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OS 215: Human Disease and Treatment (Reproduction and Hormone Regulation) LEC 01: REPRODUCTIVE HEALTH AND
OS 215: Human Disease and Treatment (Reproduction and Hormone
Regulation)
LEC 01: REPRODUCTIVE HEALTH AND HEALTH CARE DELIVERY
Exam 1 | Edelina P. Dela Paz, MD | September 3, 2012

ORIENTATION MINI-OUTLINE

I. Who’s Who

III. Grades Breakdown

II. What’s What

IV. Policies

A. On SGDs

A. On absences

B. On Tours

B. On cancellation of classes

C. On Exams

 

WHO’S WHO

Consultant Monitor: Madonna Victoria S. Calderon-Domingo, MD Liaison Officer: Chris Endecia

WHAT’S WHAT

Small Group Discussions (SGD) Every T and Th Topics:

1. Includes pathologies from younger to older age groups 2. Neonatology topics are at the end to accommodate pathology topics for the OB exam Grading: based on frequency and quality of participation Groupings: not fixed; will be announced on the day of the SGD Consultant oversees the discussion, student facilitates the SGD

OB Complex Tour Th, 3-5PM Outfit: full scrub outfit/lab gown, cap & mask, OR slippers/shoe covers Locations: OBAS, Labor Room, OPD, wards 4 groups of 20 students each

Examinations

Dates:

Written Exam Sept 7, 14, 21 Pathology Exam Sept 14, 21 BSLR-West or CH222 Exam Q’s are from general and specific objectives (see the study guide), not necessarily from the lecture and SIM only We are expected to know normal physiology that is pertinent to the topic Reading assignments and SGD topics are included in the exam

GRADES BREAKDOWN

Human Reproduction and Hormone Regulation 100% final grade 95% Pre-compre grade 60% Reproductive 40% Endocrine 5% Compre grade

Breakdown for the Human Reproduction part 80% Pre-final grade 60% Exam Each written exam is 15% each Pathology exams combined is 15% 20% SGD 20% Finals

Exemption Pass all exams! Passing grade is on a per exam basis Should be 60%, pero they sometimes curve

If Pre-Final Grade is 80% = 100% Final grade for Reproduction If you want to improve grades, take the finals (but no guarantees!) Date of final exams: either after rotation or before sembreak

POLICIES

Cancellation of classes They will try their best to reschedule In the meantime, lectures will be reading assignments SGDs will be discussed in plenary if time permits

If the lecturer has an emergency Same as cancellation of classes

On Absences If excused, SGD grade will be cancelled If unexcused, you get a zero

OUTLINE

I. Lifelines

II. Current Situation

III. Reproductive Health

IV. Sexuality

A. Sexual Health

B. Sexual Rights

A. Reproductive Health,

C. Why Sexual Health?

Development and Rights

D. Sexuality and Culture

B. Reproductive Health as Defined by WHO (1994)

C. Reproductive Rights

D. Reproductive Health Care

E. Sexuality Across Life

V. Health as a Human Right

VI. DOH Reproductive Framework

VII. Current Data in the Philippines

OBJECTIVES

General Objective: To discuss reproductive health in the context of the current health care delivery system

Specific Objectives:

1. Appreciate the 10 elements of reproductive health

2. Discuss the 12 universally accepted reproductive health and rights key concepts

3. Analyze reproductive health issues as they relate to changes in the economic, political, and social milieu

4. Develop critical awareness of the current reproductive health system in the context of COME

LIFELINES

1. The Right to Life

o Pregnancy and childbirth complications kill 500,000 women a year- a woman dies every minute

2. The Right to Liberty and Security of a Person

o Over 2 million girls a year are genitally mutilated- 6000 per day

3. The Right to Equality and to be free from all forms of discrimination

o In many countries women who become pregnant lose the right to keep their jobs

4. The Right to Privacy

o Millions of women are still denied their right to confidential family planning advice and services

5. The Right to Freedom of Thought

o Millions of women are still denied the right to make up their own minds about the reproductive health care they need

6. The Right to Information and Education

o Millions of girls are denied the information they need to help prevent accidental teenage pregnancies

7. The Right to Choose whether or not to marry and to found and plan a family

o In Asia and Africa one out of every four girls is married before

16

8. The Right to Decide Whether or When to have children

o In many countries, childless women are regarded as outcasts

9. The Right to Health Care and Health Protection

o

Millions of women are denied health care in the name of culture and religion

10.

The Right to the benefits of Scientific Progress

o

Millions of women are denied access to technological advances in reproductive health care

11.

The Right to Freedom of Assembly and Political Participation

o

Millions of women are denied the right to get together and influence community decisions that affect their lives

12.

The Right to be free from Torture and Ill Treatment

o More than a million girls are forced into prostitution every year

CURRENT SITUATION

Everyday 11 Filipino women die from a treatable complication of pregnancy…

Causes of Maternal Mortality

o

Bleeding

o

Infection

o

Hypertension

Everyday 4950 Filipino babies are born…

Everyday 30 million Fillipinos struggle to survive on a dollar a day or less…

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OS 215

LEC 01: REPRODUCTIVE HEALTH AND HEALTH CARE DELIVERY

Everyday 5205 Filipino women get pregnant without intending to (many of them in adolescent stage)…

Everyday 1530 filipino pregnant women go into induced abortion…

Everyday 5.2 million Filipino children are not in school…

(Sources: 2005 UN World Estimates, 2008 Guttmacher Institute, 2008 NDHS, 2007 NSO Census on Population)

REPRODUCTIVE HEALTH

Reproductive Health, Development and Rights

ICPD (International Conference on Population and Development) Program of Action 1994

Important population and development objectives and goals:

o

Sustained economic growth in the context of sustainable development

o

Education especially for girls

o

Gender equity and equality

o

Infant, child, and maternal mortality reduction

o

Universal access to reproductive health services, including family planning and sexual health

Reproductive Health as Defined by WHO (1994)

Within the framework of PHC… health as a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity, RH addresses the reproductive processes, functions, and system at all stages of life

It implies that people are able to have a satisfying and safe sex life and they have the capability to reproduce and the freedom to decide if, when, and how often to do so.

Reproductive Rights

Implicit in this are the rights of women and men:

To be informed

To have access to safe, effective, affordable, and acceptable methods of fertility regulation of their choice

To access of appropriate health care services

o That will enable women to go safely through pregnancy and childbirth

To provide couples with the best choice of having a healthy infant

Reproductive Health Care

The constellation of methods, techniques, and services that contribute to reproductive health and well being by preventing and solving reproductive health problems

Also includes sexual health, the purpose of which is the enhancement of life and personal relations

o Not merely counseling and care related to reproduction and sexually transmitted infections

SEXUALITY

Sexuality is more than sexual behavior or more than just reproduction. It includes:

Meanings

Identities and intersubjectivities

Relationships

Power

Concepts that relate to sex (male/female vs masculine/feminine) and sexual acts

Values and norms

What is the importance of knowing your sexuality?

Self-knowledge

To learn to respect your body and respect yourself

Sexual Health

The integration of somatic, emotional and social concepts of an individual in ways which enrich and enhance one’s personality, communication, love and human relationships.

The only document released by WHO that recognizes sex in association with love and human relationships

Why sexual health?

o Sexual well-being was correlated positively with general well- being and health

Source: The Global Study of Sexual Attitudes and Behavior (Laumann et al. 2006), which included the Philippines

Sexual Rights

Definition 1:

Sexual rights embrace human rights that are already recognized in national laws, international human rights documents and other consensus documents. These include the right of all persons, free of coercion, discrimination and violence

Definition 2:

The highest attainable standard of health in relation to sexuality

o Includes the following:

Access to sexual and reproductive health care services

Seek, receive and impart information in relation to sexuality

Sexuality education

Respect for bodily integrity

Choice of partner

Other sexual rights include:

o

Decide to be sexually active or not

o

Consensual sexual relations

o

Consensual marriage

o

Decide whether or not, and when to have children

o

Pursue a satisfying, safe and pleasurable sexual life

Sexuality and Culture

Sexual meanings are culturally embodied

o “Sexiness” and “eroticism” are embodied, with societies defining “sexy” and “erotic”

with societies defin ing “sexy” and “erotic” Figure 1 . The “Fine - tuned Female” and
with societies defin ing “sexy” and “erotic” Figure 1 . The “Fine - tuned Female” and

Figure 1. The “Fine-tuned Female” and the “Made-over Male” as examples of how sexuality has become commercialized

Sexuality relates to norms and values

o

o

o

Definitions of vice and virtue

Definitions of lewdness and pornography

Concepts of sexual intimacy and responsibility

Gender

o

Refers to socially-constructed categories, statuses and roles that go beyond the biological male and female

o

To clarify:

SEX: male or female

GENDER: masculinity or femininity

SEXUAL ORIENTATION: homo-/bi-/heterosexual

Body Image

o Socially defined “desirable” bodies relate to:

Eating disorders like anorexia and bulimia

Market for cosmetic products (ex “skin-whiteners”)

Demand for plastic surgery and other body-altering procedure

Note how these norms and values affect our bodies, the way we relate to others, and the formulation of public policies, laws.

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o If sex is seen as dirty, it can hamper sexual enjoyment and cause clinical problems

Sexuality is more than two people having sex:

o Sexual partnerships

6. Prevention and Management of Abortion and its complications (PMAC) 7. Breast and Reproductive Tract Cancers & other Gynecological conditions 8. Men’s Reproductive Health

Who can partner with whom

o

RH is not limited to women’s health but men’s health are also

Age of consent

being addressed

Conditions in partnerships (ex. Rules for polygamy)

o

Men have to be involved in the planning of pregnancy

SEXUALITY and SOCIETY

o

Social institutions (economic, political, cultural) mediate sex and sexualities

o

We learn how to be sexual through social channels

Families

Mass media

Educational institutions

Faith-based (religious) institutions

o

Society “authorizes” what we can do with our bodies

SEXUALITY and POWER

o Those who make the rules also define our roles in society, thereby altering our perception of sexuality

Sexuality Across Life

PRE-PUBERTY (Children)

o vulnerable

ADOLESCENTS AND YOUNG ADULTHOOD

o

Sexuality is intertwined with the search for identity and values- formation

o

Stage of experimentation (ex. Bi-curious)

(MID-)ADULTHOOD

o

Resolving (we hope!) one’s sexuality

o

For many, parenting

o

Sex might take a backseat (aww)

MID-LIFE/LATE ADULTHOOD

o

New questions

o

For some: time of mid-life crisis

o

Some find a surge in sexuality

o

Others need to reaffirm themselves

o

Still, others shift sexual orientation

HEALTH AS A HUMAN RIGHT

Primary Health Care

o Access to quality health care at all times

Rights-based approach

o

Sexual and reproductive rights are human rights

o

Goal is for each person to lead a fulfilling life free from discrimination, as well as foreseeable and avoidable risks

Each person, including an adolescent, has a right to health care

Only by respecting and demanding respect through sexual and reproductive rights can good sexual and reproductive health be achieved by everyone

Responsibilities

For every right, there is a responsibility

Each person has a duty and responsibility to respect the rights of others

Men and women have equal capabilities, rights, and responsibilities to make informed choices and act on these choices

DEPARMENT OF HEALTH REPRODUCTIVE FRAMEWORK

1. Maternal and Child Health, and Nutrition

2. Family Planning

3. Adolescent Reproductive Health

4. Prevention and Treatment of Reproductive Tract Infections (RTIs) including STDs, HIV and AIDS

5. Education and Counseling on Sexuality and Sexual Health

o Age appropriate health education, discussing in context of values and life skills

9. Violence against Women and Children 10. Prevention and Treatment of Infertility and Sexual Disorders
9. Violence against Women and Children
10. Prevention and Treatment of Infertility and Sexual Disorders
VAWC
MCH & N
MMR
Integrated
Service
HIV/AIDS
Delivery
Gender-
CMR
Culture-Rights-
FP
ARH
Based
Approach
Good
Governance
STI/HIV/AIDS
Access to
RH Services &
Infertility
Information
Regulation
Financing

Figure 2. Framework of DOH RH. It’s not just about family planning. It’s goal is for better quality life.

CURRENT DATA IN THE PHILIPPINES

Philippines lags behind compared with ASEAN neighbor countries Table 1. Philippines vs. Other ASEAN Neighbors

countries Table 1. Philippines vs. Other ASEAN Neighbors  Total population grew by more than 10-fold

Total population grew by more than 10-fold from 1903 to to 2007 but population growth grate (PGR) decreased from 2.87 (1903) to 2.04 (2007)

o Population growth rate (PGR) indicates how fast a population increases or decreases resulting from the interplay of births, deaths, and migration in a given period.

Access to health facilities (WHO data)

o

Many factors can prevent women from getting medical advice or treatment for themselves when they are sick. Information on such factors is particulary important in understanding and addressing the barriers women may face in seeking care during pregnancy and at the time of delivery.

o

Women in Philippines reported that the major problem they face in accessing health care for themselves was getting money for treatment (55%), concern that no drugs are available (47%) followed by concern no provider available (37%)

o

Other problems: distance to health facility (27.4%), having to take transport (26.5%), Not wanting to go alone (19.8%), Concern no female provider available (17.3%), getting permission to go for treatment (8.4%)

Total Fertility Rates (TFR), Philippines, 1973-2008

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LEC 01: REPRODUCTIVE HEALTH AND HEALTH CARE DELIVERY

o

Total fertility rate is the average number of children born to a woman during her child bearing years

mortality rate per 100000 live births compared to 1993 data of 209

o

From the National Statistics Office, the ACTUAL 1973 TFR was 6 compared to ACTUAL 2008 TFR of 3.3 and WANTED TFR of 2.4

Current Infant Mortality Rate decreased from 1990 to 2003 from 29/1000 live births

7 6 6 5.2 5.1 5 4.1 3.7 4 3.5 3.3 Actual 2.9 Wanted 3
7
6
6
5.2
5.1
5
4.1
3.7
4
3.5
3.3
Actual
2.9
Wanted
3
2.7
2.5
2.4
2
1
0
1973
1978
1983
1993
1998
2003
2008
NDS
RPFS
NDS
NDS
NDHS
NDHS
NDHS

Figure 3. Total Fertility Rate of the Philippines from 1973-2008

o Considering background characteristics (comparing 2003 and 2008 data)

Rural residents have higher actual and wanted TFR compared to urban residents

The lower the level of education, the higher the actual and wanted TFR

Those who belong to the lowest wealth quintile have higher actual and wanted TFR

Note: all TFRs (both wanted and actual) are lower for 2008 data compared to 2003 data but shows a similar trend when comparing strata

Unmet need for family planning pertains to women of reproductive age who prefer to space or limit births but are not practicing family planning

o

There was an increase in unmet need, spacing and limitation in when 2003 and 2008 data were compared

o

Rural residents, lower level of education and those belonging to the lower wealth quintile had higher unmet needs

The current use of family planning methods of married women aged 15-49

o

50.7% uses any method= 34.0 uses any modern method + 16.7 uses any traditional method

o

Rural residents, lower level of education and those belonging to the lower wealth quantile had lower use any methods

Test Statements (SWS 2011)

o

The choice of a family planning method is a personal choice of couples and no one should interfere with it: 82% agrees

o

If a couple wants to plan its family, it should be able to get information from the government on all legal methods: 73% agrees

o

The government should fund all means of family planning may it be natural or artificial means: 68% agrees

o

The use of pills can also be considered as abortion: 52% disagrees

o

The use of condoms can also be considered as abortion: 51% disagrees

o

If family planning would be included in their curriculum, the youth would be sexually promiscuous: 46% disagrees

o

For me, the plan of those who oppose the RH Bill not to pay their taxes is a reasonable protests: 39% disagrees

Trends in the Status of reproductive health in relation to the 8 MDGs

o Maternal and Child Health

Goal: Reduction in maternal mortality by one half of the 1990 levels by 2000 and a further one half by 2015

Goal: Expand the provision of maternal health services in the context of primary health care, i.e, based on the concept of informed choices, should include education on safe motherhood, prenatal care(ICPD)

Goal: Reduce maternal mortality rate by three quarters by 2015 (half by 2000, half by 2015)

Goal: Increase access to reproductive health services to 60% by 2005, 80% by 2010, and 100% by 2015 (MDG 5:Target 7,8)

Current: Slow rate of decrease in maternal death, increasing number of pregnant women in high risk category and recently there has been an increase to 211 maternal

Current: The leading causes of infant mortality are respiratory conditions of the fetus, congenital anomalies, diarrhea, measles and nutritional deficiencies

The lack of access to quality health care is a major

determinant in maternal and child mortality: prenatal, postpartum care, skilled delivery attendants during delivery, immunization

o

Family Planning

By the year 2005, provide universal access to a full range of

 

safe and reliable family planning methods

 

Countries should seek to identify and remove all the major barriers to the utilization of family planning services (ICPD)

o

Violence against women

…protect women from all kinds of economic discrimination and from sexual harassment

Countries should take full measures to eliminate all forms of exploitation, abuse, harassment and violence against women

VAW has grave reproductive health impact: unwanted pregnancy, STIs/HIV, gyne disorders, resorting to unsafe abortion, pregnancy complications, pelvic inflammatory diseases (ICPD)

o

Reproductive Cancers

Make accessible…referral…for and further diagnosis and treatment for… breast cancer and cancers of the reproductive system

The Philippines has the highest rate in breast cancer in Asia

o

Adolescent Reproductive Health

…ensure that the programs and attitude of health care providers do not restrict the access of adolescents to appropriate services and the information they need, including on sexually transmitted diseases and sexual abuse (ICPD)

o

Abortion (UP population institute study)

403,000 to 1.32 million women undergo induced abortion each year

young mothers account for 17% of induced abortions and 6% of spontaneous abortion

12% of all maternal deaths are due to abortion

36% of women who are treated for abortion complications in various hospitals are young women WHY WE NEED EFFECTIVE REPRODUCTIVE HEALTH LEGISLATION AND PROGRAMS URGENTLY

o

Significant, possibly undeclining MMR- 152/100,000 or 3,000 deaths/year

o

High unmet need for effective contraception 52%

o

High rates of unsafe abortion majority of abortions estimated at 400,000/year, resulting in 80,000 complications

o

Increasing unprotected sex among young people

o

Significant and increasing incidence of rape over 3,000/year

o

No WOMAN should DIE giving BIRTH

END

Ian: Hello Batchmates! It’s good to be reunited once again

Aca: Thanks to all who went to Vibe! Tamang lasing lang, haha! Only a few more days ‘til EQUINOX, hihi, so excited! Hallo to Tammy and Friends, Chenespak and Iannek, P-boy, K-lo, Mg and Mk! XVI Walang Kapantay! AFTG! Hi V. =)

Hannah: Hola and welkamvakler sa mga vlak B! Nagsound of music na naman ang buong bslr-W! Pagod na ang keyboard sa katatype every week ng translaloo kaya nora aunor na ako magshout attack to individuals keri? SEFTEMVER na kaya wititey sad faces allowed inside BSLR-W! Award to all charoterang kaboomboom mars! :D

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