Reproductive Health

• What do we understand by the term “reproductive health”? The term simply refers to healthy
reproductive organs with normal functions. However, it has a broader perspective and includes the
emotional and social aspects of reproduction also.

• According to the World Health Organisation (WHO), reproductive health means a total well-being
in all aspects of reproduction, i.e., physical, emotional, behavioural and social.
• A society with people having physically and functionally normal reproductive organs and normal
emotional and behavioural interactions among them in all sex-related aspects might be called
reproductively healthy.

REPRODUCTIVE HEALTH – PROBLEMS AND STRATEGIES

• India was amongst the first countries in the world to initiate action plans and programmes at a national
level to attain total reproductive health as a social goal.

• These programmes called ‘family planning’ were initiated in 1951 and were periodically assessed
over the past decades. Improved programmes covering wider reproduction-related areas are
currently in operation under the popular name ‘Reproductive and Child Health Care (RCH)
programmes’.

• Creating awareness among people about various reproduction related aspects and providing facilities
and support for building up a reproductively healthy society are the major tasks under these
programmes.

• Proper information about reproductive organs, adolescence and related changes, safe and
hygienic sexual practices, sexually transmitted diseases (STD), AIDS, etc., would help people,
especially those in the adolescent age group to lead a reproductively healthy life.

• Educating people, especially fertile couples and those in marriageable age group, about available birth
control options, care of pregnant mothers, post-natal care of the mother and child, importance of
breast feeding, equal opportunities for the male and the female child, etc., would address the
importance of bringing up socially conscious healthy families of desired size.

• Successful implementation of various action plans to attain reproductive health requires strong
infrastructural facilities, professional expertise and material support. These are essential to
provide medical assistance and care to people in reproduction-related problems like pregnancy,
delivery, STDs, abortions, contraception, menstrual problems, infertility, etc.

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POPULATION EXPLOSION AND BIRTH CONTROL

• The world population which was around 2 billion (2000 million) in 1900 rocketed to about 6 billion by
2000 and 7.2 billion in 2011.
• A similar trend was observed in India too. Our population which was approximately 350 million at the
time of our independence reached close to the billion mark by 2000 and crossed 1.2 billion in May
2011.
• A rapid decline in death rate, maternal mortality rate (MMR) and infant mortality rate (IMR) as
well as an increase in number of people in reproducible age are probable reasons for this.
• Through our RCH programmes, though we could bring down the population growth rate, it was only
marginal. According to the 2011 census report, the population growth rate was still around 2
per cent i.e. 20/1000/year, a rate at which our population could increase rapidly.
• Such an alarming growth rate could lead to an absolute scarcity of even the basic requirements, i.e.,
food, shelter and clothing, in spite of significant progress made in those areas. Therefore, the
government was forced to take up serious measures to check this population growth rate.
• The most important step to overcome this problem is to motivate smaller families by using various
contraceptive methods. You might have seen advertisements in the media as well as posters/bills, etc.,
showing a happy couple with two children with a slogan Hum Do Hamare Do (we two, our two).
Many couples, mostly the young, urban, working ones have even adopted ‘one child norm’.
• Statutory raising of marriageable age of the female to 18 years and that of males to 21 years,
and incentives given to couples with small families are two of the other measures taken to
tackle this problem.

FAMILY PLANNING
Family planning refers to practices that help individual to attain certain objectives
(i) To avoid unwanted Births
(ii) To bring about wanted birth
(iii) To regulate the interval between pregnancies
(iv) To determine the number of children in family
• Method which prevent unwanted birth or pregnancies are called contraceptive methods.
Contraceptive methods help in family planning.

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Reproductive Health

• An ideal contraceptive should be user-friendly, easily available, effective and reversible with no
or least side- effects. It also should in no way interfere with the sexual drive, desire and/or the
sexual act of the user.
• Contraceptives are categorised under temporary and permanent methods.

TEMPORARY OR SPACING METHODS:

These are the contraceptive methods which are used to prevent/delay pregnancy and/or space children. They
are of the following types.

1. NATURAL METHODS :-
• Work on the principle of naturally avoiding chances of ovum and sperms meeting. As no medicines
or devices are used in these methods, side effects are almost nil. Chances of failure, though, of this
method are also high.

A. Rhythm or Periodic abstinence method -

• Periodic abstinence is one such method in which the couples avoid or abstain from coitus from
day 10 to 17 of the menstrual cycle when ovulation could be expected. As chances of
fertilisation are very high during this period, it is called the fertile period. Therefore, by abstaining
from coitus during this period, conception could be prevented.
• 1st 7 days after Menstruation and 7 days before mensuration is called safe period because in these
14 days ovum is absent in fallopian tubes. Hence fertilization usually does not occur.

B. Withdrawal or Coitus interrupts -

• During sexual intercourse, male partner withdraws his penis from vagina just before ejaculation so as
to avoid insemination.

C. Lactational amenorrhea -
• High concentration of prolactin may lead to inhibition of menstrual cycle in lactating mother.
• Lactational amenorrhea (absence of menstruation) method is based on the fact that ovulation and
therefore the cycle do not occur during the period of intense lactation following parturition.
• As long as the mother breast-feeds the child fully, chances of conception are almost nil. However, this
method has been reported to be effective only up to a maximum period of six months following
parturition.

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Question-1: First country of world which adopted family planning programme -

(1) Japan (2) India (3) USA (4) Bangladesh
Answer: (2) India

Question-2: Government sponsored "family planning programme" started in -

(1) 1947 (2) 1977 (3) 1951 (4) 1955
Answer: (3) 1951

Question-3: Which of the following method is based on avoiding insemination?

(1) Lactational amenorrhea (2) Hormonal method
(3) Coitus interrupts (4) Periodic abstinence
Answer: (3) Coitus interrupts

Question-4: Lactational amenorrhea is effective only up to a maximum of ________ months.

(1) Two (2) Four (3) Six (4) Eight
Answer: (3) Six

2. CHEMICAL METHOD
• In this method chemicals are used which are spermicidal agent or surface-active agents which attach
themselves to spermatozoa and inhibit O2 uptake and kill sperm.
• Example: Vaginal Foam/tablets = 'Today' | Cream or Jelly = ‘‘Nim-76’’

3. BARRIER METHOD
• In this method ovum (egg) and sperms are prevented from physically meeting
with the help of barriers.

A. Condoms - Male Condom

• Condoms are barriers made of thin rubber/ latex sheath that are used to
cover the “penis in the male” or “vagina and cervix in the female” just before
coitus so that the ejaculated semen would not enter into the female
reproductive tract i.e. they prevent insemination.
• Use of condoms has increased in recent years due to its additional
Female Condom
benefit of protecting the user from contracting STDs and AIDS.
• Both the male and the female condoms are disposable, can be self-inserted and thereby gives privacy
to the user.
• ‘Nirodh’ is a popular brand of condom for the male.

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B. Diaphragms, Cervical Caps & Vaults -

• Diaphragms, cervical caps and vaults are also barriers made of
rubber that are inserted into the female reproductive tract to cover
the cervix during coitus.
• They do not prevent insemination but prevent conception by
blocking the entry of sperms through the cervix.
Cervical Cap
• They are reusable. Spermicidal creams, jellies and foams are usually
used along with these barriers to increase their contraceptive efficiency.
• They do not provide protection against STDs.

4. INTRA UTERINE DEVICES (IUDS) :-

• IUDs are contraceptive devices that are inserted inserted by doctors
or expert nurses in the uterus through vagina.
• IUDs are an ideal contraceptives for the females who want to delay
pregnancy or space between children.
• It is one of most widely accepted methods of contraception in
India. IUD
• These. IUDs are of the following types-

A. Non-medicated IUDs -
• These devices are made of plastic or stainless steel only.
➢ Mechanism: Non-medicated IUDs, promote the phagocytic cells of uterus to
phagocytosis of sperms within the uterus.
• E.g. Lippes loop - made of plastic (Polyethylene).
Copper
Releasing IUD

B. Copper releasing IUDs -

➢ Mechanism: Copper releasing IUDs, release Copper ions whcih suppress
sperm motility and the fertilizing capacity of sperms.
• E.g. CuT, Cu7, Multiload-375

C. Hormone releasing IUDs

➢ Mechanism: The hormone releasing IUDs, make the uterus unsuitable for
Hormone
implantation and the cervix hostile to the sperms. Releasing IUD
• E.g. Progestasert, LNG-20

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Reproductive Health

Question-1: CuT, Cu7, Multiload-375 are examples of -

(1) Hormone releasing IUDs (2) Non-medicated IUDs
(3) Copper releasing IUDs (4) Barrier methods
Answer: (3) Copper releasing IUDs

Question-2: Which of the following is an IUCD?

(1) Vault (2) Copper-T (3) Condom (4) Cervical cap
Answer: (2) Copper–T

Question-3: Which of the following contraceptive device is reusable?

(1) Condom (2) Cervical cap (3) Copper-T (4) LNG-20
Answer: (2) Cervical cap

Question-4: Which contraceptive method provides some protection against HIV?

(1) IUD (2) Pills (3) Condom (4) Cervical cap
Answer: (3) Condom

5. HORMONAL METHOD:
• This is the most widely used and most effective method (almost 100% effective)
• In this method oral pills, injections and implants are used.
Oral Pills -
• Pills are very effective with lesser side effects and are well accepted by
the females.
• The daily oral pills are started preferably within the first five days of
menstrual cycle.
• For 1 to 21 days Hormonal pills are given and Iron or Fe pills are given in last
7 days for recovery of blood loss in menstruation flow and to maintain
regularity of pills. Daily oral
pills
• Composition of oral pill
a) Synthetic progesterone – High concentration
b) Synthetic Estrogen – Low concentration
➢ Mechanism: Action of combination oral pill is to prevent the ovulation from ovary. This is achieved by
blocking the pituitary secretion of gonadotropin (FSH and LH) that is necessary for ovulation.
o Progesterone only preparations render the cervical mucosa thick and scanty this prevent /
retard entry of sperms. So fertilization does not take place.
• Daily oral pills for females: Mala–N, Mala–D
Implants & Injections -
• Progestogens alone or in combination with estrogen can also be used by
females as injections or implants under the skin.
• In these implants/injections, high level of progesterone Hormone is
present which Inhibit secretion of gonadotropins so ovulation in
absent.
Norplant
• E.g. Norplant (implant)

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Reproductive Health

C. Male Pill -
• Progesterone hormone can be used in male oral pills.
• In July 2000 china made progesterone pills for male (first time in world).

6. SAHELI :-
• Weekly oral pill
• Non-steroidal & non-hormonal pill. (Developed by scientists at CDRI Lucknow)
• Few side effects and high contraceptive value.
➢ Mechanism: it blocks oestrogen receptors in uterus and prevents implantation.

7. EMERGENCY CONTRACEPTIVE METHODS :-

• Contraceptives methods which are used within 72 hours of
unprotected sexual intercourse are known as emergency
contraceptives or post-coital contraceptives.
Emergency contraceptive
a) Emergency contraceptive pills - progesterone only pill. pill
e.g. i-pill, unwanted-72
b) IUD-IUD can also be used as an emergency contraception as they prevent implantation.
• Administration of ‘progestogens’ or ‘progestogen-estrogen combinations’ or IUDs within 72
hours of coitus have been found to be very effective as emergency contraceptives as they could
be used to avoid possible pregnancy due to rape or casual unprotected intercourse.

Question-1: Which of the following is a non-steroidal pill?

(1) Mala-D (2) Saheli
(3) Mala-N (4) i-pill
Answer: (2) Saheli

Question-2: Which of the following is an example of implant?

(1) Saheli (2) Unwanted-72
(3) Norplant (4) Mala-D
Answer: (3) Norplant

Question-3: Hormonal methods work mainly by preventing -

(1) ovulation (2) implantation
(3) insemination (4) parturition
Answer: (3) Ovulation

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TERMINAL METHOD
• Surgical methods, also called sterilisation, are generally advised for the male/female partner as a
terminal method to prevent any more pregnancies.
• Surgical intervention blocks gamete transport and thereby prevent conception.
• These techniques highly effective but their reversibility is very poor.

Fallopian tube cut and tied

Vas deferens
cut and tied

Vasectomy Tubectomy

• For Male: Vasectomy - A small part of the vas deferens is removed or tied up through a small
incision on the scrotum
• For Female: Tubectomy - A small part of the fallopian tube is removed or tied up through a small
incision in the abdomen or through vagina.

IMPORTANT NOTE
• Contraceptives are not regular requirements for the maintenance of reproductive health. In
fact, they are practiced against a natural reproductive event, i.e., conception/pregnancy.
• One is forced to use these methods either to prevent pregnancy or to delay or space
pregnancy due to personal reasons.
• No doubt, the widespread use of contraceptive methods have a significant role in checking
uncontrolled growth of population. However, their possible ill-effects like nausea, abdominal
pain, breakthrough bleeding, irregular menstrual bleeding or even breast cancer, though not
very significant, should not be totally ignored.

MEDICAL TERMINATION OF PREGNANCY (M.T.P.)

• Intentional or voluntary termination of pregnancy before full term is called medical termination of
pregnancy (MTP) or induced abortion.
• It is relatively safe during the 1st trimester (up to 12 weeks of pregnancy) and more risk in 2nd
trimester.
• Why MTP? Obviously the answer is to get rid of unwanted pregnancies either due to casual
unprotected intercourse or failure of the contraceptive used during coitus or rapes. MTPs are also
essential in certain cases where continuation of the pregnancy could be harmful or even fatal either
to the mother or to the foetus or both.

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• Nearly 45 to 50 million MTPs are performed in a year all over the world which accounts to 1/5th
of the total number of conceived pregnancies in a year. Obviously, MTP has a significant role
in decreasing the population though it is not meant for that purpose.
• Whether to accept / legalise MTP or not is being debated upon in many countries due to emotional,
ethical, religious and social issues involved in it. Government of India legalised MTP in 1971 with
some strict conditions to avoid its misuse. Such restrictions are all the more important to check
indiscriminate and illegal female foeticides which are reported to be high in India.
• The Medical Termination of Pregnancy (Amendment) Act, 2017 was enacted by the government
of India with the intension of reducing the incidence of illegal abortion and consequent
maternal mortality and morbidity.
o According to this Act, a pregnancy may be terminated on certain considered grounds within the
first 12 weeks of pregnancy on the opinion of one registered medical practitioner.
o If the pregnancy has lasted more than 12 weeks, but fewer than 24 weeks, two registered
medical practitioners must be of the opinion, formed in good faith, that the required ground
exist. The grounds for such termination of pregnancies are:
(i) The continuation of the pregnancy would involve a risk to the life of the pregnant woman or
of grave injury physical or mental health
OR
(ii) There is a substantial risk that of the child were born, it would suffer from such physical or
mental abnormalities as to be seriously handicapped.

AMNIOCENTESIS

• In the 14th or 16th week of pregnancy with the help of long

Long surgical needle
surgical needle, amniotic fluid is taken out from the uterus.
In this fluid, few cell of embryo (skin, liver and placenta) are
present. Foetus
• These cells are tested to know –
(i) Genetic disorder / chromosomal abnormalities like
Down syndrome
(ii) Metabolic disorder (deficiency of protein, enzymes,
hormones) amniotic fluid
(iii) Detection of Sex (Barr bodies)
• There is statutory ban on amniocentesis for sex-determination to legally check increasing
female foeticides.

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Question-1: Full form of MTP is:

(1) Maximum termination of pregnancy (2) Medical termination of population
(3) Multiple temporary pregnancy (4) Medical termination of pregnancy
Answer: (4) Medical termination of pregnancy

Question-2: MTP is relatively safe during?

(1) 12 week (2) 18 week (3) First trimester (4) 1 & 3 both
Answer: (4) 1 & 3 both

Question-3: Tubectomy, a method of population control is performed on:

(1) Both males & females (2) Males only
(3) Females only (4) Pregnant females
Answer: (3) Females only

Question-4: Purpose of tubectomy is to prevent:

(1) Fertilisation (2) Coitus (3) Egg formation (4) Follicle development
Answer: (1) Fertilisation

INFERTILITY
• If couples are unable to produce children inspite of unprotected sexual cohabitation up to 2
years this is called infertility.
• The reasons for this could be many–physical, congenital, diseases, drugs, immunological or even
psychological.
• Specialised health care units (infertility clinics, etc.) could help in diagnosis and corrective treatment
of some of these disorders and enable these couples to have children.
• However, where such corrections are not possible, the couples could be assisted to have children
through certain special techniques commonly known as assisted reproductive technologies
(ART) categorised under two types –

1. IN-VITRO FERTILISATION (TEST TUBE BABY)

• Fertilisation occurs outside the body of female in almost similar conditions as that in the body and
after it, embryo is transferred into uterus or fallopian tube of surrogate mother or same mother
• Sperms and egg can be made to fertilize in an artificial medium similar to the medium in fallopian
tube or ICSI can be used
Intra-cytoplasmic Sperm Injection (ICSI) - It is a specialised procedure to form an embryo in the
laboratory in which a sperm is directly injected into the cytoplasm of ovum.

Ovum

Sperm

ICSI

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EMBRYO TRANSFER METHODS -

a) Zygote Intra Fallopian Transfer (ZIFT) – Zygote or early embryos (with up to eight blastomere) could
be transferred into the fallopian tube of surrogate or same mother.
b) Intra Uterine Transfer (IUT) – Embryo with more than eight blastomeres (commonly 32 cells stage)
are transferred into uterus.

2. IN-VIVO FERTILISATION
• Fertilisation occurs inside the body of female, either naturally or artificially.
Gamete Intra Fallopian Transfer (GIFT) – Transfer of an ovum collected from ovary into the
fallopian tube of same female or female who can't produce one, but can provide suitable environment
for fertilisation, this is called GIFT.
Artificial insemination – If male is unable to inseminate the semen into vagina or if there is very low
sperm count in the semen then semen is artificially introduced either into vagina or into the uterus
of the female (intrauterine insemination) IUI.

Question-1: In which of the following technique is in-vivo?

(1) ZIFT (2) ICSI
(3) GIFT (4) IUT
Answer: (3) GIFT

Question-2: In which of the following methods zygote up to 32 blastomere is transferred into the
uterus?
(1) IUT (2) GIFT
(3) ZIFT (4) ICSI
Answer: (1) IUT

Question-3: If male is impotent and female is normal then which of the following technique can be
used?
(1) ICSI (2) ZIFT
(3) GIFT (4) AI
Answer: (4) Al

Question-4: Fertilisation outside the body in almost similar conditions as that in the body is termed
as-
(1) In vitro fertilisation (2) Artificial Insemination
(3) In vivo fertilisation (4) G.I.F.T.
Answer: (1) In vitro fertilisation

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 Reproductive Health

SEXUALLY TRANSMITTED INFECTIONS (STIs)

• Diseases or infections which are transmitted through sexual intercourse are collectively called
sexually transmitted infections (STI) or venereal diseases (VD) or reproductive tract infections
(RTI).
• Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B
and of course, the most discussed infection in the recent years, HIV leading to AIDS are some
of the common STDs. Among these, HIV infection is most dangerous.
• Some of these infections like hepatitis–B and HIV can also be transmitted by sharing of injection
needles, surgical instruments, etc., with infected persons, transfusion of blood, or from an infected
mother to the foetus too.
• Except for hepatitis-B, genital herpes and HIV infections, other diseases are completely curable
if detected early and treated properly.
• Early symptoms of most of these are minor and include itching, fluid discharge, slight pain, swellings,
etc., in the genital region.
• Infected females may often be asymptomatic and hence, may remain undetected for long.
• Absence or less significant symptoms in the early stages of infection and the social stigma
attached to the STDs, deter the infected persons from going for timely detection and proper
treatment.
• This could lead to complications later, which include pelvic inflammatory diseases (PID),
abortions, still births, ectopic pregnancies, infertility or even cancer of the reproductive tract.
STDs are a major threat to a healthy society.
• Therefore, prevention or early detection and cure of these diseases are given prime consideration
under the reproductive health-care programmes.
• Though all persons are vulnerable to these infections, their incidences are reported to be very high
among persons in the age group of 15-24 years – the age group to which you also belong.
• One could be free of these infections if one follows the simple principles given below:

(i) Avoid sex with unknown partners/multiple partners.

(ii) Always use condoms during coitus.

(iii) In case of doubt, go to a qualified doctor for early detection and get complete treatment if
diagnosed with disease.

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Reproductive Health

Question-1: The age group of ________ years is quite vulnerable to STDs.

(1) 10 to 19 (2) 15 to 22
(3) 15 to 24 (4) 17 to 27
Answer: (3) 15 to 24

Question-2: : Which STI is not completely curable :-

(1) Syphilis (2) Chlamydiasis
(3) Both (1) and (2) (4) Genital herpes
Answer: (4) Genital herpes

Question-3: Which of the following is not a sexually transmitted disease?

(1) Cancer (2) Acquired Immuno Deficiency Syndrome (AIDS)
(3) Genital warts (4) Syphilis
Answer: (1) Cancer

Question-4: Which among the following diseases are completely curable if detected in early stages?
(1) HIV infection (2) Chlamydiasis
(3) Hepatitis B (4) Genital herpes
Answer: (2) Chlamydiasis

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