1. NCD Crisis and Reproductive Health Trainee Intern Repa Ben 2015

2. Aims What are the pressing RH issues in Fiji ? Why is access to RH important to the development of the nation? How does NCD crisis affect RH?

3. An Introduction…… Reproductive Health 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 its functions.

4. Components of Reproductive Health It has 8 core components: 1.Family Planning 2.Maternal Health : ANC, Delivery, PNC 3.AHD-Teen Pregnancy 4.RTI/STI/HIV 5.Abortion & its Complications 6.RT Cancers 7.Child Health 8.Gender Equity, Empowerment &Reproductive Rights

5. The 8 Millennium Development Goals? 1.Eradicate extreme poverty & hunger 2.Achieve Universal Primary Education 3.Promote gender equality & empower women 4.Reduce child Mortality 5.Improve maternal health 6.Combat HIV/AIDS, Malaria & other diseases 7.Ensure environmental sustainability 8.Develop a global partnership for development

6. Global Reproductive Health Strategy. Policy to strengthen health systems Existence of a task force Inclusion of reproductive health within proposals to the global fund Human resources assessment ▫Training needs Improving data for quality of sexual and reproductive health care Standards –guidelines for service delivery Strengthening referral systems.

7. WHO Global Reproductive Health Strategy Targets the five priority aspects of reproductive health  Improve antenatal/delivery/postpartum/newborn care  Provide high quality family planning services  Eliminate unsafe abortion  Combats STI/RTI’s including HIV, cervical cancer and other morbidities  Promote sexual health ( include adolescence)

8. Reproductive Health Priorities Crude birth rate -21/1000 Contraceptive Prevalence Rate -45% Level of unmet need for family planning remains relatively high High rates of STI’s-high infertility rate Adolescent Fertility Rate –slightly decreased in the last 5 years-50/1000 Birth to teenage mothers account for 10% of all births

9. Maternal morbidity data –high & largely linked to high incidence of diabetes,other NCD’s in pregnancies, premature birth, anemia Maternal mortality ratio-30-40 per 100000 live births in the past decade Neonatal mortality rate-15/1000 births (prematurity, severe infection) Infant mortality rate-20/1000 live births

10. Abortion –not legal- high rates of case presentation Cervical cancer- incidence-51.3/100000 WHO data published in April 2011 Cervical Cancer Deaths in Fiji reached 66 or 1.61% of total deaths (Law I, Fong JJ, Buadromo EM, et al. 2004-2007 - Pap smear coverage -8.0% )

11. NCD’s and Female Motality NCD’s kill 50000 women every day (>1000 /hr - CVD) According to the 2002 STEPS Survey : Overweight (Females)-31.5% Obese (Females)-26.4 % Hypertension -10.9% Fasting blood glucose (>6.1)-15.2%

12. Obesity and Menstrual Problems Polycystic Ovarian Syndrome – as a syndrome of obesity, hirsuitism, anovulation and infertility, associated with enlarged and polycystic ovaries -Weight loss - up to 80% improvement in menstrual function, hirsuitism was reduced by 40% in the women

13. Obesity and Fertility Hamilton-Fairley et al. -studied the risk of miscarriage and associated BMI,BMI( 19-24.9),- 11% miscarriage, BMI (25-27.9) -14 %,BMI >28), 15%.

14. Obesity and Pregnancy Maternal Obesity (WHO) -BMI ->30 ▫Maternal risk -30–39.9 -increased risk of gestational diabetes mellitus(x3), chronic hypertension,preeclampsia(inc.50%),thromboemb olism - BMI of less than 30. ▫Intrapartum -induction of labor, slow labour progression,emergency caesarean section, primary postpartum hemorrhage ▫Anasthesia & surgical risk

15. Fetal risk - increased risk of prematurity,stillbirth, congenital anomalies(neural tube defects –double), macrosomia, birth injury and childhood obesity

16. Obesity and Cancer Increases rate of : endometrial carcinoma (3 x -9.5-22.5 kg overweight, to x10 - excess of weight > 22.5 kg) Post menopausal breast cancer Cervical cancer –double risk Other cancers-esophagus, pancreas,colon,kidney,thyroid,gall bladder (dec. of BMI by 1 –avoid 100000 new cases)

17. Solutions Empowering women to take ownership of their own health Risk factors -modifiable Increase coverage+quality care-prenatal to post natal care Readily available Paps smear services Strengthen delivery of comprehensive approach to contraception Rebuild village +community health networks Strength the use of data to monitor &manage performance

18. References: Steps survey 2002 Anon, (2015). [online] Available at: http://bmb.oxfordjournals.org/content/53/2/341.full.pdf [Accessed 18 Jun. 2015]. Anon, (2015). [online] Available at: http://www.health.gov.fj/wp-content/uploads/2014/09/1_Reproductive-Health- Policy.pdf [Accessed 18 Jun. 2015]. Aogd.org, (2015). [online] Available at: http://aogd.org/AOGD-Bulletin-January-2015.pdf#page=6 [Accessed 18 Jun. 2015]. Boyles, S. (2015). Obesity Linked to Infertility in Women. [online] WebMD. Available at: http://www.webmd.com/infertility-and-reproduction/news/20071211/obesity-linked-to-infertility-in-women [Accessed 18 Jun. 2015]. Cancer.org, (2015). What are the risk factors for cervical cancer?. [online] Available at: http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-risk-factors [Accessed 18 Jun. 2015]. Global Health Hub: news and blogosphere aggregator, (2011). Women: A Powerful Solution to the NCD Crisis. [online] Available at: http://www.globalhealthhub.org/2011/08/12/women-a-powerful-solution-to-the-ncd-crisis/ [Accessed 18 Jun. 2015]. ICPD 1994. (2015). [online] Available at: http://www.unfpa.org/sites/default/files/event-pdf/PoA_en.pdf [Accessed 18 Jun. 2015]. Law, I., Fong, J., Buadromo, E., Samuela, J., Patel, M., Garland, S., Mulholland, E. and Russell, F. (2013). The high burden of cervical cancer in Fiji, 2004?07. Sexual Health, 10(2), p.171. Roura, L. and Arulkumaran, S. (2015). Facing the noncommunicable disease (NCD) global epidemic – The battle of prevention starts in utero – The FIGO challenge. Best Practice & Research Clinical Obstetrics & Gynaecology, 29(1), pp.5- 14. World Life Expectancy, (2015). Cervical Cancer in Fiji. [online] Available at: http://www.worldlifeexpectancy.com/fiji- cervical-cancer [Accessed 18 Jun. 2015

19. VINAKA