Sabtu, 17 April 2010

Introduksi Kesehatan Reproduksi Wanita

Introduksi Kesehatan Reproduksi Wanita
Posted on Juli 12, 2008 by kuliahbidan

Kuliah Obstetri Ginekologi
Prof. dr. Abdul Bari Saifuddin / dr. Biran Affandi / dr. J.M. Seno Adjie
Tulisan tentang Penyakit Hubungan Seksual / Kuliah Kulit dan Kelamin
dr. Sjaiful Fahmi Daili

KESEHATAN REPRODUKSI (Reproductive Health)

International Conference on Population and Development, Cairo, 1994 (WHO/PBB) :
“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, its functions and its processes.”
“Reproductive health therefore implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.”
“Implicit in this last condition are the rights of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth, and provide couples with the best chance possible of having a healthy infant.”
“In line with the above definition of reproductive health, reproductive health care is defined as the constellation of methods, techniques, and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of the quality of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases.”

What are the essential elements of reproductive health, and how do these elements bear on every problems of fertility and infertility ?
1. Reproductive health is the opportunity, particularly for women, to regulate and control fertility. This includes not only family planning, but for some couples, the proper treatment of infertility.
2. Reproductive health should allow all women to have a safe pregnancy and childbirth.
3. Reproductive health is the striving for neonatal excellence, allowing every newborn to have the benefits of a healthy infancy.
4. Finally, reproductive health is the freedom from sexually-transmitted diseases.


International Conference on Population and Development, Cairo, 1994 (WHO/PBB)
“The aim of family planning programmes must be to enable couples and individuals to decide freely and responsibly the number and spacing of their children, and to have the information and means to do so and to ensure informed choices and make available a full range of safe and effective methods.”
“The success of population education and family planning programmes in a variety of settings demonstrates that informed individuals everywhere can and will act responsibly in the light of their own needs and those of their families and communities.”
“The principle of informed free choice is essential to the long-term success of family planing programmes.”
“Govermental goals for family planning should be defined in termes of unmet needs for information and services.”
“Demographic goals, while legitimately the subject of government development strategies, should NOT be imposed on family planning providers in the form of targets or quotas for the recruitment of clients.”


meliputi empat program / target utama :
1. Family Planning : Keluarga Berencana
2. Antenatal Care : Asuhan / Perawatan Antenatal
3. Clean and Safe Delivery : Persalinan yang Bersih dan Aman
4. Essential Obstetric Care : Pelayanan Obstetrik Esensial


Fertilisasi dan Implantasi
Embrio 1 – 10 minggu intrauterin
Fetus 11- 40 minggu intrauterin
Neonatus 0 – 1 bulan
Bayi 1 – 12 bulan
Batita 1 – 3 tahun
Balita 1 – 5 tahun
Anak 5 – 12-15 tahun (menarche)
PUBERTAS (Menarche) 12-15 tahun
Remaja (Adolesen) s/d 20 tahun
Klimakterium (Menopause) 45-55 tahun
Pasca Menopause 50-65 tahun
Senium 65 tahun ke atas

Masa embrio sampai fetus disebut masa prenatal / prakelahiran.
Masa neonatus sampai anak disebut juga masa prapubertas.


- Angka Kematian Maternal.
- Anemia
- Cakupan pelayanan ibu hamil.
- Gizi kurang
- Pertolongan oleh tenaga terlatih.
- Kehamilan usia muda
- Cakupan imunisasi tetanus toksoid.
- Penyakit menular akibat hubungan seksual.
- Tingkat pendidikan dan pengetahuan masih rendah.


1. Wanita dan anak risiko tinggi bila kehamilan melampaui kurun waktu reproduksi sehat dan atau paritas tinggi.
2. Kehamilan cukup aman bila usia ibu antara 20 sampai 35 tahun.
3. Jumlah riwayat persalinan (paritas) aman sampai dengan 3.
4. Jarak antar kehamilan cukup aman minimal 2 tahun.
5. Usia / jarak di luar batas aman : risiko kematian maternal.
6. Jumlah anak lebih dari 3 : risiko komplikasi persalinan.
7. Kematian maternal : kematian ibu yang terjadi berhubungan dengan peristiwa kehamilan, persalinan maupun nifas.
8. Penyebab utama kematian maternal : 1) perdarahan 2) infeksi/sepsis 3) preeklampsia/ eklampsia (TRIAS penyebab), 4) partus lama 5) abortus yang tidak aman 6) lain-lain.
9. The Four Too’s (4 “terlalu”) : – Too many (anak banyak) – Too early (hamil usia muda) – Too frequent (jarak antar kehamilan terlalu dekat) -Too late (hamil usia tua).
10. The Three Delays (3 “terlambat”) : – Delay in deciding to seek medical care – Delay in reaching a medical facility with adequate care – Delay in receiving qualified medical care at the facility.
11. Total Fertility Rate (TFR) : target 2.2
12. Anemia di Indonesia sebagian besar karena defisiensi Fe dan gizi kurang.

The State of World Population 1997 documents the effects of denying sexual and reproductive rights in many countries :
1. 585,000 women–one every minute–die each year from pregnancy-related causes, nearly all in developing countries. Many times this number are disabled as the result of childbirth. Much of this death and suffering could be averted with relatively low-cost improvements in health care systems.
2. About 200,000 maternal deaths per year result from the lack or failure of contraceptive services.
3. 120-150 million women who want to limit or space their pregnancies are still without the means to do so effectively. Altogether 350 million couples lack information about and access to a range of contraceptive services.
4. At least 75 million pregnancies each year (out of about 175 million) are unwanted; they result in 45 million abortions, 20 million of which are unsafe.
5. 70,000 women die each year as a result of unsafe abortion, and an unknown number suffer infection and other health consequences. Many unsafe abortions could be avoided if safe and effective means of contraception were freely available.
6. 3.1 million people were infected last year by the human immunodeficiency virus (HIV) which leads to AIDS; 1.5 million died from HIV/AIDS-related causes in 1996; 22.6 million people are living with HIV/AIDS.
7. 1 million people die each year from reproductive tract infections including sexually transmitted diseases (STDs) other than HIV/AIDS. More than half of the 333 million new cases of STDs per year are among teenagers.
8. 120 million women have undergone some form of female genital mutilation; another 2 million are at risk each year.
9. Rape and other forms of sexual violence are rampant, though many rapes are unreported because of the stigma and trauma associated with rape and the lack of sympathetic treatment from legal systems.
10. At least 60 million girls who would otherwise be expected to be alive are “missing” from various populations as a result of sex-selective abortions or neglect.
11. 2 million girls between ages 5 and 15 are introduced into the commercial sex market each year.
The UNFPA report stresses that sexual and reproductive rights are key to women’s empowerment and gender equality, and are also critical to the economic and social life of communities, nations and the world. Global and national needs coincide with personal rights and interests. Given the choice, most women would have fewer children than their parents’ generation. Ensuring that women and their partners have the right to choose will support a global trend towards smaller families, and help countries find a balance between their populations and resources. Successful development efforts will in turn bring sexual and reproductive health to more people.


Any of a diverse group of infections caused by biologically dissimilar pathogens and transmitted by sexual contact, which includes both heterosexual and homosexual behaviour; sexual transmission is the only important mode of spread of some of the diseases in the group (e.g., the classic venereal diseases), while others (e.g., hepatitis / HIV viruses, other bacterial / fungal species, etc) can also be acquired / transmitted by other nonsexual means.
(Dorland’s Illustrated Medical Dictionary, 28th ed., 1996)

Dalam batasan yang lebih sempit, atau menurut awam, sering digunakan istilah “penyakit kelamin” (venereal diseases).
Yang dimaksud dengan penyakit kelamin, jika istilah ini yang digunakan, adalah penyakit yang penularannya (terutama) melalui (hubungan) kelamin / genital.

Terdapat juga pengertian yang mungkin keliru di kalangan awam, bahwa penyakit menular seksual atau penyakit kelamin adalah penyakit yang menyerang organ kelamin / genital. Padahal, melalui modus kontak kelamin yang bervariasi (manual / oral / anal) dapat juga terjadi gejala penyakit pada kulit, mulut, anus, dan organ / sistem organ ekstragenital lainnya.

Selama dekade terakhir ini insidens PHS cepat meningkat di berbagai negara. Meskipun demikian, data yang dilaporkan tentu tidak menggambarkan keadaan sesungguhnya (“fenomena gunung es”).

Hal ini antara lain disebabkan :
1. Banyak kasus yang tidak dilaporkan.
2. Kalaupun ada laporan, sistem pelaporan yang berlaku belum ada keseragaman.
3. Fasilitas diagnostik di berbagai daerah kurang mendukung, seringkali juga terjadi salah diagnosis dan penatalaksanaan.
4. Banyak kasus yang asimptomatik (tidak memberikan gejala yang khas).
5. Bila penderita wanita, sering tanpa gejala khas (asimptomatik) sehingga mereka merasa tidak perlu berobat.
6. Program pengontrolan terhadap PHS dari pemerintah / instansi belum berjalan baik.

Secara keseluruhan, dapat dilihat bahwa ada banyak faktor yang dapat mempengaruhi peningkatan terjadinya insidens PHS, antara lain :
1. Perubahan demografik yang luar biasa : peledakan jumlah penduduk, pergerakan / mobilitas masyarakat yang bertambah (sering bepergian ke luar kota untuk pekerjaan, liburan, wisata, kongres/seminar/rapat dll).
2. Kemajuan sosial ekonomi industri, menyebabkan lebih banyak kebebasan sosial dan lebih banyak waktu yang terluang.
3. Kelalaian sistem negara dalam memberikan pendidikan kesehatan umumnya dan pendidikan seksualitas khususnya.
4. Perasaan “aman” pada penderita karena pemakaian obat antibiotik dan kovntrasepsi yang dapat dipilih sendiri, yang belum tentu benar.
5. Akibat banyak pemakaian antibiotik yang tidak sesuai, akibatnya terjadi resistensi kuman terhadap antibiotik tersebut.
6. Fasilitas kesehatan kurang memadai terutama fasilitas laboratorium dan klinik pengobatan.
7. Banyaknya kasus asimptomatik, merasa diri tidak sakit, tetapi mempunyai potensi untuk menulari orang lain.

Usaha penyuluhan dan penanggulangan harus melibatkan ketiga disiplin yang saling berhubungan :
1. segi medik
2. segi epidemiologik
3. segi psikososial


Latar belakang

1. masa remaja adalah masa yang penuh dinamika, gejolak rasa ingin tahu yang tinggi dalam berbagai hal, termasuk juga dalam hal reproduksi / seksualitas.
2. sumber informasi yang banyak dan luas tapi belum tentu benar, baik dan sehat.


Masalah yang mungkin timbul sebagai akibatnya, misalnya perilaku seksual yang tidak baik, menjadi penyebab tingginya angka kejadian kehamilan remaja / di luar nikah, aborsi, penyakit menular seksual, dsb.
Di negara berkembang, banyak perkawinan yang terjadi pada usia muda. Sehingga yang menjadi masalah mendasar sebenarnya bukan “hubungan seks / kehamilan di luar nikah”, tetapi “pernikahan / kehamilan pada usia muda” (karena pada usia belasan tahun sudah menikah, berhubungan seks, hamil dan mempunyai anak).

Makin maju / makin meningkatnya kualitas hidup masyarakat di suatu negara, tampaknya trend pola kehidupan reproduksi wanita juga ikut berubah (grafik).
1. Dengan peningkatan kualitas hidup, gizi, pengetahuan, dsb, dapat terjadi menstruasi pada anak wanita pada usia yang lebih awal (semakin muda).
2. Dengan bertambahnya wawasan, pengetahuan, dsb, dapat terjadi seorang wanita memilih untuk menikah pada usia yang lebih tua.
Hal ini menjadi masalah khusus lain kesehatan reproduksi wanita usia remaja, karena terdapat celah / “gap” yang luas antara usia menarche dengan usia perkawinan, padahal masa remaja itu adalah masa yang rentan terhadap perilaku seksual yang kurang baik (misalnya berganti-ganti pasangan, dsb), kemungkinan kehamilan yang besar (karena sudah memasuki usia reproduktif), kemungkinan terpapar penyakit menular seksual, dan sebagainya.

Essential aspects of adolescent (reproductive) health care :
1. counseling.
2. contraceptive alternatives / choices.
3. obstetric care : maintenance and termination of pregnancy
4. prevention and treatment of sexually transmitted diseases.

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