Prof. Dr. Yati Afiyanti, SKp.

MN

Perspektif Keperaw atan Bagi Kesehatan

Seksual-Reproduksi Perempuan
Di Masa Pandemik Covid -19
 ◦ Multi Peran Perempuan dalam Relasi Sosial
◦ Isu global dan Tantangan Kesehatan Perempuan
◦ Masalah Kesehatan Perempuan Sepanjang Daun
Kehidupan
◦ Perempuan adalah Kelompok Rentan di Masa
Covid Pandemik
Paparan ◦ SRH Komprehensif untuk Perempuan
◦ Comprehensive Nursing Care for Women
Reproductive Health on the Covid-19 Pandemic
◦ Nursing care: Operational Guidelines For SRH
During The Covid-19 Pandemic (WHO, 2020)
 The second citizen on the world, with characterize:
lower education & high-risk for getting domestic
violence

Malu or tabu utk bicara tentang kondisi dirinya sendiri

(cultural of silence)   kemampuan ‘empower’nya
utk membuat keputusan ttg kesehatan dirinya

Perempuan
as Berisiko menjadi miskin ketika menjadi single support
bagi keluarganya
“High Risk Person”
Mengalami diskriminasi sosial,
budaya, dll

Berisiko tinggi mengalami kematian dan komplikasi

pada masa motherhood
Multi Peran Perempuan :
Peran
Reproduksi
Peran
Peran
Merawat
Produksi
Keluarga
 ◦ World population growth
◦ Maternal mortality

Global ◦ Maternal morbidity

Issues in ◦ Unsafe abortion

◦ Menopause
Women’s ◦ STDS and HIV/AIDS

Health ◦ Cervical Cancer

◦ Advancing reproductive health
◦ Women’s violence
 ◦ Masalah psikologis pada ibu hamil
dan bulin
Isu masalah
kesehatan ◦ Pernikahan remaja
reproduksi ◦ Anemia pada ibu hamil
perempuan
di Gorontalo, ◦ Preeklamsia
Sulawesi Utara ◦ Cakupan ASI eksklusif tercapai
(personal ◦ Skrining deteksi kanker pada
komunikasi)
perempuan masih belum banyak
tersedia
 ◦ Ketidakberdayaan
◦ Kemiskinan
The
◦ Faktor sosial & budaya
Challenges ◦ Lesbi group
of Women ◦ Addictions & abuse
health ◦ Survivors of violence
◦ Devalued & discriminated dari
sist.pelayanan kesehatan
 Women’s Sexual Reproductive
Health Problem Sepanjang Daur
Kehidupan
 ◦Mutilasi alat kelamin
Balita ◦Communicable Diseases &
Perempuan Peny.Infeksi
◦Earlier Weaning
 ◦Hambatan Tum-Bang
Anak ◦Penyakit Infeksi
Perempuan ◦Malnutrisi
◦Kesulitan Belajar
 ◦Status Gizi
◦Kehamilan
Remaja ◦Menyusui
Perempuan ◦Gangguan Menstruasi
◦Kelainan Organ Genitalia
 ◦ Berat Badan  malnut or obese
◦ Kekurangan zat besi, Vit A & Iodine
◦ Morbiditas dan Mortalitas pada
Perempuan masa motherhood
Dewasa/Usia ◦ Komplikasi kehamilan, melahirkan,
Subur dan masa laktasi
◦ Peny. Infeksi Genitalia
◦ Infertilitas
 ◦ Rentan mengalami kanker genitalia
or payudara
◦ Osteoporosis
Perempuan ◦ Penyempitan pembuluh
Menopause darah/stroke
◦ Keluhan-keluhan fisiologis akibat
proses menua/aging process
 Women & Girls
Adalah Kelompok Rentan
Di Masa Pandemic Covid-19
Bagaimana data di Gorontalo,
Indonesia ??
 LBH Apik mencatat 59
kasus KDRT, perkosaan
Jakarta Post, dan kekerasan seksual
dari tanggal 16 Maret
2020 hingga 30 Maret. 17 kasus
dari 59 kasus tersebut
adalah KDRT.
Study di Turki tentang Female sexual
behavior (Yuksel & Ozgor, 2020)
◦ Results: Average frequency of sexual intercourse was significantly increased during the pandemic
compared with 6–12 months prior (2.4 vs 1.9, P=0.001). Before the pandemic 19 (32.7%)
participants desired to become pregnant, whereas during the pandemic it had decreased to 3
(5.1%) (P=0.001). Conversely, use of contraception during the pandemic significantly decreased

Bagaimana studi di INDONESIA ??

among participants compared with prior (24 vs 10, P=0.004). Menstrual disorders were more
common during the pandemic than before (27.6% vs 12.1%, P=0.008). Participants had significantly
better FSFI scores before the pandemic compared with scores during the pandemic (20.52 vs 17.56,
P=0.001).
◦ Conclusion: Sexual desire and frequency of intercourse significantly increased during the COVID‐19
pandemic, whereas quality of sexual life significantly decreased. The pandemic is associated with
decreased desire for pregnancy, decreased female contraception, and increased menstrual
disorders.
 Masalah lain
Akses kesehatan Perempuan as
dan kesehatan “careworker” tidak
reproduksi sulit terperhatikan
dan tidak
terjangkau
aspek
reproduksinya perempuan
(kespro)
Krisis Aspek di masa
pandemic
kepemimpinan gender:bantuan
perempuan, pemerintah tidak
sehingga terjadi mengenai sasaran
unmet
reproductive
untuk kebutuhan
reproduksi covid-19
needs perempuan
 ◦ Antenatal care & Postnatal care
◦ Newborn care
◦ Breastfeeding support
Comprehensive ◦ Family planning and contraception services
SRH services ◦ Cervical cancer screening
with Covid-19 for ◦ Safe abortion
women ◦ HIV/AIDS and sexually transmitted infections.
◦ Gender-based violence and domestic abuse
◦ Rape survivor
Comprehensive Nursing Care for Women
Reproductive Health on the Covid-19
Pandemic
 ◦ As primary facilitator the women’s
connection to the health care system:
Kontribusi how to make them making choices about
Perawat their health & determine the extent of the
role they wish to play in their health care
 ◦ As supporter for self-
care/assessment:
Kontribusi collaborative with the women when
Perawat sharing information & encouraging
them to be experts on what is
normal for each of them
 ◦ Provide information that addresses
the women’s concerns
◦ Becoming partners in education &

Kontribusi collaborating with each woman

◦ Supporting the woman’s analysis of
Perawat her experiences & needs
◦ Helping in building upon her current
competencies in self-care
 Nursing care:
Operational Guidelines For SRH
During The Covid-19 Pandemic
(WHO, 2020)
 Perawatan ANC:
◦ Mengidentifikasi kehamilan berisiko tinggi untuk layanan ANC
◦ Reschedule jadwal kunjungan ANC untuk mengurangi
penumpukan sambil menjaga jarak fisik;

Access for ◦ Kunjungan rumah ANC atau konsultasi dan konseling jarak
jauh untuk mengurangi paparan bagi para ibu
PNC di Masa ◦ Memprioritaskan kehamilan berisiko tinggi untuk melakukan

Pandemik ANC di fasilitas pelayanan kesehatan dengan protocol

kesehatan

Covid-19 Perawatan PNC:

◦ Memprioritaskan kontak pertama (dalam waktu 24 jam sejak
persalinan) dengan protokol kesehatan
◦ Kasus tanpa risiko, mengganti dengan kunjungan rumah dan
konsultasi dan konseling jarak jauh.
 ◦ Jika kontrasepsi regular sulit diperoleh, maka
barrier methods, fertility awareness and emergency
SRH Services contraceptives menjadi pilihan
For Access to ◦ Rencanakan perempuan untuk menggunakan long-

contraception acting methods and permanent methods

◦ Increase the range of contraceptive options (pil
kontrasepsi) for several months
 ◦ Consider reducing barriers that could delay care
(risk for adolescents, rape survivors, and other
Access to vulnerable people)

Safe ◦ Consider the option non-invasive medical

methods—emergency pill up until 12 weeks
Abortion ◦ Counseling on self-management
◦ Option for post-pregnancy contraception
 ◦ Promote self-sampling for HPV testing,
facilitating the collection of specimens
Access to through pharmacies or drop-offs at facilities.
cervical cancer ◦ Promote online advice after a negative
screening and screening test and adequate management
after a positive screening test.
Prevention
◦ Prioritize screening access for women living
with HIV.
Access for Sexual Health

◦ Increase access to
condoms and lubricant for
safer sexual practices
◦ Ketersediaan produk
untuk kebutuhan
menstruasi
◦ Self-safe and consensual
sex (konseling seksual)
 ◦ Provide information about locations,
opening hours, contact details one crisis

Access for services/shelter

◦ Ensure the availability of post-rape care
violence services including emergency
against contraception, HIV prophylaxis and

women and
treatment for STIs
◦ Strengthen screening and services for
girls identifying violence against women and
girls, gender-based violence and sexual
violence
Rumah Aman Perlindungan
Korban Kekerasan
(Perempuan dan Anak)
◦ Pusat Layanan Terpadu Seruni
Kota Semarang
◦ Pusat Pelayanan Terpadu
Pemberdayaan Perempuan dan
Anak (P2TP2A) Kota Makassar
◦ Rumah aman di Indonesia
lainnya yang difasilitasi oleh
Kementerian Sosial dan juga
P2TP2A di beberapa daerah.
◦ Rumah aman untuk perempuan
dan anak di Gorontalo?
 Take Home Message:
Reproduksi Perempuan yang Sehat Impian setiap
Perempuan, tak terkecuali Pada Masa Pandemic Covid-19
WOMEN’S
DESTINY
 ◦ WHO. (2020). Maintaining essential health operational
guidelines for the COVID-19 context.
◦ Yuksel, B. & Ozgor, F. (2020). Effect of the COVID-19 pandemic
on female sexual behavior. Int.J. Gynecol Obstet. 1-5.
◦ Hussein.J. (2020). COVID-19: What implications for sexual and

Referensi
reproductive health and rights globally. Sexual and
Reproductive Health Matters. Published online: 02 Apr 2020
◦ United Nations Population Fund HQ. (2020, March). COVID-19:
A Gender Lens PROTECTING SEXUAL AND
REPRODUCTIVE. Retrieved from www.unfpa.org
◦ Etc……………