Definition and Components

Definition of Sexual Health

In terms of sexuality, sexual health refers to a condition of physical, mental, and social wellbeing. It requires a positive attitude about sexuality and romantic relationships as well as the possibility of enjoying enjoyable and safe sexual encounters free from compulsion, prejudice, and violence.

The UN General Assembly, the Beijing Declaration, and the International Conference on Population and Development (ICPD) all accepted the WHO's definition of reproductive health, which reads as follows: A condition of total physical, mental, and social wellbeing in all areas pertaining to the reproductive system, its function, and process is referred to as reproductive health means that individuals can enjoy happy and secure circumstances.

Components of Reproductive health

The integrated Reproductive Health Care Package consists of the following components:

• Family Planning.
• Safe Motherhood.
• Child Health (Newborn care).
• Prevention and Management of Complications of Abortion.
• STI/HIV/AIDS.
• Prevention and Management of Infertility.
• Adolescent sexual and Reproductive Health.
• Problems of Elderly Women( i.e. uterine, cervical and breast cancer treatment) at the tertiary level or in the private sector.
• Gender Based Violence.

The current Primary Health Care system in Nepal will be used to offer the integrated reproductive health package. Decentralized emphasis will be placed on a comprehensive gender perspective, community involvement, fair access, and cross-sector cooperation in all facets of the package.

Family Planning

The Government of Nepal commits to equitable access to voluntary Family Planning services based on informed choice for all individuals and couples, in particular the pr vulnerable and marginalized groups.

General Objectives:

GoN strives to improve the health status of all people, regardless of their sex, caste and ethnicity.or socioeconomic status. Therefore overall objective of the FP program is to improved health status of all people through accountable and equitable health service delivery system through informed choice to access and use voluntary FP (through increased and equitable access to quality FP information and services).

Specific Objectives:

• to improve access to and use of high-quality FP services that are suitable for both singles and couples, safe, and efficient. Increasing access to services in areas where the rural poor, Dalits, other marginalized persons, and those with high unmet need reside is a particular priority.
• to foster an atmosphere that will increase both men's and women's access to high-quality family planning services.
• by putting in place a variety of behavior change communication strategies, to raise demand for family planning services.

Gap of Family Planning in Nepal

• Lack of knowledge about family planning.
• Low male participation.
• Low CPR among poor, rural, mountains and hilly areas.
• Concept of family planning has limited scopes.
• misuse of emergency contraceptives
• Misuse of abortion services
• unintended pregnancies,
• Misuse of abortion
• High unmet need.

Improving Family Planning in Nepal

• Promotes spacing method of contraceptives particularly long acting method, There should be well balanced FP method rather than only one or two methods,
• Strengthen integrated services approach.
• Strengthen and expand training for service provider.
• Expand the number of service delivery sites.
• Reduce the seasonal camp.
• Increase public private partnership.
• Address misconception and rumours.
• Increases male involvements,
• Promote use of family planning method to reduce incidence of abortion.
• Implements special program for the under privileged community.

Safe Motherhood

One of Nepal's top priorities is its safe motherhood program. The reduction of maternal and newborn mortality is its main objective. The three main elements of safe motherhood are a safe pregnancy, delivery, and new-born birth. This may be achieved by addressing preventable factors that lead to death during pregnancy, labor, and the postpartum period, expanding access to high-quality prenatal, delivery, and postnatal care, and launching a huge health awareness campaign in local communities.

Benefits:

• Reproductive Health Morbidity Prevention and management Program.
• Cervical cancer screening and prevention training.
• Birth Preparedness Package and MNH Activities at Community Level.
• NyanoJhola Programme.
• Emergency Referral Fund.
• Obstetric Fistula management.
• Management of Pelvic Organ Prolapse.
• Aama and the New born Program.
• Women and children can benefit from following services.

Rural Ultrasound Program

Birth Preparedness Package and MNH Activities at Community Level

The goal of the Rural Ultrasound Program is to quickly identify expectant mothers who are at risk for obstetric complications and send them to facilities that provide comprehensive emergency obstetric and neonatal care (CEONC). Clients in rural PHCCs and health posts are scanned by trained nurses (SBA).

(Preparation for complications and birth readiness (preparedness of money, health facilities t the delivery, transport and blood donors).

Self-care, essential ANC/PNC services (Iron, Td, Albendazole, etc) (food, rest, no smoking and drinking alcohol, including pregnancy and post-partum period), During pregnancy, birth, post partum, and neonatal period care, it is crucial to identify new babies and take early action if any danger indicators are present.

Mother and Newborn can Directly Benefit from the Following Services:

The New Born Program:

With the goal of enhancing institutional delivery, the Nepalese government implemented demand side interventions in maternal health. The first such initiative, the Maternity Incentive Scheme, was introduced in 2005 and was created to split the expense of travel to medical facilities. 2009 saw the removal of user fees from all forms of delivery care under the AamaProgramme in addition to the transport incentive. AamaProgramme was combined with a different demand side intervention known as the 4 ANC incentives programme (launched in 2009) in 2012. Free new-born care was included into the Aama program in FY 2073–74 after being started in FY 2072–73. The Aama and New Born Program, as it now exists, includes the following provisions:

Transport Incentive for Institutional Delivery:

A cash payment is made to women immediately following institutional delivery: NPR. 1,500 in mountain, NPR.1.000 in hill and NPR.500 in Terai districts.

 A cash payment of Rs. 400 is made to women on completion of Incentive f four ANC visits at the 4, 6, 8 and 9 months of pregnancy institutional delivery and post-natal care.

Free Institutional Delivery Services:

A payment to the health facility for the provision of free delivery care. For normal delivery, health facilities with less than 25 beds receive NPR. 1,000 while health facilities with 25 or more beds receive NPR. 1,500. For complicated deliveries health facilities receive NPR. 3,000; for C-Sections (surgery) NPR. 7,000. Ten complications Le APH requiring blood transfusion, PPH requiring blood transfusion or MRP or exploration, severe pre-eclampsia, eclampsia, MRP for retained placenta, puerperal sepsis, instrumental delivery, and management of abortion complications requiring blood transfusion and admission longer than 24 hours with IV antibiotics for sepsis are included as complicated deliveries. Anti-D administration for RH negative is reimbursed NPR.5000. Laparotomy for perforation due to abortion, indicated or emergency CS, laparotomy for ectopic pregnancy and ruptured uterus is reimbursed NPR. 7000.

Incentives to Health Workers for Deliveries:

A cash payment of NPR. 300 are made to health worker attending all forms of deliveries viz: normal, complicated and caesarian section. This is to be arranged form the health facility reimbursement.

Eligibility Criteria for Getting Service:

The incentives and services are available to the Nepali citizen especially the pregnant mother and newborn. This is management Program Good antenatal, intra-natal and postnatal care help to prevent the morbidity of reproductive 4. Reproductive health. Delivery services from Skilled birth attendants and the timely management of the complications reduce the risk of morbidity and mortality, Similarly awareness programme should be make effective at the community level through the mobilization of local human resources. Accessibility of health care services to all the population without the burden of financial risk. Government should more focused on preventive rather than curative services for eg: Screening test should be affordable and accessible to everyone.

Management of Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a common reproductive health morbidity in Nepal and contributes to many disability adjusted life years (DALYs) and social consequences. Multiparity maternal malnutrition, too frequent pregnancies and heavy work after delivery are the main risk factors. Each year the government allocates funds to manage POP including free screenin- providing silicon ring pessaries, Kegel exercise training and free surgical services at de hospitals

Cervical Cancer Screening and Prevention Training:

Cervical cancer is the most common cancer of women in Nepal, accounting for 214 percent of cancer among 34-64 year old women. The national guidelines on cervical cancer screening prevention (2010) call for screening at least 50 percent of women aged 30-60 years and reducing the mortality due to cervical cancer by 10 percent with recommended scr among this group every five years: Cervical cancer screening is done by visual inspection of t cervix by trained nurses or doctors. If any signs of a pre-cancerous lesion are seen, women are referred for cryotherapy to cure the lesion. This approach is cost-effective as the early detection of lesions and early management by cryotherapy will usually prevent progression to cervic cancer, and the cost of scaling up this activity is relatively low. The Family Health Division pla to scale up this approach to all 75 districts.

Obstetric Fistula Management:

Obstetric fistula affects many women from poorer communities and significantly impairs the quality of life due to the social stigma attached to this condition and their physical suffering. The government has allocated funds for the free screening of obstetric fistula, which in 2072/73 was being integrated with pelvic organ prolapsed screening and surgical services at the BP Koira Institute of Health Sciences (BPKIHS, Dharan) and Patan Academy of Health Sciences, Lalitp

Emergency Referral Fund

According to estimates from the World Health Organization (2015), 5 to 10% of pregnant women will require a caesarean section delivery in order to avert fatalities or long-term illness. It is crucial that these ladies are directed to the proper centers in circumstances of challenging geographic terrain and unavailability of CEONC services. Funds for emergency referra 2072/73 were given to 14 more districts. Each district has been given a total of NPR 200,000 as seed money, which local committees will handle in accordance with the operating standards.

The main objective of this programme is to support emergency referral transport to wome from poor, Dalit, Janajati, geographically disadvantaged, and socially and economically disadvantaged communities who need emergency caesarean sections or complication management during pregnancy or child birth.

Nyanojhola Programme

The NyanoJhola initiative was launched by the government in an effort to lower the incidence of baby mortality nationwide caused by colds and infections. The state has been supplying a pair of bhoto and daura, gloves, socks, a hat, a napkin, and wrappers for a newborn as part of the initiative, as well as a robe for a woman to wear when nursing. The items, which may be used for up to three months, are only given to infants delivered at district hospitals and community birthing centers. The Safe Motherhood Program includes a child health program to lower morbidity.

Child Health (Newborn Care)

Free sick new born care: A payment to the health facility for the provision of free sick new born care. Health facilities are reimbursed for a set package of care cost viz: 'Package 0 no cost, Package A' NPR.1000, 'Package B' NPR. 2000 and 'Package C ^ prime NPR. 5000. Health facility can claim as high as combination of NPR.8000, depending on medicines, diagnostic and treatment services A + B + C provided. 

Incentives to health worker for sick new born care: A cash payment of NPR 300 are made to health worker providing all forms of service packaged. This is to be arranged form the health facility reimbursement.

In FY 2073/74, the free new born care programme (introduced in FY 2072/73) has been merged to the Aamaprogramme. Aamaprogramme in its current form is known as the Aama and New born programme,

Mother and newborn can directly benefit from the following services:

Transport incentive for institutional delivery

Incentive for 4 ANC visits

Eligibility Criteria:

The incentives and services are available to the Nepali citizen especially the pregnant mother and newborn pregnant mother.

Prevention and Management of Complications of Abortion

Unsafe abortion is one of the leading causes of maternal morbidity and mortality. Unsafe abortion invites immediate as well as long term health problems. Most of the abortion related deaths are due to the complications of unsafe abortion and million suffer from serious often permanent injuries of reproductive health. The international conference on population and development (ICPD) called for:

• Access to safe abortion services,
• Access to compassionate,
• Quality services for the complications arising from abortion,
• Post abortion counseling and family planning service to reduce unwanted repeated pregnancies and repeated abortions.
• Challenges And Issues,
• At any gestation if the pregnancy is harmful to the pregnant women's physical and mental health as certified by an expert physician.
• Poor knowledge on Safe Abortion,
• High Unintended Pregnancy,
• Up to 12 weeks of gestation on the request of the pregnant women,
• Up to 18 weeks of gestation in case of rape or incest.

His Majesty's Government announced the Nepal criminal code (MulukiAin) on 1st Chaitra 2058 (16th March, 2002) and Royal assent was given on 10th Ashoj 2059 (27th September, 2002). The new law legalizes abortion under the following conditions:

• Prevalence of Unsafe Abortion.
• Limited Facilities.
• Abortion Stigma.

Law, Policy and Guidelines

• RTI/STD/HIV/AIDS.
• Provider-initiated testing and counselling (PITC) takes place in STI clinics, antenatal di birthing centres and maternity units, nutrition clinics and alongside postpartum, fa planning and TB services.

HIV stands for human immunodeficiency virus which makes immune system weak when inside the human body. AIDS is a group of diseases that occur when a person immune system damaged by HIV

• The government is promoting HIV testing among key populations
• Testing services are also an entry point for:

Activities of HIV AIDS

• Early access to effective medical care including for ARV therapy, treating opportuni infections, and preventive therapy for tuberculosis, other opportunistic infection.
• Normalisation of HIV in society through reduced stigma and discrimination; family planning and contraceptive services; and access to
• Managing TB/HIV co-infection. Detection and management of STIS
• Reduced HIV cases including through mother-to-child transmission
• Emotional care of affected individuals, couples and families;
• Improved coping and planning for the future;
• Referral to social and peer support.

Prevention and Management of Sub-Fertility

Despite their significance, public health concerns related to infertility prevention and management are frequently ignored. Worldwide, low fertility is on the rise, especially in metropolitan areas with ageing populations and many women who are starting families later in life. Infertility prevention, care, and treatment must be integrated into maternal, newborn, and other reproductive health-care systems.

Infertility can have many different reasons, including tubal blockage from sexually transmitted reproductive tract infections, postpartum problems, risky termination methods, and ectopic pregnancy. Infertility can also result from PCOS, which is a condition of the ovaries.

Infertility affects up to 15% of reproductive-aged couples worldwide. The psychological bu of couples without a child can be significant. Even when a country faces population press infertile couples have the rights to get support for having a child. Survey in eight districts Nepal found 7.4% of females having infertility problem. In Bajhang district, a gynaecolog camp showed that 14.2% women had sub-fertility morbidity.

Adolescent Reproductive Health

Between childhood and adulthood, the adolescent years are a time of physical, psychological, and social maturation. The International Conferences on Population and Development (ICPD) program made clear how urgent it is to address teenage sexual and reproductive health concerns, which are often disregarded by current reproductive health services. Adolescents should have access to knowledge and services that will help them understand their sexuality and shield them from unexpected pregnancies, STDs, and the eventual risk of infertility. Goal of national policies for adolescents' reproductive health:

• The objectives of National adolescent's reproductive health strategies is To improve the health and socioeconomic status of adolescent.
• To increase the availability and access the information about the adolescent health and development and provide opportunities to build skill of adolescent services. To increase accessibility and utilization of adolescent health and counselling services for adolescents.
• To create safe and supportive environment for adolescent in order to improve their legal social and economic status.

Activities of the National ASRH Programme

• 63 out of 75 districts have at least 13 AFS health facilities € 1144 health facilities are adolescent-friendly.
• Establishment of AFSH centres and AFS corners in health facility and schools of stakeholders and service providers.
• Sensitization Increased communication with health facility, female community health volunteer (FCHV). mothers' groups.
• To promote adolescent health by Counselling, family planning services, audio/visual messages and IEC materials
• For ASRH promotion, safe abortion services, school health education, management of gender-based violence (GBV) cases and other general health services.

Problems of Elderly Women

(Le tertiary-level or private sector therapy for breast, cervical, and uterine cancer) The number of older people is larger in industrialized nations, but it is also rising in emerging nations as a result of a longer life expectancy. Various reproductive health issues, hormonal changes, and osteoporosis affected elderly women.

For the purpose of preventing osteoporosis and cardiovascular illnesses, health education and counseling services are available on food, exercise, and other facets of a healthy lifestyle.

Treatment of Reproductive Tract and Urinary Tract Infection, Genital Prolapse, Fistula and Other Gynaecological Disorder:

Gender Based Violence is an attitudinal problem of men towards women in Nepal. One-third ( per cent) of women in Nepal experience GBV at home, although most violence is unreported unrecorded in informal or formal institutions. Psychological violence was found to be b followed by physical, economic and sexual violence.

The integrated reproductive health package in Nepal is delivered through the existing primary health care system. A substantive gender perspective, community participation, equitable access and intersect oral collaboration are emphasized in all aspect of package. Based on the global definition of reproductive health the above mentioned integrated package of reproductive health intervention is depicted as level of intervention. They are as follows:

• Primary health care centre level.
• Family/decision makers level.
• District level.
• Community level.
• Health post level.