C.
Family planning
To ensure that procurement of family planning commodities are made on a sustainable basis.
To ensure that provision is made for production and distribution of IEC
D. Maternal nutrition
To ensure that the nutritional status of women and adolescent girls in particular, is improved to
prevent health
problems
E. Adolescent health and development
To empower adolescents/youth by equipping them with life skills, including assertiveness, self-esteem,
value
clarification and decision making in order to achieve a positive life attitude.
To increase accessibility and availability of affordable Youth Friendly Health Services to
adolescents/youth at all
levels of the health care system.
F. STIS/HIV/AIDS
To strengthen the prevention and effective management of STI/HIV/AIDS.
To reduce the rapid spread of HIV/AIDS.
G. Abortion
To strengthen the quality and availability of Post Abortion Care (PAC) and counseling services within
the context of
Integrated Reproductive Health.
H. Infertility
To ensure the provision of appropriate services for overcoming infertility barriers to the achievement
of reproductive
intentions.
I. Health service delivery
To ensure the provision of quality reproductive health services at all levels of the health care system.
J. Other reproductive health issues
To strengthen diagnosis and management of all related reproductive health cancers at all levels of
health care
system (cancer of the cervix, breast and prostate).
To ensure that there is a preventive and curative programme for women after menopause.
To prevent harmful traditional practices, such as female genital mutilation and unsafe male
circumcision.
Activity
In your own words define Integrated Reproductive Health, practice over and over at least 4 times.
Well done, keep it up. Now that you have known the definition of IRH by heart, you can proceed to the
next topic.
Self Assessment tests
1.5 Integrated Reproductive Health Policy
The reproductive health policy was formulated by the Ministry of Health to provide guidelines to
different sectors involved in
the implementation of reproductive health programmes.
The policy sets out to respond to the country's prevailing reproductive health situation so as to improve
the standard of
living and quality of life of [Link] of Safe Motherhood
The following are the components of Safe Motherhood you need to know according to WHO, 1994.
1. Family Planning - to ensure that individuals and couples have the information and services to plan the
timing, number,
and spacing of pregnancies and to prevent unwanted pregnancies.
2. Antenatal care - Effective antenatal care is essential to detect pre-existing conditions, to provide
vitamin supplements,
vaccinations, and screen for risk factors in order to prevent complications where possible, and to ensure
that complications
of pregnancy are detected early and treated appropriately.
3. Intrapartum care - to ensure that all birth attendants have the knowledge, skills, and equipment to
perform a clean and
safe delivery, and to ensure that emergency care for high-risk pregnancies and complications is made
available to all
women who need it.
4. Postnatal care - to ensure that postpartum care is provided to mother and baby, including lactation
assistance, provision
of family planning services, and managing danger signs.
5. Post abortion care - to prevent complications where possible and ensure that complications of
abortion are detected
early and treated appropriately, to refer other reproductive health problems, and to provide family
planning methods as
needed.
6. STIs/HIV/AIDS Control - to screen and prevent transmission to baby, to assess risk for future infection;
to provide
voluntary counselling and testing; to encourage prevention; and where appropriate to expand services
to address mother to
child transmission.
Self Assessment tests
The Menstrual Cycle
The menstrual cycle is a series of cyclic events that take place in a rhythmic fashion during the
reproductive period of a
woman’s life. It starts at the age of 12-15 years which marks the onset of puberty (Menarche). It ceases
at the age of 45-50
years (Menopause). Although each woman has an individual cycle which varies in length under
physiological conditions
between 20-40 days, the average cycle is taken to be 28 days long and recurs regularly from puberty to
the menopause
except when pregnancy intervenes. The first day of the cycle is the day on which menstruation begins.
Changes during the Menstrual Cycle
We are now going to describe the menstrual cycle as propounded by Marieb, 1989. The changes are
divided into 4 groups
namely:
i. Ovarian changes
ii. Uterine changes
iii. Changes in the cervix
iv. Vaginal changes
The above changes all occur simultaneously
1. Ovarian changes during menstrual cycle
The changes in the ovary occur in 2 phases, namely;
i. Follicular phase: During this phase, one follicle in the ovary begins to mature due to the influence of
Follicle Stimulating
Hormone (FSH). This FSH is released by the anterior pituitary gland after getting stimulation from the
Hypothalamus
hormone Gonadotropin Releasing Hormone (GnRH) as a result of the positive feedback received from
the ovary. As
the follicle is maturing (graafian follicle), it is releasing large amounts of Oestrogen and little amounts of
Progesterone
from the granulosa cells of the developing follicle. This phase corresponds to the proliferative phase in
the uterine
cycle. On the 14th day of the cycle, the grafiaan follicle is ready for ovulation. Ovulation is the process in
which there is
rupture of graafian follicle with consequent discharge of ovum into abdominal cavity after maturity of
follicle, leaving
behind the corpus luteum, the yellow body that secretes a lot of progesterone and little oestrogen.
ii. Luteal phase: During this phase, the corpus luteum secretes a lot of progesterone that is responsible
for the Secretory
developments in the endometrium. This phase corresponds to the Secretory phase in the uterine cycle,
and is under
the influence of Leutenising Hormone (LH). The Corpus luteum is responsible for maintaining pregnancy
before full
placental function should fertilization occur. If fertilization does not occur, a negative feedback is sent to
the
Hypothalamus to stop producing the LH.