The Figure and Determinants of Indonesian Reproductive Health

Session Objective
To describe and discuss the current state of

global and Indonesian reproductive health problems To describe and discuss the determinants of reproductive health problems To describe and discuss the social determinants of reproductive health problems

The meaning and scope of reproductive health

The Scope of Reproductive Health

Adolescent Pre-pregnancy pregnancy

Post partum

Maternal Health

BIRT H
Neo-natal Post natal Childhood Infancy

RH addresses the reproductive process, functional and system at all stages of life

Aimed to. 1
Peopl e are able to have

a responsible, satisfying and safe sex life

the capability to reproduce the freedom to decide if, when and how often to do so.

Reproductive Health Right

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 women to go safely through pregnancy

and childbirth and provide couples with the best chance of having a healthy infant.

4 Goal to Better Reproductive Health

Goal 1:
Every sex act should be free of coercion and based

on informed and responsible choice

Goal 2
Every sex act should be free of infections

Goal 3
Every pregnancy and birth is intended

Goal 4
Every pregnancy and birth is safe

Overview of RH situation, Indonesia

RH Bloom Framework
Psychobiological

Behavior

Reproductive health status

Environment

Health service

RH status
High risk of maternal death and obstetric complication among women and female adolescent
MMR : 307/100.000 live birth IMR : 35/100 live births Complication during delivery: Prolonged labour (30.5%) Excessive bleeding (7.2%) Fever (4.5%) Convulsion (1.4%) Other (3.1%)

RH status

Unwanted and unintended birth still high

RH status
Exposure to STI and HIV/AIDS is growing

Nutrition status
The level of malnutrition is still high among women and female adolescents

Health Services status

Unmeet needs

Health Services status

Many births are still not attended by trained providers

Health behaviors status

Risk Behavior to RH among adolescent is increasing

Social Environment
Many women have poor education level

Economic Environment
Poverty and impact of economic crisis

Reproductive health is more about social health problems than biological matter

Social Determinants of RH
The provider attitude..in side the clinic

Provider attitude denial of service

One of the potential clients refused to have the

speculum exam.
The provider said to her, The problem is that

you are not educated. You cant always keep running away from the speculum. To have family planning your vagina must be examined.
The potential client was a woman with four

children. She left without getting services.41

 The provider said lots of rude words against

my suggestion to get family planning services. She even said that my behaviour is not all that straight because I was looking for family planning methods. She also said that I should not use contraceptives because I am a schoolgirl; therefore it wont help me to concentrate on school. Finally she told me that if I need anything I should come with my parents.

Provider signals that discouraging use of services

Manner (rudeness)

Respect privacy and confidentiality

Tailoring the information with the client

concern Waiting time Willingness to answer questions Attention to pain Encouragement to return

Fear of rude treatment is 22% reason of women for not using FP services

Social Determinants of RH
Poverty, gender, adolescent, education

Poverty and RH problems

The role of gender on poverty

Percentage of women using moderns contraceptive methods by wealth according to who make decisions concerning what money is

The role of gender on poverty

Percentage of women who wanted their last child, by wealth and ability to obtain permission to seek medical care

Urban and rural poverty

Rural poverty
Lack access to HS Hazardous

Urban-slum
Crowded spaces Lack of infrastructure Indoor air pollution Poor and

environment Lack access to clean water, good housing, sanitation and varied diet

overstretched sanitation Illegal status Lack of security Reduced mobility

Adolescent role

Percentage of un married 15-19 year olds who used a condom at last sexual intercourse by wealth quintile

Education role

Percentage of women using modern contraception by wealth and educational level

Sexual violence and coercion

Coercion at sexual debut/childhood

Percentage of sexualy-experienced girls and women of reproductive age reporting that first sexual was forced

Intimate partner violence

Other issues of coercion.

Coercion by non partners

Sexual violence in situation of

conflict and displacement Sexual violence and coercion against men

The consequences
Menta l health Depression, post traumatic stress disorder, sleep difficulties, somatic complaints, suicidal behavior

Reproductive health

Gynaecological trauma, unintended pregnancy, unsafe abortion, pregnancy complications, sexual dysfunction, STIs/HIV/AIDS

The consequences
Unprotected sex, early consensual initiation, multiple partners, alcohol and drug abuse; a higher risk of perpetrating or experiencing subsequent sexual violence Death from pregnancy complication, unsafe abortion, AIDS, murders of women

Behavioral

Fatal outcome

The consequences

Social outcome

Unwanted child bearing , withdrawn from school, inability to form adult relationship rejection by partner or family

Factors associated with sexual coercion

Society

Community

Relationships

Individual

Society
1
2
3
Lack of criminal sanctions against sexual violence Weak laws & policies related to the civil right of girls & women

High levels of general violence in society

Armed conflict

Community
Community norms that entitle men to sex &/ discourage womens sexual autonomy Lack of community sanctions against sexual violence

Unsafe public places

Communication norms that encourage early marriage

Relationship
1 2
3
Male dominance in the family that includes right to sex Age differences between intimate partners

Barriers to discussion/negotiation about sex

Communication norms that encourage early marriage

The complicated adolescent RH

What you can do as the physician?

Provider influence on client utilization of SRH services,framework