Reproductive health (RH) is a state of complete physical, Mental and social well-being and not merely the absent of disease or infirmity in all matter related to the reproductive system and its functions and processes.
Reproductive health, therefore, implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce, and the freedom to decide if, when and how often to do so.
The concept of reproductive health is centered on human needs and development throughout the life cycle (from the womb until old age)
What is Reproductive Rights?
The right of all couples and individuals to decides freely and responsibly the number, spacing and timing of their births.
The right to factual informed decisions freely and responsibly on all matters of reproduction.
The right to attain the highest standard of sexual and reproductive health.
The right to make decisions concerning reproduction free of discrimination, coercion and violence,
Men's reproductive rights and reproductive health needs including active and informed involvement in pregnancy, child rearing are recognized as paramount
The challenge is one of attitudinal change by men through the separation of culture from religion, as well as understanding the needs, risks and danger signs of pregnancy, childbirth and postpartum periods to support women.
Reproductive rights are human right for e.g. the recognition that safe motherhood (i.e. the right to go safely through pregnancy and childbirth) are human rights. The universal declaration of human rights (1948) states that "motherhood and childhood are entitled to special care and assistance."
Reproductive Health Indicator
Global Level
-529,000 Maternal deaths occur per annum = MMR 430/100,000 Live birth (LB) [Because, each minute day, in every, country, 1 woman dies.
Evidence have also shown that for every maternal death, 20-30 other woman suffer permanent disabilities from the complications of child birth such as: vesico vaginal fistula(VVF), a hole between the vagina and the bladder and recto vaginal fistula (RVF) a hole between the vagina and the rectum leading to continuous leakage of uring/faeces on the woman. (An average of 50, 000-100, 000 women per annum.)
WHO: Globally, 4 million babies die each year-96% of the 4 million newborn death occur in developing countries. Two-thirds newborns die in first week of life and two-thirds of such deaths occur during the first 24 hours of life
Life time risk of a woman dying of pregnancy related complications is 1:4000
Regional Level (Africa)
251,000 (47%) out of the Global maternal deaths.
- Maternal mortality ratio (MMR) =480 per 100,000 LB
- Neonatal mortality 45 death/1,000 LB
- Contraceptive prevalence rate very low: 13% for married woman
- Total fertility rate: 5.5 per woman
National Level (The Gambia)
Maternal mortality ratio: 556/100,000 live births in 2006 from 730/100,000 live births (LB) in 2001
Neonatal mortality rate: 31.2/1,000 LB, 2001 from 60/1,000 LB, 2003 from 92/1,000 LB (1993 WHO)
Infant mortality rate: 75/1,000 LB, 2003 from 92/1,000 LB (1993 census)
U5 Mortality rate: 99/1,000 LB, 2003 From 134/1,000 LB 2001
Contraceptive prevalence rate: 6.7%-1990 to 13.4% in 2001
Obstetric fistula prevalence 0.5/1000 women R. Age
Total fertility rate :6.04 children/ woman - 1993 to 5.4 children/ woman 2003
Why Do Woman Die? (Causes of maternal mortality)
Direct medical causes of maternal deaths
Eighty (80) percent of all maternal deaths globally are as a direct result of complications arising during pregnancy/delivery/post partum. A quarter of these is due to: Haemorrhage (25%) severe bleeding especially during the post partum period, sudden in onset and even dangerous when the woman is a anemic and absence of prompt and appropriate life saving care can lead to death.
Sepsis (15%) often a consequence of poor hygiene during delivery or untreated STIs. Systematic post partum care will ensure rapid detection of infection and its management by antibiotics etc
Hypertensive disorders of pregnancy
(Especially eclampsia/ convulsion): before 20 weeks gestation classify as chronic Hypertension; after 20 weeks during Labour and or within 48 hours after delivery, it is classified as PIH
(12%) Can be prevented and managed during pregnancy with anticonvulsants e.g. magnesium sulphate otherwise PIH may progress from hypertension without protein/ oedema to mule/ severe pre-eclampsia to eclampsia
Prolonged or obstructed Labour: (8%) as a result of CPD or by abnormal lie disproportion (CPD) is also common in cultures where girls marry young and are expected to prove their fertility often before they are fully grown.
Complications of unsafe abortion: (12%) can be prevented if woman have access to family planning information and services including care for abortion complication such as infection/sepsis trauma on vaginal cervical/ultra cavity
Indirect Medical Causes of Maternal Death:
Anaemia
Malaria,
Hepatitis,
Heart diseases
HIV/AIDS
TB
Interventions
Free maternal and child health services
EMCH strategy
Adolescent/youth S&RH
IMMCI strategy
Upgrading strategically located health facilities to the status of major health facilities.
Advanced midwifery; Peri- operative /anesthetist nurse training; Strengthening referral system; Construction of maternity waiting rooms; Integration and decentralization of RCH services and Focused antenatal care.
CHALLENGES
Health human resource (number of HW per100, 000 persons, Dr. 3.5, nurses - 12.5, midwives-8.2), Finance, Essential drugs & other medical drugs, Functioning health system, Activate male participation in RCH services, Functioning laboratory & blood transfusion services, Donor, private & civil society partnership, Domestication of the African protocol on women's rights & its enforcement, Adolescent/youth S&RH
The 3 Delays that Kill
Evidence have also shown that 3 major delays that contributes to materiality & morbidity are: -The delay in deciding to seek care
-Ignorance/non-recognition of danger signs of pregnancy, childbirth and postpartum period
-Lack of birth preparedness plan by family and community
The delay in reaching the facility
Poor roads, Poor communication network and Lack of transport in most rural communities.
Delay in Receiving Prompt & Appropriate Care after Arrival at the Health Facility
Deaths can be averted if woman receive prompt and adequate care - 75% of maternal deaths are preventable (source: WHO/AFRO)
This information was to provided to Health Matters by the RCH Unit of the Ministry of Health and Social Welfare.
