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
2
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
4
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.
health care
4
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.
4
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
