REPRODUCTIVE HEALTH
● Reproductive health refers to healthy reproductive organs with normal
functions.
● According to WHO, reproductive health means a total well being in all the
aspects of reproduction -physical, emotional, behavioural and social.
Reproductive Health - Problems and Strategies
● The family planning programmes were initiated at national level to attain
total reproductive health in our country in 1951.
● It is periodically assessed and currently in operation under the popular name
‘Reproductive and child health care programmes’.
● Creating awareness among people, providing facilities and support for
building up a reproductively healthy society are the major tasks under this
programme.
● With the help of audio-visual and print media, various governmental and
non-governmental agencies have taken up various steps.
● Introduction of sex eduction in school provide right information to the
youth. Proper information about reproductive organs, adolescence and
related changes, safe and hygienic sexual practices, sexually transmitted
diseases would help people, especially adolescent age groups to lead a
reproductively healthy life.
● Awareness about uncontrolled population growth, social evils like sec-abuse
and sex related crimes help to build a socially reponsible and healthy
society.
● Successful implementation of action plans requires strong infrastructural
facilities, professional expertise and material support. Medical assistance
should be provided to people in reproductive related problems like
pregnancy, delivery, STDs, abortions, contraception, menstrual problems,
infertility etc.
● Statutory ban on ammniocentesis for sex determination to legally check
female foeticides, massive child immunisation etc. Amniocentesis is the
foetal sex determination test based o the chromosomal pattern in the
amniotic fluid surrounding the developing foetus.
● ‘Saheli’ an oral contraceptive from females was developed by scientists at
the central drug research institute (CDRI) in Lucknow.
● Medical assisted deliveries and better postnatal care has decreased Maternal
Mortality Rate (MMR) and infant mortality rate (IMR).
POPULATION EXPLOSION AND BIRTH CONTROL
● The world population which was around 2 billion in 1900 rocketed to about
6 billions by 2000.
● Population in India was approximately 350 million at the time of
independence and reached over 1 billion in May 2000.
● That means, every 6th person in the world is an Indian.
● According to the 2001 census report, the population growth rate was still
around 1-7%. At this rate our population will double in 33 years.
● Important steps to overcome population explosion are to motivate smaller
families by using contraceptive methods, statutory raising of marriage age of
the female to 18 years and that of males to 21 years and incentives given to
couples with small families.
Contraceptive methods/Birth control methods
Qualities of an ideal contraceptive
1. User friendly
2. Easily available
3. Effective and reversible with no or least side effect
4. It should not interfere with the sex drive of the individual.
Types of contraceptive/birth control methods
Natural Methods: It works on the principle of avoiding changes of ovum and
sperm meeting periodic abstinence in which couples avoid or abstain from coitus
from day 10 to 17 of the menstrual cycle when ovulation could be expected. It is
the fertile period, during which chances of fertilisation is more.
Withdrawal or coitus interruptus is another method in which male partner
withdraws his penis from the vagina just before ejaculation so as to avoid
insemination.
Lactational amenorrhea (absence of menstruation) It is based on the fact that
menstrual cycle and ovulation do not occur during intense lactational period
following parturition. As long as the mother breast feeds the child, chances of
conception are almost nil. But this method is effective only upto a maximum
period of six months after parturition. No medicines or devices are used in this
method. Hence there are no side effects. But chances of failure of this method is
high.
Barrier Methods -
● In this ovum and sperms are prevented from physically meeting with the
help of barriers.
● Condoms are the rubber or latex sheath that is used to cover the penis in the
male or vagina and cervix in female., so that semen would not enter the
female reproductive tract. ‘Nirodh’ is a popular brand of condom for the
male.
● Condoms also protect 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.
● Diaphragms, Cervical caps and Vaults are made of rubber that can be
inserted into the female reproductive tract to cover the cervix during coitus.
They are reusable.
● Spermicidal creams, jellies and foams are used along with barriers to
increase their contraceptive efficiency.
Intrauterine Devices (IUDs)
It is inserted by doctors or expert nurses in the uterus through vagina. There are
three types of IUDs
(1) Non medicated IUDs ex:- Lippes loop
(2) Copper releasing IUDs ex:- CUT,CU7 multiload 375
(3) Hormone releasing IUDs ex:- Progestasert, LNG-20
IUDs work in the following ways-
(a) Increase phagocytosis of sperms within the uterus
(b) CU ions released suppresses sperm motility and the fertilizing capacity of
sperms.
(c) Hormone releasing IUDs make the uterus unsuitable for implantation and
cervix hostile to the sperms.
IUDs are one of the most widely accepted methods of contraception in India.
CHEMICAL METHODS
● Oral pills which have small doses of either progestogens or
progesterone-estrogen combination is a contraceptive method used by the
females.
● Pills have to be taken daily for a period of 21 days starting within the first
five days of menstrual cycle.
● After a gap of seven days (during which menstruation occurs) it is to be
repeated in the same pattern till the female desires to prevent conception.
● Pills are very effective with lesser side effects.
● Saheli-the new contraceptive pill which is a non-steroidal preparation can be
taken once in a week.
Infections or Implants :
● Progestogens alone or in combination with estrogen can be taken as
infections or implants under the skin.
● Their mode of action is similar to pills and their effective periods are much
longer.
● The pills are the IUD’s can be administered within 72 hours of coitus to
avoid possible pregnance due to rape or casual unprotected intercourse.
Surgical Methods:
● It is also called sterilisation. It is a terminal method to prevent any more
pregnancies.
● It blocks the transportation of gametes and prevents conception.
Vasectomy: In males, a small incision on the scrotum,through which a small part
of the vas deferens is removed or tied up.
Tubectomy:- A small part of the fallopian tube is removed or tied up through a
small incision in the abdomen or through vagina.
These techniques are highly effective but their reversibility is very poor.
● Selection of a suitable contraception should be undertaken by consulting
qualified medical professionals.
● Contraceptive methods are not regular requirements for maintenance of
reproductive health.
● It is done to prevent pregnancy or to delay or space pregnancy due to
personal reasons.
● It plays a significant role in checking uncontrolled population growth.
● It is associated with ill effects like nausea, abdominal pain, break through
bleeding, irregular menstrual bleeding or sometimes even breast cancer.
MEDICAL TERMINATION OF PREGNANCY (MTP)
● Intentional or voluntary termination of pregnancy before full term is called
MTP or induced abortion.
● The Government of India has legalised MTP in 1971 with some strict
conditions to avoid its misuse. (illegal female foeticides).
● MTP is done to get rid of unwanted pregnancies due to casual unprotected
intercourse or failure of the contraceptive or rapes.
● It is essential in cases where continuation of the pregnancy could be harmful
for both mother and the child.
● MTP’s are safe in the first trimester (12 weeks). Second trimester obortions
are much more riskier.
● Effective counselling is needed on unprotected coitus and the risk factors
involved in illegal abortions (abortion performed by unqualified quacks).
SEXUALLY TRANSMITTED DISEASES (STD)
● Diseases or infections transmitted through sexual intercourse are collectively
called as STD’s or Venereal diseases (VD) or reproductive tract infections
(RTI).
● Ex:- Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts,
trichomoniasis, hepatitis B and AIDS.
● AIDS caused by HIV infection is most dangerous.
● Mode of Infection:- Hepatitis-B, HIV can be transmitted by sharing of
injection needles, surgical instruments with infected persons, transfusion of
blood or from infected mother to the foetus.
● Except for hepatitis-B, genital herpes and HIV infections, other diseases are
completely curable if detected early and treated properly.
● Symptoms of STDs - Itching, fluid discharge, slight pain, swelling in the
genital region. Infected females are after asymptomatic and hence remain
undetected for long.
● Absence or loss of significant symptoms in the early stages and the social
stigma attached to the STDs, stops the person from timely detection and
proper treatment.
● This could lead to complications later like peliv inflammatory disease (PID),
abortions, still births, eitopic pregnancies, infertility or even cancer of the
reproductive tract.
● STDs are a major threat to a healthy society. Prevention, early detection and
cure of these diseases should be given prime importance.
● It is very high among the age group of 15-24 years.
PREVENTIVE MEASURES/SIMPLE PRINCIPLES FOR ONE TO BE
SAFE FROM STDs
(a) Avoid sex with unknown partners or multiple partners.
(b) Always use condoms during coitus
(c) In case of doubt, one should go to a qualified doctor for early detection and
get complete treatment if diagnosed with disease.
INFERTILITY
● Infertility can be defined as couples unable to produce children in spite of
unprotected sexual cohabitation.
● The causes/reasons may be physical, congenital, diseases, drugs,
immunological or even psychological.
● It can be a problem with any of the partners i.e male or female partner.
● Infertility clinics could help in diagnosis and corrective treatment for some
of these disorders.
● Where such corrections are not possible, couples could be assisted with
special techniques commonly known as assisted reproductive technologies
(ART) they are
Invitro Fertilisation (IVF) - Followed by embryo transfer (ET) together called
IVF-ET.
● It is popularly known as the test tube baby programme.
● Here ova from the wife or donor and sperms from the husband or donor are
collected and are induced to form zygote under simulated conditions in the
laboratory (In vitro fertilisation).
● The zygote or the early embryo (with upto 8 blastomeres) are transferred
into the fallopian tube (embryo transfer) to complete its further development.
This method can also be called as ZIFT (Zygote intra fallopian transfer)
● *when embryos with more than 8 blastomeres are transferred into uterus is
called as intrauterine transfer - IUT
● *Embryos formed by in-vivo fertilisation (fusion of gametes within the
female) also could be used for such transfers to assist those females who
cannot conceive.
GIFT (gamete intra-fallopian transfer) This is transfer of an ovum collected
from a donor into the fallopian tube of another female who cannot produce ovum,
but can provide a suitable environment for fertilisation and further development.
ICSI (intra cytoplasmic sperm injection) It is a specialised procedure to form
zygote or embryo in the laboratory in which sperm is directly injected into the
ovum.
Artificial Insemination: Infertility due to inability of the male partner to
inseminate the female or low sperm counts in the ejaculates can be corrected by
artificial insemination. Here, the semen collected either from the husband or a
healthy donor is artificially introduced into the vagina or into the uterus (also
called intrauterine insemination) of the female.
● These facilities are available in only a few centres in our country.
● Their benefits are affordable to only a limited number of people.
● Emotional, religious and social factors also deter people from adopting these
methods.
● Since the ultimate aim of these procedures is to have children, legal adoption
is also one of the best methods for couples looking for parenthood.
