Epidemiologi Kesehatan Reproduksi:

Kuliah Minggu ke II, 26 Agustus 2020

Konsep Epidemiologi Kesehatan

Reproduksi

Ansariadi, Ph.D

Universitas
Hasanuddin
 Outline Perkuliahan

• Definisi Sehat, kesehatan reproduksi, epidemiology dan

epidemiology, dan epidemiology kesehatan reproduksi
• Sejarah dan perkembangan kesehatan reproduksi
• Skop kajian epidemiology kesehatan reproduksi
• Penggunaan metode Epidemiologi terhadap Kesehatan
Reproduksi
References
• WHO Website:
• http://origin.who.int/topics/repro
ductive_health/en/

• UNFPA
• https://www.unfpa.org/sites/defa
ult/files/pub-
pdf/SRH_Framework.pdf
 Definisi Health
• WHO (1948)

“A state of complete physical, mental, and

social well-being and not merely the absence
of disease or infirmity.”
Reproductive System

• Role: Menghasilkan
keturunan; Mengatur
karakteristik seksual

• Organ penting (Male dan

female): Testes, Uterus,
Ovaries, ect.
 DEFINITION*
• Reproductive Health is a state of complete,
physical, mental and social well-being and not
merely the absence of disease or infirmity, in
all matters related to the reproductive health
system and to its functions and processes

• *ICDP - Cairo 1994

 Dimension of health
• Physical—The ability of the human body structure to
function properly
• Social—The ability to interact with other individuals
• Mental—The ability to process information and act
properly
• Emotional—The ability to cope, adjust, and adapt
• Spiritual—A belief in some force or dynamic other than
humans
• Environmental—External conditions and influences
affecting life and development
 Three Core Functions of Public Health
Systematically collect, analyze,
Assessment and make available information
on healthy communities

Policy Promote the use of a scientific

Development knowledge base in policy and
decision making

Assurance Ensure provision of services to

those in need

Institute of Medicine. The future of public health. Washington, DC: National Academies Press; 1988. 8
Public Health Approach
Public Health Medical
Model Versus Model
 REPRODUCTIVE HEALTH
Berarti:

• Kemampuan untuk melakukan reproduksi,

mengatur fertilitasnya,
• Perempuan melakukan kehamilan dan persalinan
yang aman, tanpa ada ganguan kesehatan.
• Reproduksi dilakukan untuk menghasilkan bayi,
anak bisa bertahan hidup, hidup berkembang
dengan sehat
 Kenapa Kesehatan Reproduksi
Penting?

• Bagian dari kesehatan secara umum, dan

baian penting dalam perkembangan manusia.

• Universal concern baik laki-laki maupun

perempuan
 Setiap menit di dunia ini:

380 wanita yang hamil

190 diantaranya tidak merencakan atau tidak

menginginkan kehamilannya
 Setiap menit di dunia ini:

• 110 wanita mengalami komplikasi

terkait kehamilan/persalinan

• 40 wanita melakukan aborsi

• 1 wanita meninggal karena
persalinan atau kelamilan
Outcomes of human reproduction

Reproductive
Sex ratio
health
Scope of Reproductive
Health
 Elements/ Components of RH
• Family-planning counselling, information, education,
communication and services.
• Safe motherhood: Prenatal care, safe delivery, essential
obstetric care, postnatal care and breastfeeding.
• Prevention and treatment of infertility and sexual
dysfunction in both men and women.
• Prevention and treatment of reproductive tract infections,
especially, sexually transmitted diseases, including
HIV/AIDS.
 Elements/ Components of RH
• Prevention and management of safe abortion practices.
• Elimination of harmful practices such as female genital
mutilation, premature marriage, and domestic and
sexual violence against women.
• Management of non-infectious conditions of the
reproductive system, such as genital fistula, cervical
cancer, complications of female genital mutilation and
reproductive health problems associated with
andropause.
Perkembangan Kesehatan Reproduksi
• 1960 an – UNFPA
• Disadarinya peningkatan penduduk dunia
• Upaya untuk mengontrol perteumbuhan
penduduk
• Kontrasepsi – Pil IUD
 1970an
• WHO mendirikan program: Special Program
of Research, Development and Research
Training in Human Reproduction (HRP)
• Melakukan riset tentang fertilitas dan issue
tentang keamanan dan efikasi metode yang
ada.
 ICPD 1994

• International Conference on Population and

Development di KAIRO

• the key event in the history of reproductive

health.
Perkembangan Kesehatan Reproduksi
• Primary health care declaration 1978

• MCH services started with more emphasis on

child survival

• Keluarga berencana di fokuskan pada ibu

• Safe motherhood initiative in 1987

• Penekanan pada maternal health

• Bertujuan menurunkan maternal mortality

• Reproductive health, ICPD in 1994
• • Penekanan pada:
– Kualitas Pelayanan
– availability and accessibility
– Keadilan sosial
– Hak-Hak Reproduksi
• Millennium development goals and
reproductive health in 2000

• SDGs dengan Kesehatan Reproduksi

• • MDGs berhubungan baik langsung maupun
tidak langsung dengan kesehatan
• • MDG 4, 5 and 6 berhubungan langsung
dengan kesehatan secara langsung sedangkan
MDG 1,2,3, and 7 berhubungan tidak
langusung

• SDG??????????
SDGs

29
 From MDGs to SDGs
• Millennium Development Goals (MDGs)
(2000-2015)
– Goal 3: Promote gender equality and
empower women
• Target 3.A: Eliminate gender disparity in
primary and secondary education,
preferably by 2005, and in all levels of
education no later than 2015
– Goal 5: Improve maternal health
• Target 5.A: Reduce by three quarters,
between 1990 and 2015, the maternal
mortality ratio
• Target 5.B: Achieve, by 2015, universal
access to reproductive health
• Sustainable Development Goals (2016-2030)
• Goal 5 “Achieve gender equality and
empower all women and girls”
• 9 targets, 14 indicators addressing multiple
concerns (none covered in the MDG framework)
• Around 34% (58 out of 169) of Targets
explicitly or implicitly address GE & EWG
• Strong emphasis on disaggregation, including
by sex and other relevant characteristics to
capture intersecting inequalities
30
 Magnitude of RH
• “Reproductive Health “ sering disamakan
dengan kehidupan perempuan: motherhood.

• Komplikasi yang tekait dengan kehamilan dan

persalinan adalah kontributor utama terhadap
status reproduksi utama wanita di dunia
• Half of the world’s 2.6 billion women are now 15 – 49
years of age.
• Without proper health care services, this group is
highly vulnerable to problems related to sexual
intercourse, pregnancy, contraceptive side effects, etc.
• Death and illnesses from reproductive causes are the
highest among poor women everywhere.
• In societies where women are disproportionately poor,
illiterate, and politically powerless, high rates of
reproductive illnesses and deaths are the norm.
• Women in developing countries and economically disadvantaged
women in the cities of some industrial nations suffer the highest
rates of complications from pregnancy, sexually transmitted
diseases, and reproductive cancers.

• Lack of access to comprehensive reproductive care is the main

reason that so many women suffer and die.

• Most illnesses and deaths from reproductive causes could be

prevented or treated with strategies and technologies well within
reach of even the poorest countries.

• Men also suffer from reproductive health problems, most notably

from STIs. But the number and scope of risks is far greater for
women for a number of reasons.
 Definisi Epidemilogy

• “The study of the occurrence and distribution

of health-related states or events in specified
populations, including the study of the
determinants influencing such states, and the
application of this knowledge to control the
health problems.”

Source: Dictionary of Epidemiology, Porta, Miquel (ed) 5th ed. Oxford, New York
USA
 Epidemiology

Masalah kesehatan tidak terdistribusi secara

acak di dalam suatu penduduk

Masalah kesehatan muncul tidak secara

kebetulan, tetapi ada penyebab yang bisa di
telusuri dengan cara yang sistematik
Epidemiology: (Stallones 1980, Ann Rev Public Health 1:69-82)
1: Distribusi masalah kesehatan:
» time
» space
» individual / group characteristics.

2: Variasi masalah kesehatan adalah respond dari:

» Variasi exposure
» variasi susceptibility.
Epidemiology Kesehatan Reproduksi
• Cabang Epidemiology yang berhubungan dengan
reproduksi

• Mempelajari distribusi dan determinan masalah

kesehatan reproduksi dalam populasi.

• Reproductive epidemiology focuses on the events in

various stages of the human reproductive process,
including sperm production, menstrual cycling,
ovulation, sexual interaction, conception, fetal growth,
and growth and development of the infant.
• Reproductive epidemiology is the study of
reproduction-related morbidity, mortality, and
other health issues in males and females.
• The topics covered in reproductive epidemiology
include development and physiology of
reproductive systems and functions, conception,
pregnancy, birth outcomes, and maternal
morbidity and mortality.
• Epidemiology menjawab pertanyaan
dengan melakukan perbandingan antar
group
Pengunaan Metode Epid di bidang Kesehatan
Reproduksi

WHO (1994) An epidemiologic Approach to Reproductive Health, p. 9