1. CHAPTER 17 Global Health in Reproduction and Infants By: Carol Holtz

2. In my country, the time of birth is associated with fear because so many mothers and babies die... It seems that no one notices women and children dying. Are we invisible? It feels that way to us. —Reverend Agnes Mukandoli of Rwanda, Partnership for Safe Motherhood and Newborn Health, 2004

3. Background Poor or inadequate sexual and reproductive health contributes to one third of the world’s burden of disease for women of childbearing age and one fifth of the total world population The Global Burden of Disease Initiative Sexual and reproductive health issues represent 18% of the world’s total burden of disease and 32% of the burden of women of childbearing age (15-44 years) Disability adjusted life years (DALYs) Definition of Reproductive Health

4. Reproductive Health Reproductive health is 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 its functions and processes. Reproductive Health Care The constellation of methods, techniques, and services that contribute to reproductive well-being by preventing and solving reproductive health problems. It also includes sexual health. (United Nations, 2004; UNFPA, 2011)

5. Reproductive Rights The United Nations’ Programme of Action of the International Conference on Population and Development, 1995 Adolescent Reproductive Health Menarche (the age at which reproduction is physically possible) varies greatly across societies In the U.S. about one million adolescents ages 11-19 become pregnant every year and 500,000 give birth 14 million young women worldwide ages 15- 19 gave birth each year

6. Teenage pregnancy rates have declined during the last 25 years in developed countries Abortion rates for teenagers in developed countries vary greatly Sexually transmitted diseases disproportionately affect teenagers as compared to older women of childbearing age Syphilis Gonorrhea Chlamydia

7. Cultural Influences Fertility Men are physiologically capable of reproducing longer than women and often marry later and become fathers at older ages than women Culture Infertility The biological failure to conceive by normal sexual activity without contraception Inability to carry a pregnancy to full term Cultural and Religious Issues

8. Family Planning and Contraception

9. Most common forms of contraception in the United States: Oral contraceptive pill Female sterilization Male condom Male sterilization Injectable Depo-Provera Nearly 98% of all women who have had sexual intercourse have used at least one type of contraception Emergency Contraception

10. Family planning services should be integrated within primary healthcare services, including: education counseling for informed contraception decision making care for STDs cervical cancer screening breast cancer screening (WHO, 2010)

11. Abortion Elective Abortion - voluntary termination of pregnancy History of Elective Abortion Childbirth by Choice Trust (1999) World Perspectives Presently, two thirds of the world’s population allows abortion upon request Women should be provided safe abortion services to the full extent of the local law WHO (2010) Packages of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn, and Child Health

14. Maternal Mortality and Morbidity The Maternal Mortality Rate: the number of maternal deaths per 1000,000 women of reproductive age for a specific period of time (usually one year) Causes of maternal mortality worldwide are ranked: 1.Hemorrhage 2.Sepsis 3.Hypertensive disorders 4.Abortion complications 5.Obstructive labor

15. Prenatal Care Includes Information and counseling on self-care at home, including nutrition, safer sex, HIV prevention and care during pregnancy, breastfeeding, family planning, and the harmful effects of drugs, alcohol, and tobacco use during pregnancy Childbirth preparation and danger signs of pregnancy Support and care for women with HIV/AIDS Assessment and assistance with domestic violence Confirmation of pregnancy Monitoring pregnancy progress, including maternal and fetal well- being Detection and treatment of pregnancy complications In some situations, antimalarial treatment, assessment of female genital mutilation, and deworming (WHO 2010)

16. Accessing Reproductive Health Care Prenatal care reduces maternal and newborn complications through regular checkups Two United Nations millennium development goals (MDG’s) Likelihood of mothers entering prenatal care increases with age and education and decreases with numbers of children

17. Delivery and Postpartum Care Skilled attendants Equipment and medicines Newborn resuscitation Immediate and ongoing newborn care Breastfeeding Care of mother after birth WHO 2010

20. Infant Health Infant Mortality Infant Mortality Rate Neonatal Mortality Rate Early Neonatal Morality Rate Late Neonatal Morality Rate Late Fetal Mortality Rate Perinatal Mortality Rate Low-Birth Weight Rate Moderately Low-Birth-Weight Rate Very Low-Birth-Weight Rate Term – Births at 37-41 weeks Preterm – Births at less than 37 completed weeks

24. Causes of neonatal deaths include: Preterm births (low birth weight) Severe infections (sepsis, pneumonia, tetanus, and diarrhea Asphyxia Congenital abnormalities Infant Abandonment in China Diarrhea in Children in Developing Countries

25. Sexually Transmitted Diseases (STDs) Prevention and Treatment Care HIV Infection and Reproduction About 700,000 children under 15 years of age are infected with HIV every year in the world The World Health Organization recommends exclusive breastfeeding from birth to 6 months of age

27. Violence Against Women United National Declaration on the Elimination of Violence Against Women of 1993 Female Genital Mutilation, also called female circumcision, female cutting Type I – Excision of the prepuce Type II – Excision of the clitoris & labia minora Type III – Excision of part or all of the external genitalia & stitching/narrowing of the opening (infibulation) Type IV – Pricking, piercing, or incision of the clitoris and/or labia

28. Male Reproductive Health Men in sub-Saharan Africa have a significant reduction in life span Men had their first sexual encounter by age 20 Male and female sterilization is common in males and females in developed countries STDs are highest in men in sub-Saharan Africa, Latin America and Caribbean areas HIV/AIDS rates are the highest in the world in sub- Saharan African men and women