1.

Reproductive Health: Introduction and Strategies

• Health: A state of complete physical, emotional, social, and behavioral well-being.

• Reproductive Health: According to the World Health Organization (WHO), this means total
well-being in all aspects of reproduction (physical, emotional, behavioral, and social).
• Major Problems: Overpopulation, lack of awareness, Sexually Transmitted Diseases
(STDs), poverty, and unemployment.
• Strategies & Programs:
o India was among the first countries to launch "Family Planning" programs at a
national level in 1951.
o Currently, these operate under the broader name Reproductive and Child Health
Care (RCH) programs.
o 8 Main Strategies of RCH: Creating audio-visual awareness, introducing sex
education in schools, spreading awareness about sex crimes, promoting equal rights
for males and females, menstrual hygiene awareness, educating about
contraceptives, providing better pre/post-natal care, and conducting massive
immunization/vaccination drives .

Amniocentesis:

• Definition: A prenatal diagnostic procedure where a syringe extracts a small amount of

amniotic fluid surrounding the developing foetus.
• Timing: Performed between the 14th to 18th week of pregnancy.
• Legal Use: Used to test for genetic or chromosomal abnormalities like Down's syndrome,
Haemophilia, and Sickle-cell anemia.
• Statutory Ban: It is legally banned for sex-determination in India because it was being
heavily misused to kill normal female foetuses (female foeticide).

2. Population Explosion and Demography

• Demography: The study of population.

• Population Explosion Facts: The world population jumped from 2 billion in 1900 to 7.2
billion in 2011. India's population was 350 million at independence and crossed 1.2 billion
in May 2011.
• Reasons for Growth: A rapid decline in the general death rate (Mortality Rate), Maternal
Mortality Rate (MMR), and Infant Mortality Rate (IMR), along with more people reaching
reproducible age.

Population Formulas & Terms:

• Mortality Rate: Number of deaths per 1000 individuals per year. This decreases the
population.
 • Natality Rate: Number of births per 1000 individuals per year. This increases the
population.
• Immigration: People entering a place (adds to population).
• Emigration: People exiting a place (subtracts from population).

Government Measures for Control:

• Promoting smaller families using slogans like "Hum Do Hamare Do".

• Statutory raising of marriageable age to 18 years for females and 21 years for males.

3. Birth Control Methods (Contraceptives)

• Ideal Contraceptive Mnemonic ("FEELS"): An ideal contraceptive should be Friendly to

the user, easily available, Effective, have Least side-effects, and have no interference with
Sexual desire or the act of coitus.

A. Natural Methods (Temporary & Reversible) These avoid the chances of the ovum and
sperms physically meeting. Chances of failure are high.

• Periodic Abstinence (Calendar Method): Avoiding sex during the "Risk Period" when
ovulation is expected.
o Formula: Ovulation day = Menstrual cycle duration - 14.
o Risk Period: Generally the 10th to 17th day of the cycle.
• Coitus Interruptus (Withdrawal): The male withdraws the penis from the vagina just
before ejaculation. Very risky.
• Lactational Amenorrhea: The absence of menstruation due to intense breast-feeding after
delivery. It prevents ovulation for a maximum of up to 6 months.

B. Barrier Methods (Temporary & Reversible) Physically prevent sperms and ova from meeting.

• Physical Barriers: * Condoms (Male & Female/Femidome): Made of thin rubber/latex.

They are self-inserted, non-reusable (use and throw), and offer privacy. Important: This is
the only contraceptive method that also protects against STDs and AIDS. "Nirodh" is a
popular brand in India.
o Diaphragms, Cervical caps, and Vaults: Reusable rubber barriers inserted into the
female reproductive tract to cover the cervix. They do not protect against STDs.
• Chemical Barriers: Spermicidal creams, jellies, and foams. They kill sperms by creating an
acidic pH and are used alongside physical barriers to increase efficiency .

C. Intra-Uterine Devices - IUDs (Temporary & Reversible) Inserted by expert doctors or nurses
into the uterus. They increase the phagocytosis (destruction) of sperms. Ideal for spacing out
pregnancies.

• Non-medicated IUDs: Example: Lippes loop.

 • Copper releasing IUDs (Cu2+ : Examples: CuT, Cu7, Multiload 375. The Cu2+ ions
suppress sperm motility and fertilizing capacity . Diagram note: The CuT device is T-shaped
with a trailing thread.
• Hormone releasing IUDs: Examples: Progestasert, LNG-20. They release
progesterone/estrogen, which makes the uterus unsuitable for implantation and the cervix
hostile to sperms.

D. Hormonal Methods: Pills, Implants, Injectables

• Oral Pills: Tablets containing small doses of progestogens or progestogen-estrogen

combinations.
o How to take: Taken orally daily for 21 days starting roughly from the 3 rd to 5th day of
the menstrual cycle, followed by a 7-day gap, and then repeated.
o Saheli: A special non-steroidal, 'once a week' pill developed by CDRI, Lucknow. It
has high contraceptive value and very few side effects. Diagram/Action note: Saheli
works by blocking estrogen receptors present in the endometrium of the uterus,
preventing implantation.
• Implants: Silicon-based, fan-shaped matchstick-like structures inserted sub-dermally
(under the skin). They inhibit ovulation and implantation and last for 5-6 years.
• Injectables: Given via injection; mode of action is the same as pills but effective periods
are longer.
• Emergency use: Hormonal methods and IUDs can be used within 72 hours of unprotected
intercourse (e.g., I-Pills) to avoid unwanted pregnancy.

E. Surgical Methods / Sterilization (Permanent & Irreversible) Terminal methods that block
gamete transport.

• Vasectomy (Males): A small part of the vas deferens is cut and tied up through an incision
on the scrotum or abdomen, stopping sperm transport.
• Tubectomy (Females): A small part of the fallopian tubes is cut and tied through an
incision in the abdomen, stopping ova transport.
• Side Effects of Birth Control: Although generally safe, potential side effects include
nausea, vomiting, mood-swings, irregular periods, heavy menstrual flow, and rarely, breast
cancer .
4. Medical Termination of Pregnancy (MTP) / Abortion

• Definition: Intentional or voluntary termination of pregnancy before full term.

• Stats: Around 45-50 million MTPs are performed worldwide yearly 1/5th of total conceived
pregnancies).
• Legality: Legalized in India in 1971, with a modified amendment Act in 2017 .
• When is it allowed? In cases of unwanted unintentional pregnancies, rapes, genetic
abnormalities, or if the foetus is causing fatal injury to the mother .
o Diagram Note: An example of maternal injury is an Ectopic Pregnancy, where the
embryo implants outside the uterus (like in the fallopian tube).
• Safety Timelines: * First Trimester (up to 12 weeks/3 months): Relatively safe. Requires the
opinion of 1 registered medical practitioner .
o Second Trimester (up to 24 weeks): Much riskier. Requires the common opinion of 2
registered medical practitioners .

5. Sexually Transmitted Infections (STIs / STDs)

• Definition: Infections transmitted through sexual intercourse. Also called Venereal

Diseases (VD) or Reproductive Tract Infections (RTI).
• High Incidence Group: People aged 15-24 years.
• Types of Pathogens:
o Bacterial: Gonorrhea, Syphilis, Chlamydiasis.
o Protozoan: Trichomoniasis.
o Viral: Genital herpes, Hepatitis-B, Genital warts, AIDS.
• Incurable STIs: Hepatitis-B, Genital herpes, and HIV/AIDS are NOT completely curable.
• HIV/AIDS Transmission routes: From mother to foetus through the placenta, sharing
contaminated needles, unprotected sex with multiple partners, and blood transfusions .
• Symptoms:
o Early: Itching, fluid discharge, pain, redness, swelling in the genital region. Females
are often asymptomatic .
 o Late (if untreated): Pelvic Inflammatory Disease (PID), abortions, stillbirth (dead child
born), ectopic pregnancies, cancer, and infertility .
• Prevention: Avoid sex with unknown/multiple partners, always use condoms, and consult
a doctor immediately if symptomatic .

6. Infertility and ART

• Definition: The inability to produce children in spite of unprotected sexual co-habitation.

• Reasons: Can be physical, congenital, immunological, psychological, or due to diseases.
o Male factors: Erectile dysfunction, low sperm count, or poor sperm motility.
o Female factors: Harm to ova production, or fimbriae unable to catch the ova.

Assisted Reproductive Technologies (ART): 1. In-Vitro Fertilization (IVF) - "Test Tube Baby
Program" Fertilization happens outside the body (in a lab/glass tube).

• ZIFT (Zygote Intra Fallopian Transfer): If the zygote or early embryo is up to the 8-celled
stage, it is transferred directly into the fallopian tube.
• IUT (Intra Uterine Transfer): If the embryo is more than the 8-celled stage, it is transferred
into the uterus.
• ICSI (Intra Cytoplasmic Sperm Injection): A specialized procedure where a sperm's
nucleus is directly injected into the ovum using a micro-needle.

2. In-Vivo Fertilization: Fertilization happens inside the body.

• GIFT (Gamete Intra Fallopian Transfer): For females who cannot produce an ovum but
can provide a suitable uterine environment. An ovum collected from a donor is transferred
into her fallopian tube for natural fertilization.
• AI (Artificial Insemination) / IUI (Intra-Uterine Insemination): For males with sperm
immobility, erectile dysfunction, or low sperm count. Semen is collected from the husband
or donor and artificially introduced into the vagina or uterus of the female.
• Adoption: Because ART is expensive and requires high precision, legal adoption of
orphaned children is heavily encouraged as one of the best methods for parenthood.

Feature Vasectomy Tubectomy

Target It is a surgical sterilization It is a surgical sterilization method for

Gender method for males. females.

Organ A small part of the vas deferens A small part of the fallopian tube is
Involved is cut and tied up. removed or tied up.

Gamete It prevents the transport of

It prevents the transport of ova (eggs).
Blocked sperms.

The incision is made on the The incision is made in the abdomen or

Incision Site
scrotum or abdomen. through the vagina.
Feature ZIFT (Zygote Intra Fallopian Transfer) GIFT (Gamete Intra Fallopian Transfer)

Full Form & Zygote Intra Fallopian Transfer Gamete Intra Fallopian Transfer involves
Meaning involves transferring a fertilized egg. transferring an unfertilized egg (ovum).

A zygote or early embryo (with up to 8

What is An ovum collected from a donor is transferred
blastomeres) is transferred into the
Transferred into the fallopian tube.
fallopian tube.

Relies on In-Vitro Fertilization (IVF), Relies on In-Vivo Fertilization, meaning

Fertilization
meaning fertilization happens outside fertilization happens naturally inside the female's
Site
the body in a lab. body.

Best for couples where blockages in

Best for females who cannot produce an ovum
Patient the fallopian tubes prevent normal
themselves, but can provide a suitable
Condition gamete fusion, but the female can
environment for fertilization and development.
carry a pregnancy.

Abbreviation Full Form Abbreviation Full Form

Reproductive and Child Health

WHO World Health Organisation RCH
Care

CDRI Central Drug Research Institute MMR Maternal Mortality Rate

IMR Infant Mortality Rate IUD Intra Uterine Devices

Medical Termination of
MTP STD Sexually Transmitted Diseases
Pregnancy

STI Sexually Transmitted Infections VD Venereal Diseases

RTI Reproductive Tract Infections PID Pelvic Inflammatory Diseases

Assisted Reproductive
ART IVF In vitro fertilisation
Technologies

ET Embryo transfer ZIFT Zygote intra fallopian transfer

IUT Intra uterine transfer GIFT Gamete intra fallopian transfer

Intra cytoplasmic sperm

ICSI AI Artificial insemination
injection

IUI Intra-uterine insemination CuT Copper T