The Figure and Determinants of (Indonesian)RH.ppt

8/22/2019 The Figure and Determinants of (Indonesian)RH.ppt

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The Figure and Determinants of

Indonesian Reproductive Health



Session Objective

To describe and discuss the current state of global and Indonesian reproductive health

problems

To describe and discuss the determinants of

reproductive health problems

To describe and discuss the social determinants

of reproductive health problems



The meaning and scope of

reproductive health



The Scope of Reproductive

Health

RH addresses the reproductive process, functional and system

at all stages of life

Adolescent

Pre-pregnancy pregnancy

BIRT

H

Neo-natal

Post natal Childhood

Infancy

Post

partum

Maternal

Health



Aimed to….

People are

able

to

have

a responsible, satisfying

and safe sex life

the capability to reproduce

the freedom to decide if,when and how often to do

so.

1

2



Reproductive Health Right

the right of men and women to be informed of and to have access to safe, effective,

affordable and acceptable methods of fertility

regulation of their choice, and

the right of access to appropriate health care

services that :

will enable women to go safely through pregnancy

and childbirth and provide couples with the best chance of having a

healthy infant.



4 Goal to Better Reproductive Health

Goal 1: Every sex act should be free of coercion and based

on informed and responsible choice

Goal 2

Every sex act should be free of infections

Goal 3

Every pregnancy and birth is intended

Goal 4 Every pregnancy and birth is safe



Overview of RH situation,

Indonesia



RH …Bloom Framework

Reproductive

health status

Psycho-

biological

Behavior

Health

service

Environment



RH status

High risk of maternal

death and

obstetriccomplication

among

women and

female

adolescent

MMR : 307/100.000 live birth

IMR : 35/100 live births

Complication during delivery:•Prolonged labour

(30.5%)

•Excessive bleeding

(7.2%)

•Fever (4.5%)

•Convulsion (1.4%)

•Other (3.1%)



RH status

Unwanted

and

unintended

birth still

high



RH status

Exposure

to STI andHIV/AIDS

is growing



Nutrition status

The level of

malnutrition isstill high among

women and

female

adolescents



Health Services status

Unmeetneeds



Health Services status

Many

births are

still notattended

by trained

providers



Health behaviors status

Risk

Behavior

to RHamong

adolescent

is

increasing



Social Environment

Many

women

have poor

educationlevel



Economic Environment

Poverty and

impact of

economic

crisis



Reproductive health is more about

social health problems thanbiological matter

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Social Determinants of RH

The provider attitude…..in side the clinic



Provider attitude denial of service

One of the potential clients refused to have thespeculum exam.

The provider said to her, “The problem is that

you are not educated. You can’t always keep

running away from the speculum. To have

family planning your vagina must be

examined.”

The potential client was a woman with four children. She left without getting services.41



The provider said lots of rude words against my suggestion to get family planning services.

She even said that my behaviour is not all that

straight because I was looking for family

planning methods. She also said that I should

not use contraceptives because I am a

schoolgirl; therefore it won’t help me to

concentrate on school. Finally she told methat if I need anything I should come with my

parents.



Provider signals that discouraging

use of services

Manner (rudeness)

Respect privacy and confidentiality

Tailoring the information with the client

concern

Waiting time

Willingness to answer questions

Attention to pain

Encouragement to return

Fear of rude treatment is 22% reason

of women for not using FP services



Social Determinants of RH

Poverty, gender, adolescent,

education



Poverty and RH problems



The role of gender on poverty

Percentage of women using moderns contraceptive methods by

wealth according to who make decisions concerning what money is



The role of gender on poverty

Percentage of women who wanted their last child, by wealth and

ability to obtain permission to seek medical care



Urban and rural poverty

Rural poverty Urban-slum

Lack access to HS

Hazardous

environment

Lack access to clean

water, good housing,

sanitation and varied

diet

Crowded spaces

Lack of infrastructure

Indoor air pollution

Poor and

overstretched

sanitation Illegal status

Lack of security

Reduced mobility



Adolescent role

Percentage of un married 15-19 year olds who used a

condom at last sexual intercourse by wealth quintile



Education role

Percentage of women using modern

contraception by wealth and educational level



Sexual violence and coercion



Coercion at sexual debut/childhood

Percentage of sexualy-experienced girls and women of reproductive age

reporting that first sexual was forced



Intimate partner violence



Other issues of coercion….

Coercion by non partners

Sexual violence in situation of

conflict and displacement

Sexual violence and coercion

against men



The consequences

Menta

l

health

Depression, post traumatic stress

disorder, sleep difficulties, somatic

complaints, suicidal behavior

Reproductive

health

Gynaecological trauma, unintended

pregnancy, unsafe abortion,pregnancy complications, sexual

dysfunction, STIs/HIV/AIDS



The consequences

Behavioral

Unprotected sex, early consensual

initiation, multiple partners, alcohol

and drug abuse; a higher risk of perpetrating or experiencing

subsequent sexual violence

Fataloutcome Death from pregnancy complication,unsafe abortion, AIDS, murders of

women



The consequences

Social

outcome

Unwanted child bearing , withdrawn

from school, inability to form adult

relationship rejection by partner or

family



Factors associated with sexual

coercion

Society Community Relationships Individual



Society

Lack of criminal sanctions against sexual

violence1

Weak laws & policies related to the civil rightof girls & women2

High levels of general violence in society3

Armed conflict4



Community

Community norms that entitle men to sex

&/ discourage women’s sexual autonomy

Lack of community sanctions against sexualviolence

Unsafe public places

Communication norms that encourage

early marriage



Relationship

Male dominance in the family that includes

right to sex1

Age differences between intimatepartners

2

Barriers to discussion/negotiation about

sex

3

Communication norms that encourage

early marriage4



The complicated adolescent RH



What you can do as the

physician?



Provider influence on client utilization of

SRH services,………framework

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