REPRODUCTIVE HEALTH - PROBLEMS AND STRATEGIES

Reproductive health simply refers to healthy reproductive organs with normal functions, but it
has a broader perspective including emotional and social aspects of reproduction.
●​ According to WHO, reproductive health means a total well-being in all aspects of
reproduction (physical, emotional, behavioural, and social).
●​ India initiated family planning programmes in 1951. Current improved programmes are
running under the name 'Reproductive and Child Health Care (RCH) programmes'.
●​ Major tasks: Creating awareness about reproduction-related aspects and providing
facilities/support for building a reproductively healthy society.
●​ Introduction of sex education in schools should be encouraged to provide right information
and discourage myths/misconceptions.
●​ Amniocentesis: A fetal sex determination and disorder test based on the chromosomal
pattern in the amniotic fluid surrounding the developing embryo. Statutory ban on
amniocentesis for sex-determination is implemented to check increasing menace of
female foeticides. It is legally used to test for genetic disorders such as Down syndrome,
haemophilia, sickle-cell anemia.
●​ 'Saheli' - A new oral contraceptive for females developed by scientists at Central Drug
Research Institute (CDRI) in Lucknow, India.
POPULATION STABILISATION AND BIRTH CONTROL
World population rocketed from 2 billion in 1900 to about 6 billion by 2000 and 7.2 billion in
2011. Indian population reached close to 1 billion by 2000 and crossed 1.2 billion in May 2011.
●​ Probable reasons for population explosion: Rapid decline in death rate, maternal mortality
rate (MMR), infant mortality rate (IMR), and an increase in number of people in
reproducible age.
●​ Important steps to overcome population growth: Motivate smaller families using
contraceptive methods (slogan: Hum Do Hamare Do), statutory raising of marriageable
age (females to 18 years, males to 21 years), and providing incentives to couples with
small families.
●​ An ideal contraceptive should be: User-friendly, easily available, effective, reversible, with
no or least side-effects, and should not interfere with sexual drive/desire.
CONTRACEPTIVE METHODS
1.​ Natural/Traditional methods - Work on the principle of avoiding chances of ovum and
sperms meeting. Side effects are almost nil, but chances of failure are high.
●​ Periodic abstinence: Couples abstain from coitus from day 10 to 17 of the menstrual cycle
(fertile period) when chances of fertilisation are very high.
●​ Withdrawal or coitus interruptus: Male partner withdraws his penis from the vagina just
before ejaculation to avoid insemination.
●​ Lactational amenorrhea: Absence of menstruation due to intense lactation following
parturition. Effective only up to a maximum period of six months following parturition.
1.​ Barrier methods - Ovum and sperms are prevented from physically meeting with the help
of barriers.
●​ Condoms: Barriers made of thin rubber/latex sheath used to cover the penis or
vagina/cervix just before coitus. 'Nirodh' is a popular brand for males. Additional benefit is
protecting the user from STIs and AIDS. They are disposable and can be self-inserted.
●​ Diaphragms, cervical caps, and vaults: Rubber barriers inserted into the female
reproductive tract to cover the cervix. Reusable, and generally used along with
spermicidal creams, jellies, and foams to increase contraceptive efficiency.
1.​ Intra Uterine Devices (IUDs) - Inserted by doctors or expert nurses in the uterus through
 vagina.
●​ Non-medicated IUDs: e.g., Lippes loop. Increases phagocytosis of sperms.
●​ Copper releasing IUDs: e.g., CuT, Cu7, Multiload 375. Cu ions suppress sperm motility
and fertilising capacity.
●​ Hormone releasing IUDs: e.g., Progestasert, LNG-20. Make the uterus unsuitable for
implantation and the cervix hostile to the sperms.
●​ IUDs are ideal for females who want to delay pregnancy or space children, widely
accepted in India.
1.​ Oral contraceptives (Pills) - Small doses of either progestogens or progestogen-estrogen
combinations taken daily for a period of 21 days (starting within the first five days of
menstrual cycle).
●​ Inhibit ovulation and implantation and alter the quality of cervical mucus to retard sperm
entry.
●​ Saheli: 'Once a week' pill containing a non-steroidal preparation with very few side effects
and high contraceptive value.
1.​ Injectables and Implants - Progestogens alone or in combination with estrogen used as
injections or implants under the skin. Mode of action is similar to pills but effective periods
are much longer.
2.​ Surgical methods (Sterilisation) - Terminal method to prevent any more pregnancies by
blocking gamete transport. Highly effective but reversibility is very poor.
●​ Vasectomy (males): Small part of the vas deferens is removed or tied up through a small
incision on the scrotum.
●​ Tubectomy (females): Small part of the fallopian tube is removed or tied up through a
small incision in the abdomen or vagina.
MEDICAL TERMINATION OF PREGNANCY (MTP)
Intentional or voluntary termination of pregnancy before full term is c/a medical termination of
pregnancy (MTP) or induced abortion.
●​ Government of India legalised MTP in 1971 with strict conditions to avoid misuse (to
check illegal female foeticides).
●​ Considered relatively safe during the first trimester (upto 12 weeks of pregnancy). Second
trimester abortions are much riskier.
●​ Essential in cases where continuation of pregnancy could be harmful/fatal to the mother
or foetus, or to get rid of unwanted pregnancies due to casual unprotected intercourse,
contraceptive failure, or rapes.
SEXUALLY TRANSMITTED INFECTIONS (STIs)
Infections transmitted through sexual intercourse are collectively c/a sexually transmitted
infections (STI), venereal diseases (VD), or reproductive tract infections (RTI).
●​ Common STIs: Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts,
trichomoniasis, hepatitis-B, and HIV leading to AIDS.
●​ Hepatitis-B and HIV can also transmit via sharing injection needles, surgical instruments,
blood transfusion, or from infected mother to foetus.
●​ Hepatitis-B, genital herpes, and HIV infections are not curable; other STIs are completely
curable if detected early.
●​ Early symptoms: Minor itching, fluid discharge, slight pain, swellings in the genital region.
●​ Complications (if left untreated): Pelvic inflammatory diseases (PID), abortions, still births,
ectopic pregnancies, infertility, or cancer of the reproductive tract.
●​ Prevention measures: Avoid sex with unknown/multiple partners, always use condoms
during coitus, and consult a qualified doctor for early detection in case of doubt.
INFERTILITY
Inability to produce children in spite of unprotected sexual co-habitation.
●​ Assisted Reproductive Technologies (ART) - Special techniques to assist infertile couples.
●​ In vitro fertilisation (IVF) - Fertilisation outside the body followed by embryo transfer (ET),
c/a test tube baby programme.
○​ ZIFT (zygote intra fallopian transfer): Zygote or early embryos (upto 8 blastomeres)
transferred into fallopian tube.
○​ IUT (intra uterine transfer): Embryos with more than 8 blastomeres transferred into
the uterus.
●​ GIFT (gamete intra fallopian transfer) - Transfer of an ovum collected from a donor into
the fallopian tube of another female who cannot produce one but can provide suitable
environment.
●​ Intra cytoplasmic sperm injection (ICSI) - Specialised procedure where a sperm is directly
injected into the ovum in the laboratory.
●​ Artificial insemination (AI) technique - Semen from husband or healthy donor is artificially
introduced into the vagina or into the uterus (IUI - intra-uterine insemination).