1. Dr. Farhat R Malik Assistant Professor Community Health Sciences

2. SESSION OBJECTIVES Define Reproductive Health. Scope of Reproductive Health. Components of RH. Reproductive Rights MDG’s and Sustainable development goals RH- Indicators Pakistani Situation

3. Reproductive Health Health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. Reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

4. COMPONENTS OF RH 1. Safe Motherhood. 2. Fertility Regulation. 3. Prevention & control of RTIs. 4. STIs & HIV/AIDS 5. Infertility. 6. New born care. 7. Male Involvement. 8. Reproductive tract Cancer detection & Management. 9. Comprehensive Family Planning Services.

5. What are Reproductive Rights? Attaining the goals of sustainable, equitable development requires that individuals are able to exercise control over their sexual and reproductive lives. This includes the rights to: Reproductive health as a component of overall health, throughout the life cycle, for both men and women Reproductive decision-making, including voluntary choice in marriage, family formation and determination of the number, timing and spacing of one's children and the right to have access to the information and means needed to exercise voluntary choice Equality and equity for men and women, to enable individuals to make free and informed choices in all spheres of life, free from discrimination based on gender Sexual and reproductive security, including freedom from sexual violence and coercion, and the right to privacy.

7. RH/FP

8. Relevance: There is a clear relationship between the indicator and FP/RH; Accuracy: The indicator measures what it purports to measure; Importance: The measurement captures something that "makes a difference" in program effectiveness; Usefulness: The results point to areas for improvement. Furthermore, the indicator captures information that helps move FP/RH strategies, priorities, or programming forward; Feasibility: Data can be obtained with reasonable and affordable effort; Credibility: The indicator has been recommended - and is being used - by leading experts and organizations such as WHO, UNAIDS, and UNFPA; Validity: To the extent possible, the indicator has been field-tested (including those measured in Demographic and Health Surveys (DHS) and Reproductive Health Surveys (RHS)) or used in practice; and Distinctiveness: The indicator lacks redundancy and does not measure something already captured under other indicators.

9. Shortlist of indicators for global monitoring of Reproductive Health 1 - Total fertility rate 2- Contraceptive prevalence 3- Maternal mortality ratio 4 - Antenatal care coverage 5 - Births attended by skilled health personnel 6 - Availability of basic essential obstetric care 7 - Availability of comprehensive essential obstetric care 8 – Peri natal mortality rate 9 - Prevalence of low birth weight 10 - Prevalence of positive syphilis serology in pregnant women 11 - Prevalence of anemia in women 12 - Percentage of obstetric and gynecological admissions owing to abortion 13 - Reported prevalence of women with genital mutilation 14 - Prevalence of infertility in women 15 - Reported incidence of urethritis in men 16 - Prevalence of HIV infection in pregnant women 17 - Knowledge of HIV-related preventive practices

10. INDICATORS LIFE EXPECTANCY AT BIRTH. MATERNAL MORTALITY RATE. INFANT MORTALITY RATE. PERINATAL MORTALITY RATE. INDUCED ABORTION RATE. NEONATAL MORTALITY RATE. TOTAL FERTILITY RATE. AGE SPECIFIC FERTILITY RATE. UNMET NEED FOR FAMILY PLANNING. CONTRACEPTIVE PREVALENCE RATE. PREVALENCE OF HIV AMONG PREGNANT FEMALES.

11. SCOPE OF RH  Global attention,ICPD in 1994.  Pakistan committed to holistic approach to RH care.  Part of general health.  Developing countries – 18% burden of disease In females ( 15-49yrs ) is due to maternal causes.  16% contribute to STDs & HIV.  Globally 0.58 million maternal deaths/ year, 99% are in developing world.

13. COMPARISON

14. SITUATION IN PAKISTAN Estimated Total Population180.8 M Lifetime Risk of Maternal Death 1 woman in 93 Maternal Mortality Ratio 260 per 100,000 LB Total Fertility Rate 3.07 Births Attended by Skilled Health Provider 39% Unmet Need for Family Planning 33%

15. Total Fertility Rate Definition : Average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given fertility rate at each age. 19882000200120102012 6.24.564.413.43.07

16. PAKISTAN The status of maternal health is poor in Pakistan. An estimated 30,000 women die each year due to pregnancy related causes. It is estimated that about 500 maternal deaths occur per 100,000 live births each year in Pakistan. Recent estimates (WHO & UNICEF) place the figures around 270/100,000 live births but in reality it may be higher because of under registration of deaths in country and absence of cause of death information.

17. CAUSES OF MATERNAL MORTALITY

19. MDG –ACHIEVEMENTS SO FAR (PAKISTAN ) Indicator 1990-91 2000-01 2004-05 Target 2005-06 2009-10 MDG Target 2015 MMR550350400300-350300140 SKILLED ATTENDED BIRTHS 184048756090+ CPR12303641.75155 TFR5.44.13.53.72.72.1 1 A/N VISIT153550 70100

20. RH……… Importance PDHS- 2013 (Preliminary Report)

21. Assignment Reproductive health issues in Pakistan, what are they?

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