Lecture 1

Harar Health Science College
Course Title: Reproductive Health
For BSc. Public health Students
CHr: 2
Compiled by:- Mr. Ferhan Abubeker (BSc, MPH)

March 27, 2017
Harar, Ethiopia 1
Course Description
This course is given to equip students with basic concepts

of Reproductive Health, components and factors affecting
RH and make them identify unmet RH needs and organize
services accordingly.
General Objectives:-
Up on completion of the Course the student will be
able to:-
 Define RH
 List and describe the major components of RH
 Identify factors affecting RH
 Determine the magnitude of major RH problems
 Identify unmet RH needs in the community and
address them through appropriate actions.
 Organize, integrate and evaluate RH services
Course Content/ out line
- Introduction to Reproductive Health
• Historical development,
• Concepts
• Components of Reproductive Health
• Reproductive Health rights
• Reproductive health problems
- Women’s health problems and status

• Early marriage
• Teenage pregnancy
• Unsafe abortion
• Emergency RH services (post-abortion care, emergency
contraceptives)
• STI including HIV/AIDS
Course Content/ out line Continued
• Harmful traditional practices (Female genital

mutilations, abduction etc.)
• Alcohol and drug abuse
• Ethiopian culture, customs and practices related to

RH
- Monitoring & evaluation of reproductive health programs

- National Reproductive Health Strategy
Teaching and Learning Methods
 Lecture /Interactive discussion
 Individual Assignment
 Group work
Grading and Evaluation System

 The student who is absent from over 20% of the contact hours should
not be eligible for final examination and is enforced to repeat the course
• Class Attendance 100% compulsory 10 %

• Group work 10%
• Individual Assignment 10%
• Mid. Sem. Exam 20 %
• Final Exam 50%
Introduction to RH
Learning Objectives:-
1. Define reproductive health
2. Discuss on rationales and components of Reproductive
Health
3. Understand magnitude of RH problems

Historical development of RH
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
Safe motherhood initiative in 1987

• Emphasis on maternal health
• Emphasis on reduction of maternal mortality
Historical development of RH Cont…
Reproductive health, ICPD in 1994 Cairo

• Emphasis on quality of services
• Emphasis on availability and accessibility
• Emphasis on social injustice
• Emphasis on individuals woman's needs and rights
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
• World Summit 2005, declared universal access to reproductive
health
The Eight MDGs
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, malaria, and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
Reproductive Health
 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
processes”.
RH definition
 The definition is coined taking into consideration three
main points:
1. Sexual health (responsible, satisfying and safe sex life),
2. Reproductive freedom (access to information, methods

and services) and
3. Safe motherhood (safe pregnancy, childbirth and healthy

children) are included.
RH implies
• 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.
• to be informed and
• to have access to safe, effective, affordable and acceptable

methods of family planning of their choice
• the right of access to appropriate health-care services that will

enable women to go safely through pregnancy and childbirth and to
have a healthy infant.
RH care
Is defined as the constellation of:
• methods,
• techniques and
• services
that contribute to reproductive health and wellbeing

by preventing and solving reproductive health
problems
Sexual health
Def;-
 A state of physical, emotional, mental, and social
wellbeing in relation to sexuality; it is not merely the
absence of disease, dysfunction, or infirmity.
• It includes a positive and respectful approach to sexuality

and sexual relationships,
• The possibility of having pleasurable and safe sexual

experiences that are free of coercion, discrimination, and
violence.
Sexuality
• It is a central aspect of humanity and encompasses sex,

gender identities and roles, sexual orientation, eroticism,
pleasure, intimacy, and reproduction.
• It is experienced and expressed in thoughts, fantasies,

desires, beliefs, attitudes, values, behaviors, practices, roles,
and relationships.
• Affected by the interaction of biological, psychological,

social, economic, political, cultural, ethical, legal, historical,
religious, and spiritual factors.
Sexual rights
1. The right of all individuals, free of coercion, discrimination
and violence,
2. The highest attainable standard of sexual health, including

access to sexual and reproductive health care services;
3. Seek, receive, and impart information related to sexuality;
4. Sexuality education;
5. Respect for bodily integrity;
6. Choose their partner;

Sexual rights Cont…
7. Decide whether or not to be sexually active;
8. Consensual sexual relations;
9. Consensual marriage;
10. Decide whether or not, and when, to have children;
11. Pursue a satisfying, safe and pleasurable sexual life.

Rationales for RH programs
• The rationales of RH programs can be viewed from the prospect of
public health intervention in developing countries and a component of
international development assistance programs.
• For three basic rationales through time are: demographic, health, and
human rights.
• Concern of rapid population growth on economic productivity, savings

and investment, natural resources, and the environment-the
“demographic” rationale-was the predominant rationale for much of the
late 1960s and 1970s.
• During the 1980s, a shift toward the health rationale occurred (driven by
the consequences of high fertility for maternal, infant, and child mortality
Rationales for RH programs …
• In the 1990s, the human rights rationale became predominant, with its focus
on women’s rights, principally reproductive rights, and the reproductive
health of women and men.
• This is associated with the UN International Conference on Population and

Development (ICPD), held in Cairo in 1994.
Demographic Rationale
• The history of RH/FP programs in developing countries partly originates

with concern about a “world population problem.”
• In the late 1940s and 1950s, the phenomenon of rapid population growth,
resulting from the gap between declining mortality and continuing high
fertility, was emerging in some South and East Asian countries.
Demographic Rationale…
• By the mid-1960s, more countries, including a number in Latin

America and the Middle East, were experiencing unprecedented
rates of population growth of more than 3 percent annually.
• At such growth rates, the size of a country’s population would

double in less than 25 years.
• Concerns about rapid population growth voiced by

demographers, social scientists, and others were based in large part
on the assumption that such growth would “serve as a brake” on
economic development and on efforts to improve living standards
of most of the world’s people residing in developing countries.
• In the late 1940s, conservationists began to write about excessive
population growth being a threat to food supplies and natural resources.
• Some 20 years later, Paul Ehrlich’s writings fueled the call to action to
deal with overpopulation.
• Concerns about the impact of rapid population growth and high

fertility were translated into what has become known as the
“demographic rationale”.
• The focus was on Family Planning.
• By helping to reduce high rates of fertility, RH/FP programs were

intended to contribute to lower rates of population growth, improved
living standards and human welfare, and lessened impact on natural
resources and the environment.
World Population Milestones
• 1 billion in 1804,
• 2 billion in 1927 (123 years later),
• 6 billion in 1999 (13 years later)
source: UN, World Population Prospects, 1998 revision

Health Rationale
• During the 1980s, a shift toward the health rationale occurred.
• This shift occurred in part because of political, ideological, and scientific

influences.
•Whereby the health rationale was more appealing to policymakers in

many countries.
• The health rationale is based on concerns about the health consequences

of high fertility.
• High rates of maternal, infant, and child mortality (and abortion) were
important health problems.
• High maternal mortality was associated with a high number of

pregnancies, births to older and younger women, and abortions.
Health Rationale Cont…
• In Chile, for example, preventing abortion due to unwanted pregnancies

was an important impetus for establishing birth control clinics.
• The health rationale is based on concerns about the health

consequences of high fertility.
• High rates of maternal, infant, and child mortality (and abortion)

were important health problems.
• It extended to considerations of equity in access to RH services.
• Class differences in access resonated with the ideological issues of the

period such as concern over human rights, which led to the development
of major human rights conventions by the United Nations in the mid-
1960s.
Human right rationale
• Reproductive Health is the subject of international human rights when the

United Nations issued a statement on population on Human Rights Day in
December 1967.
• The Teheran Conference on Human Rights, sponsored by the United
Nations, affirmed the basic right of couples to decide on the number and
spacing of their children.
• A 1969 General Assembly resolution on social progress and development
called on governments to provide families with the knowledge and means
necessary to control fertility.
• The Teheran Conference, the UN resolution helped to legitimize family

planning
• The issue of women’s right to birth control was certainly present at this time
in the United States as an element in the women’s liberation movement.
• The beginnings of advocacy for birth control were in the 19th
century, and
•The activist crusade for birth control in the United States was
launched by Margaret Sangerin 1914 and then spread to a number
of developing countries, including India and Mexico, in the 1920s.
• In the 1990s, the human rights rationale became predominant,

with its focus on women’s rights, principally reproductive rights,
and the reproductive health of women and men.
• The shift is associated with the UN International Conference on

Population and Development (ICPD), held in Cairo in 1994.
ICPD-1994
• 1994-Cairo -International Conference on Population and
Development (ICPD)
• Human rights, women’s rights, and reproductive rights are

given priority.
• Explicitly included are issues of gender equality, equity,

empowerment of women and reproductive health care.
• The aims of “population-related goals” are to “improve the

quality of life of all people.”
Reproductive rights -ICPD 1994
1.Reproductive and sexual health throughout the life cycle.
2. Reproductive self determination including:
• right to voluntary choice in marriage;
• right to determine number, timing and spacing of ones

children;
• the right to have access to the information and means

needed to exercise voluntary choice.
Reproductive rights -ICPD 1994
3. Equality and equity for men and women in all spheres of life.
• to make free and informed choices in all spheres of life, free from
discrimination based on gender
4. Sexual and reproductive security including freedom from sexual

violence, coercion and the right to privacy
A Paradigm Shift (1990s)
Theory-Human beings and human rights are at the center of concerns for
sustainable development.
Policy-Advancing human rights, especially gender equality, equity and

empowerment of women are key to population and development related
programs.
Components of Reproductive Health
Old paradigm
1. Family Planning, Unmet need for contraception
2. Maternity Care, Antenatal care, Safe childbirth, Post-

partum care
3. Child Health Care, Breast feeding promotion,

Nutrition, growth monitoring,
Immunizations,
Sickness care (ORT, ARI, malaria, etc)
New Additions
1. Gender discrimination Sex selective abortions
Son preference for food allocation, health care, education, etc.
2. Violence against women, Child pornography, Commercial sex,

Female Genital Mutilation,Spouse abuse, Rape, incest
3. Adolescent sexuality
4. Reproductive rights regarding marriage and childbearing
5. Gender equity and equality
6. Unintended pregnancy, Emergency contraception, Safe abortions
7. Chronic complications of pregnancy and childbirth
8. Sexually transmitted diseases, Acute infections, Chronic
complications, e.g.,-infertility-cervical cancer
9. HIV/AIDs
Reproductive Health Problems
• 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.
• Without proper health care services, this group is highly

vulnerable to problems related to sexual intercourse,
pregnancy, contraceptive side effects, etc.
Magnitude of RH Problem….
• Death and illnesses from reproductive causes are the highest
among poor women everywhere.
• 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 566-1400 deaths per 100,000 live births.
• Ethiopian EDHS survey of 2011 indicates that maternal

mortality is 676 per 100,000 live births.
Magnitude of RH Problem….
•In Ethiopia, contraception use in women is 27% and about

56% of women want to use contraceptive, but have no
means to do so according to the Ethiopian Demographic and
Health Survey (EDHS 2011).
• Women in developing countries & economically

disadvantaged women in the cities of some industrial nations
suffer the highest rates of complications from pregnancy,
sexually transmitted diseases, and reproductive cancers.
• Lack of access to comprehensive reproductive care is the

main reason that so many women suffer and die.

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Harar Health Science College

Course Title: Reproductive Health

For BSc. Public health Students

Compiled by:- Mr. Ferhan Abubeker (BSc, MPH)

This course is given to equip students with basic concepts

- Women’s health problems and status

• Harmful traditional practices (Female genital

• Alcohol and drug abuse

• Ethiopian culture, customs and practices related to

- Monitoring & evaluation of reproductive health programs

Grading and Evaluation System

• Class Attendance 100% compulsory 10 %

1. Define reproductive health

2. Discuss on rationales and components of Reproductive

3. Understand magnitude of RH problems

Before 1978 Alma-Ata Conference

Primary health care declaration 1978

Safe motherhood initiative in 1987

Reproductive health, ICPD in 1994 Cairo

Millennium development goals and reproductive health

1. Eradicate extreme poverty and hunger

 Reproductive health is defined as” A state of complete

1. Sexual health (responsible, satisfying and safe sex life),

2. Reproductive freedom (access to information, methods

3. Safe motherhood (safe pregnancy, childbirth and healthy

• to have access to safe, effective, affordable and acceptable

• the right of access to appropriate health-care services that will

that contribute to reproductive health and wellbeing

• It includes a positive and respectful approach to sexuality

• The possibility of having pleasurable and safe sexual

• It is a central aspect of humanity and encompasses sex,

• It is experienced and expressed in thoughts, fantasies,

• Affected by the interaction of biological, psychological,

2. The highest attainable standard of sexual health, including

3. Seek, receive, and impart information related to sexuality;

5. Respect for bodily integrity;

6. Choose their partner;

8. Consensual sexual relations;

10. Decide whether or not, and when, to have children;

11. Pursue a satisfying, safe and pleasurable sexual life.

• Concern of rapid population growth on economic productivity, savings

• This is associated with the UN International Conference on Population and

• The history of RH/FP programs in developing countries partly originates

• By the mid-1960s, more countries, including a number in Latin

• At such growth rates, the size of a country’s population would

• Concerns about rapid population growth voiced by

• Concerns about the impact of rapid population growth and high

• The focus was on Family Planning.

• By helping to reduce high rates of fertility, RH/FP programs were

• 2 billion in 1927 (123 years later),

• 3 billion in 1960 (33 years later),

• 4 billion in 1974 (14 years later),

• 5 billion in 1987 (13 years later),

• 6 billion in 1999 (13 years later)

source: UN, World Population Prospects, 1998 revision

• This shift occurred in part because of political, ideological, and scientific

•Whereby the health rationale was more appealing to policymakers in

• The health rationale is based on concerns about the health consequences