Kesehatan Reproduksi: Department Obstetri & Ginekologi Fakultas Kedokteran USU

KESEHATAN REPRODUKSI
Dr.dr.M.Fidel Ganis Siregar, M.Ked(OG), SpOG.K
Department Obstetri & Ginekologi

Fakultas Kedokteran USU
Pemeliharaan dan perawatan

kesehatan serta dampaknya pada
kesehatan reproduksi
• RH Outlook 2003
• RH Library
• Sumber dari Depkes
Millenium Development Goals
(United Nation)-􀃆 2015
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 lain
7. Menjamin kelestarian lingkungan
8. Kemitraan global dalam pembangunan
RUANG LINGKUP KES-PRO
1. Kesehatan Ibu dan Anak
2. Keluarga Berencana
3. Pencegahan dan penanggulangan Infeksi
Saluran Reproduksi(ISR), termasuk IMSHIV/AIDS
4. Pencegahan dan Penanggulangan Komplikasi Abortus
5. Kesehatan Reproduksi Remaja
6. Pencegahan dan Penanganan Infertilitas
7. Kanker pada Usia Lanjut dan Osteoporosis
Definisi SEHAT Kesehatan
Reproduksi (ICPD Kairo ,1994)
• Suatu keadaan sejahtera fisik , mental
dan sosial secara utuh, tidak sematamata
bebas dari penyakit atatu
kecacatan dalam semua hal yang
berkaitan dengan sistem reproduksi,
serta fungsi dan prosesnya .
KESEHATAN IBU DAN ANAK
• AKI Indonesiaan /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.
Safe Motherhood Initiatives
The SMI'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;
􀂄 parenteral sedatives for eclampsia;
􀂄 manual removal of placenta;
􀂄 manual removal of retained products; and
􀂄 assisted vaginal delivery.
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 that every pregnancy 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 a continuum of care connected by effective
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.
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 life-saving 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 dan hak-hak reproduksi untuk
usia lanjut
 Gender Development Index

 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
KELUARGA BERENCANA
• Total Fertility Rate 1967-1970 : 5,5
􀂄 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%
65% ibu hamil menderita 4 terlalu :
􀂄 Terlalu muda
􀂄 Terlalu tua
􀂄 Terlalu sering
􀂄 Terlalu banyak
Hal ini menujukkan bahwa masih banyak PUS
yg perlu ber 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
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)
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 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
 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
 Tidak hanya penjaja seks dan langganan , pengguna
NAPZA juga
REMAJA
USIA LANJUT
GENDER DAN KEKERASAN
PADA PEREMPUAN
TERIMA KASIH

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KESEHATAN REPRODUKSI

Dr.dr.M.Fidel Ganis Siregar, M.Ked(OG), SpOG.K

Department Obstetri & Ginekologi

Pemeliharaan dan perawatan

recognizing that every pregnancy faces risks;

training and deploying appropriate skilled health

 Kesadaran perilaku hidup bersih dan sehat

 Status gizi dan status kesehatan ibu

 Penyediaan akses terhadap pelayanan

 Kes-Pro dan hak-hak reproduksi untuk

 Gender Development Index

penanganan kesehatan dan hak reproduksi

 Human Development Indeks (HDI)

 Gender Empowerment Measure (GEM)

 Buta huruf 15-45 tahun

 Wajib belajar 9 tahun

• Increasing access to family planning

Training and performance improvement

􀂄 42% remaja tahu HIV/AIDS

 Kumulatif sampai Juni 2005 infeksi HIV 3.740 AIDS 3.358

 Kelompok berisiko tinggi waria penjaja seks

 Tidak hanya penjaja seks dan langganan , pengguna

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