REPRODUCTVE HEALTH�WOMEN SEXUAL/REPRODUCTIVE RIGHTS�& RAPE

DR ACHARA AMAECHI PETER

VISITING LECTURER, DEPATMENT OF O & G, COLLEGE OF HEALTH SCIENCES, BINGHAM UNIVERSITY

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SUBSTAINABLE DEVELOPMENT GOALS

• A collection of 17 global goals set by UN general assembly in 2015 for the year 2030

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THE SDGs

1. No poverty
2. Zero hunger
3. Good health & well being
4. Quality education
5. Gender equity
6. Clean water & sanitation
7. Affordable clean energy
8. Decent work & economic growth
9. Industry, innovation, and infrastructure
10. Reducing inequality

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11. Sustainable cities & communities

12. Responsible consumption & production

13. Climate action

14. Life below water

15. Life on land

16. peace, justice & strong institutions

17. Partnership for the goals

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A LOOK AT THE SUBSTAINABLE DEVELOPMENT GOAL 3/ TARGETS

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BEFORE WE START….

• SUBSTAINABLE DEVELOPMENT GOAL (SDG) 3: “Ensure healthy lives and promote well-being for all at all ages”
• SDG 3.7:

“by 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs”

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OUTLINE

• DEFINITION/INTRODUCTION
• COMPONENTS OF RH
• IMPORTANCE OF RH
• SEXUAL & REPRODUCTIVE RIGHTS
• RAPE
• CONCLUSION

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DEFINITION/INTRODUCTION

• Reproductive Health is defined as a condition in which, the reproductive process is accomplished in a state of complete physical, mental, social and spiritual well-being and not merely the absence of disease or disorders of the reproductive process.
• RH involves the constellation of methods, techniques and services that contribute to reproductive health and well-being through preventing and solving reproductive health problems.

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CONCEPT OF REPRODUCTIVE HEALTH

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It implies that:

• Couples have the ability to reproduce and regulate their fertility
• Women are able to go through pregnancy and child birth safely
• Outcome of the pregnancy is successful in terms of maternal and infant survival and well-being and
• Couples are able to have sexual relations free of the fear of pregnancy and of contracting any disease

EVERY MINUTE IN THE WORLDỊ:

• 380 WOMEN BECOME PREGNANT

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• 190 OF THESE DID NOT PLAN OR WISH THE PREGNANCY

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• 110 WOMEN EXPERIENCE A PREGNANCY RELATED COMPLICATION

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• 40 WOMEN HAVE UNSAFE ABORTION

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• 1 WOMAN DIES FROM A PREGNANCY RELATED ISSUES

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RH package offers the following services:

• Comprehensive family planning for females and males
• Maternal health care including safe motherhood, pre- & post abortion care for complications.
• Infant health care
• Management of reproductive health related problems of the adolescence
• Management of other reproductive health related problems of women;
• Prevention and management of RTIs/STIs and HIV/AIDS;
• Management of infertility;
• Detection & management of breast and cervical cancers;
• Management of reproductive health related issues of men

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COMPONENTS OF RH (WOMB TO TOMB)

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LIFE CYCLE PERSPECTIVE TO RH

• RH applies throughout an individual’s life cycle
• RH needs differ at each stage of life
• May reflect a healthy childhood, it is crucial during adolescence, and sets the stage for health in adulthood and beyond the reproductive years for both men and women.

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THE IMPORTANCE OF REPRODUCTIVE HEALTH

• It is a universal concern, but with emphasis to the women in her reproductive years. This is because, even as the majority of the health problems arise during reproductive years, in old age, general health is affected by earlier reproductive life.
• It contributes enormously to physical and psychological comfort and closeness, and to personal and social maturation. Poor RH is frequently associated with disease, abuse, exploitation, unwanted pregnancy and even death.
• At each stage of life, individuals needs differ with implications for future well-being.

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SAFE MOTHERHOOD

• 525,000 maternal death annually
• 2% world population are Nigerians
• 10% worldwide deaths are Nigerians!!!
• For each death 25 other women suffer long-term & often debilitating illness
• Deaths are mostly preventable

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Contributory factors to maternal death:

• Poor availability & poor quality of MCH
• Uneven & inadequate access to EMOC
• Weak community support and lack of male involvement to SMI
• High fertility, Low women status, Poverty & low literacy

Interventions:

• Scaling-up the skills of Midwives-LSS, M.O.-ELSS
• BFI & SMI

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INFANT & CHILD SURVIVAL, GROWTH AND DEVELOPMENT

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• GOBIFFFEETH

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• G – Growth monitoring
• O – Oral rehydration therapy
• B – Breastfeeding
• I- Immunization
• F – Family planning
• F- Food supplementation
• F – Female education
• E – Essential drugs
• E - Environmental protection
• T – Treatment of common illnesses
• H – Health Education

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ELIMINATION OF HARMFULL PRACTICES

• Some traditional & cultural practices that are classified harmful started out with the noblest of intentions
• Knowing the origins of this practices can contribute to the process of changing & eradicating them
• HP are a number of procedures, practices, and belief in traditional society which in the light of modern medical and health practices have clearly been shown to have a negative effect on the health of mothers & children

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PRACTICES:

• Place & method of delivery, Care of the new born; millet stalk, purging of infants, Extracting milk teeth & uvulectomy, Poor hygiene during bath; spitting on babies face, allowing infant to drink bath water, exposure to cooking smoke, With-holding colostrums
• Female genital mutilation or Female genital cutting, Facial or body marks and therapeutic scarification, Early marriage, Gishiri cut, Wife inheritance, Widow-hood rights

INTERVENTIONS:

• Re- orientation, Behavioral change communication, Women Empowerment

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ADOLESCENT REPRODUCTIVE HEALTH

• Status of RH for adolescent
• Level of effective contraception among sexually active is low
• Teenage pregnancy high, about 2/3 end up as induced abortion with severe morbidity & mortality
• Anaemia, malnutrition, growth impairment are serious development issues

FACTORS ASSC. WITH POOR ARH:

1. Lack of awareness
2. Limited access to sources of information & RH facilities
3. Population & family life education including sexuality education Is not taught in most schools

INTERVENTIONS:

• Awareness creation on RH issues & needs of adolescents
• Involvement of adolescence as stake holders in planning, implementation, monitoring and evaluation of activity
• Acceptable channels of communication
• Establish youth friendly services

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FERTILITY MGT AND REGULATION

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High fertility rate [5.7 children/woman] due to;

• Negative socio-cultural belief, Negative impacts of myths & rumors about family planning, Poor access to service in rural areas, Irregular supply of commodities, Low status of women, Increasing teenage pregnancy, Lack of male involvement.

INTERVENTIONS

• Re-awaken community awareness on family planning services
• Promotion of behavioral change communication
• Updating operational guidelines & the standard of practice
• Expanding access to service especially adolescence & people under special circumstances such as refugees & mentally challenged
• Strengthening commodity supply & logistics, Ensuring client satisfaction
• Promoting male involvement in family planning services

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PREVENTION & MGT OF �REPRODUCTIVE TRACT INFECTIONS

• The HIV epidemic has become a major health and development issue in Nigeria. Currently, it is estimated that, there are > 3 million people living with HIV/AIDs in Nigeria.

INTERVENTIONS:

• ABC of Prevention, Testing and counseling, Sustained community awareness, Promote syphilis & gonorrhea testing for all ANC clients, Dual protection
• Integrating RH services into care & support of persons infected or affected by HIV/AIDS

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PREVENTION AND MANAGEMENT OF �UNSAFE ABORTION

• Unsafe abortion is a major RH problem in Nigeria, though it is legally restricted, about 610,000 abortions take place annually in Nigeria.
• It is projected that, about 20,000 Nigerian women die every year from the complications of unsafe abortions.
• It is estimated that 80% of patients are adolescents and 3/5 of the procedure performed by non-physicians and in medically Unfit environment with it’s attendant consequences.

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Primary Prevention:

• Women empowerment and education.
• Provision of RH information to all women and men to make informed choices.
• Promote the use of all forms of Family planning.

Secondary Prevention:

• Accessible and reliable information and compassionate counseling.
• Liberalize abortion laws to promote safe abortion.

Tertiary Prevention:

• Quality services for the management of complications followings abortions.
• Post abortion care [PAC] services should be available.
• In-services training of Health workers on all aspects of abortion and PAC.

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PREVENTION & MGT OF INFERTILITY & SEXUAL DYSFUNCTION

INFERTILITY

• Infertility constitute major socio-cultural problem for couples in Nigeria. About 3% Nigerians women suffer primary sterility
• Prevalence rising due to rising incidence of STI, complication of abortions & unclean deliveries

INTERVENTIONS:

• Provide appropriate information on prevention & expanding access to quality services
• Raising comm. Awareness & integrating interventions into RH services & offering linkages with adoption services

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SEXUAL DYSFUNCTION:

• Magnitude unknown
• Sildenafil citrate [Viagra^R] approval opened up great opportunity for more open discussion

INTERVENTION;

• Advocacy & community sensitization to raise awareness
• Expanding the knowledge & skills of the service providers
• Counseling & strengthening the referral system especially services for infertility & family planning

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GENDER EQUITY

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• Elimination of Gender disparity in primary and secondary school education.

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• Improve on the ratio of literate women to men 15-24 years old.

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• Increase proportion of women gainfully employed.

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• Reduce disparity between men and women in political positions, both elected and appointed seats.

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REPRODUCTIVE TRACT MALIGNANCIES

• Breast and cervical cancers are the leading causes of cancer related deaths among women, while cancer of the prostate is the major cause of cancer related death among men.
• Prevalence of these cancers can be reduced via awareness creation among the entire populace, training of Health workers and strengthening of health facilities to provide cancer screening tests.

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PROBLEMS ASSOCIATED WITH �MENOPAUSE AND ANDROPAUSE

• Whilst the needs of women during the peri-menopausal phase have been recognized and addressed in most western countries, these needs have not been properly addressed in developing countries.
• There is need to pass information to clients on what to expect after menopause. Counsel on the need and importance of HRT. Strengthen the family, community and health system to render care.
• Little is known about andropause. There is need for counseling & more investigation to address its problems.

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WHAT IS SEXUAL HEALTH?

• Sexual health is a part of reproductive health. It includes healthy sexual development, equitable and responsible relationships and sexual fulfillment. It is also freedom from illness, disease, disability, violence and other harmful practices related to sexuality.
• Sexual health integrates emotional, intellectual, and social aspects of sexual being in order to positively enrich personality, communication, relationships and love.

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PRINCIPLES OF SEXUAL HEALTH

• Capacity to enjoy sex, and control sexual and reproductive behavior
• Freedom from shame, guilt, fear, and other psychological factors
• Freedom from organic disorder or disease that interferes with sexual and reproductive function

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WHAT ARE REPRODUCTIVE AND SEXUAL RIGHTS?

• These rights embrace certain human rights recognised in national and international legal and human rights documents, and include:
• The right of couples and individuals to decide freely and responsibly the number and spacing of their children, and to have the information and means to do so;
• The right to attain the highest standard of sexual health
• The right to make decisions about reproductive health and sexual health free of discrimination, coercion or violence

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REPRODUCTIVE RIGHTS

• Reproductive rights encompass the right to RH care, which includes the right to regular access to safe, high quality RH care services, and the right to reproductive self-determination (Reproductive Rights 2000). This includes the right to plan one’s family, freedom from interference in reproductive decision making and the right to be free from all forms of violence and discrimination which affect the reproductive life of a woman.
• Human rights include the right of women to control their sexuality and reproduction. The exercise of this right requires that the needs of present and future children and their responsibilities towards the communities should be taken into account (Beijing Fourth World Conference on Women 1995).
• Reproductive rights is defined as the respect for women’s bodily integrity and decision making, the right to express their sexuality with pleasure and without fear, abuse, disease or discrimination (International Women’s Health Conference 1994).

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RIGHT BASED APPROACH TO WOMEN RH

• Right based approach to reproductive health is an important end in itself. Human rights of women include their right to have control over and decide freely and responsibly on matters relating to their sexuality and reproductive health, free from coercion, discrimination and violence.
• Client based, right based approach reflecting gender equity and equality, reproductive rights and reproductive healthcare should be adopted. Such a right based approach should link human health and human rights in order to make a strong case for the health of women and young people.

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REPRODUCTIVE HEALTH AS A HUMAN RIGHT

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RAPE

• Rape may be defined as a sexual intercourse between a man and a woman or a girl against the will or consent of the female partner.
• Rape is a crime against humanity and a violation of the right to privacy and dignity of the human person and a violent infringement on the sexual rights of the female person.
• It’s one of the oldest crime in human history, reported more in developed countries, under-reported in developing nations.
• It thrives in secrecy, especially in some cultures where the victim is blamed rather than the perpetrators.

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• Going by the provision of law, rape is defined under section 357 of the Criminal Code which applies to the Southern part of Nigeria as:
• Any person who has unlawful carnal knowledge of a woman or girl, without her consent or with her consent, if the consent is obtained by force or by means of threats or intimidation of any kind, or by fear of harm, or by means of false and fraudulent representation as to the nature of the act, or in the case of a married woman, by personating her husband is guilty of an offence which is called rape.

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• In the Northern part of Nigeria, it is defined under section 282 of the Penal Code as:
• (1) A man is said to commit rape who … has sexual intercourse with a woman in any of the following circumstances:- (a) against her will; (b) without her consent; (c) with her consent, when her consent has been obtained by putting her in fear of death or of hurt; (d) with her consent, when the man knows that he is not her husband and that her consent is given because she believes that he is the man to whom she is or believes herself to be lawfully married; (e) with or without her consent when she is under fourteen years of age or of unsound mind.
• (2) Sexual intercourse by a man with his own wife is not rape, if she has attained to puberty.

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• The two definitions above show that in Nigeria, rape can only be committed by a man against a woman and not vice versa.
• In other climes, this is not the case because it has been recognized that a man may also be a victim of rape and it may be perpetrated by any person, including a woman. For example, in the USA, the Department of Justice defines rape as:
• Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.

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• Rape can be defined as an act done which causes penetration of one persons genital organs with the genital organs of another without their consent or where consent is obtained by force, threat or intimidation of any kind.
• PUNISMENT FOR RAPE: Life imprisonment in Nigeria, U.K, USA, and India. Death penalty in Egypt, Saudi Arabia, China and North Korea.
• Rape is committed when sexual intercourse take place with a sleeping or drunken woman because there is no consent.

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ESTABLISHING A CASE OF RAPE IN NIGERIAN COURT:

• To establish a case of rape in court, the prosecutor must be able to prove the following elements beyond reasonable doubt:
• 1. that an accused person has sexual intercourse with a woman against her will
• 2. that the act of sexual intercourse is proved by penetration of the accused person’s penis into the woman vagina
• 3. that the victim is not his wife

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EFFECT OF RAPE ON THE VICTIM:

1. Unwanted pregnancy
2. Transmission of sexually transmitted diseases like HIV/AIDS
3. Abortion
4. Suicide tendencies
5. Trauma
6. Loss of self esteem
7. Untimely death
8. Damage to body organs

N.B: Rape is a heinous crime and it usually leaves a victim emotionally disorganized.

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RAPE, SEXUAL ASSAULT AND DEFILEMENT

• In relation to rape, there must be a penetration of vagina with a penis without the consent of the female counterpart,
• while in a sexual assault, there need not be sexual intercourse at all. For example, inappropriate touching of a woman may amount to sexual assault.
• In the case of defilement, on the other hand, it is a sexual intercourse with a girl under eleven (11) years. It is immaterial in this situation whether there is consent or not as the law presumes that such a girl is incapable of giving consent.
• The crime also carries life imprisonment but the case must be prosecuted within two months of its commission.

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WHAT VICTIM SHOULD DO AFTER RAPE

• Find a safe place away from the assailant and call a relative or close friend for support.
• Report the case at a nearby police station: do not bath, change dress or remove things from the scene. Police need the evidence.
• Seek medical attention: ideally, the police should usually take the victim to the hospital for medical examination and treatment.

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MANAGEMENT OF RAPE VICTIMS

AT THE CLINIC:

• History taking
• Head to toe examination: any injuries, signs of violence
• Genito-anal examination
• Investigations for clinical management of the survivor
• Investigations carried out for evidence purposes
• Management of physical injuries: give T.T, treat wounds, antibiotics
• Post exposure prophylaxis :ARVs [Tenoforvir/Emtricitabine =Truvada]
• Pregnancy prevention: Postinor II, other emergency contraceptive
• Prophylaxis of STI’s: antibiotics

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INVESTIGATING RAPE VICTIM

• Urine: urine PT
• Blood: HIV test, VDRL, LFT, PCV
• HVS or aspirate of vagina @ posterior fornix: for evidence of spermatozoa

N.B: Need to repeat HIV test [window period]

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PROPHYLAXIS FOR STI’s

• Males & non-pregnant women:
• Norfloxacin 800mg stat
• Caps Doxycycline 100mg twice daily for 7 days
• Pregnant women:
• Spectinomycin [Togomycin^R] 2g stat
• Tabs Erythromycin 500mg Q.D.S for 7 days
• Children:
• Amoxycillin 15mg/kg T.D.S for 7 days
• Erythromycin 10mg/kg Q.D.S for 7 days

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COUNSELING OR PSYCHOTHERAPY  

• Counseling or psychotherapy can be helpful in dealing with the events of the assault itself as well as the anger, fear, depression, or anxiety that many people feel afterwards.

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• Several types of healthcare providers provide counseling, including social workers, psychologists, nurses, and psychiatrists. Some people prefer to meet one-on-one with a counselor while others prefer to meet in a group setting with other people who have had similar experiences.

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CONCLUSION

• Reproductive health, sexual and reproductive rights and rape are human right issues.
• Countries and states must put in place policies and laws to protect the rights of individuals especially women sexual and reproductive health.

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THANK YOU

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