REPRODUCTIVE HEALTH

• Reproductive Health – Problems and Strategies

• Population Explosion and Birth Control
• Medical Termination of Pregnancy
• Sexually Transmitted Diseases
• Infertility

Q. What do we understand by the term reproductive health?

A: 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.
OR
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.
Q. What is “family planning”? when was it initiated? What was its goal?
A. 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.
Q. What do you mean by RCH? What is its role?
A. ‘Reproductive and Child Health Care (RCH) programmes’. Improved programmes covering wider reproduction-
related areas are currently in operation under the popular name ‘Reproductive and Child Health Care (RCH)
programmes’.
Role of RCH-
• 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.
• With the help of audio-visual and the print-media governmental and non-governmental agencies have taken various
steps to create awareness among the people about reproduction-related aspects.
• Introduction of sex education in schools should also be encouraged to provide right information to the young so as
to discourage children from believing in myths and having misconceptions about sex-related aspects.
• Proper information about
o reproductive organs,
o adolescence and related changes,
o safe and hygienic sexual practices,
o sexually transmitted diseases (STD),
o 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
o available birth control options,
o care of pregnant mothers,
o post-natal care of the mother and child,
o importance of breast feeding,
o equal opportunities for the male and the female child, etc.,
would address the importance of bringing up socially conscious healthy families of desired size.
• Awareness of
o problems due to uncontrolled population growth,
o social evils like sex-abuse and sex-related crimes, etc.,
need to be created to enable people to think and take up necessary steps to prevent them and thereby build
up a socially responsible and healthy society.

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 • Statutory ban on amniocentesis for sex-determination to legally check increasing menace of female foeticides,
massive child immunisation, etc., are some programmes that merit mention in this connection.
• 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
o pregnancy, o contraception,
o delivery, o menstrual problems,
o STDs, o infertility, etc.
o abortions,
Q. What is the amniocentesis? Write down the steps involved in this.
A. Amniocentesis: It is the technique that reads the karyotype of the foetal cells that isolated from the amniotic fluid.
Steps involved in amniocentesis: -
• In amniocentesis some of the amniotic fluid of the developing foetus is taken to analyse the fetal cells and dissolved
substances.
• This procedure is used to test for the presence of certain genetic disorders such as, down syndrome, haemophilia,
sickle-cell anemia, etc., determine the survivability of the foetus.
Q. What is Saheli?
A. ‘Saheli’–a new oral contraceptive for the females–
• was developed by scientists at Central Drug Research Institute (CDRI) in Lucknow, India.
• Saheli–the new oral contraceptive for the females contains a non-steroidal preparation.
• It is a ‘once a week’ pill with very few side effects and high contraceptive value.
Q. What indicate improved reproductive health of the society.
A. indicators of healthy reproductive society-
• Better awareness about sex related matters,
• increased number of medically assisted deliveries and better post-natal care
• decreased maternal and infant mortality rates,
• increased number of couples with small families,
• better detection and cure of STDs and overall increased medical facilities for all sex-related problems, etc.
all indicate improved reproductive health of the society.
POPULATION STABILISATION AND BIRTH CONTROL
Q. What had an explosive impact on the growth of population?
A. In the last century
• an all-round development in various fields significantly improved the quality of life of the people.
• increased health facilities along with better living conditions had an explosive impact on the growth of population.
• 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 also probable reasons for this.
Q. Fill in the blanks- (6 billion, 7.2 billion, )
The world population which was around 2 billion (2000 million) in 1900 rocketed to about ________ by 2000 and
______ in 2011.
Q. Fill in the blanks- (350 million, 1.2 billion)
A. Our (India) population which was approximately ________ at the time of our independence reached close to the
billion mark by 2000 and crossed _______ in May 2011.
Q. What helped to bring down increasing population growth?
A. Reproductive Child Health (RCH) programme, could bring down the population growth rate, but was marginal.

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 Q. What was the population growth rate in the 2011 census report? How does the high population growth rate
impact the nation?
A. According to the 2011 census report, the population growth rate was less than 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,
Q. What are the serious measures taken by government to check population growth rate?
A. The most important step to overcome high population growth rate 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).
• Adoption an ‘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.
• contraceptive methods, which help prevent unwanted pregnancies
Q: What are ideal contraceptives?
A: 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.
Q: What are the commonly used contraceptives? OR enlist the contraceptive methods presently available.
A wide range of contraceptive methods are presently available which could be broadly grouped into the following
categories, namely
• Natural/Traditional, • Injectables,
• Barrier, • Implants and
• IUDs, • Surgical methods
• Oral contraceptives,

Q: What are the Natural methods of contraceptives? /Name the principle on which the natural contraceptives work.
Give Examples.
A: Natural methods work on the principle of 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 these methods are also high.
Ex- 1. Periodic abstinence, 2. Withdrawal or coitus interruptus, 3. Lactational amenorrhea.
Q: Define the term Periodic abstinence.
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.
Q: What is Withdrawal or coitus interruptus?
A: Withdrawal or coitus interruptus is another method in which the male partner withdraws his penis from the vagina
just before ejaculation so as to avoid insemination.
Q: Define and explain Lactational amenorrhea.
A: Lactational amenorrhea (absence of menstruation) method is based on the fact that ovulation and the menstrual
cycle do not occur during the period of intense lactation following parturition.
Therefore, 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 upto a maximum period of six months following parturition.

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 Q: What are barriers in contraceptive methods? Write down the types and function.
A: In barrier methods, ovum and sperms are prevented from physically meeting with the help of barriers. Such methods
are available for both males and females.
Q: What are condoms?
A: 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.
This can prevent conception. ‘Nirodh’ is a popular brand of condom for the male.
Q: What is the additional benefits of condom?
A: Use of condoms has increased in recent years due to its additional benefit of protecting the user from contracting
STIs and AIDS. Both the male and the female condoms are disposable, can be self-inserted and thereby gives privacy
to the user.
Q: Briefly explain barriers in female for contraception.
A: 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 prevent conception by blocking the entry of sperms through the cervix.
• They are reusable.
• Spermicidal creams, jellies and foams are usually used alongwith these barriers to increase their contraceptive
efficiency.
Q: Write a brief account on IUDs in terms of nature of work, type, and function.
A: The IUDs stands for Intra Uterine Devices (IUDs).
• These devices are inserted by doctors or expert nurses in the uterus through vagina.
• IUDs are ideal contraceptives for the females who want to delay pregnancy and/or space children.
• It is one of most widely accepted methods of contraception in India.
These Intra Uterine Devices are presently available as -
Types & examples Functions
Non-medicated IUDs (e.g., Lippes loop) IUDs increase phagocytosis of sperms within the uterus
Copper releasing IUDs (CuT, Cu7, Multiload 375) Cu ions released suppress sperm motility and the
fertilising capacity of sperms.
Hormone releasing IUDs (Progestasert, LNG-20) The hormone releasing IUDs, in addition make the uterus
unsuitable for implantation and the cervix hostile to the
sperms.

Q: What is oral contraceptive (oral pill)? Explain its uses.

A: Oral administration of small doses of either progestogens or progestogen–estrogen combinations is contraceptive
method used by the females is called as oral contraceptive. They are used in the form of tablets and hence are popularly
called the pills.
Uses/doses-
• Pills have to be taken daily for a period of 21 days starting preferably within the first five days of menstrual cycle.
• After a gap of 7 days (during which menstruation occurs) it has to be repeated in the same pattern till the female
desires to prevent conception.
• They inhibit ovulation and implantation as well as alter the quality of cervical mucus to prevent/retard entry of
sperms.
• Pills are very effective with lesser side effects and are well accepted by the females.
Q: What are injections or implants?
A: Progestogens alone or in combination with estrogen can also be used by females as injections or implants under
the skin.
• Their mode of action is similar to that of pills and their effective periods are much longer.

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 • 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.
Q: What are surgical methods of contraception? Define and differentiate between the types.
A: 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 are highly effective but their reversibility is very poor. Sterilisation procedure in the male is called
‘vasectomy’ and that in the female, ‘tubectomy’.

Vasectomy Tubectomy
Sterilisation procedure in the male is called ‘vasectomy’ Sterilisation procedure in the in the female, ‘tubectomy’

In vasectomy, a small part of the vas deferens is removed in tubectomy, a small part of the fallopian tube is
or tied up through a small incision on the scrotum removed or tied up through a small incision in the
abdomen or through vagina.

Q: What are the ill-effects of contraceptives?

A: 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.
Q: Expand and explain MTP.
A: Intentional or voluntary termination of pregnancy before full term is called medical termination of pregnancy (MTP)
or induced abortion.
• 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. 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.
Q: Why MTP?
A: 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.
Q: Write a note on danger/misuse associated MTP. How can we deal with it?
A: Danger/misuse associated to MTP
• MTPs are considered relatively safe during the first trimester, i.e., upto 12 weeks of pregnancy.
• Second trimester abortions are much riskier.
• One disturbing trend observed is that a majority of the MTPs are performed illegally by unqualified quacks which
are not only unsafe but could be fatal too.
• Another dangerous trend is the misuse of amniocentesis to determine the sex of the unborn child.
• Frequently, if the foetus is found to be female, it is followed by MTP- this is totally against what is legal.
• Such practices should be avoided because these are dangerous both for the young mother and the foetus.
• Effective counselling on the need to avoid unprotected coitus and the risk factors involved in illegal abortions as well
as providing more health care facilities could reverse the mentioned unhealthy trend.
Q: Write an account on STDs/STIs.
A: Sexually transmitted diseases-
Definition:
Infections or diseases which are transmitted through sexual intercourse are collectively called sexually transmitted
infections (STI) or venereal diseases (VD) or reproductive tract infections (RTI).

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 Example:
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 STIs.
Mode of transmission:
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.
Cure:
Except for hepatitis-B, genital herpes and HIV infections, other diseases are completely curable if detected early and
treated properly.
Symptoms/vulnerability:
• 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 STIs, 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.
• 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. There is no reason to panic because
prevention is possible.
Preventions: One could be free of these infections by following the simple principles given below:
(i) Avoid sex with unknown partners/multiple partners.
(ii) Always try to use condoms during coitus.
(iii) In case of doubt, one should go to a qualified doctor for early detection and get complete treatment if diagnosed
with infection.
Q: Define the term infertility. What are the common causes of infertility? How can we help the couple with infertility?
A: INFERTILITY: When an individual/couple are unable to produce children inspite of unprotected sexual co-habitation.
The reasons for this could be many–physical, congenital, diseases, drugs, immunological or even psychological.
The couples could be assisted to have children through certain special techniques commonly known as assisted
reproductive technologies (ART).
Q: Write a brief note on test-tube baby technique.
A: as test tube baby programme includes In vitro fertilisation (IVF) followed by embryo transfer (ET).
a) IVF: Ova from the wife/donor (female) and sperms from the husband/donor (male) are collected and are induced
to form zygote under simulated conditions in the laboratory.
b) Embryo transfer (ET):
ZIFT: Zygote intra fallopian transfer, the zygote or early embryos (with upto 8 blastomeres) could then (IVF) be
transferred into the fallopian tube.
IUT: IUT – intra uterine transfer, embryos with more than 8 blastomeres, into the uterus to complete its further
development.
*Embryos formed by in-vivo fertilisation (fusion of gametes within the female) also could be used for such transfer to
assist those females who cannot conceive.
Q: Expand and define the followings-
a- GIFT b- ICSI c- AI d- IUI
A: Answers
a- GIFT: Transfer of an ovum collected from a donor into the fallopian tube (GIFT – gamete intra fallopian transfer) of
another female who cannot produce one, but can provide suitable environment for fertilisation and further
development is another method attempted.
b- ICSI: Intra cytoplasmic sperm injection (ICSI) is another specialised procedure to form an embryo in the laboratory
in which a sperm is directly injected into the ovum.

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 c- AI: In this technique, the semen collected either from the husband or a healthy donor is artificially introduced either
into the vagina.
d- IUI: a healthy donor is artificially introduced into the uterus (IUI – intra-uterine insemination) of the female.
*Infertility cases either due to inability of the male partner to inseminate the female or due to very low sperm counts
in the ejaculates, could be corrected by artificial insemination (AI) technique.
Q: Give your comment on Adoption of child among infertile couples.
A: Though options are many, all ART techniques require extremely high precision handling by specialised professionals
and expensive instrumentation. Therefore, these facilities are presently available only in very few centres in the
country. Obviously, their benefits are affordable to only a limited number of people. Emotional, religious and social
factors are also deterrents in the adoption of these methods. Since the ultimate aim of all these procedures is to have
children, in India we have so many orphaned and destitute children, who would probably not survive till maturity,
unless taken care of. Our laws permit legal adoption and it is as yet, one of the best methods for couples looking for
parenthood.

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