SRH(331)

COMMUNITY BASED MATERNAL AND REPRODUCTIVE HEALTH NURSING

  • Course Information

    • Course Code: NRS331

    • Instructors: Mrs P. Khonco and Dr V. Ticha

    • Year: 2026

    • Institution: School of Nursing

    • Motto: Striving to excellence with care

Sexual and Reproductive Health (SRH)

  • Purpose:

    • Supports normal physiological functions such as pregnancy and childbirth.

    • Aims to reduce adverse outcomes of sexual activity and reproduction.

    • Empowers people of all ages to have safe and satisfying sexual relationships.

  • Challenges Addressed:

    • Gender discrimination

    • Inequalities in access to health services

    • Restrictive laws

    • Sexual coercion

    • Exploitation and gender-based violence

Core Components of Sexual and Reproductive Health (SRH)

  • NRS332 (Low Risk Midwifery):

    • Focuses on the following core components of SRH:

    1. Improvement of antenatal, perinatal, postpartum, and newborn care.

    2. Provision of high-quality services for contraception and infertility services.

    3. Elimination of unsafe abortions.

    4. Prevention and treatment of STIs, including HIV, reproductive tract infections, cervical cancer, and other gynecological morbidities.

    5. Promotion of healthy sexuality.

    • NRS331 will specifically focus on components 2-5.

Sexual and Reproductive Health Rights (SRHR)

  • Definition:

    • SRHR is defined as a state of physical, emotional, mental, and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease or dysfunction (WHO 2010).

  • Positive Sexuality:

    • Recognizes the role of pleasurable sexual relationships, trust, and communication in promoting self-esteem and overall well-being.

    • Individuals have the right to make personal decisions regarding their sexual health.

Legal Aspects of Sexual Health in South Africa

  • Age of Consent:

    • The age of consent for all sexual acts in South Africa is 16 years.

    • Prohibitions against sexual acts with individuals aged 12-16 years, with specific allowances for consensual acts between peers.

  • Sexual Health Requirements:

    • Requires a positive respect for sexuality and relationships, enabling pleasurable and safe experiences devoid of coercion or discrimination.

Issues Related to Unwanted Pregnancy

  • Definition:

    • Unwanted pregnancies result from various factors, including relationship status, economic conditions, or mistiming.

  • Causes:

    • Lack of contraceptive use

    • Ineffectiveness of contraception

    • Non-consensual sex, such as rape and sexual abuse.

Sexual Reproductive Health and Policy (2019)

  • Objective:

    • To enhance conditions under which South Africans can access quality SRH services throughout their lifespan.

  • Focus Areas:

    • Addresses the health and socioeconomic burden caused by SRH issues and aims to tackle social determinants and cultural norms affecting access to services.

  • Guidelines:

    • Aligns with maternal, neonatal, and child health (MNCH) policies including:

    • Antenatal and postnatal care

    • Contraception and safe conception

    • Prevention and management of cervical cancer, HIV, and STIs

    • Early detection and management of breast cancer

    • Management of occupational and non-occupational exposures using PEP (Post-Exposure Prophylaxis).

Key Factors Affecting SRHR in South Africa

  • Influencing Factors:

    • Socio-economic status

    • Rural residence

    • Educational attainment

    • Gender norms and cultural practices

    • Gender-based violence

    • Familial and community expectations regarding fertility

    • Knowledge about conception and contraception methods

    • Stigma and discrimination

Life-Cycle Approach to Reproductive Health

  • Infancy and Childhood (0-9 years):

    • Issues include sex selection, genital mutilation, discriminatory nutrition, and health care.

  • Adolescence (10-19 years):

    • Challenges include early childbearing, unsafe abortion, STIs and AIDS, undernutrition.

  • Reproductive Years (15-49 years):

    • Concerns include unplanned pregnancy, STIs and AIDS, unsafe abortion, pregnancy complications, and malnutrition.

  • Post-Reproductive Years (45+ years):

    • Health issues encompass cardiovascular diseases, gynecological cancers, osteoporosis, osteoarthritis, diabetes, and gender violence.

Reproductive Health Needs

For Adolescents

  • Youth-friendly Health Service Characteristics:

    • Convenient hours and location

    • Adequate space and privacy

    • Non-judgmental attitude by staff

    • Peer counseling available

    • Same-sex providers when possible

    • Strict confidentiality maintained

    • Training for staff in youth-friendly health service principles

    • Affordable and accessible services.

For Women of Childbearing Age

  • Areas of Focus:

    • Postpartum health, contraception, reproductive cancers, pregnancy, prenatal care, infertility, endometriosis, polycystic ovary syndrome (PCOS), menstrual health, and reproductive issues.

  • Statistics from Kenya:

    • Total fertility rate: 3.4 children per woman

    • 57% of married women use modern family planning methods

    • 85% of women aged 15-49 have been tested for HIV and received their results

    • 98% of women received antenatal care from skilled providers

    • 66% made at least four antenatal care visits

    • 72% received postnatal checks within the first two days after birth

    • 89% delivered by skilled providers

    • 82% delivered in a health facility.

For Men

  • Key Interventions:

    • Providing information and counselling, addressing sexual and gender-based violence, supporting safe abortion care, and providing prenatal and postnatal care, including assessment of male reproductive health.

Safe Motherhood

  • Overview:

    • Initiative of the UN launched in 1987 aimed at ensuring women go through pregnancy and childbirth safely and give birth to healthy children. Focus reinforced by the inclusion of reducing maternal mortality in the SDG goal 3.

    • Globally, there are over 300,000 maternal deaths annually and over 200 million women wish to avoid, delay, or end childbearing without access to contraception.

  • Statistics:

    • Complications from pregnancy and childbirth are leading causes of death among young women aged 15-19 globally.

  • Key Components for Safe Motherhood:

    • Proper nutrition and healthy lifestyle prior to conception.

    • Planned pregnancy and appropriate prenatal care.

    • Early treatment of complications when necessary.

  • Six Pillars of Safe Motherhood:

    • Family planning

    • Antenatal care

    • Obstetric care

    • Postnatal care

    • Abortion care

    • STD/HIV control

Maternal Morbidity and Maternal Mortality

  • Definitions:

    • Maternal Mortality: Death of a woman during pregnancy, childbirth, or within 42 days post-delivery due to complications.

    • Maternal Mortality Ratio (MMR): Defined as the number of maternal deaths per 100,000 live births within a year.

  • Formula for MMR:
    MMR=Total number of maternal deaths×100,000Total number of live birthsMMR = \frac{Total \ number \ of \ maternal \ deaths \times 100,000}{Total \ number \ of \ live \ births}

  • Example Calculation:

    • If 10 women die in Cape Town with an annual delivery rate of 50,000, then
      MMR=1050,000=20MMR = \frac{10}{50,000} = 20

  • Implication of MMR: Reflects the general health of women and the standard of care received during pregnancy and postpartum periods.

Causes of Maternal Deaths in South Africa

  • Major Causes:

    • Neurological and cardiovascular dysfunction

    • Anemia

    • Postpartum hemorrhage

    • Eclampsia

    • Non-obstetric causes: malnutrition, cancer

    • Insufficient healthcare facilities and transportation.

  • Risk Factors:

    • Lack of antenatal care

    • Postpartum infection

    • Home deliveries without skilled assistance

    • Unemployment, illiteracy, and poverty.

Conclusion and Further Exploration

  • Discussion Topics:

    • How can reproductive health nurses contribute to safe motherhood? Discuss and present to the class (15 minutes discussion and 5 minutes presentation).

References

  • Mc Call Sellers, P., Dippenaar, J. & da Serra, D. (2018). Sellers’ midwifery (3rd edition). Cape Town: Juta and Company.

  • Regulations relating to the conditions under which Registered Midwives and Enrolled Midwives may carry on their practice. 2990. South African Nursing Council.

  • Saving mothers 2014-2016: Seventh triennial report on confidential inquiries into maternal deaths in South Africa: Short report, 2018.

  • South African maternal, perinatal and neonatal health policy, 2021. South African National Department of Health.