KESEHATAN REPRODUKSI

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KESEHATAN REPRODUKSI Pemeliharaan dan perawatan k kesehatan h t serta t d dampaknya k pada d kesehatan reproduksi

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RH Outlook 2003 RH Library Sumber dari Depkes

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Millenium Development Goals (United Nation)-Æ 2015 1 1. 2. 3. 4. 5. 6. 7. 8.

Menghapus kemiskinan dan kelaparan Pendidikan untuk semua orang Promosi kesetaraan gender Penurunan angka kematian anak Meningkatkan kesehatan ibu Memerangi HIV/AIDS, malaria dan penyakit l i lain Menjamin kelestarian lingkungan Kemitraan global dalam pembangunan

RUANG LINGKUP KES-PRO 1 1. 2. 3.

4. 5. 6. 7.

Kesehatan Ibu dan Anak Keluarga Berencana Pencegahan dan penanggulangan Infeksi Saluran Reproduksi(ISR), termasuk IMSHIV/AIDS Pencegahan dan Penanggulangan Komplikasi Abortus Kesehatan Reproduksi Remaja Pencegahan dan Penanganan Infertilitas Kanker pada Usia Lanjut dan Osteoporosis

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Definisi SEHAT Kesehatan Reproduksi (ICPD Kairo ,1994) „

Suatu keadaan sejahtera fisik , mental dan sosial secara utuh, tidak sematamata bebas dari penyakit atatu kecacatan dalam semua hal yang berkaitan dengan sistem reproduksi, serta fungsi dan prosesnya .

KESEHATAN IBU DAN ANAK

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Kesehatan ibu dan anak „

AKI Indonesiaan /100.000 /100 000 kelahiran hidup : „ „ „ „ „ „

1986 1992 1994 1995 1997 2003

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450 421 390 373 334 307

Worldwide, it is estimated that 515,000 women die yearly from complications of pregnancy and childbirth—about one woman every minute. Some 99 percent of these deaths occur in developing countries, where a woman's lifetime risk of dying from pregnancy-related complications is almost 40 times higher than that of her counterparts in developed countries.

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Figure2

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Safe Motherhood Initiatives The SMI SMI's s target has subsequently been adopted by most developing countries. Under the Safe Motherhood Initiative, countries have developed programs to reduce maternal mortality and morbidity. The strategies adopted to make motherhood safe vary among countries and include: „ providing family planning services; „ providing postabortion care; „ promoting antenatal care; „ ensuring skilled assistance during childbirth „ improving essential obstetric care; and „ addressing the reproductive health needs of adolescents.

Essential Obstetric Care Ensuring access to essential obstetric care is especially important in reducing maternal deaths. Basic essential obstetric care (also called basic emergency obstetric care) at the health center level should include at least: „ parenteral antibiotics; „ parenteral oxytocic drugs; „ p parenteral sedatives for eclampsia; p ; „ manual removal of placenta; „ manual removal of retained products; and „ assisted vaginal delivery.

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Comprehensive essential obstetric care Comprehensive essential obstetric care services at the district hospital level (first referral level) should include all of the above, plus: „ surgery „ anesthesia „ blood transfusion

Ten years after: Key lessons learned „ „ „ „ „ „ „

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recognizing g g that every yp pregnancy g y faces risks;; increasing access to family planning services; improving the quality of antenatal and postpartum care; ensuring access to essential obstetric care (including postabortion care); expanding access to midwifery care in the community; training and deploying appropriate skilled health personnel (e.g. midwives); ensuring e su g a continuum co t uu o of ca care e co connected ected by effective e ect e referral links, and supported by adequate supplies, equipment, drugs, and transportation; and reforming laws to expand women's access to health services and to promote women's health interests.

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Ten years after: Key lessons learned „ „ „ „

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Strong political commitment. Involving national and local leaders and other key parties . Involving community members. Training and deploying a range of health care providers at appropriate service delivery levels help increase access to maternal health p y life-saving g services. services,, especially Effective communication between health care providers at both the community level and the district (first-referral). Community education about obstetric complications and when and where to seek medical care is important.

Besarnya AKI bisa ditanggulangi dengan meningkatkan: „

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Kesadaran perilaku hidup bersih dan sehat Status gizi dan status kesehatan ibu Penyediaan akses terhadap pelayanan Kes-Pro Kes Pro dan hak hak-hak hak reproduksi untuk usia lanjut Gender Development Index

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Peningkatan peran serta masyarakat dalam penanganan kesehatan dan hak reproduksi Human Development Indeks (HDI) Gender Empowerment Measure (GEM) Buta huruf 15-45 tahun Wajib belajar 9 tahun

ANTENATAL CARE W.H.O. „ „

Birth Planning Danger Signs „ „ „ „ „

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Perdarahan Pre eklampsia/eklampsia Perut nyeri Pernapasan sesak Panas

Emergency Preparedness and Complication readiness Social Support

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RECOGNITION

REFERRAL

RESPONSIVENESS

KELUARGA BERENCANA

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KELUARGA BERENCANA Total Fertility Rate 1967 1967-1970 1970 : 5,5 55 „ SDKI 1995-1997 : 2,8 „ SDKI 2002-2003 : 2,6 Contraceptive Prevalence Rate : „ 1987 : 48 % „ 1997 : 57% „ 2002 : 60,3% KB pria rendah : 4,4 %

Unmeet need (pasangan usia subur yg seharusnya harus pakai KB namun tidak memakai alat KB): „ 1997 – 9,7% „ 2002 – 8,6% „ Diharapkan 2004 – turun jadi 6,5%

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65% ibu hamil menderita 4 terlalu : „ „ „ „

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Terlalu Terlalu Terlalu Terlalu

muda tua sering banyak

Hal ini menujukkan bahwa masih banyak PUS yg perlu l ber b KB Hal ini menyebabkan unwanted pregnancy – illegal abortion – AKI meningkat

Major issues in delivering high-quality, cost-effective family planning services in low-resource settings. „ „ „ „ „ „ „

Increasing access to family planning Overcoming medical barriers Guidelines and indicators Logistics and contraceptive quality assurance Infection prevention Interpersonal communication and counseling Information, education, and communication (IEC) activities

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Major issues in delivering high-quality, cost-effective family planning services in low-resource settings.

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Training and performance improvement Supervision Quality improvement strategies Integrated services Financial management and sustainability Policy making Advocacy

PENCEGAHAN INFEKSI MENULAR SEKSUAL (termasuk HIV / AIDS)

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Penelitian terbatas Jakarta Utara (1997)- 312 klien KB: „ Prevalensi ISR 24,7% „

Klamydia 10,3% , trichomonas 5,4% , gonore 0,3%

Surabaya 599 perempuan hamil : „ Infeksi f herpes simpleks 9,9%, klamidia 8,2%, trikomonas 4,8%, GO 0,8% dan sifilis 0,7%

Base-line survey (1999) „ „ „ „

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42% remaja tahu HIV/AIDS 24% remaja tahu IMS 55% remaja mengetahui proses kehamilan 53% remaja tak tahu sama sekali bahwa berhubungan sex mengakibatkan kehamilan 45% remaja beranggapan HIV/AIDS dpt disembuhkan 42% beranggapan orang yg nampak sehat tak mungkin mengidap HIV/AIDS

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Diperkirakan th 2002 90-130 ribu orang HIV di Indonesia Kumulatif sampai Juni 2005 infeksi HIV 3.740 AIDS 3.358 Kelompok berisiko tinggi waria penjaja seks k Tidak hanya penjaja seks dan langganan , pengguna NAPZA juga

Although AIDS is incurable, the transmission of HIV is preventable. „ „

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increase people's people s awareness and knowledge of HIV/AIDS and how to protect against it; create an environment where people can openly discuss safer sexual and drug-injecting practices and ways to adopt them; provide services such as access to affordable condoms and clean injection equipment, HIV testing, and treatment for reproductive tract i f ti infections (RTIs) (RTI ) iincluding l di sexually ll transmitted infections (STIs). help people acquire the skills they need to protect themselves and their partners; reform laws to protect people's health and expand their access to health services.

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Prevention „

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Knowledge alone is not enough. People need skills, support, and motivation to change their behavior and avoid HIV infection. The same prevention approach will not work in every setting. Risk and vulnerability vary in every society, and it is not always possible to find and work with all vulnerable groups. Although targeting specific groups is important, complementary efforts to reach the general population—especially young people— are equally essential to HIV prevention. Political leadership and support are critical to an effective response to the HIV/AIDS epidemic.

Prevention „

Working with young people is key to HIV prevention efforts. Effective approaches include: „ „ „ „ „ „ „

HIV/AIDS life-skills education; communications programs involving mass media; condom access; voluntary l t counseling, li testing, t ti and d referral f l services; i management of STIs; participation of parents and other adults; and strategies to strengthen the social and economic status of young people.

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Care and Support „

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Collaboration with local organizations g and agencies can help enhance a project's visibility and effectiveness. By allowing more channels for entry to care and support services, integration of services with local institutions and community groups (e.g., religious institutions, hospitals, local health facilities, schools) help maximize use of scarce resources and skills and increase access. Promotion of community- and home-based care as part of a continuum of care is important in efforts to control the AIDS epidemic.

Care and Support „ „

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Collaboration with hospital-based services can facilitate continuity of home-based care and support services. Involving community members (including people with and affected by HIV/AIDS, local leaders, traditional healers, families members, women's groups) in the planning and implementation of services is integral to a project's success and helps ensure sustainability of services. Community members and volunteers, volunteers especially people with HIV/AIDS, can be trained and supported to provide project services and play a vital role in educating their peers and caring for people with HIV/AIDS (Kerrigan, 1999).

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KESEHATAN REPRODUKSI REMAJA

Survei Depkes 1995/1996 „

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Remaja 13-19 13 19 th di Jabar dan Bali , terdapat kehamilan remaja 7% dan 5% Kehamilan Tidak Dikehendaki (Pradono 1997 N=1310) : „ „

61% usia 15-19 th 12,2% melakukan pengguguran „

7,2% ditolong dokter/bidan , 10,2% oleh dukun, 70,4% tanpa pertolongan

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Kehamilan Remaja „

Dampak fisik, fisik kesehatan mental dan emosi, keadaan ekonomi dan kesejahteraan sosial dalam jangka panjangÆ thdp remaja , keluarga , bangsa

Masalah KesPro Remaja „ „ „ „ „ „ „ „

Perilaku berisiko Kurangnya akses pelayanan kesehatan Kurangnya informasi yg benar dan dapat dipertanggung jawabkan Banyak informasi salah tanpa tapisan Termasuk masalah IMS – HIV/AIDS Tindakan kekerasan seksual K h Kehamilan il dan d persalinan li muda d usia i (AKI , AKB naik) Kehamilan tak dikehendaki umur<20 th ( resiko 2-4 x AKI dp ibu berusia 20-35 th

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Penyebab mendasar „ „

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Rendahnya pendidikan remaja Kurangnya ketrampilan petugas kesehatan Kurangnya kesadaran semua pihak akan pentingnya penanganan kesehatan remaja

Lesson learned „

Key strategies for reaching and serving youth include: - developing youth-friendly services;

- involving youth in program design, implementation, and evaluation; - training providers to attend to the special needs and concerns of adolescents; - encouraging community advocacy efforts to support youth development and promote positive adolescent health behaviors; - implementing programs that provide complete and accurate sexual health information; and - incorporating skills-building exercises into youth programs to help young people improve their self-esteem, develop their communication skills about sexuality, and strengthen their ability to negotiate safer sexual practices.

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KESEHATAN REPRODUKSI USIA LANJUT

Sensus penduduk 2000 : „ Wanita > 50 th : 15,5 juta „ Pria > 55 th : 14,2 juta Statistik : Th 2002 wanita it menopause 30,3 30 3 juta j t Laki2 andropause 24,7 juta

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Masalah „

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Wanita kekurangan estrogenestrogen banyak keluhan ,kualitas hidup turun. Meningkatnya nyeri tulang dan sendi Nyeri sanggama Jantung koroner Keganasan Dementia Gangguan produktivitas

Depending on the resources available, appropriate services for older women may include: „

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Counseling g on diet,, exercise,, and other elements of a healthy lifestyle to prevent cardiovascular disease and osteoporosis. Treatment of reproductive tract and urinary infections, uterine prolapse, fistulas, and other gynecological disorders. Screening and treatment for cervical cancer and breast cancer Counseling on menopause and alleviation of symptoms Medical management of women at high risk for fractures, cardiovascular disease, and breast cancer. Support services for older women caring for family members infected with HIV and for grandchildren orphaned by the disease

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Pada laki laki :andropause „ Penurunan hormon androgen dan testosteron „ Impotensi „ Keluhan tulang dan sendi „ Pembesaran kelenjar „ Kanker kelenjar prostat

GENDER DAN KEKERASAN PADA PEREMPUAN

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To address these concerns, gender-sensitive family planning and reproductive health programs have broadened their understanding of needed services to ensure access to: „

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information about sexuality (including the effect of contraceptive methods on sexual satisfaction), and counseling on personal sexual problems advice on how women can negotiate sexual matters with their partners and gain greater control over their sexual lives; sexual education and youth-friendly health services for adolescents screening for common mental illnesses, such as depression and anxiety, followed by appropriate treatment or referrals; services i (or ( appropriate i t referrals) f l ) for f victims i ti off violence i l and d trafficking, including medical treatment, legal advice, sanctuary, and psychological counseling community-based programs that address gender issues, including sexual double standards, folk beliefs about sex and reproduction, and women's right to control their own bodies activities that involve men in reproductive health issues and programs as clients, partners, and gatekeepers

Providers who are sensitive to gender and sexuality issues: „ „

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consistently treat female clients with respect; collect ll t information i f ti about b t a client's li t' sexuall partners, t practices, and problems to help determine their health and family planning needs; help clients assess their STI risks; determine how much control clients have over their sexual lives and, when appropriate, suggest a contraceptive method that can be used without their partner's knowledge, offer to talk to the client's partner, or teach the client how to negotiate sexual matters; query clients about their situation, including the possibility of domestic violence and trafficking; and look for signs of STIs, evidence of physical and sexual abuse, and damage from FGM during physical exams.

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