1. REPRODUCTIVE HEALTH TRENDS AND ISSUES CFH-PHC 6590-001 G. LOPEZ M.D

2. A JOINT ENTERPRISE Student ceases to be a data bank in which deposits of knowledge are made by the teacher to become a participatory actor who responds to the challenges of each problematic situation

3. DEFINITION* 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 related to the reproductive health system and to its functions and processes *adopted by ICDP - Cairo 1994

4. REPRODUCTIVE HEALTH Implies: Ability to reproduce,to regulate their fertility,and to practice and enjoy sexual relationships That reproduction is carried to a successful outcome through infant and child survival,growth,and healthy development. That women can go safely through pregnancy and childbirth,that regulation of fertility can be achieved without health hazards and that people feel and are safe in having sex

5. REPRODUCTIVE HEALTH GOALS (WHO Program) *Experience healthy sexual development and maturation and have the capacity for equitable responsible relationships and sexual fulfillment *Achieve their desired number of children safely and healthily,when and if they decide to have them

6. REPRODUCTIVE HEALTH GOALS (WHO program) *Avoid illness, disease and disability related to sexuality and reproduction and receive appropriate care when needed * Be free from violence and other harmful practices related to sexuality and reproduction

7. REPRODUCTIVE HEALTH LIFE STAGES BIRTH INFANCY AND CHILDHOOD ADOLESCENCE ADULTHOOD MATURE AGE ( Post Menopause- Geriatrics)

8. REPRODUCTIVE HEALTH LIFE RISKS INFECTIONS RAPE AND ABUSE STDs/HIV/AIDS LEUKORRHEA MENSTRUAL DYSFUCTIONS ABORTION PREGNANCY BIRTH TRAUMA PELVIC FLOOR LESIONS( Prolapse- Incontinence) TUMORS (Breast- Cervix- Endometrium- Ovaries-Vagina) OSTEOPOROSIS- FRACTURES

9. REPRODUCTIVE HEALTH INTERVENTIONS AND PROGRAMS POPULATION IDENTIFICATION DETECTION OF RISK GROUPS PREVENTION Motivation,Promotion Education SEX EDUCATION EPIDEMIOLOGIC PSYCHOPROPHILACTIC (Lamaze ) ONCOLOGIC CARE AND TREATMENT FOLLOW-UP ACCORDING TO LEVELS AND RISKS

10. Reproductive health selected aspects (1990-1995) WHO

11. MATERNAL PRACTICES INFLUENCING CHILD SURVIVAL IN REPRODUCTIVE LIFE STAGES PRECONCEPTION: 1) Conception delaying actions: postponement of marriage-birth spacing-contraception- abstinence-breast-feeding PREGNANCY: 2)Specific preventive practices to “protect” pregnancy,e.g.: dietary restrictions; traditional practices; modern practices; rituals; prenatal care. 3)Treatments for sickness/complications-traditional- modern 4) Dietary practice an care- Food taboos 5) Work activities: physical demands of work (energy) 6) Other behaviors: smoking-use of drugs-etc

12. MATERNAL PRACTICES INFLUENCING CHILD SURVIVAL IN REPRODUCTIVE LIFE CYCLE CHILDBIRTH 7) Place selected for birth- Hygiene- :Home-Health Facility 8) Attendant: self/family-tba-qualified POST-NATAL :9) Breast-feeding practices-use of colostrum-duration-partial breast-feeding- pattern(demand,schedule,nighttime) 10) Supplementary feeding: type/timing/amount of foods offered;special foods;use of bottle feeding 11)Dietary practices of mother:food taboos/restrictions/supplements.

13. MATERNAL PRACTICES (cont) 12) Household hygienic practices: cleaning;bedding;diapers;food preparation; storage;latrine/toilet;water/soap; general environment. 13) Specific prevention practices traditional (taboos;rituals;circumcision)-modern postpartum childcare: (immunizations; vitamins;contraception) 14) Sickness care practices: traditional ( food restrictions; medicines;rituals) modern. 15) Activities ( work) of the mother: time resuming household work-Outside work care - Care of infant during work (place of care home or work) Delegation of care ( sibling/relative) unqualified or qualified caretaker.

14. SOME GLOBAL OVERVIEW DATA Birth rate per 1000 population(1999 ): World: 23-More developed countries: 11- Less developed countries: 26-Less developed countries excluding China:29 2) Infant Mortality rate (Infant deaths per 1000 live births) (1999): World: 57- More developed countries: 8- Less developed countries: 62- Less developed countries excluding China:68 3) Contraceptive use women in union (1999 ): Prevalence % rate all methods- World: 58- More developed countries: 72- Less developed countries:55- Less developed countries excluding China:44

15. GLOBAL OVERVIEW DATA (Cont) Contraceptive use modern methods(1999 ): World: 51- More developed Countries: 59- Less developed countries 49- Less developed countries excluding China: 37 Maternal Mortality Ratio ( Per 1000 live births) (1992) World: 320 -More developed countries: 9- Less developed countries: 350- Less developed countries excluding China: 410) Life time chance of Maternal death according to region ( 1987): Africa 1 in 21- Asia 1 in 54 - South America 1 in 73- Caribbean 1 in140- North America 1 in 6366- Northern Europe 1 in 9850