Lecture 1&2: Overview and Concepts of Reproductive Health PDF

# HEALTH ## Lecture 1&2: Overview and Concepts of Reproductive Health ### College of Nursing - Yarmouk University - Jordan ## Content of the lecture - Reproductive Health Definition - Components of Reproductive Health - Reproductive health indicators - Definitions and key concepts of the Reproduct...

# HEALTH ## Lecture 1&2: Overview and Concepts of Reproductive Health ### College of Nursing - Yarmouk University - Jordan ## Content of the lecture - Reproductive Health Definition - Components of Reproductive Health - Reproductive health indicators - Definitions and key concepts of the Reproductive System - Female Reproductive Cycle - Global perspective - In Jordan ## Introduction - Reproductive health and safe motherhood are critical aspects of public health, with significant implications for individuals, families, and societies. ## Definition of 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 process". ## Definition of Reproductive health - Reproductive health refers to the overall well-being of individuals in all matters related to the reproductive system, including access to healthcare services, education, and information. Key components of reproductive health at the global level include: ## Components of Reproductive Health - Quality family planning services - Promoting safe motherhood: prenatal, safe delivery and post natal care, including breast feeding - Prevention and treatment of infertility - Prevention and management of complications of unsafe abortion - Safe abortion services - Treatment of reproductive tract infections, including sexually transmitted infections - The health of the mother affects the whole family #### **Complications of unsafe abortion** - risk of **hemorrhage** after delivery - **hypertension** during pregnancy ## Reproductive Health indicators #### **Key definitions** - **Total Fertility Rate**: Total number of children a woman would have by the end of her reproductive period, if she experienced the currently prevailing age-specific fertility rates throughout her childbearing life. TFR is one of the most widely used fertility measures to assess the impact of family planning programs. - **Contraceptive Prevalence (any method)**: Percentage of women of reproductive age who are using a contraceptive method at a particular point in time. - **Maternal Mortality Rate**: The number of maternal deaths per 100 000 live births from causes associated with pregnancy and child birth. - **Antenatal Care Coverage**: Percentage of women attended, at least once during pregnancy, by skilled health personnel for reasons relating to pregnancy. - **Births Attended by Skilled Health Personnel**: Percentage of births attended by skilled health personnel. This doesn't include births attended by traditional birth attendants. - **Availability of Basic Essential Obstetric Care**: Number of facilities with functioning basic essential obstetric care per 500 000 population. Essential obstetric care includes, Parenteral antibiotics, Parenteral oxytocic drugs, Parenteral sedatives for eclampsia, Manual removal of placenta, Manual removal of retained products, Assisted vaginal delivery. These services can be given at a health center level. - **Availability of Comprehensive Essential obstetric care**: Number of facilities with functioning comprehensive essential obstetric care per 500 000 population. It incorporates obstetric surgery, anesthesia and blood transfusion facilities. - **Perinatal Mortality Rate**: Number of Perinatal Deaths (deaths occurring during late pregnancy, during childbirth and up to seven completed days of life) per 1000 total births. Deaths which occur starting from the stage of viability till completion of the first week after birth (22 weeks of gestation up to end of first week after birth, WHO). - **Prevalence of Anemia in Women**: Percentage of women of reproductive age (15-40) screened for hemoglobin levels with levels below 11 g/dl for pregnant women and below 12 g/dl for non pregnant women. - **Percentage of Obstetric and Gynecological Admissions Owing to Abortion**: Percentage of all cases admitted to service delivery points providing in-patient obstetric and gynecological services, which are due to abortion (spontaneous and induced . - **Prevalence of Infertility in Women**: Percentage of women of reproductive age (15-49) at risk of pregnancy (not pregnant, no contraception and non-lactating) who report trying for a pregnancy for two years or more. - **HIV Prevalence in Pregnant Women**: Percentage of pregnant women (15-24) attending antenatal clinics, whose blood has been screened for HIV, who are sero-positive for HIV. ## Key components of reproductive health at the global level - **Access to Family Planning**: Ensuring individuals have access to a range of contraceptive methods to make informed choices about the number and timing of pregnancies. - **Maternal Health**: Reducing maternal mortality rates through access to quality antenatal care, skilled birth attendants, and emergency obstetric care. - **Preventing Gender-Based Violence**: Addressing gender inequalities and violence against women and girls to protect their reproductive health rights. ## Safe Motherhood - Safe Motherhood: is a global initiative focused on reducing maternal mortality and morbidity. ## Safe Motherhood - The strategies adopted to make motherhood safe vary among countries and include: - Providing family planning services. - Providing post abortion care. - Promoting antenatal care. - Ensuring skilled assistance during childbirth - Improving essential obstetric care. - Addressing the reproductive health needs of adolescents. ## Essential Services include: - Community education on safe motherhood - Prenatal care and counseling, including the promotion of maternal nutrition - Skilled assistance during childbirth - Care for obstetric complications, including emergencies - Postpartum care ## Global Challenges - Despite global efforts to improve reproductive health and safe motherhood, challenges persist. These challenges include: - **Healthcare Access**: Disparities in access to healthcare services, particularly in low-income countries, hinder progress. - **Teenage Pregnancy**: High rates of teenage pregnancy can lead to health risks for both mothers and babies. - **Maternal Mortality**: Maternal mortality remains unacceptably high in some regions, primarily due to complications during childbirth. ## Part 2: Overview of the Female Reproductive System ## Overview of the Female Reproductive System - **Main Components**: - **Ovaries**: Function as the primary reproductive organs, producing ova and hormones. - **Fallopian Tubes**: Transport ova from ovaries to the uterus. - **Uterus**: Site for implantation and fetal development. - **Vagina**: Birth canal and the pathway for menstrual flow and intercourse. - **External Genitalia**: Include structures such as the labia, clitoris, and mons pubis. #### **Diagram of the female reproductive system** - Infundibulopelvic (suspensory) ligament - Fallopian tube - Corpus of uterus - Fundus of uterus - Fimbria - Ovary - Ovarian ligament - Uterine artery and vein - Isthmus - Vaginal fornix - Vagina - Round ligament - Broad ligament - Internal os - Cervical canal - Cervix - External os - Ovarian artery and vein ## Key Definitions - Reproductive System - **Ovulation**: Release of a mature egg from the ovary. - **Menstruation**: Shedding of the uterine lining. - **Fertilization**: Union of an ovum and sperm, usually in the fallopian tube. - **Implantation**: Embedding of a fertilized egg into the uterine wall. ## Female Reproductive Cycle - The female reproductive cycle describes the regular and recurrent changes in the anterior pituitary secretions, ovaries, and uterine endometrium that are designed to prepare the body for pregnancy (Fig. 11.7). The female reproductive cycle is often called the menstrual cycle because menstruation provides a marker for each cycle's beginning and end if pregnancy does not occur. Significant deviations from the 28-day cycle are associated with reduced fertility. - The first day of the menstrual period is counted as day 1 of the woman's cycle. The female reproductive cycle is further divided into two cycles that reflect changes in the ovaries and uterine endometrium. #### **Diagram of the female reproductive cycle** - Hypothalamus - Gonadotropin-releasing hormone - Anterior pituitary - Follicle-stimulating hormone (FSH) - Luteinizing hormone (LH) - Follicular phase - Ovulation - Luteal phase - Progesterone - Estrogen - Glands - Spiral arteries - Veins - Functional layer - Basal layer - Menstrual phase - Proliferative phase - Secretory phase - Ischemic phase - Menstrual phase #### **Key hormones** - **Estrogen**: Stimulates growth of the uterine lining and development of secondary sexual characteristics. - **Progesterone**: Maintains the uterine lining for pregnancy. - **Follicle-Stimulating Hormone (FSH)**: Stimulates follicle development. - **Luteinizing Hormone (LH)**: Triggers ovulation and corpus luteum formation. After the ovary releases a mature ovum during ovulation, the ruptured follicle transforms into the corpus luteum. Hormonal Secretion: The primary function of the corpus luteum is to produce hormones, mainly progesterone, and to a lesser extent, estrogen. ## The Ovarian Cycle - **Follicular Phase**: Development of follicles in the ovaries. The follicular phase is the period during which an ovum matures. It begins with the first day of menstruation and ends approximately 14 days later in a 28-day cycle. - **Ovulation**: Mid-cycle release of the mature ovum. Near the middle of a 28-day reproductive cycle, approximately 2 days before ovulation, LH secretion rises markedly. Secretion of FSH also rises, but less than LH does. These surges in LH and FSH cause a slight fall in follicular estrogen production and a rise in progesterone secretion, stimulating final maturation of a single follicle and release of its mature ovum. - **Luteal Phase**: Formation of the corpus luteum, which secretes hormones to maintain the uterine lining. After ovulation and under the influence of LH, the remaining cells of the old follicle persist for approximately 12 days as a corpus luteum. The corpus luteum secretes estrogen and large amounts of progesterone to prepare the endometrium for a fertilized ovum. Levels of FSH and LH decrease during this phase in response to higher levels of estrogen and progesterone. If the ovum is fertilized, it secretes human chorionic gonadotropin (hCG) that causes the corpus luteum to persist to maintain an early pregnancy. If the ovum is not fertilized, FSH and LH fall to low levels, and the corpus luteum regresses. Decline of estrogen and progesterone with the regression of the corpus luteum results in menstruation as the uterine lining breaks down. #### **Diagram of the timing events in the menstrual cycle** - LH - Day 1 - Days before - Follicular phase - Days after - Luteal phase - Menstruation - OVULATION #### **Diagram of key events in the ovarian cycle** - LH - Day 1 - Ovulati on - Follicular growth - Luteal function - Menstruation - Oestradiol - OVULATION - Progesterone (an oestradiol) ## Endometrial Cycle - **Menstrual Phase**:Occurs at the start of the cycle (Days 1-5). - Characterized by the shedding of the uterine lining (endometrium) when fertilization does not occur. This phase involves the discharge of blood, mucus, and tissue. - **Proliferative Phase**: Lasts from approximately Days 6-14. - Driven by increasing estrogen levels, the endometrium thickens and regenerates in preparation for a potential implantation. Glands and blood vessels proliferate, making the lining suitable for a fertilized egg. - **Secretory Phase**: Occurs from Days 15-28. - Following ovulation, progesterone from the corpus luteum causes further thickening and vascularization of the endometrium. If fertilization occurs, the lining will remain to support the developing embryo; if not, hormone levels drop, leading back to menstruation. #### **Diagram of the ovarian cycle** - FSH - LH - Developing follicle - Mature follicle - Early corpus luteum - Regressive corpus luteum - Follicular phase - Ovulation - Luteal phase - Days 1 - Estrogen - Progesterone - Thickness of endometrium - Ovarian hormone secretion - Days 1 3 5 7 9 11 13 15 17 19 21 23 25 27 - Menstruation - Proliferative phase - Secretory phase - Menstruation ## Jordan's National Strategy - Reproductive and Sexual Health 2010-2030 - This strategy was developed by the Higher Population Council- Jordan ## In Jordan - According to the findings of the Population and Family Health Survey 2017-201824 and priority research the following issues were identified to describe the status of sexual and reproductive health in Jordan: - The percentage of women (aged 25-49 years) who married under the age of 18 years is high and stands at (15%), even though it has decreased compared to previous population and family health surveys. However, recent specialized studies on child marriage according to the age of marriage indicate that child marriage among Jordanians tended to increase in 2012-2015 (from 9.7% in 2012 to 11.6% in 2015), and reached very high levels among Syrian women, increasing from 35.3% in 2012 to 43.8% in 2015.) - The percentage of adolescent marriage has increased (10% of married women aged 15 -18 years who have married under the age of 15). #### **Contraceptive Use**: - Only 29% of married women aged 15-49 use any form of contraception, and just 19% use modern methods like the IUD or the pill - Among Jordanian women, the most common methods are the IUD (29%) and the pill (13%) #### **Antenatal Care**: - 87% of young mothers sought antenatal care during their pregnancies - Nearly all births (98%) occur in hospitals or clinics #### **Child Marriage and Motherhood**: - 81% of young wives had begun childbearing by the time of the survey, with 89% of girls married in childhood having children #### **Fertility Preferences**: - On average, young men want larger families (3.9 children) compared to young women (3.3 children). #### **Family Planning Knowledge**: - Only 37% of those over the age of 15 can name a method of contraception - There is a significant gender gap in contraceptive knowledge, with adolescent boys (16%) being much less knowledgeable than young women (62%) #### **Table 3.4.1 Exposure to mass media: Women** - Background - Age - Residence - Region - Governorate - Nationality - Education - Wealth quintile - Reads a newspaper at least once a week - Watches television at least once a week - Listens to the radio at least once a week - Accesses all three media at least once a week - Accesses none of the three media at least once a week - Number of women ## Conclusion - In conclusion, reproductive health and safe motherhood are global priorities, and progress is being made in many countries, including Jordan. Ensuring access to quality healthcare, education, and gender equality are key factors in advancing these critical aspects.