REPRODUCTIVE HEALTH ISSUES IN PAKISTAN DR. ROSHAN ARA QAZI Professor of Obstetrics & Gynaecolog LUMHS,Jamshoro.

Reproductive Health Learning Objectives To know the definition and description of Reproductive Health in general and the key issues of reproductive and post reproductive age in particular.

Reproductive Health Definition WHO has defined Reproductive Health as “Reproductive Health (RH) 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 to its function and process.”

Reproductive Health Reproductive Health is for the male and the female and covers the entire life span. It includes services for sexual health reproduction and family planning.

Elements of Reproductive Health Information, education and counseling on human sexuality and reproduction. Elimination of discrimination against girls and women. Care during the entire maternity cycle which includes prenatal, intranatal and postnatal care, as well as emergency obstetrics care.

Elements of Reproductive Health Access to quality services for the management of complications from unsafe abortion. In circumstances where abortion is legalized, it should be made safe. Post abortion family planning counseling and service should be made available. Access to quality family planning services including a full range of contraceptives.

Elements of Reproductive Health Prevention and treatment of reproductive tract infections, including sexually transmitted diseases, prevention of HIV/AIDS and availability of affordable condoms. Recognition and acceptance of the enhanced role of men. Management of menopause.

Elements of Reproductive Health Facilities to receive referral for infertility and all morbid conditions related to reproduction, such as cancers of the reproductive systems and breast etc. Appropriate sexual and Reproductive Health information and culturally accepted services to adolescents. Elimination of harmful cultural practices like very young age marriages and violence.

Statistics of Pakistan Health and Demographic Indicators Total world population 6 billion Total Pakistan population 145.0 million Population growth rate 20.3% Doubling time 30 years Contraception % knowing method Contraceptive prevalence rate Total fertility rate 97% 30% 5.0

Statistics of Pakistan Health and Demographic Indicators Infant mortality rate 90/1000 live births Maternal mortality rate 340/100,000 live births Births 39 per 1000 pop Deaths 11 per 1000 pop Percent of population of age <15 65+ Total 42 4 60

Rights and Principles Reproductive rights include: The right to care which should ensure highest standards of sexual and Reproductive Health. The right to freely decide the number and spacing of children and to have the information and resources to practice family planning.

Life Cycle Approach to Reproductive Health RH is not merely confined to the health of the individual at the age he/she is capable for reproduction. The life cycle approach recognized that each stage of life, from infancy to old age has reproductive needs. The health of the infant is largely dependent on the mother’s health status and access to health care during pregnancy, childbirth and immediate postpartum period.

Life Cycle Approach to Reproductive Health RH concerns increases during adolescence and particularly for women during the reproductive years. Earlier reproductive events will have a bearing on the general health of an individual when one gets old. RH needs are therefore from “cradle to grave” or “womb to tomb”

Reproductive Health: Life Cycle Approach Stages in life cycle Health Issues Promotion, prevention, Treatment, Rehabilitation Perinatal (28 wks of Gestation –7 days after birth Fetal death Intra-uterine retardation (low Birth weight & prematurity) Immunizable diseases. Prenatal care. Nutrition. Immunization with tetanus Toxoid.

Reproductive Health: Life Cycle Approach Stages in life cycle Health Issues Promotion, prevention, Treatment, Rehabilitation Infancy (Birth – 1 year) abnormal growth and development Malnutrition. Communicable disease. Accidents. Child abuse. Care of mother & newborn (mother baby care package) Breast feeding Immunization(EPI) Growth monitoring (mile stones) Nutrition, education & counseling. Oral rehydration therapy (ORT) Chronic diarrheal diseases. (CDD) Control of upper respiratory tract infection. Education and counseling on prevention against accidents and abuse.

Reproductive Health: Life Cycle Approach Stages in life cycle Health Issues Promotion, prevention, Treatment, Rehabilitation Child hood (1 – 10 years) Infectious diseases. Malnutrition. Accidents and injury Child abuse. Immunization (EPI) Oral rehydration therapy (ORT) Chronic diarrheal diseases. (CDD) Acute respiratory tract infection (ARI) control. Growth monitoring. Nutrition supplementation. Parent’s counseling on normal growth & development of a child. Prevention against accidents and abuse.

Reproductive Health: Life Cycle Approach Stages in life cycle Health Issues Promotion, prevention, Treatment, Rehabilitation Adolescence (11 – 21) Unhealthy lifestyle Early marriage Unwanted pregnancy Complication of teen age pregnancy Morbidity and mortality due to early pregnancy RTIs / STDs Education on health lifestyles. Nutrition and fertility awareness. FP information and service. Counseling on sexuality. Treatment of RTIs and referral.

Reproductive Health: Life Cycle Approach Stages in life cycle Health Issues Promotion, prevention, Treatment, Rehabilitation Adulthood / reproductive years 22 – 45 years Unhealthy life style. Nutritional problems Menstrual abnormalities. Genital tract cancers. Breast lumps. Genital tract benign tumors. Excessive vaginal discharge. Premarital general health. Anemia. Education on healthy life style. Balanced diet. Calcium & Iron Early detection, counseling and treatment. Screening, diagnosis & treatment. Screening and counseling. Early diagnosis and treatment. Counseling, reassurance & treatment of pathological discharge Counseling and screening. Early detection and treatment.

Reproductive Health: Life Cycle Approach Stages in life cycle Health Issues Promotion, prevention, Treatment, Rehabilitation Adulthood / reproductive years 22 – 45 years Pregnancy and related problems Maternal mortality & morbidity. Complications of abortions. Fertility regulation Infertility Sexual abuse / harassment. Harmful traditional practices RTIs /STDs / HIV/AIDS Maternal care Nutrition FP information and service. Infertility diagnosis / referral Counseling on human sexuality. Violence against women & Violence against Men RTIs, HIV/AIDS diagnosis & management / referral

Reproductive Health: Life Cycle Approach Stages in life cycle Health Issues Promotion, prevention, Treatment, Rehabilitation Post Reproductive Years Female Sexual dysfunction. Menopausal problems. Osteoporosis. Cancers of reproductive tracts. Inability to cope. Depression Counseling / assurance Nutrition Supportive care Early diagnosis and treatment of cancers

Reproductive Health: Life Cycle Approach Stages in life cycle Health Issues Promotion, prevention, Treatment, Rehabilitation Male Male Sexual dysfunction. Occupation related RH illness. Inability to cope. Depression Counseling / assurance Nutrition Supportive care Early diagnosis and treatment of cancers

Key Measures for the Community Reproductive Health of both male and female is important. In a life cycle approach, one must take care of a fetus, neonate, infant, child, adolescence and finally the adult in both reproductive and post reproductive years. Every problem in the life cycle must be clearly taken care by each and every concerned member of the society to full fill the needs of a healthy community.

The End Thank You