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KESEHATAN REPRODUKSI
Pemeliharaan dan perawatan
k h t t d k d kesehatan serta dampaknya pada
kesehatan reproduksi
RH Outlook 2003 RH Outlook 2003
RH Library
Sumber dari Depkes
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Millenium Development Goals
(United Nation)- 2015
1 Menghapus kemiskinan dan kelaparan 1. Menghapus kemiskinan dan kelaparan
2. Pendidikan untuk semua orang
3. Promosi kesetaraan gender
4. Penurunan angka kematian anak
5. Meningkatkan kesehatan ibu
6. Memerangi HIV/AIDS, malaria dan penyakit
l i lain
7. Menjamin kelestarian lingkungan
8. Kemitraan global dalam pembangunan
RUANG LINGKUP KES-PRO
1 Kesehatan Ibu dan Anak 1. Kesehatan Ibu dan Anak
2. Keluarga Berencana
3. Pencegahan dan penanggulangan Infeksi
Saluran Reproduksi(ISR), termasuk IMS-
HIV/AIDS
4. Pencegahan dan Penanggulangan
Komplikasi Abortus Komplikasi Abortus
5. Kesehatan Reproduksi Remaja
6. Pencegahan dan Penanganan Infertilitas
7. Kanker pada Usia Lanjut dan Osteoporosis
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Definisi SEHAT Kesehatan
Reproduksi (ICPD Kairo ,1994)
Suatu keadaan sejahtera fisik mental Suatu keadaan sejahtera fisik , mental
dan sosial secara utuh, tidak semata-
mata 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 kelahiran AKI Indonesiaan /100.000 kelahiran
hidup :
1986 450
1992 421
1994 390
1995 373 1995 373
1997 334
2003 307
Worldwide, it is estimated that 515,000
women die yearly from complications of women die yearly from complications of
pregnancy and childbirthabout one woman
every minute.
Some 99 percent of these deaths occur in
developing countries, where a woman's
lifetime risk of dying frompregnancy-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 's target has subsequently been adopted The SMI 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
Ensuringaccess to essential obstetric care is 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;
parenteral sedatives for eclampsia; p p ;
manual removal of placenta;
manual removal of retained products; and
assisted vaginal delivery.
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Comprehensive essential
obstetric care
Comprehensiveessential obstetric Comprehensive essential obstetric
care services at the district
hospital level (first referral level)
should include all of the above,
plus:
surgery surgery
anesthesia
blood transfusion
Ten years after: Key
lessons learned
recognizing that every pregnancy faces risks; g g y p g y ;
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 a continuum of care connected by effective e su ga co t uu o ca e co ectedby 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
Strongpolitical commitment. 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
services, especially life-saving services. , p y g
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:
Kesadaran perilaku hidup bersih dan Kesadaran perilaku hidup bersih dan
sehat
Status gizi dan status kesehatan ibu
Penyediaan akses terhadap pelayanan
Kes-Pro dan hak-hak reproduksi untuk Kes Pro dan hak hak reproduksi untuk
usia lanjut
Gender Development Index
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Peningkatan peran serta masyarakat Peningkatan peran serta masyarakat
dalam penanganan kesehatan dan hak
reproduksi
Human Development Indeks (HDI)
Gender Empowerment Measure (GEM) Gender Empowerment Measure (GEM)
Buta huruf 15-45 tahun
Wajib belajar 9 tahun
ANTENATAL CARE W.H.O.
Birth Planning Birth Planning
Danger Signs
Perdarahan
Pre eklampsia/eklampsia
Perut nyeri
Pernapasan sesak
Panas 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 1970 : 5 5 Total Fertility Rate 1967-1970 : 5,5
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 Unmeet need (pasangan usia subur yg
seharusnya harus pakai KB namun tidak
memakai alat KB):
1997 9,7%
2002 8,6% 2002 8,6%
Diharapkan 2004 turun jadi 6,5%
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65% ibu hamil menderita 4 terlalu : 65% ibu hamil menderita 4 terlalu :
Terlalu muda
Terlalu tua
Terlalu sering
Terlalu banyak
Hal ini menujukkan bahwa masih banyak PUS
l b yg perlu ber 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.
Training and performance improvement
Supervision
Quality improvement strategies
Integrated services
Financial management and sustainability
Policy making
Advocacy
PENCEGAHAN INFEKSI MENULAR PENCEGAHAN INFEKSI MENULAR
SEKSUAL (termasuk HIV / AIDS)
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Penelitian terbatas
J akarta Utara (1997)- 312 klien KB: J akarta Utara (1997)- 312 klien KB:
Prevalensi ISR 24,7%
Klamydia 10,3% , trichomonas 5,4% ,
gonore 0,3%
Surabaya 599 perempuan hamil :
f Infeksi herpes simpleks 9,9%, klamidia
8,2%, trikomonas 4,8%, GO 0,8% dan
sifilis 0,7%
Base-line survey (1999)
42% remaja tahu HIV/AIDS 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 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 Diperkirakan th 2002 90-130 ribu orang
HIV di Indonesia
Kumulatif sampai J uni 2005 infeksi HIV
3.740 AIDS 3.358
Kelompok berisiko tinggi waria penjaja
k seks
Tidak hanya penjaja seks dan
langganan , pengguna NAPZA juga
Although AIDS is incurable, the
transmission of HIV is preventable.
increasepeople's awareness andknowledge of increase peoples 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 (RTI ) i l di ll infections (RTI s) including sexually
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
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 populationespecially young people
are equally essential to HIV prevention.
Political leadership and support are critical to
an effective response to the HIV/ AIDS
epidemic.
Prevention
Workingwith youngpeople is key to HIV Working with young people is key to HI V
prevention efforts. Effective approaches
include:
HIV/ AIDS life-skills education;
communications programs involving mass media;
condom access;
l t li t ti d f l i voluntary counseling, testing, and referral services;
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
Collaboration with local organizations and g
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
scarceresources andskills andincrease 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
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 andvolunteers especially people Community members and 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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KESEHATANREPRODUKSI KESEHATAN REPRODUKSI
REMAJ A
Survei Depkes 1995/1996
Remaja 13 19 th di J abar dan Bali Remaja 13-19 th di J abar 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 kesehatan mental dan Dampak fisik, kesehatan mental dan
emosi, keadaan ekonomi dan
kesejahteraan sosial dalam jangka
panjang thdp remaja , keluarga ,
bangsa
Masalah KesPro Remaja
Perilakuberisiko 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 il d li d i (AKI Kehamilan dan persalinan muda usia (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
Rendahnya pendidikan remaja Rendahnya pendidikan remaja
Kurangnya ketrampilan petugas
kesehatan
Kurangnya kesadaran semua pihak
akan pentingnya penanganan akan pentingnya penanganan
kesehatan remaja
Lesson learned
Key strategies for reachingandservingyouth 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 andaccurate 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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KESEHATANREPRODUKSI KESEHATAN REPRODUKSI
USIA LANJ UT
Sensus penduduk 2000 : Sensus penduduk 2000 :
Wanita > 50 th : 15,5 juta
Pria > 55 th : 14,2 juta
Statistik :
Th 2002 it 30 3 j t Th 2002 wanita menopause 30,3 juta
Laki2 andropause 24,7 juta
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Masalah
Wanita kekurangan estrogen banyak keluhan Wanita kekurangan estrogen- banyak keluhan
,kualitas hidup turun.
Meningkatnya nyeri tulang dan sendi
Nyeri sanggama
J antung koroner
Keganasan
Dementia
Gangguan produktivitas
Depending on the resources available,
appropriate services for older women may
include:
Counseling on diet, exercise, and other elements of a g , ,
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 highrisk for 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 Pada laki laki :andropause
Penurunan hormon androgen dan
testosteron
Impotensi
Keluhan tulang dan sendi Keluhan tulang dan sendi
Pembesaran kelenjar
Kanker kelenjar prostat
GENDER DAN KEKERASAN 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:
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;
i ( i t f l ) f i ti f i l d services (or appropriate referrals) for victims of violence and
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:
consistently treat female clients with respect;
ll t i f ti b t li t' l t collect information about a client's sexual partners,
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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