2020

REPRODUCTIVE HEALTH AND HYGIENE

Reproductive health is ability of a person to concive and deriver safely

 OBJECTIVE OF REPRODUCTIVE HEALTH

  High fertility levels contribute directly to poverty, reducing women’s opportunities, diluting

expenditure on children’s education and health, precluding savings, and increasing

vulnerability and insecurity

..

  Achieve universal primary education

 Girls in developing countries are often pulled out of school to care for siblings and by early

marriage and pregnancy.

 Girls in small families are less likely to drop out of school due to their mother’s pregnancy,

or to be pulled out due to the costs of schooling or the indirect costs of foregone household

labor if a child attends school.

  Promote gender equality and empower women

 Guaranteeing sexual and reproductive health and rights ensures that girls and women lead

longer and healthier lives.

  When encouraged and provided with opportunities, men seek out reproductive healthcare,

thus increasing the possibility for better health outcome for themselves, their partners, and

families.

  Reduce child mortality

• Maternal behavior and fertility are important determinants of child health and survival.

• In pregnancies spaced at least three years apart, infant mortality rates drop by 24%; and

under-five mortality rates drop by 35%. Annually, pregnancy spacing could save the lives of

3 million children under age five.

  Improve maternal health

  Women in developing countries are more than 45 times more likely to die from pregnancyrelated

complications than women in the developed world.

 For every woman who dies in pregnancy or childbirth, approximately 30 others (15 million

women annually) suffer injuries, infection and disabilities.

 Access to and correct, consistent use of family planning and emergency obstetric care can

significantly reduce maternal morbidity and mortality.

  Combat HIV/AIDS, malaria, and other diseases

• Ensuring universal access to sexual and reproductive health would help combat HIV/AIDS

by encouraging consistent and effective use of condoms; influencing sexual behavior

through education, counseling and risk reduction; preventing mother-to-child transmission

of HIV; reducing the prevalence of STIs and helping guarantee women in malaria-endemic

areas receive effective anti-malarial drug treatments during their pregnancy.

Key Facts and Figures on Sexual and Reproductive Health

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  Ensure environmental sustainability

  The past century of population growth has put increasing pressure on natural resources as

the scale of human needs and activities has expanded.

  By 2025, with the projected future population growth, between 2.4 and 3.2 billion people

may be living in water-scarce situations.

  Global partnerships

  Global partnership is required to provide adequate financing for the effective provision of

reproductive health drugs and supplies.

  New resource estimates indicate that US $36 billion per year is needed by 2015 to provide

the necessary sexual and reproductive health services around the world.

Objectives of family planning programmes

Some important issues to cover in the assessment of the community perspectives on

family planning include6:

􀂃 Ideal family size, ideal timing and spacing of births;

􀂃 Knowledge and use of contraceptive methods;

􀂃 Attitudes and practices regarding abstinence;

􀂃 Sources of family planning information and services;

􀂃 Religious perspectives on family planning;

􀂃 Attitudes and practices regarding abortion;

􀂃 Men’s participation in family planning;

􀂃 Changes in attitudes since being forced to migrate;

􀂃 Barriers and facilitators to accessing family planning services;

􀂃 Perceptions about the quality of family planning services;

􀂃 Adolescent perspectives on family planning and contraceptive methods.

effects, and also helps reduce discontinuation.

Sexually transmitted infections and HIV/AIDS

HIV/AIDS

HIV (human immunodeficiency virus) is the

virus that causes AIDS (Acquired Immune

Deficiency Syndrome).  

HIV is spread

between persons in the following ways:

􀂃 Sexual intercourse

􀂃 Mother-to-child

􀂃 Blood transfusion

􀂃 Contaminated instruments, needles and

gloves

HIV is not spread by casual contact such as

kissing, shaking hands, or sharing food,

clothing, or toilet seats. Nor can it be spread

by mosquitoes.

Accurate diagnosis is critical in the fight

against both HIV and other STIs. HIV

diagnosis is feasible even in resourcelimited

settings using tests that detect HIV

Major signs:

􀂃 Weight loss of more than 10% body weight

􀂃 Diarrhoea for more than 1 month

􀂃 Fever for more than 1 month

Minor signs:

􀂃 Persistent cough for more than one month

􀂃 Generalized itching skin rash

􀂃 Recurring shingles (herpes zoster)

􀂃 Thrush of mouth and throat

􀂃 Chronic severe and spreading cold sores (herpes simplex)

􀂃 Generalized enlarged lymph nodes

􀂃 Loss of memory

􀂃 Loss of intellectual capacity

􀂃 Peripheral nerve damage 

health care

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Sexually transmitted infections (STIs)

Infections caused by viruses.

Common viral infections include human papillomavirus

(HPV), genital herpes, hepatitis B and C, genital warts, and HIV. There is no cure for

these infections, but some symptoms may be relieved with medications. Clients with

these infections often need ongoing support and care from health care providers. Left

untreated, viral infections can lead to cervical cancer, liver damage, and even death. One

major infection caused by viruses is HIV. HIV is the virus that causes Acquired Immune

Deficiency Syndrome (AIDS). HIV slowly damages the body’s immune system, reducing

its ability to fight other diseases. People living with HIV—after years of infection without

any signs or symptoms—develop AIDS. When they have AIDS, they may get sick more

easily with certain illnesses (skin rashes, chronic diarrhoea, wasting, pneumonia, oral

thrush, or tuberculosis). Without treatment, most people with AIDS will eventually die

from illnesses their bodies can no longer fight.

Transmission

The bacteria and viruses that cause STIs, including HIV, are carried in body fluids

including semen, vaginal fluid, mucus membrane secretions (fluids released from the skin

that lines the anus, vagina, mouth), and blood. Infections are spread by actions that

transfer body fluids, such as:

􀂃 Vaginal intercourse;

􀂃 Anal intercourse (with a man or a woman);

􀂃 Oral intercourse (risk is with the person using their mouth);

􀂃 Other sexual activities that allow body fluids to enter the mouth, anus, or vagina or to

touch an open cut or sore;

􀂃 Skin-to-skin contact of the genitals (spreads human papilloma virus (HPV), herpes

and primary syphilis).

Infections in the blood (Hepatitis B, Hepatitis C, and HIV) are also spread by sharing

needles with an infected person (for example, among injecting drug users), transfusions

of infected blood or blood products, tattooing, body piercing, or being cut with needles,

razors, or other sharp objects that are contaminated with HIV, or infected blood touching

Prevention and management of STIs and HIV/AIDS

1..Distribution of condoms

Field staff should develop a plan to address the prevention and management of

STI/HIV/AIDS depending on the most pressing needs identified through the assessment.

One possible option is the distribution of condoms. The consistent and correct use of

condoms is known to prevent the transmission of HIV. Condom distribution should be

included in plans at all stages of the emergency and, as highlighted in the Inter-agency

Field Manual Reproductive Health in Refugee Situations, should include the following:

􀂃 Condoms and instructions for their use should be available on request in health

facilities (especially where STIs are treated) and distribution centres. Staff should be

trained in the promotion, distribution and use of condoms;

􀂃 Promotional campaigns should be launched at sports events, mass rallies, dance and

theatre venues, group discussions, and other locally-appropriate meeting points to

promote the use of condoms and provide information on where and how to obtain

them;

􀂃 Liaise with local health authorities and groups involved in HIV prevention in the

populations surrounding the camp to coordinate condom distribution in those areas;

􀂃 Start partial cost-recovery of condoms through social marketing if and when feasible

and appropriate, for example through shops, bars, and community distribution agents.

While the above points are oriented primarily to ensuring wide access of condoms to the

crisis-affected population, field workers should also ensure that condoms are readily

Adherence to the universal precautions

Universal precautions are a set of measures undertaken at the health facility level to

prevent the transmission of HIV (and other illnesses transmitted via blood or body fluids)

among patients and health care workers. These measures include64:

􀂃 Frequent hand washing;

􀂃 Use of gloves and protective clothing (e.g. waterproof gowns or aprons), masks

and/or eye shields as necessary for all procedures involving contact with blood or

other potentially infected body fluids;

􀂃 Use of new, disposable injection equipment;

􀂃 Adequate incineration and sterilization facilities, and proper disposal of medical

waste;

􀂃 Use of appropriate techniques for the disinfection and sterilization of medical

equipment;

􀂃 Treatment of work injuries through washing of wounds, rinsing of eye or mouth

splashes and PEP as appropriate;

􀂃 The safe handling of sharp objects, including the use of puncture-resistant containers

for used needle disposal;

􀂃 Proper handling of contaminated waste, including human waste and corpses.

Blood transfusion safety

The transmission of HIV through the infusion of infected blood is close to 100%. It is

crucial in emergency settings, as under any circumstance, that blood transfusion is

undertaken under the highest safety standards. There are several measures that field staff

can take to ensure safe blood transfusion, including64:

􀂃 Reduce the need for blood transfusion by training health care to use volume

replacement solutions where possible;

Public health guide for emergencies I 177

Post-exposure Prophylaxis (PEP)

Post-exposure prophylaxis against HIV infection is the immediate use of antiretroviral

drugs after exposure to potentially infectious blood or other body fluid. It is effective

when used more immediately after the exposure, but is not 100% effective. According to

the WHO, dual or triple drug therapy is recommended for PEP. The following drug

dosage guideline depends on drugs previously taken by the source patient and known or

possible cross resistance to different drugs.  

Information, Education, and Communication (IEC)

IEC activities are important in all reproductive health activities and have been a

cornerstone in the fight against HIV/AIDS. Appropriately designed and targeted

communications aimed at informing and educating populations about their health can lead

to changes in beliefs and behaviours that underlie many health problems. Field staff

should develop an IEC strategy that focuses on the population’s largest information gaps

as determined through needs assessment

field-test both the messages (i.e. does the target audience interpret the message as

intended) and the communication method chosen. Examples of key HIV/AIDS-related

messages that can conveyed to a population via IEC activities include:  

􀂃 How to use condoms and how to dispose of them safely

􀂃 How HIV is and is not transmitted

􀂃 Means of prevention

􀂃 Common signs and symptoms

􀂃 Where to receive counselling

􀂃 Where to receive treatment

􀂃 Where to go for support services

􀂃 Why it is important to inform and involve all sexual partners

􀂃 Safe sex practices

􀂃 Importance of early treatment

There exist many excellent resources to guide the development of HIV/AIDS IEC

programmes.    

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Treatment and management of STIs

Because laboratory testing is not always possible in emergency settings, a syndromic

approach to STI treatment and prevention should be adopted. Technical details about the

treatment of specific STIs can be obtained in standard medical textbooks. The success of

STI care in a population depends on consistent availability of drugs.

After diagnosing based on observed syndromes, effective treatment for STIs should be

initiated as quickly as possible. Patients should be encouraged to comply and complete

the complete course of STI treatment needed. If possible, the tracing of partners of

patients with STIs should be encouraged so that they can be treated as well.

Examples from the   

Treatment and management of HIV/AIDS

The MISP includes three primary strategies to reduce the transmission of HIV/AIDS:

􀂃 Ensure safe blood transfusions;

􀂃 Enforce respect for universal precautions

􀂃 Provision of individual education programmes and counselling;

􀂃 Provision of condoms and education on their use;

􀂃 Assistance with partner notification;

􀂃 Clinic-based IEC strategies;

􀂃 Community-based education and support programmes for AIDS patients;

􀂃 Syndromic management of STIs using local or WHO flowcharts available to all staff;

􀂃 A checklist to guide comprehensive case management, monitoring and supervision;

􀂃 Availability of appropriate drugs.

HIV testing

In an emergency, HIV testing must be available, and in some cases devoted, first and

foremost, to ensuring a safe blood supply for transfusions. A voluntary HIV testing and

counselling (VCT) programme is a lower priority in a refugee situation but should not be

ruled out if resources are available and if these services are available in the host country

or were available in the country of origin.  

HIV care and treatment, post-emergency phase

People known to be HIV infected or to have AIDS should remain within their

communities or within the refugee settlements, where they should have equal access to all

available care and support45. Needs assessments should be conducted to determine if

prevention or care and treatment of opportunistic infections including tuberculosis is

needed. .

Adolescents

Adolescents should be included in HIV prevention activities. Adolescents can identify

what makes them vulnerable and create strategies to address these risks. To run an

effective youth program, tap into networks that adolescents belong to: integrate

HIV/AIDS materials into health and nutrition programmes, or existing sports events in

the community. Many programmes use peer educators to reach youth through music,

dance, drama, sports competitions, home visits, group discussions, income generation

activations or HIV/AIDS club.

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Identifying human resources

The prevention and management of STI/HIV/AIDS will require different human

resources depending on the type of services to be offered. Field staff designing and

managing IEC activities should ideally be trained in communication skills and have the

relevant background and experience to ensure messages and information provided are

technically accurate and up-to-date

Gender-based violence

Gender-based violence (GBV) against women, including sexual violence, is increasingly

  documented in emergencies – particularly those associated with armed conflict -but also

in disaster and post-emergency settings. Sexual violence is perhaps the most serious form

of gender-based violence in these settings and will be the focus of this chapter.

During conflicts, sexual violence happens in a number of settings and can have specific

characteristics that are different than sexual violence during times of relative peace.

“wives” for the combatants.     

 Care