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2017 GH Sesi 11 BD Women’s Health

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Introduction

 A woman is a human

 Gender vs sex

 Gender is non biologic characteristics subjected to a human because of his/her sex

 Socially constructed characteristics of man and woman

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Women’s health problem

 Related to reproductive health

1. Pregnancy and delivery 2. Breast feeding

3. Family planning

 Gynecological problem: different problems in age cycle

 Disease that a woman has higher risk than a man, ex. COPD related to cooking fuel

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Gender based problems which

affect women’s health

 Access to health service

 Unequal opportunities to study and work

 Lack of nutrition

 Psychological well being

 Adherence to a treatment

 Inadequate information

 Sexual violence

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Adolescent girls

 Highest causes of death globally: Self-inflicted injuries, road traffic injuries and drowning

 Depressive disorders and schizophrenia are leading causes of ill health.

 Risk of HIV infection: Twice among adolescent girls and young women (15-24 years) compared to boys and young men in the same age group.

 More than 15 million of the 135 million live births worldwide are among girls aged 15-19 years

 An estimated three million unsafe abortions occur globally every year among girls aged 15-19 years.

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Reproductive age(15-44 years old)

 Causes of death in developing countries: HIV/AIDS, with unsafe sex being the main risk factor in developing countries.

 Maternal deaths are the second biggest killer of women of

reproductive age. Every year, approximately 287 000 women die due to complications in pregnancy and childbirth, 99% of them are in developing countries.

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Older women

 Women live longer than men

 Non communicable disease, mostly related to the life style when they are younger

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Source:

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Maternal health indicators

Global Indonesia

Maternal mortality 216/100 000 live births 346/100 000 live births

Percentage of birth assisted by skilled birth attendants

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The Lancet2016 387, 462-474DOI: (10.1016/S0140-6736(15)00838-7)

Copyright © 2016 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.Terms and Conditions

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Cause of maternal death

 severe bleeding (mostly bleeding after childbirth)

 infections (usually after childbirth)

 high blood pressure during pregnancy (pre-eclampsia and eclampsia)

 complications from delivery

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Family planning

 It is estimated that 225 million women in developing country would like to delay or stop childbearing but does not get access to the contraception

 Limited access

 Limited choice of method

 Poor service quality

 Fear of side effect

 Cultural or religious barrier

 Gender based barriers

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Maternal survival strategies6

All women Subsets of women

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Strategies to decrease maternal

mortality

 eliminate inequalities in access to and improve quality of reproductive, maternal, and newborn health care services;

 ensuring universal health coverage for comprehensive reproductive, maternal, and newborn health care;

 managing all causes of maternal mortality, reproductive and maternal morbidities, and related disabilities; and

 strengthening health systems to respond to the needs and priorities of women and girls

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Gynecological problems

 Sexually transmitted infection

 Each year, there are an estimated 357 million new infections with 1 of 4 STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis.

 More than 290 million women have a human papillomavirus (HPV) infection.

 STIs such as HSV type 2 and syphilis can increase the risk of HIV acquisition.

 Over 900 000 pregnant women were infected with syphilis resulting in approximately 350 000 adverse birth outcomes including stillbirth in 2012

 Serious consequence beyond the direct complication, ex. Infertility, mother to child transmission

 DALYs lost because of gonorrhea and chlamydia infection in women is 10 times more than in men

 Gynecological cancer

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Gynecological problem

 Abortion

 22 millions unsafe abortion annually, 47 000 death, and 5 millions complication

 220 deaths/100 000 unsafe abortion in developing world

 520 deaths/100 000 unsafe abortion in Sub Saharan Africa

 Female genital mutilation

 Intentional procedure that injure female genital organ without medical reason

 No health benefit for the girls

 More than 200 million girls and women alive today have experienced FGM in 30 countries in Africa, the Middle East and Asia where FGM is concentrated.

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Sexual Violence

 any sexual act or attempt to obtain a sexual act by violence directed against a person's sexuality, regardless of the relationship to the victim

 Physical and mental health impact:

 Injury

 increased risk of reproductive health problem,

 transmission of IMS,

 suicide

 different mental disturbance

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Medical response to sexual

violence victims

 Treat emergency injury

 Collect evidence of violence for legal procedure

 Prevention of IMS

 Prevention of hepatitis

 Prevention of HIV

 Prevention of pregnancy

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Health disparity by sex

 In general, women live longer than men because of biological and behavioral protection

 In Low income countries, women’s life expectancy became the

same as men

 Some diseases tend to have higher prevalence in women due to non biologic factor:

 Less access to health care because of different woman man positition

 Society preference on boy or man

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Why invest on women’s health

Women’s status and empowerment

affect

their

maternal health (

including access to and use of services

during pregnancy and childbirth

)

Maternal health effects

survival and long term well

being

of the child through its effect on their education,

growth, and care

Maternal death and illness is

costly

for families

Maternal health affects economic

productivity

and

overall health service delivery

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Reduce the global maternal mortality ratio to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average by 2030

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Sustainable Development Goal 5

Targets

5.1 End all forms of discrimination against all women and girls everywhere

5.2 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation

5.3 Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation

5.4 Recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally

appropriate

5.5 Ensure women’s full and effective participation and equal opportunities for

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Sustainable Development Goal 5

Targets

5.6 Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International

Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences

5.aUndertake reforms to give women equal rights to economic resources, as well as access to ownership and control over land and other forms of property, financial services, inheritance and natural resources, in accordance with national laws

5.bEnhance the use of enabling technology, in particular information and communications technology, to promote the empowerment of women

5.cAdopt and strengthen sound policies and enforceable legislation for the

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References

 http://data.unicef.org/topic/maternal-health/antenatal-care/

 Alkema, L. et al., 2016. Global, regional, and national levels and trends in maternal mortality

between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet (London, England), 387(10017), pp.462– 74. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26584737 [Accessed December 4, 2016].

 Kementerian Kesehatan Republik Indonesia, 2014. Situasi Kesehatan Ibu, Infodatin, Mother’s day, Jakarta.

 Say, L. et al., 2014. Global causes of maternal death: a WHO systematic analysis. The Lancet. Global health, 2(6), pp.e323–33. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25103301 [Accessed December 5, 2016].

 United Nations, 2015. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division., Geneva: World Health Organization.

 World Health Organization, 2009. Women and health, today’s evidence tomorrow's agenda, Geneva.

 http://www.un.org/sustainabledevelopment/gender-equality/

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