive health.
8. Problems of elderly women (i.e. uterine, cervical and
breast cancer treatment) at the tertiary level or the
private sector.
9. Gender Based Violence
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4/6/2021 43
R.H SERVICES PROTOCOL
AT DIFFERENT LEVEL

4/6/2021 44
District Level
Primary Health Care center level
Sub-Health post/ Health Post level
Community level
Family / Decisional makers level

SN Services Activities
1. Family Planning I. Identification of necessity
II. Keeping information of various
places or organization
providing the facilities of
family planning
2. Safe motherhood I. Identification of female being
pregnant
II. Identification of danger signs
III. Proper care of pregnant
mother
4/6/2021 45
Family Level

3. Care of the
newborn
I. Proper care of the newborn
II. Identification of complication
in the newborn and
immediately taking for
treatment in health centers
III. Immunization as per the
schedule
4. Prevention and
management of
complication of
abortion
I. Information regarding
complications and signs of
abortion
II. Information regarding centers
providing abortion services
III. Information regarding family
planning methods
4/6/2021 46

5. Prevention and
management of
RTI/STD/HIV/AIDS
1. Encourage use of condom
2. Information and seeking help
regarding infection in
reproductive organs and other
various sexually transmitted
disease
6. Prevention and
management of
sub-fertility cases
1. Identify subfertility
2. Treatment of subfertility in the
related health institution by the
couple
7. Adolescent
reproductive
health
1. Activities related to Family Life
Education like: Having talk
among parents and children
2. Delay marriage
4/6/2021 47

Providing adequate nutrition to
the adolescent especially to girls
Education to girls
8. Problem of
elderly women
i.e. uterine
cervical and
breast cancer
treatment at the
tertiary level or
in the private
sector
1. Identify the problem related
to reproductive organs
2. Keeping information
regarding respective institute
that can provide information
regarding these matters
4/6/2021 48

9. Gender Based Violence
• Promote Gender friendly environment
• Be aware about gender based violence and its
impact on health
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1.Family planning
• Sexuality and gender information, education,
and counseling for adolescents, youth, men, and
women.
Community based contraceptives distribution
through community based health workers/
volunteers, women’s groups, community based
workers.
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COMMUNITY LEVEL

• Social marketing of condoms and re-supply of
oral pills through community service.
• Counseling and referral for other contraceptive
methods.
• IEC for LAM.
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2. Safe Motherhood
• Counseling /education for breast feeding, nutrition,
FP, rest exercise etc.
• Awareness rising for risk factors.
• Recognizing dangers signs and support SBA
• Create awareness about services that SBA offers.
• Mobilize community to support referral and
transportation ( emergency fund and transport)
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• Identification of local health institution of maternal
and neonatal health MNH) services.
• Help the poor and underprivileged to utilize MNH
services.
• IEC /counseling for danger signs during pregnancy,
delivery, postpartum for mother.
• Encourage utilization of antenatal care services.
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• Birth preparedness and complication readiness with
families (delivery by SBA and preparation or
arrangement of emergency funds and transport, blood
donors).
• Detection of complication complications in mother and
baby and facilitation for referral to health facility.
• Postnatal visit for mother and baby.
• Encourage for registration of maternal death.
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3. New born
Care
Counseling regarding :
•Health of new born baby
•keeping baby warm
•Immediate breast feeding
•Encourage breast feeding
•Immunization as per schedule
•Registration for neonatal death and
death event.
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4. Prevention and
management of
complication of
abortion
1. Counseling regarding
prevention of unplanned
pregnancy, family planning
and provision for distribution
of condom and pills.
2. Identification of abortion and
signs of complication of
abortion.
3. Referred to health facilities
where facilities are available
4/6/2021 56

5. Prevention and
management
of
RTI/STD/HIV/
AIDS
1. Counseling regarding safe sex
2. Distribution and encourage
the use of condom
3. Information, Education and
counseling regarding safe sex
and gender equality
4. Education and counseling
regarding infection to
reproductive organs STI/HIV
AIDS
4/6/2021 57

6. Prevention and
management of
sub-fertility
cases
Information regarding
prevention an treatment of sub-
fertility.
Referral of subfertility couple to
health institution and provide
adequate required help.
4/6/2021 58

7. Adolescent
reproductive
health
1. Education and counseling
regarding sexual behavior and
gender equality
2. Creating awareness regarding
danger of early age pregnancy
3. Family life education.(same as
above)
4. Information on risks of teenage
pregnancy.
4/6/2021 59

8. Problem of
elderly women
( i.e. uterine
cervical and
breast cancer
treatment)
1. Identify the problem
related to reproductive
organs
2. Keeping information
regarding respective
institute that can provide
information regarding
these matters
4/6/2021 60

1.
` Family
Planning
1. Monitoring community based activities
2. Provision of pills, condom and depo
3. Provision of facility of IUCD in the health
institution where there are related health
workers
4. Counseling and referral for permanent
family planning method
5. Counseling, management and referral of
side-effect of related family planning
method and appropriate counseling
regarding change of family planning
method
6. Increasing the availability of other family
planning method
4/6/2021 62

2
.
Safe
motherhoo
d
1. Focussed ANC visit for each
pregnancy
2. Delivery facilities and use of
partograph, oxytocin and placenta
delivery.
3. Identification of danger signs and
complication and immediate referral
4. Perform episiotomy and perineal tear
5. Treatment of malaria according to
national guidelines
6. Treatment of postnatal mothers of
sepsis
7. Postpartum visit
8. Registration of maternal death.
4/6/2021 63

3. Newborn Care
• Immediate and exclusive breast feeding.
• Resuscitation and stabilization of newborn with
asphyxia using bag and mask hypothermia and sepsis.
• Identify, stabilize and manage premature / LBW
newborn with kangaroo mother care and refer if
necessary.
• Treatment of minor infections and referral after
stabilization for major infections in newborns.
• Immunization for newborn.
• Encourage for registration of neonatal birth and death
event.
4/6/2021 64

4. Prevention
and
manageme
nt of
complicati
on of
abortion
1. Identification of abortion by minor
physical examination
2. Resuscitation, IV drip and refer
3. Post abortion f/p counselling.
4/6/2021 65

5. RTI/STI/HI
V/
AIDS
1. Identify, syndromic management and
refer white discharge, lower abdominal
pain, ulcer of reproductive organs,
swelling of testes and groin region
2. Partner treatment and referral
3. Encourage and distribute condom
4. Advertisement, education and
information regarding various method
of treatment
4/6/2021 66

6. Prevention and
management of
subfertility
cases
Same
7 Adolescent
reproductive
health
1. Make available of pills and condom
2. Provide ANC, natal PNC and
newborn care according to national
standard
3. Conduct health education( family
life clinic)
4. School health program
5. Identify reproductive health problem
and refer
8. Problem of
elderly women
1. Same
4/6/2021 67

Primary Health Care Center Level
4/6/2021 68

1. Family
Planning
1. Provide the facilities of Minilap,
permanent method of family planning
for male
2. Provide other method of family
planning method as per the nation
guidelines
3. Management and treatment of
complication
4. Facilities of postmortem
5. Provide the facilities of long term
temporary family planning method
and management of side effects and
complication
4/6/2021 69

2
.
Safe motherhood Start I/V drip and first dose of
antibiotics prior to referral for
complications
Provide with the facility of forceps
delivery, vacuum delivery
3
.
Care of the
newborn
Keep baby warm, resuscitation and
breast feeding and treatment of
newborn baby as per the national
guidelines
4/6/2021 70

4
.
Prevention
and
management
of
complication
and abortion
Start the required treatment like
• Antibiotics, IV drip, use of
oxytocin,
• Uterus evacuation for less than 3
months abortion,
•
•Refer for more than 3 months
abortion,
• Use of analgesic and sedatives,
management of pain:
4/6/2021 71

5
.
RTI/STI/HIV/
AIDS
•Treatment of STD according to signs and
symptoms
•Treatment of STI and RTI
•Encourage and distribution of condom
6
.
Prevention and
management of sub
fertility cases
Treatment of sub fertility, semen analysis and
referral with appropriate counseling to
health centers having the facilities
7
.
Adolescent
reproductive health
•Treatment of STI
•Special attention to be given to early age
pregnant mothers during their ANC, natal
and PNC period
•Linkage with school systems and NGO
8
.
Problem of elderly
women
• Same
4/6/2021 72

1
.
Family
Planning
Same +Provision and expansion of facilities
of permanent family planning method like
minilap, laproscopy,vasectomy facilities and
facilities of semen analysis.
Long acting contraceptive methods
2
.
Safe
motherhood
•Treatment of maternal sepsis
•Treatment of high risk mothers
•Treatment of serious complication during
natal period, facilities of anesthesia, C/S and
provision of blood transfusion if available
•Treatment of referred case
•Provide with the facility of forceps delivery
3
.
Care of the
newborn
Same
4/6/2021 74

4. Prevention an
management of
complication of
abortion
Uterus evacuation for abortion done
within 2nd trimester
Treatment of complication of
abortion-MA, MVA, D and E
Provide local/general anesthesia
Cure of complication like septicemia,
peritonitis and renal failure and
referral of the case to the appropriate
health center
5. RTI/STI/
HIV/AIDS
Treatment of disease based on signs
and symptoms and laboratory
investigations
HIV/PMTCT
4/6/2021 75

Education, Information and
counseling regarding the
prevention of above mentioned
condition
6. Prevention an d
management of sub
fertility cases
Cure and treatment of
subfertilityand if required
referral of case to better center
7. Adolescent
reproductive health
Same
8. Problem of elderly
women
Same
4/6/2021 76

1.Reproductive health

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