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Reproductive Healthrelations outside of marriage as well as within it,and about the sexuality of young people. A third development, that brought a unity to theothers, was the articulation of the concept al human rights treaties in terms ofwomen’s health in general and reproductivehealth in particular gradually gained acceptanceduring the 1990s.Three rights in particular were identified: The right of couples and individuals to decidefreely and responsibly the number and spacingof children and to have the information andmeans to do so; The right to attain the highest standard of sexualand reproductive health; and, Therighttomakedecisionsfreeofdiscrimination, coercion or violence.Subsequent articulations of reproductive rights havegone further, so that, for example, maternal death isdefined as a “social injustice” as well as a “health6

Reproductive ernments to address the causes of poor maternalhealth through their political, health and legal systems.These strands became fused in the concept ofreproductive health, which was first clearly articulated inthe preparations for Cairo and which has become acentral part of the language on population. The newparadigm reflects a conceptual linking of the discourseon human rights and that on health. It proposes a radicalshift away from technology-based, directive, tion. It argues that it is possible to achievethe stabilization of world population growth, whileattending to people’s health needs and respecting theirrights in reproduction. It reinforces and gives legitimacyto the language of health and rights, and validatesconcerns raised by the international women’s movementand by health professionals who had recognized theneeds of people in sexuality and reproduction beyondfertility regulation.7

Reproductive Health1.2.DevelopmentofReproductiveHealthBefore 1978 Alma-Ata Conference Basic health services in clinics andhealth centersPrimary health care declaration 1978 MCHservicesstartedwithmoreemphasis on child survival Family planning was the main focus formothersSafe motherhood initiative in 1987 Emphasis on maternal health EmphasisonreductionofmaternalmortalityReproductive health, ICPD in 1994 Emphasis on quality of services Emphasis on availability and accessibility Emphasis on social injustice Emphasis on individuals woman's needs andrights8

Reproductive HealthMillennium development goals and reproductivehealth in 2000 MDGs are directly or indirectly related to health MDG 4, 5 and 6 are directly related to health,while MDG 1,2,3, and 7 are indirectly related tohealth World Summit 2005, declared universal accessto reproductive health “Sexual and reproductive health is fundamentalto the social and economic development ofcommunities and nations, and a key componentof an equitable society.”The Lancet 20069

Reproductive Health1.3. Magnitude of Reproductive HealthProblemThe term “Reproductive Health “is most often equatedwithoneaspectof women’slives;motherhood.Complications associated with various maternal issuesare indeed major contributors to poor reproductivehealth among millions of women worldwide.Half of the world’s 2.6 billion women are now 15 – 49years of age. Without proper health care services, thisgroup is highly vulnerable to problems related to sexualintercourse, pregnancy, contraceptive side effects, etc.Death and illnesses from reproductive causes are thehighest among poor women everywhere. In societieswhere women are disproportionately poor, illiterate, andpolitically powerless, high rates of reproductive illnessesand deaths are the norm. Ethiopia is not an exception inthis case. Ethiopia has one of the highest maternalmortality in the world; it is estimated to be between 566– 1400 deaths per 100,000 live births. Ethiopian DHSsurvey of 2005 indicates that maternal mortality is673per 100,000 live births. In Ethiopia, contraceptionuse in women is 14.7% and about 34% of women want10

Reproductive Healthto use contraceptive, but have no means to do soaccording to the Ethiopian Demographic and HealthSurvey (EDHS 2005).Women in developing countries and economicallydisadvantaged women in the cities of some industrialnations suffer the highest rates of complications ductive cancers. Lack of access to comprehensivereproductive care is the main reason that so manywomen suffer and die. Most illnesses and deaths fromreproductive causes could be prevented or treated withstrategies and technologies well within reach of even thepoorest countries. Men also suffer from reproductivehealth problems, most notably from STIs. But thenumber and scope of risks is far greater for women for anumber of reasons.11

Reproductive Health1.4. ComponentsofReproductiveHealth Quality family planning services Promoting safe motherhood: prenatal, safedelivery and post natal care, including breastfeeding; Prevention and treatment of infertility Prevention and management of complications ofunsafe abortion; Safe abortion services, where not against thelaw; Treatmentofreproductivetractinfections,including sexually transmitted infections; Information and counseling on human ctive health; Active discouragement of harmful practices, suchas female genital mutilation and violence relatedto sexuality and reproduction; Functional and accessible referral12

Reproductive HealthThe approach recognizes the central importance ofgender equality, men's participation and responsibility.2. Reproductive health indicatorsFollowing on a number of international conferences inthe 1990s, in particular the 1994 ICPD, many countrieshave endorsed a number of goals and targets in thebroad area of reproductive health. Most of these goalsand targets have been formulated with quantifiable andtime-bound hindicatorsA health indicator is usually a numerical measure whichprovides information about a complex situation or event.When you want to know about a situation or event andcannot study each of the many factors that contribute toit, you use an indicator that best summarizes thesituation. For example, to understand the general healthstatus of infants in a country, the key indicators areinfant mortality rates and the proportion of infants of lowbirth weight. Maternal health care quality, availability13

Reproductive Healthand accessibility can be measured using maternalmortality.Reproductive health indicators summarize data whichhave been collected to answer questions that arerelevant to the planning and management of RHprograms. The indicators provide a useful tool to tion and impact. Indicators are expressed interms of rates, proportions, averages, categoricalvariables or absolute numbers.2.1. CRITERIA FOR SELECTINGINDICATORSIndicator selection raises technical questions about theimplications of data collection as well as otheroperational issues. A good indicator has a number ofimportant attributes, and those recommended by theWorld Health Organization (WHO, 1997c) are outlinedbelow.14

Reproductive Health1. To be useful, an indicator must be able to act as a“markerofprogress”towardsimprovedreproductive health status, either as a direct orproxy measure of impact or as a measure ofprogress towards specified process goals.2. To be scientifically robust, an indicator must bea valid, specific, sensitive and reliable reflection ofthat which it purports to measure. A valid indicatormust actually measure the issue or factor it issupposed to measure. A specific indictor must onlyreflect changes in the issue or factor underconsideration. The sensitivity of an indicatordepends on its ability to reveal important changesin the factor of interest. A reliable indicator is onewhichwouldgivethesamevalueifitsmeasurement was repeated in the same way onthe same population and at almost the same time.3. Toberepresentative,anindicatormustadequately encompass all the issues or populationgroups it is expected to cover.15

Reproductive Health4. To be understandable, an indicator must besimple to define and its value must be easy tointerpret in terms of reproductive health status.5. To be accessible the data required for anindicator should be available or relatively easy toacquire by feasible data collection methods thathave been validated in field trials.6. To be ethical, an indicator requires data which areethical to collect process and present in terms ofthe rights of the individual to confidentiality,freedom of choice in supplying data, and informedconsent regarding the nature and implications ofthe data required.These indicators can be input, process, out-put andimpact indicators.16

Reproductive HealthFigure 1: A Conceptual Framework for Monitoring andEvaluating Reproductive Health Programme tions orbidity

Reproductive HealthPolicies &ProductsProceduresAdvocacy and IECNational policiesContraceptivesand legislationLogisticsSource: A.T.P.L. Abeykoon (1999).2.2. Sources of data Routine service statistics: summaries of healthservice records can give information and it isvery cheap, but may be incomplete or sometimesmay not give enough information. It gives inputand process indicators. PopulationCensus:Thedatacollectedatpopulation censuses such as population by ageand sex, marital status, and urban and ruralresidence provide the denominator for theconstruction of process, output and impactindicators. Vital statistics reports: The vital registrationsystem collects data on births, deaths andmarriages. These data are available by age, sex18

Reproductive Healthandresidence.Thesedataprovidethenumerator for the construction of process, outputand impact indicators. Special studies: collection and summarization ofinformation for a particular purpose. Sample surveys : For Example Demographic andHealth survey2.3. Reproductive Health Indicators forGlobal MonitoringThere are seventeen reproductive health indicatorsdeveloped by the United Nation Population Fund(UNFPA). The list and description of these indicators aregiven below.1. Total fertility rate: Total number of children awomanwouldhavebytheendofherreproductive period, if she experienced thecurrently prevailing age-specific fertility ratesthroughout her childbearing life. TFR is one ofthe most widely used fertility measures to assessthe impact of family planning programmes. The19

Reproductive Healthmeasure is not affected by the age structure ofthe female population.2. Contraceptiveprevalence(anymethod):Percentage of women of reproductive age whoare using (or whose partner is using) acontraceptive method at a particular point intime.3. Maternal mortality ratio: The number ofmaternal deaths per 100 000 live births fromcauses associated with pregnancy and childbirth.4. Antenatal care coverage: Percentage ofwomenattended,atleastonceduringpregnancy, by skilled health personnel forreasons relating to pregnancy.5. Births attended by skilled health personnel:Percentage of births attended by skilled healthpersonnel. This doesn’t include births attendedby traditional birth attendants.20

Reproductive Health6. Availability of basic essential obstetric care:Number of facilities with functioning basicessential obstetric care per 500 000 population.Essential obstetric care includes, Parenteralantibiotics, Parenteral oxytocic drugs, Parenteralsedatives for eclampsia, Manual removal ofplacenta, Manual removal of retained products,Assisted vaginal delivery. These services can begiven at a health center level.7. ssentialfacilitieswithfunctioning comprehensive essential obstetriccare per 500 000 population. It nsfusion facilities.8. Perinatal mortality rate: Number of perinataldeaths (deaths occurring during late pregnancy,during childbirth and up to seven completed daysof life) per 1000 total births. Deaths which occurstarting from the stage of viability till completionof the first week after birth (22 weeks of gestationup to end of first week after birth, WHO). Total21

Reproductive Healthbirth means live birth plus IUFD born after fetusreached stage of viability.9. Low birth weight prevalence: Percentage oflive births that weigh less than 2500 g.10. 10. Positive syphilis serology prevalence inpregnant women: Percentage of pregnantwomen (15–24) attending antenatal clinics,whose blood has been screened for syphilis, withpositive serology for syphilis.11. Prevalence of anaemia in women: Percentageof women of reproductive age (15–49) screenedfor haemoglobin levels with levels below 110 g/lfor pregnant women and below 120 g/l for nonpregnant women.12. Percentage of obstetric and gynaecologicaladmissions owing to abortion: Percentage ofall cases admitted to service delivery pointsproviding in-patient obstetric and gynaecologicalservices, which are due to abortion (spontaneousand induced, but excluding planned terminationof pregnancy)22

Reproductive Health13. . Reported prevalence of women with FGM:Percentageofwomeninterviewedinacommunity survey, reporting to have undergoneFGM.14. Prevalence of infertility in women: Percentageof women of reproductive age (15–49) at risk ofpregnancy (not pregnant, sexually active, noncontraception and non-lactating) who reporttrying for a pregnancy for two years or more.15. Reported incidence of urethritis in men:Percentage of men (15–49) interviewed in acommunity survey, reporting at least one episodeof urethritis in the last 12 months.16. omen(15–24)attending antenatal clinics, whose blood hasbeen screened for HIV, who are sero-positive forHIV.17. .KnowledgeofHIV-relatedpreventionpractices: The percentage of all respondentswho correctly identify all three major ways of23

Reproductive Healthpreventing the sexual transmission of HIV andwho reject three major misconceptions about HIVtransmission or prevention.3. Gender and Reproductive HealthSex refers to biological and physiological attributes ofthat identify a person as male or femaleGender refers to the economic, social and culturalattributes and opportunities associated with being maleor female in a particular social setting at a particularpoint in time.Gender equality means equal treatment of women andmen in laws and policies, and equal access to resourcesand services within families, communities and society atlarge.Gender equity means fairness and justice in thedistribution of benefits and responsibilities betweenwomen and men. It often requires women-specificprogrammes and policies to end existing ction,exclusion or restriction made on the basis of socially24

Reproductive Healthconstructed gender roles and norms which prevents aperson from enjoying full human rights.Gender stereotypes refer to beliefs that are soingrained in our consciousness that many of us thinkgender roles are natural and we don’t question them.Genderbias referstogenderbasedprejudice;assumptions expressed without a reason and aregenerally unfavorable.Gender mainstreaming: the incorporation of genderissues into the analysis, formulation, implementation,monitoring of strategies, programs, projects, policies andactivities that can address ine

the drive for efficiency and effectiveness, they supported the establishment of free-standing "vertical" family planning bodies, generally quite separate from other related government sectors such as health, often, Reproductive Health 5 indeed, set up within the office of the president or the