RH all together ,et 2022,1234.@#RHa.pptx

Introduction to reproductive health
By Elias Teferi (phD)
4/10/2024 2

Introduction
Definition
 Reproductive health is defined as
” A state of complete physical, mental, and social
well being and not merely the absence of disease
or infirmity, in all matters related to the reproductive
system and to its functions and process”.
This definition is taken and modified from the WHO
definition of health.
4/10/2024 3

Introduction…
 Reproductive Health addresses the human sexuality
and reproductive processes, functions and system at
all stages of life and 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.”
4/10/2024 4

Introduction…
 Men and women have the right to be informed and
have access to safe, effective, affordable and
acceptable methods of their choice for the regulation
of fertility which are not against the law, and
 the right of access to appropriate health care
services for safe pregnancy and childbirth and
 provide couples with the best chance of having a
healthy infant.
4/10/2024 5

Introduction…
• Reproductive health is life-long, beginning even
before women and men attain sexual maturity
and continuing beyond a woman's child-bearing
years.
4/10/2024 6

Historical development of the concept of
RH
• It is helpful to understand the concept and to
examine its origins.
• During the 1960s, UNFPA established with a
mandate to raise awareness about population
“problems” and to assist developing countries in
addressing them.
4/10/2024 8

Historical development…
• At that time, Concern about population growth
(particularly in the developing world and among the
poor) coincided with the rapid increase in
availability of technologies for reducing fertility -
the contraceptive pill became available during the
1960s along with the IUD and long acting hormonal
methods.
4/10/2024 9

In 1972, WHO established the Special Program of
Research, Development and Research Training in
Human Reproduction (HRP), whose mandate was
focused on research into the development of new
and improved methods of fertility regulation and
issues of safety and efficacy of existing methods.
4/10/2024 10

Modern contraceptive methods were seen as
reliable, independent of people’s ability to practice
restraint, and more effective than withdrawal,
condoms or periodic abstinence.
Moreover, they held the promise of being able to
prevent recourse to abortion (generally practiced
in dangerous conditions) or infanticide.
4/10/2024 11

• Population policies became widespread in
developing countries during the 1970s and 1980s
and were supported by UN agencies and a variety
of NGOs.
 The dominant paradigm argued that rapid
population growth would not only hinder
development, but was itself the cause of poverty
and underdevelopment.
4/10/2024 12

• Almost without exception, population policies
focused on the need to restrain population growth;
very little was said about other aspects of
population, such as changes in population
structure or in patterns of migration.
• The 1994 ICPD has been marked as the key
event in the history of reproductive health.
4/10/2024 13

Development of Reproductive Health
Before 1978 Alma-Ata Conference
• Basic health services in clinics and health centers
• Primary health care declaration 1978
• MCH services started with more emphasis on child
survival
• Family planning was the main focus for mothers
4/10/2024 14

Development of Reproductive Health …
Safe motherhood initiative in 1987
• Emphasis on maternal health
• Emphasis on reduction of maternal mortality
Reproductive health, ICPD in 1994
• Emphasis on quality of services
• Emphasis on availability and accessibility
• Emphasis on social injustice
• Emphasis on individuals woman's needs and rights
4/10/2024 15

Three rights in particular were identified:
• The right of couples and individuals to decide
freely and responsibly the number and spacing of
children and to have the information and means to
do so;
4/10/2024 16

• Historical development…
• The right to attain the highest standard of sexual
and reproductive health; and,
• The right to make decisions free of discrimination,
coercion or violence.
4/10/2024 17

Development of Reproductive Health…
Millennium development goals and reproductive
health in 2000
• MDGs are directly or indirectly related to health
• MDG 4, 5 and 6 are directly related to health,
• while MDG 1,2,3, and 7 are indirectly related to
Health
4/10/2024 18

Millennium development goals…
 Emphasis on eradicating extreme poverty &
 improving the health & welfare of the world’s
poorest people by 2015.
4/10/2024 19

THE MISSING GOAL IN MDGS
4/10/2024 20

MDGs Relevance to Health Perspective
 Provide a common set of priority for addressing
poverty
 Place health at the heart of the MDGs:
– three of the eight are health goals
 Set quantifiable & ambitious targets
 Calls for global partnership for development
4/10/2024 21

2005 WORLD SUMMIT
• RH was not explicitly prioritized in the MDGs
although many SRH & rights themes appear in
the MDGs
• In 2005 at the World Summit made corrections &
included the recommendation to achieve universal
access to RH by 2015
• Sustainable development goal (SDG)
--Goal 3 and 5 are health related
4/10/2024 22

SDG 2016-2030
• SUSTAINABLE DEVELOPMENT GOALS (SDGS) AND SEXUAL &
REPRODUCTIVE HEALTH AND RIGHTS (SRHR)
• The SDGs, adopted at the UN Summit in New York in
September 2015, lay out the agenda for health and
sustainable development over the next 15 years.
• These 17 goals are very comprehensive and cover a wide
range of domains that are essential to sustainable
development. Of these 17 goals, targets from goals 3, 4
and 5 are specific to increase access to SRHR.

• Goal 3: Ensure healthy lives and promote wellbeing for all at
all ages
• 3.1. By 2030, reduce the global maternal mortality ratio to
less than 70 per 100,000 births.
• 3.7. By 2030, ensure universal access to sexual and
reproductive healthcare services, including for family
planning, information and education, and the integration of
reproductive health into national strategies and programmes.
• 3.8. Achieve universal health coverage, including financial
risk protection, access to quality essential health-care
services and access to safe, effective, quality and affordable
essential medicines and vaccines for all.

• Goal 4: Ensure inclusive and equitable quality education and
promote lifelong learning opportunities for all
• 4.7. By 2030, ensure that all learners acquire the knowledge and
skills needed to promote sustainable development, including,
among others, through education for sustainable development
and sustainable lifestyles, human rights, gender equality,
promotion of a culture of peace and non-violence, global
citizenship and appreciation of cultural diversity and of culture’s
contribution to sustainable development.

• Goal 5: Achieve gender equality and empower all
women and girls
• 5.6. Ensure universal access to sexual and
reproductive health and reproductive rights as agreed
in accordance with the Programme of Action of the
International Conference on Population and
Development and the Beijing Platform for Action and
the outcome documents of their review conferences.

Development of Reproductive health
Services in Ethiopia
– FGAE was established in 1967 (FP introduced for
the fist time in Ethiopia)
– Attempts to integrate family Planning in to MCH
program of the Ministry of Health ( 1979)
– Family healthy Department established (1987)
– Population Policy developed (1993)
4/10/2024 27

Development…
– RH concept introduced in Ethiopia after ICPD
(1994)
– National RH needs assessment done (1997)
– Ethiopia became the signature of the MDGs
(2000)
– National RH strategy developed in 2006
– National Adolescent and youth RH strategy
developed in 2007
4/10/2024 28

Rationale: Why RH & Development?
Consequences of unwanted fertility
• RH mortality:
– High MMR, PMR
• Sexual morbidity & mortality:
– STI/HIV
• Maternal morbidity: Complications of
– unwanted pregnancy,
– fistula,
– maternal depression, cancer
4/10/2024 29

Rationale: Why RH & Development?
• High economic burden to households &
society due to
– loss of mothers
• Violence against women
• Gender inequality
• Harmful cultural practices:
– Early marriage &
– FGM/C
4/10/2024 30

RH CARE
 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.

Objectives of RH care
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, for regulation of fertility which are not
against the law & to have information, education
& means to do so
4/10/2024 32

Objectives of RH ...
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
4/10/2024 33

Magnitude of Reproductive Health
Problem
• The term “Reproductive Health “is most often
equated with one aspect of women’s lives;
motherhood.
• Complications associated with various maternal
issues are indeed major contributors to poor
reproductive health among millions of women
worldwide.
• Half of the world’s 2.6 billion women are now 15 –
49 years of age..
4/10/2024 34

Magnitude of…
• Without proper health care services, this group is
highly vulnerable to problems related to sexual
intercourse, pregnancy, contraceptive sideeffects,
etc.
• Death and illnesses from reproductive causes are
the highest among poor women everywhere
4/10/2024 35

Magnitude of…
• In societies where women are disproportionately
poor, illiterate, and politically powerless, high rates
of reproductive illnesses and deaths are the norm.
• Ethiopia is not an exception in this case.
• Ethiopia has one of the highest maternal mortality
in the world; it is estimated to be 412 deaths per
100,000 live births (EDHS 2016).
4/10/2024 36

Magnitude of …
 Ethiopian DHS survey of 2005 indicates that maternal
mortality is 673 per 100,000 live births.
 676 maternal deaths per 100,000 LBs( 2011 EDHS.)
• In Ethiopia, contraception use by women is 27% and
• about 25% ( 2011 EDHS) and 34% (2005 EDHS)
women want to use contraceptive, but have no
means to do so.
4/10/2024 37

Magnitude of …
• Women in developing countries and economically
disadvantaged women in the cities of some
industrial nations suffer the highest rates of
complications from pregnancy, sexually transmitted
diseases, and reproductive cancers.
4/10/2024 39

Lack of access to comprehensive reproductive care
is the main reason that so many women suffer and
die.
• Most illnesses and deaths from reproductive causes
could be prevented or treated.
• Men also suffer from reproductive health problems,
most notably from STIs. But the number and scope
of risks is far greater for women.
4/10/2024 40
Magnitude of…

Components of Reproductive Health
1. Quality family planning services
2. Promoting safe motherhood: prenatal, safe
delivery and post natal care, including breast
feeding;
3. Prevention and treatment of infertility
4. Prevention and management of complications of
unsafe abortion;
5. Safe abortion services, where not against the law;
4/10/2024 41

Components…
6. Treatment of reproductive tract infections, including
sexually transmitted infections;
7. Information and counseling on human sexuality,
responsible parenthood and sexual and
reproductive health;
8. Active discouragement of harmful practices, such
as female genital mutilation and violence related to
sexuality and reproduction;
9. Functional and accessible referral
4/10/2024 42

Integrated approaches to reproductive
health
Rationale
• To effectively link various components of RH.
• To provide complementary RH services either by
the same provider in the same facility or by
different providers in the same area
• To address the need of people and their
concerns
4/10/2024 43

Advantages of integrated approaches
• It addresses a range of clients RH needs
• It saves time & money for clients as services
are obtained during a single visit
• A single service provider may offer a range of
RH services
• Clients satisfaction & utilization of services
increases
4/10/2024 44

Advantages….
• Clients gain confidence in the service provider
• Coordination & cost effectiveness of services are
improved
• Opportunities to create client awareness of the
availability of other services increase
4/10/2024 45

Disadvantages
• Health workers require more training and work
loads may be too heavy
• Resource spread more thinly difficult to attribute
expenditures to a specific result
4/10/2024 46

Reproductive health indicators
Following on a number of international conferences
in the 1990s, in particular the 1994 ICPD, many
countries have endorsed a number of goals and
targets in the broad area of reproductive health.
 Most of these goals and targets have been
formulated with quantifiable and time-bound
objectives.
4/10/2024 48

Evidence for monitoring: Reproductive
health indicators
 A health indicator is usually a numerical measure
which provides information about a complex
situation or event.
 When you want to know about a situation or event
and cannot study each of the many factors that
contribute to it, you use an indicator that best
summarizes the situation.
4/10/2024 49

Reproductive health indicators …
For example, to understand the general health
status of infants in a country, the key indicators
are infant mortality rates and the proportion of
infants of low birth weight.
4/10/2024 50

• Maternal health care quality, availability and
accessibility can be measured using maternal
Mortality. Indicators are expressed in terms of rates,
proportions, averages, categorical variables or
absolute numbers.
• Reproductive health indicators summarize data
which have been collected to answer questions that
are relevant to the planning and management of RH
programs.
4/10/2024 51

Sources of data for monitoring
Reproductive health
Routine service statistics:
summaries of health service records can give
information and it is very cheap, but may be
incomplete or sometimes may not give enough
information.
4/10/2024 52

Sources of data….
Population Census:
• The data collected at population censuses such
as population by age and sex, marital status, and
urban and rural residence provide the denominator
for the construction of process, output and impact
indicators.
4/10/2024 53

Vital statistics reports: The vital registration
system collects data on births, deaths and
marriages. These data are available by age, sex
and residence. These data provide the numerator
for the construction of process, output and impact
indicators.
4/10/2024 54
Sources of data….

Sources of data….
Special studies: collection and summarization
of information for a particular purpose.
Sample surveys : For Example Demographic
and Health survey
4/10/2024 55

Reproductive Health Indicators for Global
Monitoring
There are seventeen reproductive health indicators
developed by the United Nation Population Fund
(UNFPA) which are listed below.
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.
4/10/2024 56

• TFR is one of the most widely used fertility
measures to assess the impact of family planning
programmes .
2. Contraceptive prevalence (any method):
Percentage of women of reproductive age who are
using (or whose partner is using) a contraceptive
method at a particular point in time.
4/10/2024 57

3. Maternal mortality ratio: The number of maternal
deaths per 100 000 live births from causes
associated with pregnancy and child birth.
4. Antenatal care coverage: Percentage of women
attended, at least once during pregnancy, by skilled
health personnel for reasons relating to pregnancy.
5. Births attended by skilled health personnel:
• Percentage of births attended by skilled health
personnel. This doesn’t include births attended by
traditional birth attendants.
4/10/2024 58

6. Availability of basic essential obstetric care:
• Number of facilities with functioning basic essential
obstetric care per 500 000 population.
• Essential obstetric care includes, Parenteral
antibiotics, Parenteral oxytocic drugs, Parenteral
sedatives for eclampsia, Manual removal of
placenta, Manual removal of retained products,
Assisted vaginal delivery. These services can be
given at a health center level.
4/10/2024 59

7. Availability of comprehensive essential
obstetric care:
Number of facilities with functioning comprehensive
essential obstetric care per 500 000 population. It
incorporates obstetric surgery, anesthesia and blood
transfusion facilities.
8. Perinatal mortality rate: Number of perinatal
deaths (deaths occurring during late pregnancy,
during childbirth and up to seven completed days of
life) per 1000 total births.
4/10/2024 60

• Total birth means live birth plus IUFD born after
fetus reached stage of viability.
9. Low birth weight prevalence: Percentage of live
births that weigh less than 2500 g.
10. Positive syphilis serology prevalence in
pregnant women: Percentage of pregnant
women (15–24) attending antenatal clinics, whose
blood has been screened for syphilis, with positive
serology for syphilis.
4/10/2024 61

11.Prevalence of anemia in women: Percentage of
women of reproductive age (15–49) screened for
hemoglobin levels with levels below 110 g/l for
pregnant women and below 120 g/l for non
pregnant women.
4/10/2024 62

12.Percentageof obstetric and gynaecological
admissions owing to abortion: Percentage of all
cases admitted to service delivery points providing
in-patient obstetric and gynaecological services,
which are due to abortion (spontaneous and
induced, but excluding planned termination of
pregnancy)
4/10/2024 63

13. Reported prevalence of women with FGM:
• Percentage of women interviewed in a community
survey, reporting to have undergone FGM.
14.Prevalence of infertility in women: Percentage
of women of reproductive age (15–49) at risk of
pregnancy (not pregnant, sexually active,
noncontraception and non-lactating) who report
trying for a pregnancy for two years or more
4/10/2024 64

15. Reported incidence of urethritis in men:
Percentage of men (15–49) interviewed in a
community survey, reporting at least one episode
of urethritis in the last 12 months.
16. HIV prevalence in pregnant women:
• Percentage of pregnant women (15–24) attending
antenatal clinics, whose blood has been screened
for HIV, who are sero-positive for HIV.
4/10/2024 65

17.Knowledge of HIV-related prevention
practices: The percentage 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.
4/10/2024 66

Human sexuality and
sexual behavior

Outline
Human sexuality
Sexual behavior
Socio-economic and cultural
aspects of sexual and reproductive
health

INTRODUCTION
Reproductive health: a state of complete physical,
mental and social well-being, and not merely the
absence of disease or infirmity, with respect to
reproductive processes, functions and system at all
stages of life.
The WHO assessed in 2008 that "Reproductive and
sexual ill-health accounts for 20% of the global
burden of ill-health for women, and 14% for men.
"Reproductive health is a part of sexual and
reproductive health and rights.

Sexual Health; definition
…a state of physical, emotional, mental and social well-being in
relation to sexuality; it is not merely the absence of disease,
dysfunction or infirmity.
 Sexual health requires a positive and respectful approach to
sexuality and sexual relationships, as well as the possibility of
having pleasurable and safe sexual experiences, free of coercion,
discrimination and violence.
 For sexual health to be attained and maintained, the sexual rights
of all persons must be respected, protected and fulfilled.

Where are we now?
• Sexual health is fundamental to the
– physical and emotional health and well-being of
individuals, couples and families, and
– to the social and economic development of
communities and countries.
Sexual health, when viewed affirmatively,
encompasses
– the rights of all persons to have the knowledge
and opportunity to pursue a safe and threat free
sexual life.

Sexual Rights – WHO working definition
• Sexual rights include the right of all persons,
free of coercion, discrimination and violence, to
– the highest attainable standard of sexual
health, including access to sexual and
reproductive health care services
– seek, receive and impart information related
to sexuality
– sexuality education
– respect for bodily integrity
– choose their partner

Sexual Rights……
– decide to be sexually active or not
– consensual sexual relations
– consensual marriage
– decide whether or not, and when, to have
children
– pursue a satisfying, safe and pleasurable
sexual life

Make-up Of An Individual’s
Unique Sexual Being
Ω physical
Ω psychological
Ω social
Ω cultural
Ω spiritual

o Sensuality
o Intimacy
o Sexual Identity
o Reproduction
o Sexualization
Five Features of Sexuality:

o knowledge of anatomy & physiology
o understanding sexual response
o body image
o satisfaction of skin hunger
o attraction template
o fantasy
SENSUALITY
awareness and acceptance of our own body

o caring
o sharing
o risk taking
o vulnerability
o self disclosure
INTIMACY
experiencing emotional closeness to
another

o gender roles
o orientation
o self esteem & confidence
level
o relationships with family &
friends
SEXUAL IDENTITY
process of discovering who we are in
terms of sexuality

o contraception & fertility issues
o lifestyles
o STIs (including AIDS)
o anatomy & physiology
o morality issues
REPRODUCTION
values, attitudes & behaviors relating to
reproduction

o style of dress
o appearance & body language
o advertising
o movies, talk shows & media
o harassment & sexual assault
SEXUALIZATION
use of sexuality to influence, control or
manipulate

Values…
VALUES: the qualities in life which are deemed
important or unimportant, right or wrong, desirable
or undesirable
MORAL VALUES: relate to our conduct with and
treatment of other people, more than just right or
wrong, looks at the whole picture
SEXUAL MORAL VALUES: relate to the rightness
and wrongness of sexual conduct and when and
how sexuality should be expressed
SOURCES OF SEXUAL VALUES: we acquire our
sexual values from our social environment

introduction
• Sexual behaviors:
- are actions (touching, kissing & other stimulation of the body)
related to the expression of one’s sexuality.
• Sexual orientation:
– is the erotic or romantic attraction (or “preference”) for sharing
sexual expression with members of the opposite sex
(heterosexuality), one’s own sex (homosexuality), or both sexes
(bisexual).
– Asexuality :-not having sexual feelings, but still
love other people
– Transsexuality :–who feels born in a wrong body

Introduc cont.’
• Sexual activity can be classified in a number of ways.
• It can be divided into acts which involve one person,
also called autoeroticism, such as masturbation, or
two or more people such as vaginal sex, anal sex, oral
sex or mutual masturbation
• Attitudes to sexual behavior have altered in many
countries.

• Worldwide communications, including the
internet, have had a bearing on social norms.
• Most people are married and married people
have the most sex. Sexual activity in young
single people tends to be sporadic, but is
greater in industrialized countries than in
developing countries.
Introduc cont.’

Risky sexual behavior
• sex without condom use/inconsistent condom use
• Sex under the influence of alcohol
• starting sexual activity at a young age especially
with people 10 years older than them
• having a high-risk partner, someone who has
multiple sex partners or infections
• sex with a partner who has ever injected drugs.
• engaging in sex trade work
• having multiple sex partners
• MSM(men having sex with men)

Study conducted in America
,virginia at STD clinic ,October 2012

Ethiopian situation
• EDHS,2011
– 11% of married women in Ethiopia are in
polygamous unions,
9 % having only one co-wife and
2 %having two or more co-wives
Rural women are more likely to be in
polygamous unions (12 percent) than
urban women (5 percent).

Ethiopian situation cont’
– Among women age 25-49,
29 % first had sexual intercourse before
age 15,
62 % before age 18, and
 by age 25 the majority of Ethiopian women
(88 %) had had sexual intercourse.
The median age at first sexual intercourse
for women age 25-49 years is 16.6 years,

• EDHS,2011
– The median age at first sex for men age 25-
49 is 21.2 years, about six years later than
for women.
– 51% of all women age 15-49 were sexually
active in the four weeks before the survey,
– 14 % had been sexually active in the year
before the survey but not in the four weeks
prior to the interview,

• Rural women were more likely to be recently
sexually active (55 %) than urban women (38
percent).
• Women residing in Benishangul-Gumuz (56
%), Oromiya (55 %), and SNNP (53 %) were
more likely than women in other regions.

• EDHS,2016
– <1% of women reported that they had two
or more partners in the past 12 months.
Among these women 19% reported
using a condom during their last sexual
intercourse
The mean number of lifetime partners
among all women who have ever had
sexual intercourse is 1.6.

– 3% of men age 15-49 reported that they
had two or more partners in the past 12
months,
19% of them reported using a condom
during their last sexual intercourse.
The mean number of lifetime partners
among all men who have ever had
sexual intercourse is 2.9

Other studies in Ethiopia
• Study in Amhara region high school and preparatory by Getachew Mullu
(Hindawi,2016)
 16% of respondents reported that they had sexual intercourse prior to the
data collection period
 The mean age of first sexual intercourse were 17.2 years
 From those who start sex, 44 (14.7%) were involved in risky sexual
behavior.
By Mehlet belete ,
risky sexual behavior amon
AAU undergraduate
students

Other study cont’
• Study in Oromia region at Haramaya high school and
preparatory students (Shore and Shunu april,2017J.
Public Health Epidemiol )
– 49.9% of them ever had sexual intercourse; of
these, 46.7% of them had sexual intercourse at
the age less than 15 year old.
– 134 (36.9%) of them had sexual intercourse in
the last 12 months before the survey.
– From sexual active youths: 34.3% of then did not
use condom during the last sexual intercourse

Social, economic and
cultural aspects of sexual
and reproductive health

Society and culture cont’
• Religious and cultural values
– Enhance vulnerability (denial of full range of
accurate information, violence)
• In some religions, sexual behavior is regarded as
primarily spiritual. In others it is treated as primarily
physical.
 Judaism: sex between man and woman within
marriage is sacred and should be enjoyed;
celibacy is considered sinful.

Society, culture and RH
• Family and community may Enhance vulnerability
(denial of information, gender based violence,
incest, abuse)
Sexual violence is also more likely to occur
where beliefs in male sexual entitlement are
strong, where gender roles are more rigid.
 Some societies, such as those where the
concepts of family honor and

Society and culture cont’
 Roman Catholic Church: Most forms of sex without the
possibility of conception are considered intrinsically disordered
and sinful, such as the use of masturbation, and contraception.
 In Islam: It is acceptable for a man to have more than one
wife, but he must take care of those wives physically, mentally,
emotionally, financially, and spiritually.
 Hinduism emphasizes that sex is only appropriate between
husband and wife, in which satisfying sexual urges through
sexual pleasure is an important duty of marriage.

Laws, policies and human rights
Laws and legal frameworks can
o obstruct (laws which criminalize sex outside
of marriage or set a different age of consent)
In the West, sex before marriage is not
illegal.
There are social taboos and many religions
condemn pre-marital sex. In many Muslim
countries, such as Saudi Arabia, Pakistan,
Afghanistan,

Education
• The correlation between sexual health outcomes and
levels of education is well known.
• In most society communicating about sex is
considered as taboo.
• The United Nations Population Fund (UNFPA)
recommends comprehensive sexuality education, as it
enables young people to make informed decisions
about their sexuality.
• In Africa Egypt teaches knowledge about male and
female reproductive systems, sexual organs,
contraception and STDs in public schools at the
second and third years of the middle-preparatory
phase (when students are aged 12–14)
• Education policies, which provide accurate, evidence-
based and appropriate sexual health information and
counseling will go a long way in reducing stigma and

Economy and SRH
Poor, marginalized communities have poorer sexual
health outcomes
Poor sexual health can contribute to poverty (by
limited earning potential and necessitating
spending on health care)
Poverty intimately connected to participation in sex
work and transactional sex
In many contexts, participation in sex work and
transactional sex associated with poorer health
outcomes

Access to Health service &
SRH
Gender bias
Discrimination (exclusion)
Lack of comprehensive and quality service
Cost

Conceptual shifts in sexual health
service delivery
• From hospital to community
• From vertical to horizontal(integration)
programming
• From individual behaviour change to a focus
on networks and broader context
• From a focus on reproductive age to a
lifespan perspective
• From a focus on women to a concern for
gender

The way forward
• Sexuality Education(safe sexual practice)
– A condition to be able to live up to the Human
Rights and to fight stigma and discrimination;
– To promote Sexual wellbeing and Sexual Health;
– To prevent STI, HIV & AIDS and unwanted
pregnancies;
– To prevent sexual abuse & support the abused;
– To empower people to be able to make individual
choices about their sexuality, bodies and lives.

Rights-Based Approach to
Reproductive Health
4/10/2024 110

Introduction
• Human rights and reproductive health advocates
increasingly are working together to advance women’s
and men’s well-being.
• The modern human rights system is based on a series of
legally binding international treaties that make use of
principles of ethics and social justice, many of which are
directly relevant to reproductive health care.
• By placing reproductive health in a broader context, a
rights-based approach can provide tools to analyze the
root causes of health problems and inequities in service
delivery.
4/10/2024 111

Introduction….
• A rights-based approach can challenge the status quo
and pressure governments into working proactively for
reproductive health.
• The concept of RH is rooted in the modern human rights
system developed by UN.
• Since 1945, the UN has created internationally
recognized standards for a range of human rights,
including the right to health.
• the UN General Assembly adopted the Universal
Declaration on Human Rights in 1948.
4/10/2024 112

Rights-Based Approach
• The 1994 International Conference on Population and
Development in Cairo created a comprehensive
framework to realize reproductive rights and health
4/10/2024 114

The rights-based approach:
• Places the health & well being of individuals at
the center of program policy design
• Recognizes the importance of gender equity &
equality
• Builds on existing international human rights
agreements
4/10/2024 115

Benefits of a Rights-Based Approach
• Human rights can provide core values and an ethical
framework for public health practitioners.
• International treaty obligations increase the pressure
on governments to provide adequate health services,
fight violence against women, and take other actions
that improve public health.
• Framing a health problem like maternal mortality as a
human rights or social justice concern raises its visibility
and can make it an urgent policy concern.
4/10/2024 116

Rights based approach assumes
• Health and rights are inseparable
• Gender equity and equality
• Client centered health care
• Informed choice
• Voluntary decision making
4/10/2024 117

Sexual rights
1.Expect and demand equality, full consent, mutual
respect, and shared responsibility in sexual
relationships
2.Make decisions about reproduction free of
discrimination, coercion and violence.
4/10/2024 119

Client-centered, comprehensive care
Client-centered care:
1. Emphasizes free & informed consent
and respect for clients’ rights & needs
2. Involves clients in program design
& evaluation
3. Is provided by technically competent,
compassionate, & well-supervised staff
4. Integrates or links service components
5. Ensures privacy & confidentiality in counseling & treatment
for all clients, including adolescents
Comprehensive care addresses the full range of SRH
needs & provides referrals when appropriate.
4/10/2024 122

Reproductive Health Rights
4/10/2024 123

Basic Definitions and Concepts
• Health
– is a state of complete physical, mental and social well being
and not merely the absence of disease or infirmity.
• 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 related to the reproductive system and its functions
and processes.
• Reproductive Health Care
– is defined as the constellation of methods, techniques and
services that contribute to RH and wellbeing by preventing
and solving RH problems.
4/10/2024 124

Basic Definitions and Concepts
• Reproductive Rights
– embrace certain human rights recognized in the
international legal and human rights documents:
– The rights of couples and individuals to decide freely
and responsibly the number and spacing of their
children, and to have the information and the means
to do so;
– The right to attain the highest standard of sexual and
reproductive health;
– The right to make decisions free of discrimination,
coercion or violence.
4/10/2024 125

Sexual and Reproductive Rights
• SRH rights include a broad range of SRH issues which
fall within the scope of twelve basic human rights.
• In every country, a variety of laws, policies and
practices exist which affect SRH and rights.
• They may relate to the provision of information and
education on SRH, and/or regulate access to FP and
other basic SRH services.
4/10/2024 126

1. The right to life
– which means among other things that no
women’s life should be put at risk by reason of
pregnancy.
2. The right to liberty and security of the person
– which recognizes that no person should be
subject to FGM, forced pregnancy, sterilization or
abortion.
3. The right to equality and to be free from all forms of
discrimination
 including in one’s sexual and reproductive life.
4/10/2024 127

4. The right to privacy
– meaning that all sexual and reproductive health care services
should be confidential and all women have the right to
autonomous reproductive choices.
5. The right to freedom of thought
– which includes freedom from the restrictive interpretation of
religious texts, beliefs, philosophies and customs as tools to
curtail freedom of thought on SRH care and other issues.
4/10/2024 128

6. The right to information and education
– as it relates to SRH for all, including access to full
information on the benefits, risks, and effectiveness of
all methods of fertility regulations in order that all
decisions taken are made on the basis of full, free and
informed consent.
4/10/2024 129

7. The right to choose whether or not to marry to
found and plan a family
8. The right to decide whether or when to have
children
– All persons have the right to decide freely and
responsibly on the number and spacing of their
children. This includes the right to decide
whether or when to have children and access to
the means to exercise this right.
4/10/2024 130

9. The right to health care and health protection
– which includes the right of clients to the highest possible
quality of health care and the right to be free from
traditional practices which are harmful to health.
10. The rights to the benefits of scientific progress
– which includes the right of SRH service clients to
new RH technologies, which are safe, effective
and acceptable.
4/10/2024 131

11. The right to freedom of assembly and political
participation
– which includes the right of all persons to seek to influence
communities and governments to prioritise sexual and
reproductive health and rights.
12. The right to be free from torture and ill treatment
– including the rights of all women, men, and young people to
protection from violence, sexual exploitation and abuse
Source: IPPF, 2000
4/10/2024 132

SRH rights ……
 Sexual rights embrace human rights that are already recognized
in national laws, international human rights documents and
other consensus statements.
 The Ethiopian Constitution imposes a responsibility and duty
to the respect and enforcement of fundamental rights and
freedoms.
 The following articles from the constitution and the
international laws are important to protect sexuality rights.
4/10/2024
133

SRH rights cont’…
Article 10 ( 1): Human rights and freedoms, emanating
from the nature of mankind, are inviolable and
inalienable.
Article 14: Rights to life, the Security of Person and
Liberty
Article 16: Every one has the right to protection
against bodily harm.
Sexual, and reproductive health rights are the right for
all people, regardless of age, gender and other
characteristics, to make choices regarding their own
sexuality and reproduction, provided that they respect
the rights of others.
4/10/2024
134

SRH rights cont’
• Human rights relating to gender- based violence
(GBV) against women are set out in basic human
rights treaties and include the human right
– Full respect for human dignity.
– Be free from inhuman or degrading treatment or
punishment.
– The highest attainable standard of physical and
mental health.
– Freedom from discrimination and violence,
public or private, due to any status, including
gender, race, ethnicity or age.
4/10/2024
135

SRH rights cont’
– Full equality between women and men in
decision- making.
– Freedom from sexual abuse, physical abuse, and
psychological violence.
– A work place free from violence and abuse.
– Freedom from marital rape.
– Freedom from female genital mutilation and
other traditional harmful practices.
4/10/2024 136

SRH rights cont’
• Freedom from trafficking and forced prostitution.
• Freedom from violence associated with armed
conflict, including murder, systematic rape, sexual
slavery, and forced pregnancy.
• Freedom from forced sterilization and forced
abortion.
• Freedom from coercive use of contraceptives.
• Freedom from female infanticide
4/10/2024
137

Application of Human Right to sexual and
Reproductive Health
Right to life
– promote Safe motherhood and advocate against
Maternal Mortality and Morbidity
– Infanticide, Genocide, and Violence
Right to Liberty & Security of the Person
– Protection of women and children from sexual abuse
– sexual harassment,
– female genital mutilation
4/10/2024 138

Reproductive Health
Right to be Free from all forms of discrimination
– discrimination with regard to access to sexual and
reproductive health services
– discrimination which denies legal protection against
violence
– campaign for laws which prohibit discrimination
against women and their effective enforcement
4/10/2024 139

Reproductive Health
Right to Information and Education
– youth access to information and education
– programmes which enable service users to make
decisions on the basis of full, free, and informed
consent
– discourage programmes which do not give full
information on the relative benefits, risks, and
effectiveness of all methods of fertility regulation
4/10/2024 140

Reproductive Health
Right to be Free from Torture and Ill Treatment
– protection of women and children from sexual
exploitation, prostitution
– protection of women and children sexual abuse,
coercion in any sexual activity, and domestic violence
– legislation which prohibits abortion on the grounds of
rape.
4/10/2024 141

4/10/2024 143
International and National
instruments, policies and strategies
for realization of RH rights

International declarations, Conventions,
Plan of Actions
• Convention on the Elimination of All forms
Discrimination Against Women (CEDAW)-1979
– Equal rights to citizenship, education, employment,
health care and access to family planning
– Equal rights to participate in social, cultural and
economic activities
– Equality before the law, including property and
contractual rights
4/10/2024 144

International declarations, Conventions, Plan of
Actions
• CEDAW
– The right to participate in political and public life,
including the right to vote, to stand for election and
hold public office, and to represent their countries
internationally
– Eliminate sex role stereotyping, particularly those
based on notions of the inferiority or superiority of
either sex
4/10/2024 145

Vienna Declaration and Program of Action (1993)
– Women’s rights are Human rights
– Eliminate violence in public and private life
– Action on all forms of sexual harassment,
exploitation and trafficking in women
4/10/2024 146

Vienna Declaration and Program of Action
• Violence against women
– Any act of gender based violence (GBV) that results
in or is likely to result in physical, sexual or
psychological harm or suffering to women, including
the threat of violence, coercion, or arbitrary
deprivations of liberty, whether occurring in public or
private life
4/10/2024 147

Vienna Declaration and Program of
Action
• The Declaration states that governments should
– Condemn violence against women
– Adopt without delay appropriate policies and measures
to eliminate violence against women
– Prevent, investigate and punish acts of violence against
women, and inform women of their rights
– Promote the protection of women through legal,
political, administrative and cultural measures
4/10/2024 148

International Conferences
• International Conference on Population and
Development (1994 Cairo)
– Emphasis on Reproductive Health & Rights
– Meeting RH needs rather than Demographic targets
– Women’s involvement in planning, organizing implementing
and evaluating of programs
– Comprehensive and factual information and a range of
reproductive services including family planning, accessible,
affordable and convenient to all users, including adolescents
4/10/2024 149

• 4th World Conference on Women and the
Beijing Declaration
– Advancement of women
– Equality between women and men
– Quality RH services for women, men &
adolescents
– Decide freely and responsibly on issues related
to sexuality
– Mutual respect, consent and shared
responsibility for sexual behaviour and its
consequences
4/10/2024 150

• Millennium Summit (MDGs), 2000
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, tuberculosis, malaria and other
important diseases
7. Ensure environmental sustainability
8. Develop global partnership for development
4/10/2024 151

Millennium Development Goals
– Four out of the eight MDGs are directly linked with
RH.
– The MDGs can't be achieved if questions of RH are
not adequately addressed
– Addressing women's problems particularly expanding
quality FP and RH services could greatly contribute
towards the attainment of the MDGs.
– There should be generous support and efforts for
expansion of RH services.
4/10/2024 152

The Maputo Plan of Action
– African countries are not likely to achieve the MDGs
without significant improvements in the SRH service
– The 2nd Ordinary Session of the Conference of African
Ministers of Health, meeting in Gaborone, Botswana,
in October 2007, adopted the Continental Policy
Framework on SRH and Rights - endorsed by AU Heads
of State in Jan. 2006.
– POA - Operationalization of the continental policy
framework for SRH and rights 2007-2010
4/10/2024 153

• Key strategies
– Integrating STI/HIV/AIDS, and SRHR programs and services
– Repositioning FP as an essential part of the attainment of
health MDGs
– Addressing the sexual and reproductive health needs of
adolescents and youth
– Addressing unsafe abortion
– Delivery of quality and affordable services in order to promote
Safe Motherhood, child survival, maternal, newborn and child
health
4/10/2024 154

• Cross cutting issues
– Increase domestic resources for SRH and rights
– Males as an essential partner of SRHR programs
– A multi sectoral approach to SRHR
– Community involvement and participation
– Commodity security with emphasis on FP and emergency
obstetric care and referral
– Operational research for evidence based action and
effective monitoring tools
4/10/2024 155

• Cross cutting issues
– Integration of nutrition in STI/HIV/AIDS, and SRHR
especially for pregnant women, and children by
incorporating nutrition in the school curriculum,
fortification of food
– Involvement of families and communities
– Involvement of the Ministries of Health in conflict
resolution
– Rural-urban service delivery equity
4/10/2024 156

Target groups
• SRH services shall be provided to all who need
them.
• Emphasis to be given
– men and women of reproductive age
– Newborns
– Young people
– Rural population
– Mobile population
– Cross-border populations
– Displaced persons
– Other marginalized groups.
4/10/2024 157

• Expected outputs
– HIV, STI, Malaria and SRH services integrated into
primary health care
– Strengthened community-based STI/HIV/AIDS/STI and
SRHR services
– FP repositioned as key strategy for attainment of MDGs
– Youth-friendly SRHR services positioned as key strategy
for youth empowerment, development and wellbeing
4/10/2024 158

• Expected outputs
– Incidence of unsafe abortion reduced
– Access to quality Safe Motherhood and child survival
services increased
– Resources for SRHR increased
– SRH commodity security strategies for all SRH
components achieved
– Monitoring, evaluation and coordination mechanism
for the Plan of Action established
4/10/2024 159

National Policies and Laws
• The Constitution of 1995 (Article 35)
– Equality with men
– Equality in marriage
– Affirmative action in public & private institutions,
in political, social and economic life is firmly in
place
– Laws, customs and practices that oppress or cause
bodily or mental harm are prohibited
4/10/2024 160

• The Constitution of 1995 (Article 35)
– Maternity leave with pay
– Consultation on policies
– Acquisition, control and administration, use and
transfer of property including land and equal
treatment in inheritance
– Equality in employment and pension entitlement
– Access to family planning and information
4/10/2024 161

• Population policy
– Expand access to FP and related services
– Encourage and support participation of non -
government organization
– Creating conditions that will permit users the
widest possible choice of contraceptive by
diversifying the methods mix available
4/10/2024 162

• National Health Policy
– Expand Health Service coverage to reach all
Ethiopians – rural and unprivileged segment
• HSDP
– Improve access to and quality RH services
– Service providers’ guidelines, manuals
– Building capacity
4/10/2024 163

• Revised Family Law and Penal Code
– Empower women
– Promote Reproductive Rights women, men,
adolescents
– Eradicate harmful practices
– Expand RH services
– Revision of articles related to Abortion
4/10/2024 164

• Reproductive Health Strategy
• Adolescent and Youth Reproductive Health Strategy
• Technical and Procedural Guidelines for Safe abortion
Services
– Rape or Incest
– Continuation endangers the life of the mother
– Fetal deformity
– Mentally or physically unfit, under age
4/10/2024 165

• National policy on women
• Policy on prevention and control of HIV/AIDS
• Youth Policy
4/10/2024 166

Major Maternal Health
Problems
& factors contributing to the
problems
19/04/2019 168

Objectives of session
1. Understand RH problems affecting women &
children
2. Discuss contributing factors to the problems
3. Solution to maternal health problems
19/04/2019 169

Brain storming
• What are the major maternal health
problems?
• Discuss areas of action to overcome the
major maternal health problems.
19/04/2019 170

Maternal health problems
• Women have the right to the enjoyment of the
highest attainable standard of physical and mental
health.
• This is vital to their life and well-being and their
ability to participate in all areas of public and private
life.
• However, they are the population group who are
largely suffering from problems related to sexual
health, pregnancy, contraceptive side effects etc.
19/04/2019 171

RH problems
RH problems are those related to:
Mothers
Children
Adolescents
Men
19/04/2019 172

MATERNAL HEALTH….
Over 500,000 mothers die every year due to major
killers:
– hemorrhage,
– sepsis,
– abortions & obstructed labor.
These get further complicated when tied with:
• Low socio - economic problems
19/04/2019 173

Maternal Death Watch
• 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
19/04/2019 174
Every Minutes …

Health problems affecting women through out their life cycle
19/04/2019 175

Problems…
• The major maternal health problems include
Unintended pregnancy & Unsafe abortion
Problems related to Pregnancy & childbirth
HTP
VAW
HIV/AIDS & STIS
Cancers of Reproductive organs
Malnutrition
Etc .
19/04/2019 176

Unwanted pregnancy & unsafe abortion
Worldwide nearly 230 million (1 in 6) women of
reproductive age lack information on and access
to a full range of contraceptive methods.
• Contraceptive services, even where they exist,
often do not meet women’s needs.
• In developing countries more than 120 million
couples have an unmet need for safe and effective
contraception
19/04/2019 178

Unwanted pregnancy& unsafe abortion
• In many countries, women have little control over
sexual relations and contraceptive use, which limits
their ability to prevent unintended pregnancies
• Between 20% and 50% of all women report having
experienced sexual coercion, abuse, or rape,
putting them at high risk for unwanted pregnancy.
• Adolescents and unmarried women are particularly
vulnerable
19/04/2019 179

Unwanted pregnancy& unsafe abortion...
• Out of 182 million pregnancies occurring each
year in the developing world about 80 million or
40% are unwanted or ill-timed.
• 46 million unwanted pregnancies end in abortion
each year,
• Unsafe abortions threaten the lives of a large
number of women, representing a grave public
health problem.
19/04/2019 180

Unwanted pregnancy& unsafe
abortion...
• About 20 million unsafe abortions take place each
year—95% of them in the developing world.
• Complications of unsafe abortion kill at least 78,000
women every year.
• Hundreds of thousands of other women experience
short- or long-term disabilities including severe
bleeding, injury to internal organs, and infertility.
19/04/2019 181

Maternal health problems:
Mostly pregnancy & childbirth is related to the
causes & complications
- Too early
- Too late
- Too close
- Too many
19/04/2019 182

Pregnancy & child birth…
• The common maternal health problems
during pregnancy and child birth includes
– Ecclamicia
– Anemia
– APH
– Obstructed labor, fistula, uterine prolapse
– PPH
– Sepsis , Etc
19/04/2019 183

Harmful traditional practices
(HTP)
• Harmful traditional practices are another threat
to the health of mothers
– Eg. FGM, early marriage, Abduction, rape etc.
Female genital mutilation (FGM)
• FGM is practiced all over the world, more in
Africa & Asia
19/04/2019 184

HTP…
• FGM is being practiced in about 26 African
countries, where more than 100 million
women and girls are estimated to have had
FGM
• According to WHO report every year around
two million young girls suffer from this
procedure
19/04/2019 185

Adjusted relative risks of certain obstetric complications
in women with FGM
19/04/2019 186
Complications FGM I FGM II FGM III
C/S 1.03(0.88–1.21) 1.29 (1.09–1.52) 1.31(1.01–1.70)
SB or early
neonatal death
1.15(0.94–1.41) 1.32 (1.08–1.62) 1.55(1.12–2.16)

Violence Against Women (VAW)
• VAW is one of the most alarming health problems
• WHO estimated that about one-quarter of the
world’s women are subjected to violence and abuse
in their homes with rates over 50% in Thailand & as
high as 80% in Pakistan
• In Ethiopia, Eg. Butajira
• 71% of ever-partnered women experienced any
form of violence over their lifetime
19/04/2019 187

STIs /HIV/AIDS
• Worldwide an estimated
38.6 million people were living with HIV
4.1 million became newly infected
• about 50% of the new infections are in women
• Adolescent girls in sub-Saharan Africa are 3-4x
more likely to be infected than boys
19/04/2019 188

Reproductive organ cancers
• Cervical cancer is an important women’s health
problem in developing countries, killing some
200,000 women each year.
• It is the third most common cancer overall and the
leading cause of death from cancer among women
in developing countries.
19/04/2019 189

Reproductive organ cancers
• At least 370,000 new cases are identified each
year; 80 percent are in developing countries.
• Rates are highest in Central America and sub-
Saharan Africa.
19/04/2019 190

Malnutrition
• An estimated 450 million adult women in
developing countries are stunted, a direct result of
malnutrition in early life.
• Micronutrient deficiency are common problems
among women, Particularly Anemia
• According to EDHS 2005, 30.6% of pregnant
mothers and 29.8% of breast feeding mothers
have any form of anemia
19/04/2019 191

UNDERLYING FACTORS CONTRIBUTING
ISSUES & CONCERNS
Lack of Information –
 about the physical, psychosocial changes
 potential risks to health & development
of risky behaviors
 rights to health, education ,
 availability of services
19/04/2019 192

MH……
• Socio - culture & political situations (instability)
• Low agricultural output
• Poor nutrition
• Poor communication network
19/04/2019 193

UNDERLYING FACTORS ctd…
• Lack of Life Skills
• lack the necessary skills such as
communication, decision making, negotiation,
critical thinking skills to make responsible
decision.
19/04/2019 194

UNDERLYING FACTORS ctd …
• Lack of access to health services need services
that are friendly with emphasis on
– confidentiality,
– non-judgmental attitude
– convenient hours of operation
• Lack of Safe & Supportive environment
19/04/2019 195

Hindering Factors to Access &
Utilization of Health Services
 Most don’t recognize illness
 Not aware of consequences of illness
 Don’t know they can get help to prevent
or treat illness
 Lack of skills of service providers to
deal with adolescent concerns
19/04/2019 196

High Risk Fertility Behavior
19/04/2019 197
0
5
10
15
20
25
30
35
40
%
Birth Order 4+ Birth interval<24 mth Mothers aged<18

Low Status of Women
Limited Access to education
Female literacy
30.9%
Female primary School Enrollment
51.2%
Female secondary School enrollment
13.7%
Limited representation in Governance 7.7%
Limited access to employment 45%
19/04/2019 198

Women Waiting at Health Facility
19/04/2019 199

Contributing Factors to Maternal Deaths
Early age pregnancy
HIV among pregnant
women
Malaria
Malnutrition
HTP
19/04/2019 200

How does the following factors affect
RH
1. Individual
2. Household
3. Community
4. Health systems
19/04/2019 201

Household behaviors affect RH outcomes
RH
out-
comes
RH
outcome
Households/
Communities
Household
behaviors
& risk
factors
Household behaviors and risk
factors:
Avoiding risky behaviors
Eating the right foods
Health-care demand
Control of money and spending
decisions of household
Household behaviors and risk
factors:
Avoiding risky behaviors
Eating the right foods
Health-care demand
Control of money and spending
decisions of household
Note: underlined items are forces beyond health system;
other items may be influenced by health policy, programs.
19/04/2019 202

Household behaviors and high maternal mortality
High
maternal
mortality
RH
outcome
Households/
Communities
Household
behaviors
& risk
factors
Examples of household behaviors
and risk factors for high maternal
mortality:
Girl fed last and least
Early marriage and pregnancy
Low demand for prenatal care
Examples of household behaviors
and risk factors for high maternal
mortality:
Girl fed last and least
Early marriage and pregnancy
Low demand for prenatal care
19/04/2019 203

Household resources affect RH outcomes
RH out-
comes
RH
outcomes
Households/
Communities
Household
behaviors &
risk factors
House-hold
resources
Household resources:
Household income
Access to information
Quality of housing
Education of household members
Owning a TV, radio
Feedback from RH outcomes
19/04/2019 204

Kids with
diarrhea
RH
outcomes
Households/
Communities
Household
behaviors &
risk factors
House-hold
resources
Household resources affecting
diarrhea prevalence & treatment:
Water supply
Sanitation facilities
Educational attainment & capacity to
use oral rehydration
Household resources & prevalence of diarrhea
19/04/2019 205

Maternal
deaths
HNP
outcomes
Households/
Communities
Household
behaviors &
risk factors
House-hold
resources
Community
factors
Community factors affecting risk of
mothers dying during delivery:
Distance from referral facility
Availability of transport
Tradition of delivering at home
Community factors & maternal deaths
19/04/2019 206

Solutions…
• Improve access & utilization of contraceptive
methods
– Mobilizing and providing sufficient resources to
meet the growing demand for access to
information, counseling, services and follow-up
on the widest possible range of safe, effective,
affordable and acceptable contraceptive methods
• Comprehensives post abortion care
19/04/2019 207

Solutions…
• Providing Good quality Maternal health services
– Improving access to Essential obstetric care
(Basic & emergency)
– Equipping the facility with skilled man power,
equipments & necessary supplies
– Promoting good referral system etc
19/04/2019 208

Solutions…
• Making STDs and HIV/AIDS prevention and control
an integral component of reproductive and sexual
health programs
• Avoiding of all forms of VAW & care and support for
victims of VAW
• Avoiding all forms of harmful traditional practices.
• Good nutrition & Micronutrient supplementation for
mothers
19/04/2019 209

4/10/2024 211
Comprehensive abortion care
Lecture by:
Elias Teferi

4/10/2024 212
Learning objectives
• At the end of this lecture, the students will be able
to:
• Describe the global and National situations of abortion
• Discuss the elements of PAC and Post abortion FP
options
• Familiar with women centered comprehensive abortion
care and National Legal background

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Contents
• Global & National magnitude of unsafe abortion
• Reasons and consequences of unsafe abortion
• Approaches in abortion care and their key elements
• Legal provisions of abortion (Ethiopia)

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Brainstorming
• Is abortion a public health problem? justify?
• What efforts have been made globally?
Nationally?
• Were they all successful? What has gone
wrong?
• Include your recommendation

4/10/2024 215
Definitions
• Abortion
– Termination of pregnancy before fetal viability
– before 28 weeks of GA or
– birth weight of <1000gm
• Safe abortion
– Performed by qualified persons using correct techniques and in
sanitary conditions.
• Unsafe abortion
– 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.

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Global efforts
• As early as 1967, the World Health Assembly passed
Resolution WHA20.41, which stated that
“abortions … constitute a serious public health problem in many countries”, and
requested the Director-General to “continue to develop the activities of the World
Health Organization in the field of health aspects of human reproduction”.
• The 1987 Safe Motherhood Conference drew the world’s
attention to the shocking fact that over half a million women
die needlessly due to complications related to pregnancy and
childbirth.
– Identified unsafe abortion as one of the most easily preventable causes of this maternal
death
• The 1990 MDG5 Maternal mortality reduction

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Efforts…
• The 1994 ICPD consensus noted that “All Gov’ts and
relevant intergov’al and NGOs are urged to
strengthen their commitment:
– to deal with the health aspect of unsafe abortion
as a major public health concern and
– to reduce the recourse to abortion through
expanded and improved family-planning services.

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Global and National Magnitude
• In spite of these all actions for more than 4 decades
and a rise in contraceptive use globally, unsafe
abortion continues to be a major public health
problem in many countries
• Unsafe abortion is a critical public health
concern in many developing countries, causing
the deaths of tens of thousands of women
worldwide each year

4/10/2024 219
Global causes of Maternal mortality
hypertensive
Disorder, 13%
obstracted Labor,
8%
Other Direct
causes, 20%
Indirect causes,
20% Hemorrhage, 25%
Sepsis, 15%
Unsafe
abortion, 13%

4/10/2024 220
Magnitude…
• Unsafe abortions are concentrated in
developing countries (around 95%)
• A woman dies every eighth minute
somewhere in a developing country due to
complications arising from unsafe abortion.

4/10/2024 221
Magnitude…
 Africa has the highest rate of death caused
by unsafe abortion of any region (100
deaths per 100,000 live births, resulting in
29,800 deaths each year)
 In Africa, unsafe abortion accounts for 12%
of maternal deaths

4/10/2024 222
Magnitude…
• Ethiopia,
– Unsafe abortions account 25-50% of maternal
deaths.
– Abortion complications are a leading cause of
hospitalization
– The share of unsafe abortion from all pregnancy
related deaths is 32%.

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Reasons for Induced Abortion
• To stop childbearing
• To postpone childbearing
• Socioeconomic conditions
• Relationship problems
• Age
• Health (including mental)
• Coercion (e.g., rape, incest)

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Consequences of unsafe abortion
• Health
Physical Complications
– hemorrhage
– Sepsis
– Generalized peritonitis
– Uterine perforation
– Gangrenous uterus
– Shock
– Tetanus…
– Death
• Psychological problems
• Long tem- infertility
• Economic
– Loss of productivity due
to illness
– Treatment cost
health system
individuals

4/10/2024 225
What needs to be done?
• Ending the silent pandemic of unsafe abortion
is an urgent public-health and human-rights
imperative
• Providing easily accessible and quality care
related to termination of pregnancy at all
service levels

4/10/2024 226
Approaches
• There are two types of care related to
termination of pregnancy:
– women centered comprehensive abortion care
– Post abortion care

4/10/2024 227
woman-centered comprehensive
abortion care
• Providing abortion services that takes into
account the various factors that influence
–A woman’s individual health needs
»Physical & mental
–Her personal circumstances and
–Her ability to access services

4/10/2024 228
Women centred…
• Comprises three key elements:
• Choice:
– the right & opportunity to select b/n options
• Access:
– having access to the needed service
• Quality:
– having respectful and confidential service

4/10/2024 229
The goals of a woman-centered ……
• To provide safe, high-quality services
• To decentralize services to the most local level possible
• To be affordable and acceptable to women
• To understand each woman’s particular social
circumstances and individual needs and to tailor her
care accordingly
• To reduce the number of unplanned pregnancies and
abortions
• To identify and serve women with other sexual or
reproductive health needs

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Post abortion care (PAC)
• A comprehensive service for treating women that
present to health facilities after abortion has
occurred
PAC is an approach for:
– Reducing morbidity and mortality from complications of
unsafe and spontaneous abortion, and
improving women’s sexual and reproductive health and
lives

4/10/2024 231
Essential Elements of Post abortion Care
Source: Postabortion Care Consortium Task Force, Essential Elements of Postabortion Care: An Expanded
and Updated Model, PAC in Action #2, Special Supplement.
Counseling
Treatment
Contraceptive and family planning services
Reproductive and other health services
Treat incomplete and unsafe abortion
and potentially
life-threatening complications
Help women prevent an unwanted
pregnancy or practice birth spacing
Preferably provide on-site,
or via referrals to other accessible
facilities in providers’ networks
Prevent unwanted pregnancies and
unsafe abortion
Mobilize resources to help women
receive appropriate and timely care for
complications from abortion
Ensure that health services reflect and
meet community expectations and
needs
Identify and respond to women’s
emotional and physical health needs
and other concerns
Community and service provider partnerships

4/10/2024 232
Linkages to other RH services
• Linkages are essential and logical if the RH of women is to
improve
• Lack of linkages contributes to women's continued poor
health status
• Where to link:
– Treatment of STDs
– Cervical cancer screening for women over age 30 - 35
– Pre pregnancy advice (e.g., nutrition, immunization, management of
existing medical conditions)

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Strategies for improving quality of PAC
1.Upgrade clinical care
• The essential elements of high quality clinical services include:
– Use of appropriate technology for the setting & the patient
– Appropriate pain management before, during, and after
the clinical procedure
– Infection prevention practiced by all providers
– Adequate supplies of essential medications and surgical
equipment
– Improved client-provider interactions

4/10/2024 234
Strategies…
2. Provide family planning information and
services
Need for Post abortion FP Services
•Unsafe abortion is a prime indicator of unmet need for FP
•Failure to provide FP is a major contributor to the problem of
unsafe abortion
•Emergency treatment is not linked to FP counseling or services

4/10/2024 235
Post abortion FP …
Factors Contributing to the Risk of Repeat Unsafe Abortion
• Lack of understanding of patients’ reproductive health needs
(provider)
• Lack of FP services for some groups of women (e.g.,
adolescents, single women)

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Factors Contributing to repeat …
• Separation of emergency services from FP services
• Misinformation about which FP methods are appropriate post
abortion (provider and patient)
• Lack of recognition of problem of unsafe abortion and patient
FP needs (provider)

4/10/2024 237
Requirements for Establishing Post abortion FP Services
• Develop links between emergency care and FP services
• Develop protocols for provision of post abortion contraception
• Orient staff (all levels) about the program
• Train service delivery team
• Use research results to support improvements in post abortion
care and FP services

4/10/2024 238
Importance of Starting Post abortion FP Immediately
Increased risk of repeat pregnancy because:
– Ovulation may occur by day 11 post abortion
– 75% of women will have ovulated within 6 weeks post
abortion

4/10/2024 239
Which FP Methods to Use Post abortion
• All modern methods are acceptable provided that:
– Thorough counseling is given to ensure voluntarism and
choice
– Clients are screened for precautions

4/10/2024 240
Strategies …
3. Expand access to PAC
– Train community health workers to provide FP and make
referrals
– Make PAC services available at the community level
– Train mid-level practitioners to perform MVA
– Improve referral systems for reproductive health services

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Strategies …
4. Plan comprehensive PAC services
– Plan PAC services to improve quality of care and
cut health care costs
– Offer outpatient PAC services
5. Involve male partners
– Inform male partners about PAC treatment and
follow-up care

4/10/2024 242
Strategies ….
6. Enhance Policy makers role
– Support high-quality, women-centered services
– Develop national norms and standards regarding PAC, including
pain management, infection prevention, and family planning
counseling and services
– Decentralize services to extend access and care to women in
rural and marginal urban areas
– Develop local training capability to ensure that health care
providers working in RH are routinely trained in PAC as a
comprehensive care model
– Provide supportive supervision system

4/10/2024 243
What has been done in Ethiopia?
• Government commitment & legal issues
• PAC national treatment guideline was
developed in 2002
• The revised penal code in 2004 addressed
abortion
• MOH produced a service guideline based on
the revised penal code in 2006

4/10/2024 244
Has been done...
• PAC Services started few years ago mainly by
NGOs
• Providing TOTs and provider training
• Supply of MVA and key instruments
• Efforts to incorporate PAC in pre-service
training

4/10/2024 245
The legal provisions of
abortion services

4/10/2024 246
Legal issues
• Abortion has been a controversial issue in field of politics,
social life, religion and medical profession .
• The pro-life activist claims that abortion is morally wrong and
legally criminal act that disregards the right of the fetus in-
utero
• In addition to moral concern others argue that legalization
increases:
– rate of Abortion and put unbearable burden on the limited health
service recourses
– Increases Risk of HIV/AIDS
– Decline in contraception use
• Almost all religions stands against abortion

4/10/2024 247
Legal issues…
• The pro-choice groups insist that it’s private right of a woman
and the woman should decide when and how often to have a
baby.
• In Addition, making abortion illegal doesn’t prevent women
from seeking abortion
• Abortion mortality is highest in places where abortion is illegal
• Cost of Rx complication is Higher than provision of safe
abortion
• Many million pregnancies occur from Contraception failure
(back UP), Rape & incest

4/10/2024 248
Legal issues…
• Regardless of the controversy, abortion is legal practice under
different conditions in more than 100 countries mostly in
developed world
• Of the world's population,
– 40% have access to legal abortion on request (47 countries only 2 in
Africa S .Africa & Tunisia)
– 23% for social or socio-economic reasons (9 countries 1 in Africa
Zambia)
– 12% for medical reason, health-threatening pregnancies or those
resulting from rape or incest (38 countries 22 in Africa),
– 25% if the woman's life is in danger (47 countries 19 in Africa).

4/10/2024 249
Facts on the controversy
• Unsafe abortion & higher maternal mortality and morbidity from
abortion tends to occurs in areas with Restrictive legislation.
– WHO estimated that unsafe abortions rose from 3.7 to 5.0
million during 1990-95 in Africa.
– Rapid decline in abortion mortality following legalization of
abortion in Romania
• In Romania
– abortion was legal since 1957
– In 1966 the government banned abortion.
– The number of maternal deaths from septic abortion
increased from 64 in 1966 to 173 in 1967 and 192 in
1968.
– Reached 341 During 1969-89

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Legal issues in Ethiopia
• In the 1931 penal code of Ethiopia, abortion law
totally prohibited induced abortion
• The 1958 penal code (article 534 and 536) relatively
liberalized the 1931 code
• Allows TOP only on medical grounds (to save the life or health of
the pregnant woman from grave and permanent danger) .
• What is the current stand of Ethiopia?

4/10/2024 251
Ethiopia…
• The FDRE 2004 revised penal code addressed the
issues of abortion with the intent of:
– Reducing maternal morbidity & mortality from unsafe
abortion
– Action by the government to fulfill its commitments
• ICPD
• MDGs
• The MOH developed abortion service guideline in
2005

4/10/2024 252
Ethiopia….
• Article 551
1. TOP by a recognized medical institution within the period
permitted by the profession is not punishable where:
A. Pregnancy results from rape or incest
B. Continuation of the pregnancy endangers the life of the mother
or the child or the health of the mother or where the birth of
the child is a risk to the life or health of the mother
C. The fetus has an incurable and serious deformity
D. The pregnant woman, owing to physical or mental deficiency
she suffers from or her minority, is physically as well as mentally
unfit to bring up the child

4/10/2024 253
Ethiopia…
2. In the case of grave & imminent danger
which can be averted only by an immediate
intervention, an act of TOP in accordance
with the provisions of Art. 75 of the code is
not punishable

4/10/2024 254
Ethiopia….
• The Guideline focuses on how to:
– Interpret the law
– Define women’s eligibility
– Determine where services are provided
– Determine who provides abortion care
– Outline providers responsibilities
– Provide guidance to the care of women

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Interpretation & eligibility
• Art. 551-1-A (Rape or incest)
– On disclosure of the woman
– Not required to submit evidence
– Not required to identify the offender
• Art 551-1-B
– Follow the knowledge of standard medical indications that
necessitate TOP to save the life or health of the mother, in good
faith
– Woman shall not necessarily be in state of ill health
– Determine in good faith that the continuation of the pregnancy
or the birth of the fetus poses a threat to her health or life

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Interpret….
• Art 551-1-C (fetal deformity)
– Necessary tests
• Art 551-1-D (physical or mental deficiency, or minority)
– Stated age on the medical records
– Disability definition-physical or mental
– Determine in good faith that the woman is disbaled
• Art 551-2 (grave & imminent danger)
– Providers authorized to perform TOP on women whose
medical condition warrant immediate action

4/10/2024 257
Application to all sub articles
• Obtain informed consent
• Provider shall not be prosecuted if the
information provided by the woman is later
found to be incorrect
• Minors & mentally disabled shall not be
required to sign a consent

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Where services are to be provided
• Public & private facilities fulfilling criteria of
the guideline
• Community Health posts (Lower clinics)
• Health centers (Medium & Higher clinics)
• District/Zonal Hospitals
• Referral hospitals

4/10/2024 259
Who can provide abortion care
• First trimester abortion:
• Clinical Nurses, Midwives, Health
Officers, GPs and above
• Second trimester:
• GPs & HOs with additional training, Obst
& gynecologists

4/10/2024 260
Providers responsibilities
• Understand the law & the guideline
• Recognize their domain of responsibilities
(Abortion care tasks by provider category).
• Acquire requisite skills to manage clients
seeking CAC

4/10/2024 261
Care of women
• Pre-procedure
– Counseling & informed decision
– Diagnosis of pregnancy
– Exclude ectopic pregnancy
– Assessment of gestational duration
– Cervical preparation

4/10/2024 262
Procedures
• Medical abortion
• Surgical methods
– Vacuum aspiration
– Sharp metallic curettage
• Trained HO, GMP or Ob/gy

4/10/2024 263
Post procedure
• Monitor vital signs
• Complications management
• Discharge instructions
• Post procedure counseling
• Post abortion FP
• Administer TT
• Pap smear
• STIs
• Follow up appointment (7-10 day later)
• Discharge when able & v/s are stable

4/10/2024 264
Other issues
• Referral
• Training of providers
• Essential equipment & supplies
• Monitoring & evaluation

4/10/2024 265
Implementation Plans
The issuance of the Law & the Guidelines do not
guarantee implementation
– Dissemination
– Regional strategic plans
– Expanding pool of providers
– Availing alternative technologies for safe abortion
• Medical methods of abortion
– Values clarification
– Informing women

4/10/2024 266
Reading assignment
• Current implementation status
– How many regions?
– Hospitals?
– Health centres etc?

4/10/2024 267
References
• Global and regional estimates of the incidence of unsafe abortion and associated mortality
in 2003, WHO, 5th edition, © 2007
• IPAS, ESOG. A National Assessment of the Magnitude and Consequences, of Abortion in
Ethiopia, (April 2009)
• John M. Pile, Inna Sacci, Ratha Loganathan. Postabortion Family Planning Operations
Research Study in Perm, Russia, September 2003
• FIGO, ICM, ICN, USAID FAMILY PLANNING: A KEY COMPONENT OF POST ABORTION CARE,
Consensus Statement: 25 September 2009
• WHO. Post-abortion family planning: A practical guide for programme managers
WHO/RHT/97.20
• FMOH. Guidelines for Safe Abortion Services in Ethiopia, July 2006

SEXUAL HEALTH & HUMAN
SEXUALITY

Sexual health
In line with the definition RH, SH care is defined as
the constellation of methods,
techniques
& services that contribute to RH &
well being by preventing & solving RH
problems.

Sexual ctd…..
RH also includes sexual health, the purpose of
which is the
 enhancement of life &
 personal relations, &
 NOT merely counseling &
 care related to reproduction & STDs“

WHOs’ definition of SH
• Sexual health is a state of
– Physical, emotional
– Mental & social well-being related to sexuality,
• It is not merely the absence of
– Disease,
– Dysfunction or infirmity

DEFINITION OF SEXUALITY (WHO)
A central aspect of being human throughout life
& encompasses
– Sex
– Gender identities & roles
– Sexual orientation
– Eroticism (sexual desire)
– Pleasure
– Intimacy & reproduction

Early history of sexuality
Earliest teachings of sexuality were rooted in religion
Greek mythology theory of homosexuality:
– Split of double-males Gay man
– Split of male-female Heterosexual
– Split of double-female Lesbian woman

15th century Christianity:
Malleus Maleficarum (the Witch’s Hammer)
linked
• wet dreams,
• sexual lust, &
• sexual dysfunction to witchcraft!

SCIENTIFIC STUDY OF SEXUALITY
Began in the 19th century: because of
• BIOLOGICAL ADVANCES
– Discovery of sperm in semen
– Observing fertilization of egg by sperm
• PSYCHOLOGICAL ADVANCES
– Sigmund Freud’s (1856-1939) theories on clitoral Vs vaginal
orgasm & psychosexual stages
– 1st ever sex survey on 10,000 Germans by Magnus H. (1868-
1935); data destroyed by Nazis

Eg. Sigmund Freud
1905: “3 essays on the theory of sex”
– Libido goes through a process of maturation over
the life span; important because libido is our
driving force
– Neurosis is entirely caused by sexual motives

3 COMPONENTS OF PERSONALITY:
– Id: basic part of personality that includes libido
– Ego: operates on reality principle
– Superego: conscience; contains values & ideals

INDICATION FOR RATIONAL FOR SH

CONCERNS: WITH WHAT DOES SEXUAL
HEALTH DEAL
• Women’s Issues
– Menopause (climacteric)
– Osteoporosis
– Hormone Replacement Therapy (HRT)

Concerns: ctd …
• Male Issues
–Male Climacteric
–Benign Prostatic Hypertrophy

Sexuality & Cancer
Women:
• Breast
• Cervical
• Ovarian
Men:
• Prostate
• Testicular

Concerns: ctd …
• Alcohol, Drugs & Sexuality
– Alcohol >  inhibitions > aggression & violence, 
sexual performance, infertility
– Drugs > aphrodisiacs, some drugs can  sexual
function (impotence/infertility), Spanish fly, amyl
nitrate

ORIGINS OF SEXUAL DIFFICULTIES
Organic factors:
– Vascular, endocrine, neurological
– Illnesses & Disabilities (diabetes, arthritis, cancer,
multiple sclerosis, strokes)
– Spinal Cord Injuries, cerebral palsy, blindness,
deafness
– Coping: accept limitations & explore options
– Medications: psychiatric,  BP, cancer, GI,
methadone, nonprescription drugs

Origins ctd …
– Cultural Influences
• Negative childhood learning
• Sexual double standard
• Narrowly defined sexuality
• Rigid goals > performance anxiety

Individual Factors
• Sexual knowledge & attitudes
–Self-concept & body image;
–Emotional problems
• Sexual abuse & assault

Origins ctd …
– Relationship Factors
• Unresolved problems
–dislike, resentment, anger
–lack of trust, respect, power

Ineffective communication
–inaccurate assumptions
–reliance on gender stereotypes
–lack of listening & negotiations
• Fears about pregnancy or STI/Ds
• Concealment of true sexual orientation

DESIRE PHASE DIFFICULTIES
• Hypoactive sexual desire/inhibited sexual desire
> low/absent sexual desire; usually temporary; often due to relationship problems,
past abuse, internalized - attitudes re: sex
• Dissatisfaction with frequency of sexual activity
> inability to compromise re: differing levels of desire, polarization: one feels
deprived, other feels pressured
• Sexual Aversion Disorder > extreme, irrational fear of sexual
activities or ideas; consistent phobic response, often due to sexual abuse or assault

EXCITEMENT PHASE DIFFICULTIES
• Female Sexual Arousal Disorder
inhibited lubrication;
often due to apathy,
anger, fear,  estrogen levels;
non coital activities may  lubrication; use of water-
soluble jelly helps

ORGASM PHASE DIFFICULTIES
• Female Orgasmic Disorder > anorgasmia -
absence of orgasm; situational; cultural
factors
• Male Orgasmic Disorder > inability to
ejaculate during sex
• Premature Ejaculation > varies with couples;
based on subjective satisfaction; many men
experience; 25% often; physiological
predisposition & anxiety

Dyspareunia
• Painful intercourse in men> phimosis
(tight foreskin); infected/irritated foreskin; Peyronie’s disease (fibrosis in
penis); other pelvic/genital infections
• Painful intercourse in women>  lubrication many reasons; infections in
vagina/bladder; smegma under clitoral hood; deep pelvic pain < pressure on
organs or endometriosis; STI/Ds; fear or (-) attitudes re: sex
• Vaginismus> strong, involuntary contractions of outer 1/3 of vagina; due to
fear/ambivalent < assault, hostility, chronic pain, strong sexual taboos

WHAT DOES SEXUAL
HEALTH REQUIRE?
Sexual health requires a positive & respectful approach
to sexuality & sexual relationships as well as the
possibility of having
– Pleasurable &
– Safe sexual experiences
– Free of coercion
– Discrimination & violence's

GOAL OF THE HUMAN SEXUALITY
• Counseling & Wellness Services to enable clients to have
access to
– sexual health information,
– Education & services
– Teaching life skills
• Empower clients to make informed decisions about their
own SH.
• Discuss any sexual health topic desired:
– Contraceptive options,
– Safer sex,
– How to communicate with partners,
– STIs,
– HIV/AIDS,
• Sexual decision-making & sexual assault

HOW TO ATTAIN & MAINTAIN SEXUAL
HEALTH
The sexual rights of all persons must be
–Respected
–Protected &
–Fulfilled

HOW IS SEXUALITY EXPERIENCED & EXPRESSED
– Thoughts
– Fantasies
– Desires
– Beliefs
– Attitudes
– Values
– Behaviors
– Practices
– Roles & relationships

How expressed ctd …
• While sexuality includes all of the above
dimensions,
• not all of them are always experienced or
expressed

Sexuality is influenced by the interaction of
– Biological
– Psychological
– Social economic
– Political, legal
– Cultural,
– Historical
– Religious & spiritual factors

Sexual rights (WHO; 1)
Sexual rights embrace human rights that are
already recognized in
– National laws
– International human right documents &
– Other consensus & statements

Sexual rights (WHO; 2)
The highest attainable standard of sexual health,
including
– Access to sexual &
– RH care services

Sexual health: right seek, receive & impact information
related to:
– Sexuality
– Sexuality education
– Respect for bodily integrity
– Choose their partner
– Decide to be sexually active or not
– Consensual sexual relations, marriages
– Decide whether or not, & when to have children &
– Pursue a satisfying, safe & pleasurable sexual life

All these rights have created
Growing awareness about the importance of
–right to health, including SRH
–gender-mainstreaming of health, including
SRH
–sexual & reproductive rights & needs

SEXUAL & REPRODUCTIVE RIGHTS
The right to
• Life
• Liberty & security of the person
• Equality & to be free from all forms of discrimination
• Privacy
• Freedom of thought
• Information & education

The right to
• Choose whether or not to marry to found & plan a family
• Decide whether or when to have children
• Health care & health protection
• Benefits of scientific progress
• Freedom of assembly & political participation
• Be free from torture & ill treatment

The IPPF Sexual & Reproductive Rights of Clients:
Every client has the right to
INFORMATION
ACCESS
CHOICE
SAFTY
PRIVACY
CONFIDENTIALITY
DIGINITY
COMFORT
CONTINUTY
OPINION

The Concept of Sex, Sexuality & Sexual Health
Sex is the set of anatomic & physiological
characteristics enabling the physical
differentiation of human beings.
Sexual Health the capacity of individuals to
enjoy a satisfactory sexual life without risk

Concept ctd …
• Sexual & RH & well-being are essential if people are to have
responsible, safe, & satisfying sexual lives.
• Sexual health requires a positive approach to human sexuality & an
understanding of the complex factors that shape human sexual
behavior.

Concept ctd …
These factors affect whether the expression of
sexuality leads to
– sexual health & well-being or
– to sexual behaviors that put people at risk or
– make them vulnerable to sexual & reproductive ill-
health.

Concept ctd …
A dramatic changes in understanding of
human sexuality & sexual behavior.
– Pandemic of HIV played a major role
but it is not the only factor

The toll taken on people’s SH by other
– STIs,
– Unwanted pregnancies,
– Unsafe abortion,
– Infertility,
– Gender-based violence,
– Sexual dysfunction, &
– Discrimination on the basis of sexual orientation
has been amply documented & highlighted in
national & international studies.

Human Sexuality & Sexual Health, therefore, is the area
dealing with
– information leading to the building of attitudes,
– beliefs & values about such topics as identity,
– body image &
– gender role,
– sexual development,
– RH relationships & intimacy (SIECUS, 2004).

Information on Human Sexuality & Sexual Health
• is crucial for preparing children for their lives
as adults & parents.
– It will provide young people with skills such as
responding adequately to demands
– For sexual intercourse or
– Offers of drugs,
– Taking responsible decisions,
– Managing situations of risk, &
– Seeking appropriate health services,
– Counseling & care.

Question for reflection
What are the different ways of
expressing sexuality with or
without risk?

CONCLUSION: MAJOR MESSAGES
• Sexuality is determined by various factors, on
– Personal
– Social, & cultural levels
• Sexual health goes beyond absence of
– Negative outcomes &
– Involves well-being

Conclusion ctd ….
• Sexual health promotion is inextricably bound
up with norms & values
• Sexual health promotion should be guided by
– PH instead of moralistic concerns
• Sexual rights are useful tool in keeping sexual
health promotion on track

Question for discussion/Reflection
• Can I as an adult truly understand my children?
• How will I know when I will be capable to have a child?
• Is sexual pleasure worth the risk of pregnancy &
contracting a Sexually Transmitted Infection (STI)?
• So I have decided to be sexually active what am I going
to do to prevent an unwanted pregnancy?
• How would I want my partner to end a relationship with
me?

Resources
• Websites:
– http://www.priory.com/sex.htm
– http://www.umkc.edu/sites/hsw/health/issues.ht
m
– http://onhealth.webmd.com/women/in-
depth/item/item,92445_1_1.asp

RH all together ,et 2022,1234.@#RHa.pptx

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