Lecture 1&2:Overview and Concepts of

Reproductive Health
 • Reproductive Health Definition
• Components of Reproductive Health
• Reproductive health indicators
• Definitions and key concepts of the
Content of Reproductive System
the lecture • Female Reproductive Cycle
• Global perspective
• In Jordan
 Introduction
• Reproductive health and safe motherhood are
critical aspects of public health, with significant
implications for individuals, families, and societies.
Definition of Reproductive health
• Reproductive health is defined as” 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 system and to its functions and process”.
 • Reproductive health refers to
the overall well-being of
individuals in all matters related
Definition of to the reproductive system,
Reproductive including access to healthcare
health services, education, and
information. Key components of
reproductive health at the global
level include:
 • 1.Quality family planning services
• 2. Promoting safe motherhood: prenatal, safe

• delivery and post natal care, including breast
• feeding
Components of • 3. Prevention and treatment of infertility
Reproductive • 4. Prevention and management of complications
of unsafe abortion
Health
• 5.Safe abortion services
• 6.Treatment of reproductive tract infections
• including sexually transmitted infections;
Reproductive Health indicators

• 1. Total Fertility Rate: Total number of children a woman would have

by the end of her reproductive period, if she experienced the
• currently prevailing age-specific fertility rates throughout her
childbearing life. TFR is one of the most widely used fertility measures to
assess the impact of family planning programs.
 Reproductive Health indicators

• 2.Contraceptive Prevalence (any method):

• Percentage of women of reproductive age who are
using a contraceptive method at a particular point in
time.
 Reproductive Health indicators

3. Maternal Mortality Ratio: The number of
maternal deaths per 100 000 live births from
causes associated with pregnancy and child
birth.
4. Antenatal Care Coverage: Percentage of
women attended, at least once during
pregnancy, by skilled health personnel for
reasons relating to pregnancy.
 Reproductive Health indicators

5. Births Attended by Skilled Health Personnel:
Percentage of births attended by skilled health
personnel. This doesn’t include births attended
by traditional birth attendants.
 Reproductive Health indicators

• 6.Availability of Basic Essential Obstetric Care:

• Number of facilities with functioning basic essential obstetric
care per 500 000 population.
• Essential obstetric care includes, Parenteral antibiotics,
Parenteral oxytocic drugs, Parenteral sedatives for eclampsia,
Manual removal of placenta, Manual removal of retained products,
Assisted vaginal delivery. These services can be given at a health
center level.
 Reproductive Health indicators

• 7. Availability of Comprehensive Essential obstetric care: Number of facilities

with functioning comprehensive essential obstetric care per 500 000 population. It
incorporates obstetric surgery, anesthesia and blood transfusion facilities.

• 8. Perinatal Mortality Rate: Number of Perinatal Deaths (deaths occurring during

late pregnancy, during childbirth and up to seven completed days of life) per 1000
total births. Deaths which occur starting from the stage of viability till completion
of the first week after birth (22 weeks of gestation up to end of first week after birth,
WHO).
 Reproductive Health indicators

• 9 Prevalence of Anemia in Women: Percentage of women of reproductive

age (15–45) screened for hemoglobin levels with levels below 11 g/dl for
pregnant women and below 12 g/dl for non pregnant women.

• 10. Percentage of Obstetric and Gynecological Admissions Owing to

Abortion: Percentage of all cases admitted to service delivery points providing
in-patient obstetric and gynecological services, which are due to abortion
(spontaneous and induced .
Reproductive Health indicators

• 11. Prevalence of Infertility in Women: Percentage of women

of reproductive age (15–49) at risk of pregnancy (not pregnant,
no contraception and non-lactating) who report trying for a
pregnancy for two years or more.
 Reproductive Health indicators

• 12. HIV Prevalence in Pregnant Women:

• Percentage of pregnant women (15–24) attending
antenatal clinics, whose blood has been screened for
HIV, who are sero-positive for HIV.
Key components of reproductive health at the global level

• Access to Family Planning: Ensuring individuals have access to a range

of contraceptive methods to make informed choices about the number
and timing of pregnancies.
• Maternal Health: Reducing maternal mortality rates through access to
quality antenatal care, skilled birth attendants, and emergency obstetric
care.
• Preventing Gender-Based Violence: Addressing gender inequalities and
violence against women and girls to protect their reproductive health
rights.
 Safe Motherhood
Safe Motherhood: is a global initiative focused on
reducing maternal mortality and morbidity.
Safe Motherhood
The strategies adopted to make motherhood safe vary among
countries and include:
• Providing family planning services.
• Providing post abortion care.
• Promoting antenatal care.
• Ensuring skilled assistance during childbirth
• Improving essential obstetric care.
• Addressing the reproductive health needs of adolescents.
 Essential Services include:

• 1. Community education on safe motherhood

• 2. Prenatal care and counseling, including the
• promotion of maternal nutrition
• 3. Skilled assistance during childbirth
• 4. Care for obstetric complications, including
• emergencies
• 5. Postpartum care
Global Challenges

• Global Challenges: Despite global efforts to improve reproductive

health and safe motherhood, challenges persist. These challenges
include:
• Healthcare Access: Disparities in access to healthcare services,
particularly in low-income countries, hinder progress.
• Teenage Pregnancy: High rates of teenage pregnancy can lead to
health risks for both mothers and babies.
• Maternal Mortality: Maternal mortality remains unacceptably high in
some regions, primarily due to complications during childbirth.
Part 2: Overview of the Female
Reproductive System
Overview of the Female Reproductive System

• Main Components:
• Ovaries: Function as the primary reproductive organs, producing ova and
hormones.
• Fallopian Tubes: Transport ova from ovaries to the uterus.
• Uterus: Site for implantation and fetal development.
• Vagina: Birth canal and the pathway for menstrual flow and intercourse.
• External Genitalia: Include structures such as the labia, clitoris, and mons
pubis.
Key Definitions - Reproductive System

• Ovulation: Release of a mature egg from the ovary.

• Menstruation: Shedding of the uterine lining.
• Fertilization: Union of an ovum and sperm, usually in the fallopian tube.
• Implantation: Embedding of a fertilized egg into the uterine wall.
 Female Reproductive Cycle
• The female reproductive cycle describes the regular and
recurrent changes in the anterior pituitary secretions, ovaries,
and uterine endometrium that are designed to prepare the body
for pregnancy (Fig. 11.7). The female reproductive cycle is
often called the menstrual cycle because menstruation
provides a marker for each cycle's beginning and end if
pregnancy does not occur. Significant deviations from the 28-
day cycle are associated with reduced fertility.
• The first day of the menstrual period is counted as day 1 of the
woman's cycle. The female reproductive cycle is further
divided into two cycles that reflect changes in the ovaries and
uterine endometrium.
• The duration
of the cycle
is
approximatel
y 28 days,
although it
may range
• from 20 to
45 days (
 Hormonal Regulation
Key Hormones:
• Estrogen: Stimulates growth of the uterine lining and
development of secondary sexual characteristics.
• Progesterone: Maintains the uterine lining for pregnancy.
• Follicle-Stimulating Hormone (FSH): Stimulates follicle
development.
• Luteinizing Hormone (LH): Triggers ovulation and corpus
luteum formation. After the ovary releases a mature
ovum during ovulation, the ruptured follicle transforms
into the corpus luteum. Hormonal Secretion: The primary
function of the corpus luteum is to produce hormones,
mainly progesterone, and to a lesser extent, estrogen.
 The Ovarian Cycle

• Follicular Phase: Development of follicles in the ovaries. The follicular phase is

the period during which an ovum matures. It begins with the first day of
menstruation and ends approximately 14 days later in a 28-day cycle.
• Ovulation: Mid-cycle release of the mature ovum. Near the middle of a 28-day
reproductive cycle, approximately 2 days before ovulation, LH secretion rises
markedly. Secretion of FSH also rises, but less than LH does. These surges in LH
and FSH cause a slight fall in follicular estrogen production and a rise in
progesterone secretion, stimulating final maturation of a single follicle and
release of its mature ovum.
• Luteal Phase: Formation of the corpus luteum, which secretes
hormones to maintain the uterine lining. After ovulation and under
the influence of LH, the remaining cells of the old follicle persist
for approximately 12 days as a corpus luteum. The corpus luteum
secretes estrogen and large amounts of progesterone to prepare
the endometrium for a fertilized ovum. Levels of FSH and LH
decrease during this phase in response to higher levels of
estrogen and progesterone. If the ovum is fertilized, it secretes
human chorionic gonadotropin (hCG) that causes the corpus
luteum to persist to maintain an early pregnancy. If the ovum is
not fertilized, FSH and LH fall to low levels, and the corpus luteum
regresses. Decline of estrogen and progesterone with the
regression of the corpus luteum results in menstruation as
the uterine lining breaks down.
 Timing events in the menstrual cycle.
2. LH surge

LH
Days befor Days afte
e r

Day Day
1 1
Follicular phas Luteal phas
e e

0 8 12 16 20 24 28
4
Menstruation OVULATIO
N
Anim ated ovarian events

Key events in the ovarian cycl

e
2. Ovulati
LH
on
1. Follicular 3. Luteal functio
Day growth n
1

0 8 12 16 20 2 28
4 4
Oestradio
Menstruation Progesterone (a
l OVULATIO
nd oestradiol)
 Endometrial Cycle
• Menstrual Phase:Occurs at the start of the cycle (Days 1-5).
• Characterized by the shedding of the uterine lining (endometrium) when fertilization does not
occur. This phase involves the discharge of blood, mucus, and tissue.
• Proliferative Phase: Lasts from approximately Days 6-14.
• Driven by increasing estrogen levels, the endometrium thickens and regenerates in preparation
for a potential implantation. Glands and blood vessels proliferate, making the lining suitable for a
fertilized egg.
• Secretory Phase: Occurs from Days 15-28.
• Following ovulation, progesterone from the corpus luteum causes further thickening and
vascularization of the endometrium. If fertilization occurs, the lining will remain to support the
developing embryo; if not, hormone levels drop, leading back to menstruation.
 In Jordan
• According to the findings of the Population and Family Health Survey 2017-201824
and priority research the following issues were identified to describe the status of sexual
and reproductive health in Jordan:
• The percentage of women (aged 25-49 years) who married under the age of 18 years is
high and stands at (15%), even though it has decreased compared to previous population
and family health surveys. However, recent specialized studies on child marriage
according to the age of marriage indicate that child marriage among Jordanians tended
to increase in 2012-2015 (from 9.7% in 2012 to 11.6% in 2015), and reached very high
levels among Syrian women, increasing from 35.3% in 2012 to 43.8% in 2015.)
• The percentage of adolescent marriage has increased (10% of married women aged 15
-18 years who have married under the age of 15).

Sexual and Reproductive Health Priorities and Studies based on the Results of the Population and Family Health Survey (2017-2018)
Contraceptive Use:
• Only 29% of married women aged 15-49 use any form of contraception, and just 19% use modern
methods like the IUD or the pill
Higher Population Council

UNFAP-Jordan
.
• Among Jordanian women, the most common methods are the IUD (29%) and the pill (13%)
Higher Population Council
.
Antenatal Care:
• 87% of young mothers sought antenatal care during their pregnancies
Higher Population Council

• Nearly all births (98%) occur in hospitals or clinics

Higher Population Council
.
 In Jordan

•Child Marriage and Motherhood:

•81% of young wives had begun childbearing by the time of the survey, with
89% of girls married in childhood having children
Higher Population Council
 In Jordan
•Fertility Preferences:
•On average, young men want larger families (3.9 children) compared to young women (3.3 children).
Higher Population Council
.
•Family Planning Knowledge:
•Only 37% of those over the age of 15 can name a method of contraception
Higher Population Council
.
•There is a significant gender gap in contraceptive knowledge, with adolescent boys (16%) being much
less knowledgeable than young women (62%)
Higher Population Council
.
 Conclusion

• In conclusion, reproductive health and safe motherhood are global

priorities, and progress is being made in many countries, including Jordan.
Ensuring access to quality healthcare, education, and gender equality are
key factors in advancing these critical aspects.