Advanced Women’s Health Care / Code: MSNW 113)

Health Promotion for Women

Presenter(s):Dr. Nadia Eltohamy

 Topic: Student Learning Outcomes (SLOs)

Student Learning Outcomes (SLOs)

 At the end of this lecture the students should be able to :

 Explain Preconception care

 Describe female genital mutilation
 Demonstrate Healthy nutrition
 Define Parenting
 Demonstrate role of nurse in women’s Health promotion and disease prevention

2
 Introduction

 Healthcare move from disease focus to preventive focus so

health promotion for women should begin prior to conception
as conception education and screening provide opportunity to
promote health for mother and infant furthermore to decrease
the morbidity and mortality .
 Concepts
 The WHO defines Health as a state of “complete physical, mental and social
well-being and not merely the absence of disease or infirmity.”

 According to (WHO ): Health promotion is the process of enabling people to

increase control over their health and its determinants, and thereby improve their
health.
 Guiding Framework for Health Promotion

 Biological Domain
 Psychological and Social Domain
 Political Domain
 Environmental Domain
 Sexual Domain
 Guiding Framework for Health Promotion

 Biological
Domain :
 Knowledge of biological and physiological factors
before ,during and after pregnancy are very important in
health promotion during preconception, pregnancy and
postpartum period .
 Guiding Framework for Health Promotion

Preconception

 Preconception care is the provision of biomedical, behavioral

and social health interventions to women and couples before
conception occurs.
 A set of prevention and management interventions that aim to

identify and modify biomedical , behavioral, and social risks to

a woman’s health or pregnancy outcome (CDC’s Select Panel
on Preconception Care, June 2005)
 Guiding Framework for Health Promotion

Aims of Preconception care

 To improve maternal and child health, in both the short and long
term .
 Opportunities to prevent and control diseases occur at multiple

stages of life.
 To secure optimal health & nutritional condition in both parents

 To
ensure that the women & her partner are in optimal state of
physical & emotional heath at the onset of pregnancy.
 Guiding Framework for Health Promotion

Aims of Preconception care

 To promote the prenatal health which include developing positive

attitude about sexuality , womanhood & childbearing.

 Tobenefit women being treated for a condition such as sickle cell

anemia , hypertension , heart disease ,diabetics this may cause a
high-risk pregnancy.
 Guiding Framework for Health Promotion

What is the effect of Preconception Care

 Reduce maternal and child mortality
 Prevent unintended pregnancies
 Prevent complications during pregnancy and delivery
 Prevent stillbirths, preterm birth and low birth weight
 Prevent birth defects
 Prevent neonatal infections
 Prevent underweight and stunting
 Prevent vertical transmission of HIV/STIs
 Lower the risk of some forms of childhood cancers
 Lower the risk of type 2 diabetes and cardiovascular disease later in life.
 Preconception Care Package

 Reproductive Planning & Infertility

 Genetic conditions
 Chronic Disease Management
 Physical/Sexual/Emotional abuse
 Vaccine- preventable diseases
 Female genital mutilation
 Too early, unwanted and rapid successive pregnancies
 Nutritional conditions
 Biological Domain

Reproductive Planning & Infertility

• Discuss reproductive goals and issues at each visit

• Creating awareness and understanding of fertility and infertility and their
preventable and unpreventable causes.
• Defusing stigmatization of infertility and assumption of fate.
• Screening and diagnosis of couples following 6–12 months of attempting
pregnancy, and management of underlying causes of infertility/sub-fertility,
including past STIs.
• provide counseling and immunizations as indicated to prevent acquisition of
STIs, and provide indicated STI testing and treatment.
• When pregnancy is desired, discuss medications, health conditions, and
activities that may affect fertility
 Biological Domain

Family and Genetic History

• Assess pregnancy risks on the basis of maternal age, maternal and

paternal health, obstetric history, and family history
• Family planning
• When pregnancy is not desired, discuss safe sex and effective
contraceptive methods
• Genetic counselling &Appropriate treatment of genetic conditions
• Community-wide or national screening among populations at high risk
• Offer a full range of contraceptive methods and provide appropriate
contraceptive counseling that is tailored to each patient’s preference
• Counsel women on the importance of birth spacing
 Biological Domain

Chronic Disease Management

Hypertension: Women of reproductive age should have blood pressure checks during routine
care.
 If diagnosed with hypertension, they should be counseled on lifestyle changes and medications
that are safe in pregnancy.

Diabetes: Women who have diabetes should be counseled about the importance of glycemic
control.
• Hypothyroidism: Poorly controlled hypothyroidism may cause developmental growth, and
neurologic abnormalities.

Assess for use of teratogenic medications and optimize risk profile of medications
 Biological Domain

Physical/Sexual/Emotional abuse

• All women of reproductive age should be screened for current,

recent past, or childhood physical, sexual, or emotional
interpersonal violence and referred to appropriate resources when
needed.
• Health promotion to prevent dating violence
• Providing age-appropriate comprehensive sexuality education that
addresses gender equality, human rights, and sexual relations
 Biological Domain

Physical/Sexual/Emotional abuse

• Recognizing signs of violence against women

• Providing health care services (including post-rape care),
referral and psychosocial support to victims of violence
• Changing individual and social norms regarding drinking,
screening and counselling of people who are problem
drinkers, and treating people who have alcohol use
disorders
 Biological Domain

Vaccine- preventable diseases

 Vaccination against rubella (4 weeks before the

pregnancy )
 Vaccination against tetanus and diphtheria(between 27
and 36 weeks of pregnancy)
 Hepatitis
 Female genital mutilation (FGM)

• Discussing and discouraging the practice with the girl and her parents
and/ or partner
• Screening women and girls for FGM to detect complications
• Informing women and couples about complications of FGM and
about access to treatment
• Removing cysts and treating other complications
 Guiding Framework for Health Promotion

Sexual Domain
 Sexualityis abroad term which includes not only the dimensions of
sexual desire and sexual response but also the individual’s view of
self and presentation of self .
 Guiding Framework for Health Promotion

Sexual Domain
Preconception :
 Assessing the individual knowledge and practice of sexuality .
 Education about sexual function , safe sex .
 Referral of Individual with sexual dysfunction to expert in sex

therapy.
 Screen for STD
 Guiding Framework for Health Promotion

Sexual Domain
Pregnancy :
 Sexual desire and sexual response during pregnancy are affected by

physical , hormonal and psychosocial factors.

 Sexual activity during pregnancy is perfectly safe in normal
pregnancy .
 The semen deposited has chemical that can help in cervical

effacement
 Guiding Framework for Health Promotion

Sexual Domain
Postpartum :
 Resumed sexual relation 2 weeks following delivery.
 Return to pre pregnancy sexual response pattern delayed for up to 12 weeks
due to decrease vaginal lubrication and orgasmic intensity
 Well-rested, emotionally supported mother feel more interest in resuming
sexual relation.
 Sharing of family tasks and responsibilities, childcare , loving communication
will improve marital relationship .
 Use of ware soluble gels for lubrication , suitable positions.
 Suitable contraceptive method
 Biological Domain

Nutrition during preconception and pregnancy

• Supplementing iron and folic acid
• Women at high risk for NTDs should take higher levels of folic acid
• Screening for anemia and diabetes
• Monitoring nutritional status
• Supplementing energy and nutrient-dense food
• Management of diabetes, including counselling people with diabetes
mellitus
 Biological Domain

Nutrition during preconception and pregnancy

 Eating well means eating a variety of healthy foods and also eating enough
food. This combination helps a pregnant woman and her baby stay healthy
and strong because it:
• Helps a woman resist illness during her pregnancy and after the birth
• Keeps a woman’s teeth and bones strong
• Gives a woman strength to work
• Helps the baby grow well in the mother’s uterus
• Helps a mother recover her strength quickly after the birth
• Supports the production of plenty of good quality breast milk to
nourish the baby.
 Biological Domain

Nutrition during preconception and pregnancy

 Eating a variety of foods

 It is important for pregnant women (like everyone else) to eat

different kinds of food :main foods

 Carbohydrates
 Grow foods (proteins)
 Glow foods (vitamins and minerals)
 Go foods (fats, oils and sugar)
 plenty of fluids.
 Biological Domain

Nutrition during preconception and pregnancy

 Main foods (carbohydrates) : (injera, rice, pasta, bread, breadfruit ).

 Grow foods (proteins): are needed for the growth of muscles, bones, and strong blood. Everyone
needs protein to be healthy and to grow. Some grow foods that are high in proteins are:

• Legumes (beans, peas, soybeans, and lentils)

• Eggs
• A fish, chicken leg, three eggs, a steak .
• Cheese, milk and yogurt
• Nuts and seeds
• Cereal, wheat, corn .
• Meat, poultry and fish.
 Biological Domain

Nutrition during preconception and pregnancy

 Glow foods (micronutrients) :contain vitamins and minerals, which

help the body fight infection and keep the eyes, skin and bones
healthy and strong. (Fruits and vegetables ).
 Biological Domain

Benefits of early and exclusive breastfeeding

 Provides the best nutrition for the newborn

 Is easily digested and efficiently used by the baby’s body
 Protects against infection and other illnesses
 Offers some protection against allergies
 Is cost-effective and affordable
 Promotes mother-baby bonding
 Provides the woman with a degree of contraceptive protection

(though less than 100% effective) if she is exclusively breastfeeding

until her first menstrual period returns after the birth.
 Guiding Framework for Health Promotion

 Phycologicaland Social Domain :

 Phycological domain involves feelings, behavior and changes in

behavior.
 Social domain encompasses social networks such as families and

communities
 Guiding Framework for Health Promotion

Phycological and Social Domain

 Preconception:
 Psychosocial evaluation and counseling
 Asses the couples social , financial and psychological readiness for
pregnancy and commitment to parenthood.
 Preconception classes should be available in education program to
improve the parenting skills and pregnancy outcome .
 Promote the intrauterine bonding throw providing knowledge and
skills about fetal growth and development .
 Guiding Framework for Health Promotion

Phycological and Social Domain

 Pregnancy :
 Asses the psychological issues during pregnancy as depression ,
emotional liability and self esteem and body image disturbance.
 All pregnant women experience stress which can be harmful for pregnant
women , causing fatigue, sleepiness, anxiety, poor appetite or overeating
and most of pregnancy related discomfort .
 Health care provider should screen and assess the domestic abuse ,
depression symptoms , provide the behavioral therapy in the form of
support groups , counseling or psychotherapy in the 1st line of treatment
 Guiding Framework for Health Promotion

Phycological and Social Domain

 Postpartum:
 Baby blues start about 3-4 days after delivery, the postpartum
women experience mood swings, difficulty concentrating and lack of
appetite .
 Health promotion strategies : advise the mother
• Talk to someone about the feeling
• Ask for help
• Practice exercise (Meditation , take bath …)
• Don’t try to be super mom, don’t upset .
 Guiding Framework for Health Promotion

Phycological and Social Domain

 Postpartum:
 Postpartum depression : it appears during the 1st 6 month after delivery and can have harmful
effect on the maternal –newborn bonding ,family function and is considered medical emergency .
 Health promotion strategies :
 Early screening and recognizing PP depression
 Mothers support
 Counseling
 Medication
 Sibling rivalry:
 Parent can encourage older children to verbalize their emotions
 Role play safe handling of doll
 Tolerate some regression
 Give older child individual attention
 Encourage grandparents and other visitors to pay attention to older child
 Guiding Framework for Health Promotion

 PoliticalDomain:
 It encompass governmental efforts in establishing environmental
and behavioral changes that promote health.
 Laws affecting the mother’s mental and physical health during the
preconception , pregnancy and postpartum period.
 Guiding Framework for Health Promotion

Political Domain
 Pregnancy & postpartum :
 Working pregnant women are allowed unpaid leave and maternity
leave after labour
 Protection against their risk of exposure to hazards in the
workplace
 Pregnant women have the right to modified work task , job
protected during the ,maternity leave .
 Guiding Framework for Health Promotion

 Environmental Domain :
 It is defined as the external conditions and influences on the
woman who has exposed to various chemicals in the work setting ,
home or other environments.
 Guiding Framework for Health Promotion

Environmental Domain
 Preconception and Pregnancy :
 Avoid the exposure to chemicals during preconception period and the 1st trimester .
 Work area should be well ventilated
 Work area should be safe for the mother and the outcome .
 Avoiding unnecessary pesticide use/providing alternatives to pesticides
 Informing women of childbearing age about levels of methyl mercury in fish
 Promoting use of improved stoves and cleaner liquid/gaseous fuels
 All women of childbearing age should be screened for alcohol consumption, tobacco use, and
drug use.
 Providing brief tobacco cessation advice, pharmacotherapy (including nicotine replacement
therapy, if available) and intensive behavioral counselling services
 Screening of all non-smokers (men and women) and advising about harm of second-hand smoke
and harmful effects on pregnant women and unborn children
 Guiding Framework for Health Promotion

Environmental Domain
 Postpartum :
 Breast feeding mother should take care from chemicals ,
medications, illegal drugs as it transmitted in breast milk and may
affect her infant .
 Take Home Message
 1. Eating well during pregnancy and breastfeeding means eating a variety of foods and
enough foods — at least 200 additional calories every day.
 2. Eating well with little money is possible by buying cheap nutritious foods like beans
and organ meats, growing legumes, keeping chickens, using whole grains, and making soups.
 3. Pregnant and breastfeeding women need to eat a variety of main foods
(carbohydrates), grow foods (proteins), go foods (sugars and fats), and glow foods (vitamins
and minerals, particularly iron, folate, calcium, iodine and Vitamin A).
 4. Iron pills and folate (folic acid) tablets should be provided to pregnant women as part
of routine antenatal care.
 5. Personal hygiene, especially hand washing and keeping the genital area clean, helps to
prevent infection during pregnancy (and at all times).
 Take Home Message
 6. Getting plenty of rest and sleep, and avoiding alcohol, cigarettes, illegal drugs,
strong chemicals and infectious persons helps to protect the pregnant woman and her
unborn baby.
 7. Immunization against tetanus should be a routine part of antenatal care.
 8. Feeding colostrum, followed by full and exclusive breastfeeding, is the best and
only nourishment a baby needs in the first 6 months of life.
 9. Full and exclusive breastfeeding may protect the woman from becoming pregnant
again up to 6 months after the birth, but only if feeding is very frequent and her
menstrual periods have not returned.
 10. Birth spacing of at least 2 years is good for the health of the woman, her baby and
any older children — in fact for all her family.
 Topic: Summary – Outcomes Achieved

Summary – Outcomes Achieved

• Antenatal care provides a key entry point for a broad range

of health promotion and disease prevention services.
• It is essential for healthcare providers and women to talk
about important issues affecting the woman’s health and
her pregnancy.
 Topic: References

References

Lowdermilk D.L (2016)Maternity and Women’s Health
Care,11th Ed. Elsevier Inc.

Ricci, S. 2007. Essentials of Maternity Newborn and
Women’s Health Nursing .1st Edition . Lippincott
Williams & Wilkins, Philadelphia.

World Health Organization;

www.who.int/topics/millennium_development_goals/about/e
n/
World Health
Organization;www.who.int/topics/pregnancy/en/