Reproductive Health Care Quiz

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Questions and Answers

Which component is NOT considered a part of reproductive health care?

Treatment of reproductive tract infections

Quality family planning counseling

Safe abortion services where legal

Promotion of harmful practices (correct)

Which of the following is NOT a domain of reproductive health as defined?

Reproductive health technology (correct)

Women's empowerment

Health service provision

Universal rights

What is the primary focus of reproductive health according to the content?

The prevention of all diseases

Maximizing population growth

Providing free medical care for all

The equality between men and women (correct)

Which of the following best describes Youth Friendly Health Services as per WHO?

Accessible, safe, effective, and acceptable services for adolescents Signup and view all the answers

Which statement accurately describes prenatal and postnatal care in reproductive health?

It includes services like breastfeeding support. Signup and view all the answers

What is primarily associated with maternal deaths during delivery?

Failure to get skilled help in time Signup and view all the answers

Which type of professionals are classified as skilled attendants at birth?

Those trained in obstetric management Signup and view all the answers

Which of the following is NOT a minimum skill required for a skilled attendant?

Diagnosing all diseases Signup and view all the answers

Why is cultural sensitivity important for skilled attendants?

To ensure effective interpersonal communication Signup and view all the answers

What is one of the specific skills a skilled attendant must perform during an examination?

Screening for endemic conditions Signup and view all the answers

What is a primary goal of postpartum care?

To focus on the physical and emotional recovery of the mother Signup and view all the answers

What is categorized as an indirect cause of maternal mortality?

Malaria Signup and view all the answers

Which complication is NOT considered life-threatening in the postnatal period?

Severe fatigue Signup and view all the answers

What skill is essential for a skilled attendant concerning uterine contractions?

Assessing the effectiveness of uterine contractions Signup and view all the answers

Which factor contributes to the first delay in seeking care for obstetric complications?

Lack of awareness of complications Signup and view all the answers

What typically causes the second delay in reaching a health facility after deciding to seek care?

Poor transportation options Signup and view all the answers

When should all women receive a postpartum visit after delivery?

Within the first week Signup and view all the answers

What is the primary focus of the 'three delays model' in maternal mortality?

Barriers to accessing care Signup and view all the answers

Which of the following is a condition that may require referral during pregnancy?

Intrauterine fetal death Signup and view all the answers

Which socio-economic factor might contribute to the first delay in seeking obstetric care?

Employment status Signup and view all the answers

What is an example of a direct obstetric cause of maternal mortality?

Unsafe abortion Signup and view all the answers

Which of the following is NOT a reason for the third delay in obtaining care at a health facility?

Difficulty communicating with healthcare providers Signup and view all the answers

What percentage of maternal mortality is caused by indirect factors?

28% Signup and view all the answers

Which factor is NOT listed as affecting the utilization of youth-friendly health services (YFHS)?

Lack of experience Signup and view all the answers

What is the definition of maternal mortality according to WHO?

Death of a woman while pregnant or within 42 days of termination of pregnancy from any cause. Signup and view all the answers

What percentage of maternal mortality is attributed to direct causes?

72% Signup and view all the answers

Which of the following does NOT represent a key intervention strategy for maternal health?

Increased peer pressure Signup and view all the answers

What is considered a late maternal death?

Death from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy. Signup and view all the answers

How many women die each day due to pregnancy or childbirth-related causes?

800 Signup and view all the answers

Which component is NOT considered a part of maternal health?

Emergency trauma care Signup and view all the answers

What does maternal morbidity refer to?

Any physical or psychological deviation from well-being during pregnancy or within a year postpartum. Signup and view all the answers

What disparity exists in health needs between men and women according to biological differences?

Women require regular health check-ups to prevent unwanted pregnancies. Signup and view all the answers

What is the primary purpose of monitoring institutional deliveries with a partograph?

To prevent prolonged labour Signup and view all the answers

Which of the following is NOT one of the five cleans in delivery care?

Clean medications Signup and view all the answers

What is a key strategy to ensure skilled care during childbirth?

All births in health facilities Signup and view all the answers

What is the most critical single intervention for safe motherhood?

Presence of a skilled health professional at every birth Signup and view all the answers

What does skilled birth attendance depend on?

Presence of a skilled attendant and an enabling environment Signup and view all the answers

What does the 'enabling environment' refer to in the context of skilled birth attendance?

Availability of drugs and supplies for skilled care Signup and view all the answers

Why is access to emergency obstetric care crucial during childbirth?

To manage complications that may arise Signup and view all the answers

How did the proportion of institutional deliveries in Ethiopia change between the years 2005 and 2019?

Increased from 5% to 48% Signup and view all the answers

Signup and view all the answers

Study Notes

Introduction to Family Health

The presentation is an introduction to family health, presented by Firehiwot Haile (MPH RH).
The learning objectives include defining family and family health, listing and discussing family health components, discussing characteristics of a healthy family, and discussing determinants of family health.

Definition of Family

A family is a group of two or more people related by birth, marriage, or adoption, living together in a household.
It is the smallest social unit in society, focused on its members' replacement and unique to the community's context.
Different family types exist: nuclear (married couple and children), extended (nuclear plus relatives), and joint (two or more married couples).

Definition of Family Health

Health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1958).
Family health is the positive interaction among family members, enabling them to achieve optimum physical, mental, and social well-being.
It is a component of community health and a unit of healthcare.

Major Components of Family Health

Reproductive health: Safe motherhood (family planning, antenatal care, obstetric care, post-natal care, abortion care, and control of STI/HIV/AIDS), nutritional deficiencies, low birth weight (LBW), reproductive tract infections (RTIs), and infertility. Adolescent health (suicide, depression, and STIs) is also encompassed.
Child health: Childbearing, rearing, child health services (nutrition, immunization, and growth monitoring), child mortality, and social health problems (child abuse, street children, child labor, juvenile delinquency, and battered baby syndrome).
Gender issues: Girls trafficking, gender mainstreaming, female genital mutilation (FGM), and female feticide (sex-selective abortion).
Aging: Problems of aging and active aging.
Mental health: The state of mental health, its causes and prevention, along with national mental health policy

Characteristics of a Healthy Family

Commitment: Interdependent parts of a family must work together, support each other and coordinate in order for survival.
Togetherness: Family members should spend time together participating in activities to foster strong family bonds.
Appreciation: Mutual admiration and appreciation among family members are essential for a healthy family unit.
Good communication: Strong communication creates a sense of belonging and strengthens relationships
Spiritual well-being: Shared faith amongst family members promotes support, patience, forgiveness, and acceptance

Determinants of Family Health

Socioeconomic factors: Availability of resources to meet daily needs, social norms, attitudes, discrimination, exposure to crime and violence.
Physical environment: Exposure to toxins, contaminants (air, water, food, and soil) and other hazards are significant determinants of poor health outcomes.
Health Services: Access to, and quality of, health services significantly impacts health status.
Genetics: Hereditary diseases (e.g., anemia, hemophilia, and cystic fibrosis) contribute to issues with health status.
Lifestyle/individual behaviors: Dietary and physical activity practices, hygiene, alcohol consumption, cigarette smoking, and other drug use have an impact on health outcomes.
Culture: Factors like marginalization, stigmatization, loss or devaluation of language and culture and lack of access to appropriate health care and services are key determinants.

Introduction to Reproductive Health (RH)

Definition of RH: A "state of complete physical, mental, and social wellbeing" in all matters related to reproductive systems, functions, and processes (ICPD, 1994).
Components of RH: Sexual health, reproductive freedom (access to information, methods, and services), and safe motherhood (safe/healthy pregnancies, childbirth and healthy Children.)

Sexual Health

A positive and respectful approach to sexuality and sexual relationships that are free of coercion, discrimination, and violence.
Sexuality includes aspects like sex, gender identities and roles, sexual orientation and sexual intimacy.
It acknowledges that sensuality and awareness of one's own body, and others' bodies are crucial aspects of sexuality.

Concept of RH

Implies a responsible, satisfying, and safe sexual life, as well as successful maternal and infant survival, freedom to control reproduction, and minimization of gynecological diseases throughout life.
Right to information and access to safe, effective, affordable, and acceptable family planning services, access to appropriate health care services that facilitate safe pregnancies/childbirth, and lead to healthy infant outcomes.
Equality between men and women and empowering women in reproductive health is fundamental.

Components of RH care

Quality family planning counseling, information, education, and services (IEC).
Prenatal, safe delivery, and postnatal care, including breastfeeding.
Prevention and treatment of infertility and complications of unsafe abortions.
Safe abortion services (where legal).
Treatment of reproductive tract infections, other conditions of the reproductive system, counseling on human sexuality, responsible parenthood, and reproductive health, and discouragement of harmful practices.

Youth-Friendly Health Services (YFHS)

Defined by WHO as services that are accessible, safe, effective, acceptable, and appropriate for adolescents to address their needs, in the right place and at the right price.
The ideal approach addresses the demands and standards for delivery of quality service in the context of youth health needs.
This should include characteristics and programming for better youth-based health services,

Maternal Health and Safe Motherhood

Maternal Health concerns the health of women during pregnancy, childbirth, and the postpartum period.
It encompasses areas like family planning, preconception care, prenatal care, and postnatal care.
Women's specific needs, like the prevention and treatment of unwanted pregnancy, and managing complications during and after childbirth, are crucial to ensure a positive and fulfilling experience.

Maternal Morbidity and Mortality

Maternal Morbidity: Any deviation from physiological or psychological well-being during pregnancy, childbirth, and the postpartum period (up to 42 days or 1 year).
Maternal Mortality: The death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management.
Pregnancy-related death: Death of a woman while pregnant or within 42 days of termination, regardless of the cause.
Important causes of mortality include direct causes like obstetric complications, and indirect causes like existing diseases (e.g., malaria) or complications (e.g., blood infections).
Late maternal death: A maternal death resulting from obstetric complications, more than 42 days, but less than a year after pregnancy termination.

Global Situation in Maternal Mortality (MM)

Global MMR: In 2020, 223 deaths per 100,000 live births.
Ethiopia's MMR: In 2022, 267 deaths per 100,000 live births.
Trends show a decrease in maternal mortality, highlighting the need for continued efforts in maternal health programs.

Causes of Maternal Mortality

Direct causes: Obstetric complications, pregnancy, labor and the puerperium, interventions, omissions, incorrect treatment & effects of chains of events. Indirect causes: Existing diseases (e.g., malaria, anemia HIV/AIDS) or complications aggravated during pregnancy

The Road to Maternal Mortality (The Three Delays Model)

Maternal death results from three key delays: • The first delay: Delay in deciding to seek care for an obstetric complication due to socio-economic factors (e.g., women’s status, literacy, income, employment, workload), culture, values, and beliefs • The second delay: Delay in physically reaching the care facility due to inaccessibility (e.g., difficulty in finding or paying for transportation, lack of available transportation, road conditions etc) • The third delay: Delay in obtaining care once present at the facility due to poor skills of health providers, shortages of supplies, and basic equipment, lack of blood supplies and or operating theaters, or non-availability of health personnel.

Maternal Health Services (Safe Motherhood)

Comprehensive care before, during, and after pregnancy and childbirth.
Key strategies to achieve safe motherhood include reducing the number of high-risk and unwanted pregnancies, reducing obstetric complications, and reducing the case-fatality rate in women with complications.
Components: Preconception care; Antenatal care; Delivery services; Postpartum care; Post-abortion care; Family planning; RH education for Adolescents; Community education on safe motherhood

Antenatal Care

Aims: To improve maternal and perinatal outcomes through prevention, early detection, and management of complications.
Best practice: All pregnant women benefit from a minimum of 8 antenatal visits, each lasting at least 20 minutes, covering prevention, early detection, and management of potential complications like anemia, vaginal bleeding, preeclampsia, infection, abnormal fetal growth/position, HIV, syphilis, malaria, and malnutrition, to name a few.

Focused Antenatal Care (FANC)

A focused approach to ANC characterized by individualized care, client-centered care, fewer but more comprehensive visits, identifying disease, and care provided by skilled providers.
Goals: Early detection and treatment of problems/complications; Prevention of complications/diseases; Birth preparedness and complication readiness; Health promotion.

WHO's 2016 ANC Model

The model recommends a minimum of eight contacts: 5 in 3rd trimester, 1 in 1st trimester and 2 in 2nd trimester.
These contacts are scheduled over specific gestational weeks.

Intra-partum Care

Aims: Safe and clean delivery.
Recognition, early detection, and management of complications like hemorrhage, eclampsia, and prolonged/obstructed labor.
Strategies: All women and birth attendants should be aware of clean delivery practices (clean hands and surfaces.) Health providers should be adequately trained in and practice clean and safe delivery techniques to avoid unnecessary vaginal examinations and episiotomies. Care should promptly refer cases of prolonged or obstructed labor to a higher level of care. All institutional deliveries should be monitored using an adapted partograph.

Institutional Delivery

To ensure skilled care during childbirth, all deliveries ideally take place in health facilities.
This allows for prompt treatment of potential complications.

Skilled Attendance at Birth

Definition: A process of providing adequate care to women during labor, delivery, and the postpartum period.
This attendance depends on skilled health providers and an enabling environment.

Minimum set of Skills for the Skilled Attendant

A detailed history, relevant questions, addressing cultural sensitivity and interpersonal skills.
General examination identifying deviations from normal, and screening for prevalent or endemic conditions.
Recording of vital signs (temperature, pulse, respiration, blood pressure).
Calculating the estimated date of delivery.

Postpartum Care

Comprehensive medical care provided to women after childbirth.
Focuses on the physical and psychological well-being of the mother and the newborn baby.
The postpartum period typically lasts 6-8 weeks.
Primary focus: preventing major complications (haemorrhage, infection, hypertension, sepsis), and supporting breastfeeding.

Post-abortion care

Emergency treatment for complications of incomplete/potentially life-threatening abortions.
Comprehensive care including family planning counseling and links between post-abortion emergency services and reproductive health care.
Essential components include emergency treatment (diagnosis and management of complications), partner counseling/management; family planning counseling and services, and links between post-abortion care and reproductive health system.

Gender and Reproductive Health

Sex: Biological differences (e.g., genitals, chromosomes, hormones). Gender: Economic, social, and cultural attributes associated with being male or female in a particular social setting at a particular point in time.
Gender equality: Equal treatment, policies, and access to resources and services.
Gender equity: Fairness in distributing benefits and responsibilities between men and women.

Family Planning

Decision-making process by couples (or individuals) to determine the number and spacing of their children.
Objectives: Limit family size, space children, reduce maternal/child morbidity/mortality related to unwanted/high-risk pregnancies, and help infertile couples conceive.
Advantages: Reduced maternal/child morbidity/mortality, improved family well-being (better food, clothing, housing and living standards), reduced fertility rates promoting economic development, conservation of natural resources, and decreased dependence of youth.

Family Planning Methods

Refers to methods or ways to prevent unwanted pregnancy.

Hormonal Contraceptive Methods

Oral contraceptives (pills): Contain estrogen and progestin, taken daily; immediate effect.
Injectable contraceptives: Systemic progestin preparations administered by injection, every 2-3 months, effective immediately, reduced need for daily medication, and long-term.
Implants: Matchstick-sized progestin-filled rods inserted under the skin of the upper arm, provide up to 5 years of protection, highly effective, immediately effective and user friendly.
Contraceptive patches: Release daily doses of hormones via the Skin, used for 3 weeks followed by one week without a patch.

Contraceptive Patches

Releases daily doses of hormones (estrogen and progestin) into the bloodstream through the skin.
Used for 3 weeks, followed by a withdrawal bleed week

Injectable Contraceptives

Systemic progestin preparations by injection, given every 2-3 months.

Intrauterine Contraceptives Devices (IUDs)

Small flexible plastic devices inserted into the uterus, with or without copper, preventing pregnancy for years.
Types: Copper-releasing (e.g., Copper T 380A, Nova-T) and progestin-releasing (e.g., Progestasert, LevoNova).

Surgical Sterilization

Tubal Ligation: Sealing of fallopian tubes to prevent egg passage.
Vasectomy: Sealing of vas deferens to prevent sperm transport.

Emergency Contraception

Methods used to prevent pregnancy following unprotected sexual intercourse.
Types: Emergency contraceptive pills (ECPs), and Copper releasing IUDs.

Menstrual Cycle and Safe Period

Ovulation typically occurs 10-16 days before the next menstrual cycle.
Calculating the safe period involves determining the fertile and infertile days in the menstrual cycle.

Child Health

Biologically: Child is in developmental stage of childhood, between infancy and adulthood. Health: state of physical, mental, intellectual, social and emotional well-being. Healthy Children grow in families, environments and communities with opportunities to reach their full potential.
Causes of Child Mortality in Ethiopia; Neonatal causes, pneumonia, diarrhea, malaria, measles, Malnutrition, HIV/AIDS

Child Health Services

Newborn care, Immunization, Growth monitoring, early detection and treatment of health problems.

Growth and Development

Process from conception to maturity, orderly sequence in each person.
Growth: Gradual increase in body size, increase in cell numbers and size.
Development: Maturation of organs and systems, acquisition of physical, intellectual, and interpersonal skills, ability to adapt to stress, creative expression.

Growth Assessment Parameters

Weight for age—Growth faltering
Height for age—Stunting
Weight for height—Wasting
Head circumference (average 35cms)
Mid-upper arm circumference (1-5 years; normal >12 cm)

Vaccine Management System

Cold chain: Ensuring potency, quality and safety of vaccines by maintaining correct temperature during transport and storage.
Importance of Cold chain systems: Ensuring potency; Quality of Vaccines; Safety of Vaccines (from Manufacturer to Children/Women)

Vaccination Storage

National level: Storing Vaccines up to 6 months, using appropriate storage temperatures to preserve Vaccine Potency
Regional level: Storing Vaccines up to 3 months, and sending Vaccines via appropriate Insulated Containers
District Level: Storing Vaccines up to 1 month, and sending vaccines via insulated containers
Health Facility: Storing Vaccines up to 1 month, maintaining storage conditions to preserve Vaccine Potency.

Cold Chain Equipment

Cold boxes: Transporting vaccines
Vaccine carriers: Carrying vaccines (16-20) vials.
Ice packs: Maintaining the cold temperature during storage and transportation.

Tools for monitoring the cold chain

Cold Chain Refrigerators graph
Cold chain Monitor Card
Thermometers: Checking temperatures.
StopWatch and Freeze Tag cards: Checking storage/ transportation temperatures, for immediate action based on findings.

Vaccine preventable disease surveillance

Monitoring vaccine effectiveness through randomised field trials; retrospective cohort studies, case control and incidence density measures

HIV/AIDS and Reproductive Health

Introduction: HIV and AIDS are significant health and development challenges, causing millions of deaths. Current global trends show about 1.5 million new infections.
Transmission: Sexual contact, direct contact with infected blood or secretions and Mother -to-child transmission;
Prevention: Primary prevention (ABC/Condoms, Screening); Secondary prevention (ART); and Tertiary Prevention (Psycho-social Support)
Proposed Treatment target: Aims to provide testing, treatment and Viral suppression by implementing 90-90-90 Treatment Approach
STI and Syndromic Approach: Identifying and treating common symptoms and potential pathogens in STI's, enabling more inclusive and efficient STI management. Identifying and treating the main pathogens in a community/region will aid in the overall reduction of STI's in the region.

Sexually Transmitted Infections (STIs)

Introduction: STI is commonly caused by organisms transmitted via sexual contact, poses a significant burden of disease and economic consequences globally.
Etiology: Caused by more than 30 different pathogens (bacteria, viruses, protozoa), often occurring as mixed infections and are characterised by a variety of symptoms.
Epidemiological synergy with HIV: Inflammatory STIs and genital ulcers increase HIV acquisition; STIs may increase resistance to HIV treatments. HIV affects susceptibility to STI pathogens leading to difficulties in treatment and spread of infections.
Approaches to STI management: Etiologic, Clinical, and Syndromic approaches.

Population Dynamics

Defining a Population as a group of individuals of the same species living and interbreeding in a given geographic area. Population dynamics refer to variations among populations due to births, deaths, and migration.

Measures of Fertility and Reproduction

Fecundity: Physiological capacity to conceive.
Infecundity (sterility): Lack of capacity to conceive (primary, secondary).
Fecundability: Probability of conception during a menstrual cycle.
Fertility or natality: Manifestation of fecundity.
Infertility: Inability to bear a live birth.
Natural fertility: Fertility without deliberate parity control.
Reproductivity: Extent to which a group replaces itself through natural processes.
Gravidity: Number of pregnancies.
Parity: Number of live births from a given woman.
Birth interval: Time between successive live births.
Pregnancy interval: Time between successive pregnancies.

Measures of Mortality

Mortality: Deaths in a population over a given period.
Crude Death Rate (CDR): Number of deaths per 1,000 population in a given year (a measure of health status of population) .
Age-specific Mortality Rate (ASMR): Deaths in specified age groups per 1,000 population in the same age group (used for comparing mortality at different ages).
Infant Mortality Rate (IMR): Number of deaths of infants under one year of age per 1,000 live births.
Under-five Mortality Rate (<5MR): Number of deaths of children under five years of age per 1,000 children under five years of age (also a measure of health status of population).
Neonatal Mortality Rate (NNMR): Deaths of infants under one month of age per 1,000 live births (measure of prenatal and obstetric care).
Post-neonatal Mortality Rate (PNNMR): Deaths of infants between one month and one year of age per 1,000 live births.
Maternal Mortality Ratio (MMR): Number of maternal deaths related to pregnancy, childbirth, and post-natal complications per 100,000 live births.
Lifetime risk of maternal death: Calculated by multiplying the maternal mortality rate by the length of woman’s reproductive age.

Questions (page 309)

Using given data (population, women of reproductive age, number of births, and maternal deaths), calculate the maternal mortality ratio, maternal mortality rate, and lifetime risk of maternal death for country X in a given year.

Measurement of Migration

Migration: Movement of people from one geographic area to another, crossing pre-defined boundaries.
Types: Internal (within a country) and international (across borders).
Measures: Net internal migration (in-migrants - out-migrants); Net international migration (immigrants - emigrants); Gross internal migration; Overall net migration; Immigration rate; and emigration rate

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Test your knowledge on reproductive health care, including prenatal and postnatal care, skilled attendants, and youth-friendly health services according to WHO guidelines. Answer questions about the key components and priorities in reproductive health to deepen your understanding of this vital area of healthcare.