2. DEFINITION OF REPRODUCTIVE HEALTH “WHO,1994” A state of complete physical, mental and social well being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to it’s functions and processes at all stages of life”.

3. Why is reproductive health so important? Women are the cornerstones of the family, therefore, the health of women is a pre-requisite for the health of the whole family, community and society Both women and men have reproductive health needs and concerns, but women alone who bears most of the burden of her reproductive ill health. Reproductive health conditions – maternal mortality and morbidity ( HIV/AIDS and Sexually transmitted diseases), need emphasis from the health providers

4. Factors affecting women’s health  Poverty and other economic factors  Lack of personal and social status and opportunities Legal status (examples) Son preference (examples) Lack of decision-making power and participation Status through child bearing Lack of education  Demographic factors (examples)  Traditional harmful practices:- e.g. female genital mutilation  Lack of access to health care  Lack of political support (examples)

5. Contents of Reproductive Health Approach Prevention and management of unwanted pregnancies; Services to promote safe motherhood; Services to promote child survival; Nutritional services to vulnerable groups; Prevention and treatment of STDs; Reproductive Health service for adolescents; Health, sexuality and gender related counseling; and Establishment of an effective referral system

6. A A ge phases included in RHC A. Pre-reproductive years: childhood and adolescence years are involved in this phase.

7. B- Reproductive years. 1- Age of marriage of girls between 21-25 years and that of boys between 26-30 years. 2- Maternal care and safe motherhood. 3- Infant and child care 4- Legal abortion 5- Family planning 6- Reproductive tract infections (RTls) and sexual transmitted disease (STD) including HIV I ADIS. 7-Infertility. 8-Environmental and occupational reproductive health B- Reproductive years. 1- Age of marriage of girls between 21-25 years and that of boys between 26-30 years. 2- Maternal care and safe motherhood. 3- Infant and child care 4- Legal abortion 5- Family planning 6- Reproductive tract infections (RTls) and sexual transmitted disease (STD) including HIV I ADIS. 7-Infertility. 8-Environmental and occupational reproductive health

8. C- post-menopausal years Assessment Care during menopause as well as during post menopausal years

9. Components of Reproductive Health 1. Girl child needs: Vaccination. Nutrition Healthy life style

10. Strategies to improve girl child health Reduce the mortality rates (define each) Protect children against the six communicable diseases, and be given proper nutrition, and to promote breast feeding. All children should have the right to education, and having an equity of status and opportunities.

11. Cont. Reducing the major childhood diseases, particularly infectious and parasitic diseases, and to prevent malnutrition among children especially girls. Special attention to the hygiene and health promotion and counseling. Efforts should be made toward community and socioeconomic development. Maintaining clean sanitary environment.

12. II- Adolescent Girl Adolescent girl reproductive health issues:- A.Menstruation. B.Female genital mutilation. C.Early marriage and teenage pregnancy

13. Adolescent girl needs:- Nutritional needs Personal health and hygiene “menstrual hygiene Biological and sexual maturation. Sex education. The mental health of adolescents

14. Strategies to improve & fulfill adolescents female health:- Assessment counseling Care provided to achieve adolescent health

15. III- Mature women 1- Maternal health & safe motherhood Why mothers form a vulnerable group ? 1. Maternal health is a basic requirement for:  Normal intrauterine growth and development.  Favorable outcome of pregnancy. 2. Mother is exposed to the risk of morbidity (health hazards) and mortality during pregnancy, labour, and the puerperium, and which are largely preventable, or controllable. 3.Mother is responsible for health promotion of children, and welfare of family.

16. Objective of maternal Health  Health promotion of mother: satisfying requirements of normal pregnancy and labour, for fetal health, and favorable outcome (including adequate nutrition).  Prevention of health hazards to which the mother may be exposed during pregnancy, labour, and the puerperium.  Control of health hazards, by health appraisal, for early case-find­ing and management.

17. Program of maternal health A- Pre-conception care Preconception care is concerned with continual care for young females from birth throughout the different stages of growth and development. This care takes the form of:-  health promotion and prevention of health hazards to prepare the female for normal child bearing (examples)  Health appraisal: medical care and periodic examination, for early case-finding and management.  Premarital care (for both couples).

18. Importance of premarital care: Early detection of health problems and accordingly better chance of treatment. Providing guidance, preparation for marriage, family education, training in the art of child rearing and family planning. Prevention of health problems for the couple and their future children.

19. Components of premarital care: A- Premarital Assessment; I- History Taking. II-Physical Examination. III- Laboratory Investigations B- Premarital Education 1- Health education about the healthy life sty 2- Nutrition 3- Mood altering drugs 4- Family planning C- Premarital Counseling

20. PREGNANCY CARE Prenatal care Goals : The main goal is the safety and welfare of the mother and her fetus. The preparation of mother for labor, lactation and subsequent care of her child. The early detection and appropriate treatment of high- risk conditions. The reduction of maternal and infant mortality, stillbirth, and Prematurity, (Define each) To increase the number of breastfed babies.

21. Components of antenatal care A) Registration; initial and return visits B) Assessment C) Health Education D) Immunization E) Clinical service F) Social service

22. Natal care Natal care Requirements : 1)Early prenatal care, to allow for health promotion, early case-finding and management, and preparing for any expected difficulty or problem. 2)The nurse midwife of MCH center is responsible for home deliveries. 3) Asepsis, to prevent infection (sterile articles and dressings). 4) First aid service, including transport, care during childbirth

23. Cont. Encourage delivery at health facility. Increasing number of well equipped health facilities that provide delivery service. Increase number of supervised deliveries. Improving referral system for cases that require emergency care. Improving quality of care through improving obstetric departments.

24. 3.Postnatal Care a- Medical care For home deliveries For hospitalized cases b- Chemoprophylaxis c- Follow-up and re-examination:

25. Interconceptional Care Interconceptional Care Requirements Health promotion: adequate nutrition and healthful living. Birth control for proper pregnancy-spacing, and postponing pregnancy for the recommended period of time when indicated, e.g. with maternal morbidity, or after Caeserian or unfavourable outcome of previous pregnancy.

26. Legal Abortion Legal Abortion  Each year an estimated 36million to 53 million abortions are performed world wide. Of those, as many as 20 million are considered unsafe_ that is, they take place outside health care systems, are performed by unskilled providers under unsanitary conditions, or both. Most but not all, unsafe abortions take place in developing countries where abortion is limited by law.  Common complications include incomplete abortion, infection, hemorrhage, and intra-abdominal injuries, including cervical laceration and uterine perforation. All can be fatal if left untreated.

27. Family planning Advantages Components Birth control methods Assessment Counselling

28. 4- Reproductive Tract Infections, Sexually Transmitted Diseases & AIDS Reproductive tract infection (RTI) is a generic term used to cover three types of infections:- Endogenous vaginal infection. Sexually transmitted diseases. Infection related to reproductive tract procedure (introgenic infection due to medical procedure). Sexually transmitted disease/ AIDS: The sexually transmitted diseases represent a health problem of high priority in several areas of the world.

29. Prevention and treatment of RTIs and STDs:- Increasing efforts in reproductive health programs to prevent, detect and treat STDs and other reproductive tract infections. Providing specialized training to all health-care providers in the prevention and detection of, and counseling on STDs, especially infections in women and youth. Making information, counseling for responsible sexual behavior and effective prevention of STDs and HIV integral components of all reproductive and sexual health services. Promoting and distributing high-quality condoms as integral components of all reproductive health-care services.

30. Cont. Institute screening and case-finding of Syphilis by serological testing of all pregnant women not previously tested during antenatal care, with adverse pregnancy outcomes and treatment of sero-reactive women and their partners. Train health care provides to refer complicated cases. Intensify research on methods to control the HIV/AID pandemic and to find an effective treatment for the disease. Routine screening and treatment for infection can be incorporated into family planning, prenatal and maternal and child health services. For many women, these contents are socially acceptable than clinics specializing in STDs.

31. 5- Infertility Factors contributing to infertility:- A- Factors related to women B- Factors related to men:-

32. Management of Infertility Taking complete reproductive history from couples. Complete physical examination of each partner so we may discover chronic disease, or endocrine disturbance. Careful examination of reproductive organs to identify RTI, cysts, and structural defect. Special test such as semen evaluation. Hormonal therapy may be given to the man or woman. Surgical procedures. Laparotomy to relieve pelvic adhesive and obstruction

33. Prevention of infertility:- Program for prevention and treatment of STDs and RTI, and safe delivery services would have an important impact on preventing infertility. Treatment of chronic disease. Premarital examination for early detection of cases.

34. C- post-menopauSal years. Screening of genital and breast cancers. Health appraisal Prevention and care of chronic disease including Gy. Problems Counseling about healthy life style

35. V- Women beyond reproductive age Train providers at the primary health care level to be able to counsel women beyond reproductive age and to detect and treat different post menopausal conditions. Set standards and guidelines for health services for the management of post menopausal morbidity conditions. Hormonal replacement therapy should not be advocated as a routine services, but used only for curative purpose.

36. Cont. Information, education and communication components are essential elements of the reproductive health services for women beyond reproductive age. Non hormonal therapy:- is essential in the prevention and treatment of common morbidity conditions of women beyond reproductive age and their life, such therapy include calcium supplements, flouride, anabolic steroid and exercise programs.

37. Thank you