Overview of SRH & Rights

1. Overview of SRH & Rights Maternal mortality prevention Dr Nicholas Ehikhale

2. Session overview • SRH • SRH problems- Maternal mortality • Safe motherhood • SR rights • Way forward

3. What is SRH? • Why the attention on SRH?

4. "Reproductive health is 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 to its functions and processes” (WHO, 2002) • “Sexual health is a state of physical, emotional, mental, and social well being related to sexuality and not merely the absence of disease, dysfunction, or infirmity” (WHO, 2006)

5. SRH problems

6. MM and morbidity- unsafe abortion • Gender based violence • FGM

7. Gender Based Violence • 15% to 71% ever experienced physical or sexual violence, or both, by an intimate partner in their lifetime, • 4 to 15 percent of pregnant women have experienced violence • Femicide or the killing of women- Middle EastSouth Asia and China • As much as one third of Nigerian women reported being victims of violence (Anyogu and Arinze-Umobi, 2010)

8. FGM • "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons." (WHO, 1997) • National prevalence 30% (NPC and ICF Macro, 2009)

9. Maternal mortality * death of a woman while pregnant * or within 42 days of delivery/ termination * irrespective of the duration or the site of the pregnancy * from any cause related or aggravated by the pregnancy or its management * but not from accidental or incidental causes (WHO, 2000)

10. Maternal mortality contd. • About 300,000 women die each year as a result of pregnancy related issues- WHO, 2014 • That is 800 women daily • About 95% of these deaths occur in developing countries- SSA and Asia • For every mortality there are 30 morbidities

11. Majority of the causes of MM are preventable: • Obstetric complications- haemorrhage, sepsis, unsafe abortion, pre eclamp, eclamp, p Obstr lab • Indirect causes- Malaria, D/M, cardiac dx • MMR in Nigeria= 545/ 100,000 live births

12. Three phases of delay Theoretical model: (1) Decision making process (2) Reaching the hospital (3) Receiving adequate care

13. Decision Referral Responsiveness

14. Unsafe abortion • About 45 million unwanted pregnancies are terminated each year • An estimated 19 million of these are unsafe • 40% of all unsafe abortions are performed on young women aged between 15 and 24 • About 68,000 women die every year as a result of unsafe abortion • Associated with considerable morbidity- reproductive tract infection, infertility

15. Unsafe abortion in Nigeria • 610, 000 abortions in Nigeria yrly (Henshaw et al., 1998) • Contributes 10- 20% to MMR in Nigeria • 20,000 deaths yearly due to unsafe abortion (Ezegwui et al., 2013; Unuigbe et al., 1988) • Huge burden on the health system • Ass. 30% of Nig women (WRA) experiencing unwanted pregnancy in life time (Sedgh et al., 2006; Oye- Adeniran et al., 2004) via poor knw & assess

16. Bottlenecks to safe abortion in Nigeria • High unmet need for family planning- 20% • Low contraceptive prevalence rate- 15% • Abortion law • High cost of procedure • Poor access to services • Poorly trained personnels

17. Maternal mortality prevention

18. What is safe motherhood?

19. A woman’s ability to have a safe and healthy pregnancy and delivery + at a time she wants

20. The Safe Motherhood Initiative • A global effort that aims to reduce deaths and illnesses among women and infants • Launched in 1987 • Essential services for Safe Motherhood were identified and lessons were learned

21. Priorities for Safe Motherhood • Advance Safe Motherhood through human rights • Skilled attendance at all births • Access to quality emergency obstetrical care • Access to quality reproductive health care, including family planning and safe post-abortion care • Empower women, ensure their choices • Improve access to high quality maternal health services • Prevent unwanted pregnancy and address unsafe abortion • Health education and community mobilization

22. SR rights

23. -Universal declaration of human rights 1948 -ICPD Cairo 1994 International Conference on Population & Development

24. ICPD: shift in focus • From “population control” to “free choice” • From the limited concept of FP/MCH to the broader concept of SRH

25. Key elements of the new focus • Provide universal access to family planning and sexual and reproductive health services and reproductive rights; • Deliver gender equality, empowerment of women and equal access to education for girls; • Address the individual, social and economic impact of urbanization and migration; • Support sustainable development and address environmental issues associated with population changes

26. Key elements contd. • Emphasis on individual choices through expanded information and services • Affirmation that sexual and reproductive health is a human right- the RIGHTS approach

27. RIGHTS approach • Emerging from the Cairo convention • sexual and reproductive health is a human right • Reproductive health as a component of overall health, throughout the life cycle, for both men and women • The right of all couples to decide freely and responsibly the number, spacing and timing of their children and to have information and means to do so • The right of women to have control over, and decide freely and responsibly on, matters related to their sexuality, including SRH – free of coercion, discrimination and violence • Cornerstone to development

28. Way forward

29. Role of health providers • Role of government • Role of individuals • Role of institutions • Advocacy for more government commitment

30. Thank you