21/05/2007

KESEHATAN REPRODUKSI

Pemeliharaan dan perawatan

k
kesehatan
h t sertat d
dampaknya
k pada
d
kesehatan reproduksi

„ RH Outlook 2003
„ RH Library
„ Sumber dari Depkes

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Millenium Development Goals

(United Nation)-Æ 2015
1
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
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
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
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
/100 000 kelahiran
hidup :
„ 1986 – 450
„ 1992 – 421
„ 1994 – 390
„ 1995 – 373
„ 1997 – 334
„ 2003 – 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
„ recognizing
g g that every
yppregnancy
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
„ 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
p y life-saving
g services.
„ 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
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
„ 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 :

„ Terlalu muda
„ Terlalu tua
„ Terlalu sering
„ Terlalu banyak
„ Hal ini menujukkan bahwa masih banyak PUS
yg perlul 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.

„ 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)

„ 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.
„ 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

„ 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

„ 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

„ 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

„ 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
„ 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
„ Wanita kekurangan estrogen-
estrogen 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:
„ 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:

„ 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:
„ 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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