Reproductive Health is a state of complete physical, mental and social well-being and not merely absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capacity 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 of 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 regulating fertility which are not against the law, and the right to access appropriate health care services that will enable women to have a safe pregnancy and childbirth and provide couples with the best chance 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 enhancement of life and personal relations, and not merely counseling and care related to reproduction and sexually transmitted diseases.

Pakistan ranks behind most developing countries in the reproductive health risk index . Pakistan has one of the lowest records in female health and education and its fertility rate of 4.00 and population growth rate of 1.9 is considerably higher than other Asian countries including Bangladesh , India and Sri Lanka

One in 38 Pakistani women dies from pregnancy related causes as compared to 1 in 230 women in Sri Lanka. Almost one half of women are anemic throughout their pregnancies. Maternal mortality is estimated as 350-400 per 100000 live births.. Approximately 80% deaths are due to direct obstetric causes. Hepatitis is the most frequently cited indirect cause of maternal death. About 12% of deaths are due to induced abortion.

Pakistan is one of the few countries in the world where men outnumber women. This unfavorable ratio is mainly a consequence of excess mortality of young girls and women in the childbearing age. Infant mortality and morbidity associated with pregnancy relates conditions are high and the rate of infant mortality from all causes is one of the highest in Asia.

The extent of reproductive tract infections in Pakistan has not been documented. Studies in a comparable setting suggest that women suffer a substantial but silent burden. Reproductive tract infections including sexually transmitted diseases can cause pelvic inflammatory disease, ectopic pregnancy, infertility and chronic pain and also increase women’s susceptibility to HIV infection.

Cancers of the breast and reproductive tract constitute a significant proportion of cancers seen in Pakistan. A study involving 5 hospitals in 4 provinces found 19%of women had cancers of gyneacological causes. Cancer of the breast is the most common, accounting for 20% of all cases.

Women’s disproportionate poverty, low social status and reproductive role expose them to high health risks, resulting in needless suffering, many preventable deaths and disability. This unfortunate situation can no longer be ignored.

Consonant with ICPD recommendations appropriate quality reproductive health services will be integrated in the primary health care service provision set up. The availability of RH services will ensure that the patients are able to have their basic reproductive health care needs addressed at a health facility which is within easy reach by a health provider with whom they are familiar and who understands their health needs.

Whilst quality service provision in the four priority areas will be ensured the remaining components will be appropriately focused upon in RH/ health training, health education & awareness creation activities in the communities.

Guidelines for various service delivery cadres on their roles and responsibilities pertaining to components of reproductive health service package will help in defining their role for effective service provision. The service provision managers will also be able to use these guidelines as a checklist for ensuring quality RH service provision.

Will be provided by a collaborative arrangement at the Regional Training Institutes of Ministry of Population Welfare. These training institutes, 12 in number located in all the four provinces are involved as a post ICPD initiative in provision of training in RH to various cadres of service providers. The training aims at imparting clear concepts regarding RH components and reproductive health counseling through role play and modular based on interactive teaching methodologies with the help of audio/visual aids. The training also includes appropriate on hands training in clinic settings on RH including family planing. Infection prevention is also included in the RH training.

Essential equipment to health outlets will be provided. Full range of contraceptives including IUCDs and injectables will be provided along with adequate quantities of appropriate IEC material on family planning and other RH components.

The existing reporting system will be suitably amended through a consultative process to reflect RH related activities.

Quality of RH services will be ensured through:

a) Finalization of strategic plan through a consultative process and ensuring its availability at all service outlets.

b) Guidelines for doctors and paramedical staff for management and treatment of RH related problems will be provided to all service providers.

c) Service provision guidelines and standards will be monitored regularly and weak areas identified will be rectified through on job training of service providers.

d) Regular review of RH service provision through periodic clinical audit

e) Periodic evaluations of service quality and rectification of weak areas through refresher training and other suitable interventions.