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
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
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
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.
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.
Older women
Women live longer than men
Non communicable disease, mostly related to the life style when they are younger
Source:
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
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
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
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
Maternal survival strategies6
All women Subsets of women
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
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
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.
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
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
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
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
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
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
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
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/