BIOLOGY · CHAPTER 3
Reproductive Health
Complete study notes covering reproductive health strategies, population control, birth control methods, medical
termination of pregnancy, sexually transmitted infections, and infertility and assisted reproductive technologies.
3.1 Problems & Strategies 3.2 Population & Birth Control 3.3 MTP 3.4 STIs 3.5 Infertility & ART
i Overview
• Reproductive health (WHO definition) — total well-being in all aspects of reproduction: physical, emotional, behavioural and
social
• A reproductively healthy society = people with normal reproductive organs AND normal emotional/behavioural interactions in all
sex-related aspects
• India was among the first countries in the world to initiate national-level action plans for reproductive health (1951 — called
"family planning")
• Currently operating as Reproductive and Child Health Care (RCH) programmes
3.1 Reproductive Health — Problems and Strategies
AWARENESS AND EDUCATION
• Audio-visual and print media, government and NGO agencies create awareness about reproduction
• Sex education in schools — provides correct information; discourages myths and misconceptions
• Topics to cover: reproductive organs, adolescent changes, safe/hygienic sexual practices, STDs, AIDS, birth control, breast-
feeding, post-natal care
• Educating fertile couples and those of marriageable age about family planning options
KEY GOVERNMENT PROGRAMMES AND MEASURES
Amniocentesis ban Statutory ban on using amniocentesis for sex determination — to legally check female foeticide.
(Amniocentesis: amniotic fluid sampled to analyse foetal cells; legitimate use is for genetic disorders
like Down syndrome, haemophilia, sickle-cell anaemia)
Child immunisation Massive immunisation programmes to reduce infant mortality
RCH programmes Medical assistance for pregnancy, delivery, STDs, abortions, contraception, menstrual problems,
infertility
Saheli New oral contraceptive developed at CDRI, Lucknow; non-steroidal; once-a-week pill; very few side
effects; high contraceptive value
Marriageable age Statutory raising of marriageable age — female to 18 years, male to 21 years
INDICATORS OF IMPROVED REPRODUCTIVE HEALTH
Reduced maternal and infant mortality rates · Increased medically assisted deliveries · Increased couples with small families
· Better detection and cure of STDs · Greater access to medical facilities for sex-related problems
3.2 Population Stabilisation and Birth Control
POPULATION EXPLOSION — KEY FACTS
World population ~2 billion in 1900 → ~6 billion by 2000 → 7.2 billion in 2011
India at independence ~350 million → close to 1 billion by 2000 → crossed 1.2 billion in May 2011
Growth rate (2011) Less than 2% = 20/1000/year — still alarmingly high
Causes Rapid decline in death rate, MMR (maternal mortality rate) and IMR (infant mortality rate);
increased people in reproductive age
IDEAL CONTRACEPTIVE PROPERTIES
User-friendly · Easily available · Effective · Reversible · No or minimal side effects · Must NOT interfere with sexual drive,
desire, or the sexual act
CONTRACEPTIVE METHODS
① Natural / Traditional Methods ② Barrier Methods
• Periodic abstinence — avoid coitus days 10–17 of menstrual • Physically prevent ovum and sperm meeting
cycle (fertile period); prevents chances of fertilisation • Condoms — thin rubber/latex sheath; male ('Nirodh') and
• Withdrawal (Coitus interruptus) — male withdraws before female types; disposable, self-inserted; also protects against
ejaculation STIs and AIDS
• Lactational amenorrhea — no ovulation during intense • Diaphragms, cervical caps, vaults — rubber barriers
lactation after parturition; effective up to 6 months post- inserted to cover cervix; reusable; used with spermicidal
partum only creams/jellies/foams
• No medicines/devices → side effects nil; but failure rate high
③ Intra Uterine Devices (IUDs) ④ Oral Contraceptives (Pills)
• Inserted by doctors/nurses into uterus through vagina • Progestogens alone or progestogen–estrogen combinations;
• Non-medicated IUDs — e.g. Lippes loop taken as tablets
• Copper releasing IUDs — CuT, Cu7, Multiload 375; Cu ions • Taken daily for 21 days starting within first 5 days of
suppress sperm motility and fertilising capacity menstrual cycle; 7-day gap (menstruation) → repeat
• Hormone releasing IUDs — Progestasert, LNG-20; make • Mechanism: inhibit ovulation and implantation; alter cervical
uterus unsuitable for implantation; cervix hostile to sperms mucus to block sperm entry
• All IUDs increase phagocytosis of sperms in uterus • Saheli — non-steroidal, once-a-week pill; very few side effects;
developed at CDRI, Lucknow
• Most widely accepted method in India; ideal for spacing
pregnancies
⑤ Injectables and Implants ⑥ Surgical Methods (Sterilisation)
• Progestogens alone or with estrogen given as injections or • Terminal method; blocks gamete transport → prevents
implants under the skin conception
• Mode of action same as pills; effective period much longer • Vasectomy (male) — small part of vas deferens removed/tied
• Emergency contraceptives — progestogen/progestogen- via small scrotal incision
estrogen combinations or IUDs used within 72 hours of coitus; • Tubectomy (female) — small part of fallopian tube
used after rape or unprotected intercourse removed/tied via small abdominal or vaginal incision
• Highly effective but reversibility very poor
POSSIBLE SIDE EFFECTS OF CONTRACEPTIVES
Nausea · Abdominal pain · Breakthrough bleeding · Irregular menstrual bleeding · Risk of breast cancer (rare). Should
always be used under guidance of qualified medical professionals.
3.3 Medical Termination of Pregnancy (MTP)
• MTP (Medical Termination of Pregnancy) — intentional or voluntary termination of pregnancy before full term; also called
induced abortion
• ~45–50 million MTPs performed per year globally = 1/5th of all conceived pregnancies
• Government of India legalised MTP in 1971 with strict conditions; amended in 2017
WHY MTP?
• To end unwanted pregnancies from unprotected intercourse, contraceptive failure, or rape
• When continuation of pregnancy is harmful or fatal to mother or foetus or both
MTP ACT 2017 — LEGAL GROUNDS RISKS AND MISUSE
• Risk to life or grave physical/mental health injury to the • Safe in first trimester (up to 12 weeks); much riskier in
pregnant woman second trimester
• Substantial risk that the child would be born with serious • Majority of MTPs performed illegally by unqualified
physical or mental abnormalities quacks — unsafe and potentially fatal
• Up to 12 weeks — opinion of 1 registered medical • Misuse of amniocentesis for sex determination → illegal
practitioner female foeticide
• 12–24 weeks — opinion of 2 registered medical • Amniocentesis for sex determination is banned in India
practitioners
3.4 Sexually Transmitted Infections (STIs)
• Also called Venereal Diseases (VD) or Reproductive Tract Infections (RTI)
• Transmitted through sexual intercourse; some also via blood transfusion, shared needles, or mother to foetus
• Incidence highest in age group 15–24 years
• Infected females often asymptomatic — can remain undetected for long
COMMON STIS
Disease / Pathogen Curability Additional Notes
Gonorrhoea Curable if detected early Bacterial infection
Syphilis Curable if detected early Bacterial infection
Chlamydiasis Curable if detected early Bacterial infection
Trichomoniasis Curable if detected early Protozoal infection
Genital warts Curable if detected early Viral (HPV)
Genital herpes Not completely curable Viral (HSV); also spread by non-sexual routes
Hepatitis-B Not completely curable Also spread via needles, blood, mother to foetus
HIV / AIDS Not curable Most dangerous; also spread via needles, blood, mother to foetus; discussed in Ch. 7
EARLY SYMPTOMS
• Itching, fluid discharge, slight pain, swellings in genital region
• Often minor and easily dismissed — especially in females (frequently asymptomatic)
COMPLICATIONS IF UNTREATED
• Pelvic Inflammatory Diseases (PID)
• Abortions, still births, ectopic pregnancies
• Infertility
• Cancer of the reproductive tract
PREVENTION OF STIS
(i) Avoid sex with unknown or multiple partners
(ii) Always use condoms during coitus
(iii) If in doubt, consult a qualified doctor immediately for early detection and complete treatment
3.5 Infertility and Assisted Reproductive Technologies
• Infertility — inability to produce children despite unprotected sexual cohabitation (for ~2 years)
• Causes: physical, congenital, diseases, drugs, immunological, or psychological
• In India, females are often incorrectly blamed — the problem more frequently lies with the male partner
• Infertility clinics help diagnose and treat some disorders; where correction is not possible → Assisted Reproductive
Technologies (ART)
ASSISTED REPRODUCTIVE TECHNOLOGIES (ART)
IVF + ET ZIFT IUT
In Vitro Fertilisation + Embryo Transfer Zygote Intra Fallopian Transfer Intra Uterine Transfer
"Test tube baby" programme. Ova Zygote or early embryo (up to 8 Embryos with more than 8 blastomeres
(wife/donor) + sperms (husband/donor) blastomeres) transferred into the transferred into the uterus to complete
induced to form zygote in lab. Embryo fallopian tube. development.
then transferred into female genital tract.
GIFT ICSI AI / IUI
Gamete Intra Fallopian Transfer Intra Cytoplasmic Sperm Injection Artificial Insemination
Ovum from donor transferred into the Sperm directly injected into the ovum Semen (husband or donor) artificially
fallopian tube of a female who cannot in the laboratory to form an embryo. Used introduced into vagina or uterus (IUI —
produce ova but can provide the in severe male infertility cases. intra-uterine insemination). Used when
environment for fertilisation and male cannot inseminate or has very low
development. sperm count.
LIMITATIONS OF ART
All ART techniques require high-precision handling by specialised professionals and expensive instrumentation. Presently
available only in very few centres in India. Benefits are affordable to only a limited number of people. Emotional, religious
and social factors are also deterrents.
LEGAL ADOPTION — A VALID ALTERNATIVE
India has many orphaned and destitute children. Indian laws permit legal adoption, which remains one of the best methods
for couples seeking parenthood.
★ Quick Revision — High-Yield Points
Define reproductive health as per WHO.
Total well-being in all aspects of reproduction — physical, emotional, behavioural and social. Not just the absence of disease
or infirmity in the reproductive system.
When did India launch its first national reproductive health programme?
1951, called 'family planning'. Currently operating as Reproductive and Child Health Care (RCH) programmes.
What is lactational amenorrhea and what is its limitation?
Absence of menstruation (and therefore ovulation) during intense lactation following delivery. It is an effective natural
contraceptive method only up to a maximum of 6 months after parturition.
How do copper-releasing IUDs work?
Cu ions released from devices like CuT, Cu7, and Multiload 375 suppress sperm motility and fertilising capacity. All IUDs
also increase phagocytosis of sperms within the uterus.
What is Saheli? Why is it significant?
A non-steroidal oral contraceptive pill for females, developed at CDRI, Lucknow. It is a once-a-week pill with very few side
effects and high contraceptive value.
What is the difference between vasectomy and tubectomy?
Vasectomy (male): small part of vas deferens removed/tied through a scrotal incision. Tubectomy (female): small part of
fallopian tube removed/tied through abdominal or vaginal incision. Both are highly effective but have very poor reversibility.
When was MTP legalised in India? What is the safe window?
Legalised in 1971; amended in 2017. Safe during the first trimester (up to 12 weeks). Second-trimester abortions are
significantly riskier. Up to 12 weeks requires 1 doctor's opinion; 12–24 weeks requires 2 doctors' opinions.
Which STIs are not completely curable?
Hepatitis-B, genital herpes, and HIV infections are not completely curable. All other common STIs are curable if detected
early and treated properly.
What is ZIFT vs IUT?
ZIFT (Zygote Intra Fallopian Transfer): zygote or embryo with up to 8 blastomeres transferred into the fallopian tube. IUT
(Intra Uterine Transfer): embryo with more than 8 blastomeres transferred into the uterus.
What is ICSI and when is it used?
Intra Cytoplasmic Sperm Injection — a sperm is directly injected into the ovum in the laboratory to form an embryo. Used in
cases of severe male infertility.
What are emergency contraceptives and when should they be used?
Progestogen or progestogen-estrogen combinations, or IUDs administered within 72 hours of coitus. Used to avoid possible
pregnancy after rape or casual unprotected intercourse.
What complications can untreated STIs cause?
Pelvic Inflammatory Diseases (PID), abortions, still births, ectopic pregnancies, infertility, and cancer of the reproductive
tract.