Reproductive Health Challenges amongst The University of Nairobi youth

1. Reproductive Health Challenges amongst The University of Nairobi youth Dr Carol Odula-Obonyo M.Med(Ob/Gyn), F.U.O.N. February 28th 2015 School of Medicine College of Health Sciences

2. Outline • Definitions • Susceptibility to sexual advances-STI’s, HIV, abortion • Youth friendly services • Lessons learnt

3. WHO's definition of health Health is as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity

4. Reproductive health Health is as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life.

5. Implication Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

6. Continued • Implicit in this are 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 couples/women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant

7. Reproductive health -a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

8. Meaning of “The Right to Health” Every human being is entitled to the enjoyment of the highest attainable standards of health conducive to living a life of dignity.

9. Sexual health-"Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled."

10. Definition of Sexual Health Sexual Health includes the ability to enjoy mutually fulfilling sexual relationships, freedom from sexual abuse, coercion, or harassment, safety from sexually transmitted diseases, and success in achieving or in preventing pregnancy.

11. Maternal Health • Motherhood is meant to be a positive and fulfilling experience • For many women it is however associated with suffering, ill-health and even death • Good news: the deaths and suffering are totally preventable • Bad news: the deaths and suffering continue year after year

12. Maternal death "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes."

13. Direct Maternal Death Results from obstetric complications of pregnancy, labour and puerperium and from interventions or any after effects of these events e.g. death from PPH. The “BIG FIVE” causes of direct maternal deaths are: bleeding (haemorrhage), unsafe abortion, hi blood pressure complications (PET/Eclampsia), obstructed labour and infection (sepsis)

14. Indirect maternal deaths Are deaths that result from worsening of existing maternal condition by pregnancy or delivery e.g.: Malaria, diabetes, sickle cell disease, HIV, cardiac disease

15. Maternal Mortality Rate The number of maternal deaths per year for every 100,000 women of repro age (WRA), 15-49 years This measure reflects both the risk of death among pregnant and recently pregnant women, and the proportion of all women who become pregnant in a given year. It therefore can be reduced either by reducing obstetric risk (as is true for the ratio, above) and/or by reducing the number of pregnancies

16. Maternal Mortality Ratio Is the number of maternal deaths per 100,000 live births This measure indicates the risk of maternal death among pregnant and recently pregnant women. It is a measure of obstetric risk and a reflection of a woman’s basic health status, her access to health care, and the quality of service that she receives

17. Life Time Risk of Maternal Death This measure reflects the probability of maternal death faced by an average woman cumulated over her entire reproductive life-span. Like the maternal mortality rate, it reflects both a woman’s risk of dying from maternal death, as well as her risk of becoming pregnant in the course of a reproductive lifetime

18. A look at our statistics • Total population 38-40 million • Very youthful – pyramid with a very wide base • Proportion of births under skilled care 42% • Maternal mortality ratio 488/100,000 • CPR 39% modern, total 46% KDHS 2008-9

19. A look at our statistics contd…. • Total fertility rate- 4.6 • Unplanned pregnancies- 17%- unwanted, 26%- mistimed • Contraceptive use- 46% • Unmet need for contraception among married women- 25% • Maternal mortality rate- 488/100,000

20. Statistics • 55% population less than 19 years • Average age for first sexual experience/debut is 15 years • 1/3 of pop between 13 and 19 • 40 % of women who die of abortion are below age 20 • 80% of young people have had sex by age 20 • Almost 50% of adolescents begin childbearing before age 20 • Young people disproportionately represented among abortion-seekers many of whom endure the risk of unsafe clandestine procedures

21. Beware!!!!!!!

22. Definitions • Youth-Age 15 to 24 years • Youth friendly services-Those that attract young people, respond to their needs and retain clients for continuing care

23. Investing in our youth

24. Youth all over the world……… “..nothing for us without us..”Thy have a right to know, to get involved and to access the services.

25. Issues at a glance • Half of the world’s population <25 • 30% are between 10-24 • 20% are between 10 and 19 • 87% live in low income countries • Africa- below the age of 25 years constitute about 60% of our population:- 10-24yr = 33% • Many of them are married Why have we forgotten their contraceptive and other RH needs???

26. Young people’s decision-taking and reproductive health behaviours Institutions Family Peers Individual Partners Household Communities Fertility • Abortion • Morbidity  -STI/HIV -RTI -Anaemia • Mortality •  Nutritional status Factors that influence young people’s reproductive health Reproductive health outcomes

27. At what age…in Kenya? • Menarche…………… • Sexual debut………….. • First birth……………… • Marriage…………. • Drinking ……………………… • Smoking………………….

28. Sexual activity and childbearing-young women

29. Examples • Nicaragua-First birth before age 20 so one of the highest adolescant fertility rates in the world. • Cambodia-1st birth at 20-22. • South Africa-1 in 3 girls child <20 • Adolescent women’s contraceptive use is less consistent than that of adult women with a much higher failure rate.

30. Problem area • Differences -urban/rural, in-school/out-of-school, girls/boys influence access to health care and sources of education, information and support. • Risk factors - early sexual initiation, substance abuse, depression, ignorance about contraception.

31. Are youth more vulnerable? • Sexual abuse-rape, defilement, cross generational sex • Lack of youth friendly services • Early sexual behaviour is condemned & pregnancy perceived shame full- fear to seek safe abortion services where they exist. • Limited financial resources

32. CONTRACEPTION • This is prevention of a male and female gamete to meet and hence preventing a pregnancy from occurring and refers to enjoyment of sex without one conceiving • This is different from family planning which refers to a couple having the number of children that you desire and can be able to support, by either using natural or artificial means • The right to contraception of choice is protected under several agreements and treaties Kenya has signed and ratified.

33. Why contraception? • Prevents unplanned pregnancies and can give one the freedom to choose the right time for parenthood • Condoms protect one from HIV/Aids and sexually transmitted infections (STIs)

34. Ask yourself: “Why do I need Contraception?” Answer is simple: to control your natural fertility. If a woman didn’t use contraception she would have up to 15 pregnancies in her life time!. Contraception protects us and allows us to enjoy a very pleasurable and fun part of living- sex.

35. CPR IN VARIOUS REGIONS

36. Reasons for not using Contraceptives • Little knowledge on contraceptives within the community • Cultural barriers: Myths & misconceptions • Health system problems: • Cost • Lack of training for providers • Lack of supplies *All these lead to unwanted pregnancy

37. YP and condom use • “Blind trust”- YP tend to trust their partners easily and blindly. Condoms may be used during the 1st, 2nd and 3rd sexual contacts, thereafter be abandoned without HCT • Myths and beliefs- condoms are association with promiscuity; not 100 percent effective; cheaper are not good (GoK type), no sexual satisfaction • Condoms have holes: • Boy-girl relationship and courting: may make condom use unfavorable: sexual activity is not a planned occurrence

38. YP and condom use • Girls are particular on the type / brand of condoms use: generally expect the boy to meet the cost • Sexual coercion as part of courting, seen as normal, hence condoms may not be used in such cases: or incase it’s the first sexual contact

39. Not in a sexual relationship???????? Arm yourself with all your choices.

40. Goal • To have children by choice, not by chance

41. Contraception • Against conception • Use of contraceptives enables couples achieve the objectives of family planning-planning when to start, how to space, & when to stop giving birth.

42. Family Planning A comprehensive term meaning: • Planning of pregnancies so that they occur at the right time • Spacing of births for optimal health of all family members, • Stopping of births when the total size has been attained.

43. Male Involvement

44. What is the commonest method used by UON students????? • P2, Postinor 2, Emergency pill, the Friday pill • Pills • Coil • Patch • Condoms • Injection • Spermicide • Calender/Counting days • Natural

45. You can have a healthy sexual life or • Preventing pregnancy • Preventing infection • Having a healthy baby Let's discuss the choices

46. The Pill • Take a pill every day • Women with HIV or on ART can use safely and effectively • Does not protect against STI or HIV transmission Use condoms to prevent infection • Less menstrual bleeding and cramps • Most common side-effects: headaches, nausea, spotting

47. Who can and cannot use the Pill Most women with HIV or on ART can use this method safely and effectively But usually cannot use the Pill if: Some other serious health conditions Smokes cigarettes AND age 35 or older High blood pressure Taking rifampicin May be pregnant Gave birth in the last 3 weeks Breastfeeding 6 months or less

48. Benefits of Contraception • To the women: • Helps women avoid pregnancies at the extremes of maternal age. • Helps women decrease risk of death by decreasing parity • Helps women prevent high risk pregnancies • Helps women eliminate/decrease abortion risks • Improve health of women thru noncontraceptive benefits of FP eg. Prevention of STIs, & reproductive tract cancers(Ca ovary & endometrium)

49. Hormones:Mechanisms of Action/menstrual cycle • Suppression of hormones responsible for ovulation • Thickening of cervical mucus, blocking sperm

50. Hormonal Methods • Combined pill (micro-pill) • Progestin-only pill (mini-pill) • Contraceptive patch • Vaginal ring • Contraceptive injections • Contraceptive implants • Emergency pill