TOPIC 1 Reproductive Health: Problems and Strategies The word ‘Reproductive health’ simply refers to healthy reproductive organs with normal functioning. 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. The improved reproductive health of society requires following factors better awareness about sex related matters. ¢ increased number of medically assisted deliveries and better postnatal care. increased number of couples with small families. * better detection and cure of STDs (Sexually Transmitted Diseases). A Tehy ing tive nd Awareness of Reproductive Health Some of the measures taken for the awareness of reproductive health are as follows * The family planning programmes were initiated in India in 1951 and were periodically assessed over the past decades. These programmes were improved and later included reproduction related areas under the popular name Reproductive and Child Healthcare (RCH) programmes. It was launched in 1997. Major tasks of RCH programme are creating awareness among people about reproduction related aspects. providing facilities and support for building up a reproductively healthy society.In schools, introducing sex education is a good step to — provide right information to adolescents and to discourage them from believing in myths and misconceptions about sex related issues. ¢ Married couple or those in marriageable age group should be educated about available birth control options, care of pregnant mothers, postnatal care of the mother and child, importance of breast feeding, equal opportunities for the male and female child, etc. Successful implementation of action plans like providing medical assistance and care to reproduction related problems, pregnancy, delivery, STDs, abortions, contraception, menstrual problems, infertility, etc. need strong support and infrastructural facilities. _ Amniocentesis * itis a prenatal diagnostic technique based on chromosomal pattern. © In this technique, a sample of amniotic fluid is taken from the _uterus of a pregnant woman to detect the early development foetus. j © The’benefits of amniocentesis include the diagnosis of _ chfomtiosomal abnormalities and developmental dToetus. However, it is being misused for the sex- determinatior vs foetus, as it leads to female foeticides. * Therefore, statutory ban on amniocentesis for sex-determination keeps check on female foeticides. Population Explosion The tremendous increase in the size and growth rate of population is called population explosion. It occurs due to increased health facilities and better living conditions of population. * Other reasons for population explosion include Decreased death rate. Declined Maternal Mortality Rate (MMR). Decreased Infant Mortality Rate (IMR). Increase in the number of people in reproductive age. ¢ According to the 2001 census report, the population growth rate was around 1.7%, i.e. 17/1000/year. By this rate, our population could double in 33 years. The 15th census of India was conducted in 2011 which showed decadal growth of 17.70%. Methods to prevent population explosion include * Raising the marriageable age, i.e. 18 years for females and 21 years for males. * Couples with small families should be given some incentives. (i pe FfBirth control is an important step to control the population growth by motivating smaller families to us contraceptive methods. =, 5 Contraceptive methods are ideal if they are user friendly, — easily available, effective, reversible with no side effects ing and non-interfering with the sexual drive, desire and the sexual act. There are several methods of birth control that ~ can be categorised as follows 1. Natural Methods The natural methods of birth control involve the preventio of sperm and ovum meeting during coitus or reproductive” phase. 3 (i) Periodic abstinence or rhythm method In this method, couples avoid coitus from day 10-17 (1 period) of the menstrual cycle. Coitus interruptus or ‘rejected sexual intea Fiaval amenorrhea It is the absence of menstruation during the period of intense lactation following parturition. (ii) 2. Barrier Methods to These methods are based on the prevention of ovum and f sperm from physically meeting with the help of barriers. The barriers may be mechanical or chemical and can be used by both males and females. Mechanical Barriers (i) Condoms They are made of thin rubber or latex i sheath to cover the penis in male or vagina and Cervix | in females (femidom). They prevent meeting of sperm and ova. Condoms provide protection from sexually 5 transmitted diseases. (ii) Diaphragms, cervical caps and vaults They are made up of rubber and are inserted into the female reproductive tract to cover the cervix during coitus. They are reusable. Chemical Barriers include spermicidal creams, jellies and ally used along with the barriers to inReproductive Health 3. Intra Uterine Devices (IUDs) These devices are placed in the uterus doctors or expert nurses. IUDs are idea for females who want to delay pregnan hrough vagina by | contraceptives cy. These are one of the most widely accepted contraception methods in India. These are of following types ¢ Non-medicated IUDs, e.g. lippes loop. ¢ Copper-releasing IUDs, e.g. Cu-T, Cu-7 and multiload 37h ¢ Hormone-releasing IUDs, e.g. progestasert, LNG-20. IUDs prevent contraception in the following ways * Increase phagocytosis of sperms within the uterus. * Copper-releasing IUDs suppress sperm motili 1 . fertilising ability of sperm by releasing * The hormone releasing IUDs make implantation and make the " § - iefertiusing aDINIty OF sperm f « The hormone releasing TUD. for implantation and make t Y Teleasing coppe Ss make uterus unsuitab he cervix hostile for 4, Oral Contraceptives These are hormonal preparations Their major features include « Pills are of two types-combined pills and mini pills. Combined pills (Mala-D and Mala-N) contain synthetic progesterone and oestrogen whereas mini pills contain progestin (progesterone like synthetic hormone) only. * Oral pills inhibit ovulation and modify the quality of cervical mucus to prevent/retard the motility of sperms. They also modify uterine endometrium by making it unsuitable for implantation. * Oral pills have to be taken daily for a period of 21 d starting within the first five days of menstrual * Saheli, an oral contraceptive pill develop scientists at Central Drug Research (CDRI), Lucknow, contains a non-st entchroman. It is once-a~ | in the form of pills.hormone) only. TTT OT Oral pills inhibit ovulation and modify the quality of cervical mucus to prevent/retard the motility of sperms. They also modify uterine endometrium by making it unsuitable for implantation, Oral pills have to be taken daily for a period of 21 days starting within the first five days of menstrual cycle. Saheli, an oral contraceptive pill developed by scientists at Central Drug Research Institute (CDRI), Lucknow, contains a non-steroid called centchroman. It is once-a-week pill, with very few side effects and high contraceptive value, 5. Implants or Injections These are effective for longer period and their mode of action is similar to that of oral contraceptives. Progesterone alone or in combination with oestrogen is used by females as injections (Depo Provera) or implants P under the skin. q6. Emergency Contraceptives y These include administration of high dose of progesterone or progestogen-oestrogen combinations within 72 hours of coitus. These have been found to be very effective in n Preventing possible pregnancy due to unprotected intercourse. 7. Sterilisation or Surgical Methods Sterilisation methods are used by male or female partner as a terminal, permanent and stable method to prevent pregnancies. These methods block the transport of gametes and prevent conception. These are of following two types _ (i) Vasectomy is applied in case of males. In this metho small portion of vas deferens is removed or cut ~_ up through an incision on the scrotum | passage of sperms from the testes to. ie penis: of ©(W Vasectomy is applied in case of males, In this method, _ small portion of vas deferens is removed or cut and up through an incision on the scrotum to prevent the — passage of sperms from the testes to copulatory organ, 1.e penis, Vas deferens cut and tied Is. ni Testis c of Figure 3.1 Vasectomy in male ii) Tubectomy is applied in case of females, where a small , y is app part of Fallopian tube is removed or cut and tied up through a small incision in the abdomen or through days vagina to prevent the passage of ova from ovary to le. Fallopian tube. Fallopian tubes 7S cut andtied /74 It is the intentional or voluntary termination of pregnancy (induced abortion) before the full term. MTP has following characteristics ¢ The Government of India had legalised MTP in 1971 with some strict conditions to avoid its misuse. These are important to check indiscriminate and illegal female foeticides, which are reported to be high in India. ¢ MTP is done in certain cases where pregnancy can be harmful and even fatal either to the mother or to the Oost eu aofét SSChapterwise CBSE Solved Papers : BIOLOGY | foetus or both or due to the failure of contraceptive used during coitus. MTPs are considered relatively safe during the first trimester } (upto 12 weeks) of pregnancy. | MIP. During second trimester, MTPs are unsafe and could be fatal | too. . About 45-50 million MTPs are carried out in a year all over i BSc, the world. These have a significant role in decreasing population though they are not meant for that purpose. 1 in . hig of MTP is that it is being misused to abort the | as no female foetus. It has also raised many emoti j t on: ie ethical and social issues too. . *TOPIC 2 Sexually Transmitted : Diseases (STDs) and Infertility ‘ i ansmitted STDs are those diseases or infections, which ies through sexual intercourse. These are also cal Venereal Diseases (VDs) or Reproductive ea Assiste Infections (RTIs). Some common STDs are Ben 5S syphilis, genital herpes, trichomoniasis, hepatitis-B, AIDS, Techne cryptorchidi scrotum), et ete. : Sometimes Among the above mentioned STDs, three viral infections, treatment o ite. AIDS, genital herpes and hepatitis-B are not curable, Some ofl while others are curable. ‘ The early general symptoms of STDs are. IVE (in V * itching in genital area. Test-Tub * fluid discharge. (i) Ova fi * slight pain in genital areas. * husba + swellings in the genital region. : The patients with STDs remain undetected and untreated due to * the absence or less significant symptoms in the early stages of infection. * social stigma attached to the STDs, € The late detection leads to the complications like Pelvic Inflammatory Diseases (PIDs), abortions, still births, ectopic pregnancies, infertility and the cancer of the Teproductive tract, 2 ee The incidence of these diseases is high |5-24 years. These inf oelebs:awpeyeurere ua. The incidence of these diseases is high in the persons of age group 15-24 years. These infections can be avoided or prevented by the following ways * Avoid sexual practices with unknown partners or multiple partners. Use of condoms during coitus. * In case of any doubt, visit a doctor immediately for the detection and treatment. Infertility The inability to produce children inspite of unprotected sexual practices is called infertility. It is one of the major aspects of reproductive health. The reasons of infertility can be physical, congenital diseases, drugs, immunological or even psychological. Common causes of infertility in males include oligospermia (low sperm count), azoospermia, Ic Iti ovi is(failure OF testes vw ucseon me Sometimes corrective treatments do not lead to the es, treatment of infertility. In such cases, ARTs are used. e Some of the ARTs are IVE (/n Vitro Fertilisation) or Test-Tube Baby Programme (i) Ova from wife/donor female and sperms from the husband/donor male are made to fertilised to form zygote in the laboratory under same conditions as in the body (in vivo). This is called in vitro fertilisation (fertilisation outside the body). (ii) Zygote or early embryo is transferred into Fallopian tube or uterus for further development. This is called _ Embryo Transfer (ET). It can be of following two types, namely (a) ZIFT (Zygote Intra Fallopian Transfer) in whi embryos up to 8 blastomeres are transferred i the Fallopian tubes. jage iple il EMpryo eames types, namely 4 (a) ZIFT (Zygote Intra Fallopian Transfer) in which — embryos up to 8 blastomeres are transferred into the Fallopian tubes. (b) TUT (Intra Uterine Transfer) in which embryos of more than 8 blastomeres are transferred into the uterus. ICSI (intra Cytoplasmic Sperm Injection) It is carried out by directly injecting the sperm into the ovum to form an embryo in the laboratory. Embryo transfer is done later on by IUT technique in woman. In Vivo Fertilisation It is performed by the fusion of gametes within the female and then this zygote can be used for ZIFT or IUT. GIFT (Gamete Intra Fallopian Transfer) It is done by the transfer of an ovum collected from a donor female into the Fallopian tube of another female, who is unable to produce ova, but can provide suitable conditions for fertilisation and further development of the — foetus. *