Overview of SRH & Rights
Maternal mortality prevention
Dr Nicholas Ehikhale
Session overview
SRH problems- Maternal mortality
Safe motherhood
SR rights
Way forward
• What is SRH?
• Why the attention on SRH?
• "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 relating to the reproductive system
and to its functions and processes” (WHO,
• “Sexual health is a state of physical,
emotional, mental, and social well being
related to sexuality and not merely the
absence of disease, dysfunction, or infirmity”
(WHO, 2006)
• SRH problems
• MM and morbidity- unsafe abortion
• Gender based violence
Gender Based Violence
• 15% to 71% ever experienced physical or sexual
violence, or both, by an intimate partner in their
• 4 to 15 percent of pregnant women have
experienced violence
• Femicide or the killing of women- Middle EastSouth
Asia and China
• As much as one third of Nigerian women reported
being victims of violence (Anyogu and Arinze-Umobi,
• "all procedures involving partial or total
removal of the external female genitalia or
other injury to the female genital organs
whether for cultural, religious or other nontherapeutic reasons." (WHO, 1997)
• National prevalence 30% (NPC and ICF Macro,
Maternal mortality
death of a woman while pregnant
or within 42 days of delivery/ termination
irrespective of the duration or the site of the
from any cause related or aggravated by the
pregnancy or its management
but not from accidental or incidental causes
(WHO, 2000)
Maternal mortality contd.
• About 300,000 women die each year as a
result of pregnancy related issues- WHO, 2014
• That is 800 women daily
• About 95% of these deaths occur in
developing countries- SSA and Asia
• For every mortality there are 30 morbidities
• Majority of the causes of MM are preventable:
– Obstetric complications- haemorrhage, sepsis,
unsafe abortion, pre eclamp, eclamp, p Obstr lab
– Indirect causes- Malaria, D/M, cardiac dx
• MMR in Nigeria= 545/ 100,000 live births
Three phases of delay
Theoretical model:
(1) Decision making process
(2) Reaching the hospital
(3) Receiving adequate care
Unsafe abortion
• About 45 million unwanted pregnancies are terminated each
• An estimated 19 million of these are unsafe
• 40% of all unsafe abortions are performed on young women
aged between 15 and 24
• About 68,000 women die every year as a result of unsafe
• Associated with considerable morbidity- reproductive tract
infection, infertility
Unsafe abortion in Nigeria
– 610, 000 abortions in Nigeria yrly (Henshaw et al.,
– Contributes 10- 20% to MMR in Nigeria
– 20,000 deaths yearly due to unsafe abortion
(Ezegwui et al., 2013; Unuigbe et al., 1988)
– Huge burden on the health system
– Ass. 30% of Nig women (WRA) experiencing
unwanted pregnancy in life time (Sedgh et al.,
2006; Oye- Adeniran et al., 2004) via poor knw &
Bottlenecks to safe abortion in
High unmet need for family planning- 20%
Low contraceptive prevalence rate- 15%
Abortion law
High cost of procedure
Poor access to services
Poorly trained personnels
Maternal mortality prevention
What is safe motherhood?
A woman’s ability to have a safe
and healthy pregnancy and
+ at a time she wants
The Safe Motherhood Initiative
• A global effort that aims to reduce deaths and
illnesses among women and infants
• Launched in 1987
• Essential services for Safe Motherhood were
identified and lessons were learned
Priorities for Safe Motherhood
Advance Safe Motherhood through human rights
Skilled attendance at all births
Access to quality emergency obstetrical care
Access to quality reproductive health care, including
family planning and safe post-abortion care
Empower women, ensure their choices
Improve access to high quality maternal health
Prevent unwanted pregnancy and address unsafe
Health education and community mobilization
SR rights
-Universal declaration of human
rights 1948
-ICPD Cairo 1994
International Conference on Population &
ICPD: shift in focus
From “population control” to “free choice”
• From the limited concept of FP/MCH to the
broader concept of SRH
Key elements of the new focus
• Provide universal access to family planning and
sexual and reproductive health services and
reproductive rights;
• Deliver gender equality, empowerment of women
and equal access to education for girls;
• Address the individual, social and economic impact
of urbanization and migration;
• Support sustainable development and address
environmental issues associated with population
Key elements contd.
• Emphasis on individual choices through expanded information
and services
• Affirmation that sexual and reproductive health is a human
right- the RIGHTS approach
RIGHTS approach
• Emerging from the Cairo convention
• sexual and reproductive health is a human right
• Reproductive health as a component of overall health,
throughout the life cycle, for both men and women
• The right of all couples to decide freely and responsibly
the number, spacing and timing of their children and to
have information and means to do so
• The right of women to have control over, and decide
freely and responsibly on, matters related to their
sexuality, including SRH – free of coercion, discrimination
and violence
• Cornerstone to development
Way forward
Role of health providers
Role of government
Role of individuals
Role of institutions
Advocacy for more government commitment

the lecture by Dr Nicholas