REPRODUCTIVE HEALTH

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.

Reproductive Health – Problems And Strategies

➢ India was amongst the first countries to initiate action plans and programmes at a national level to
attain total reproductive health as a social goal. These programmes are called ‘family planning
programmes’, they were initiated in 1951
➢ Improved programmes are currently in operation under ‘Reproductive and Child Health Care (RCH)
programmes’.
Aims of RCH are
o Creating awareness among people on reproduction
o Providing facilities and support for building up a reproductively healthy society
o Audio-visual and the print-media to bring awareness
o Governmental and non-governmental agencies to create awareness
o Parents, close relatives, teachers and friends to have major role in dissemination of
Information
o Introduction of sex education in schools
o Discourage children from believing in myths and misconceptions about sex-related aspects
o Proper information about reproductive organs, adolescence and related changes
o Safe and hygienic sexual practices
o Information on sexually transmitted diseases (STD), AIDS,etc.,
o Educating people, especially fertile couples and those in marriageable age group
o Educating fertile people about available birth control options
o Care of pregnant mothers, postnatal care of the mother and child
o Importance of breast feeding
o Equal opportunities for the male and the female child, etc.,
o Awareness of problems due to uncontrolled population growth
o Social evils like sex-abuse and sex-related crimes, etc.,
o Implementation of better techniques and new strategies from time to time
o Statutory ban on misuse of amniocentesis (a foetal sex determination test based on the
▪ chromosomal pattern in the amniotic fluid surrounding the developing embryo) for
sex-determination to legally check increasing female foeticides
o Massive child immunisation, etc., are some programmes

‘Saheli’–a new oral contraceptive for the females–was developed by Central Drug Research Institute
(CDRI) in Lucknow

Population Explosion And Birth Control:

➢ Increased health facilities, better living conditions are the cause of population explosion.
➢ Out of 6 billion world population 1 billion are Indians.
➢ Rapid decline in death rate, maternal mortalility rate (MMR) and infant mortality rate (IMR)
are major cause of population growth.
➢ Indian population growth rate is around 1.7 percent (2001 census report), i.e., 17/1000/year,
at this rate our population will double in 33 years. This will lead to an absolute scarcity of even
the basic requirements, i.e., food, shelter and clothing
Measures to control population explosion
➢ Most important step was to motivate smaller families by using various contraceptive methods
➢ Happy couple with two children with a slogan Hum Do Hamare Do (we two, our two)
➢ Many couples, mostly the young and urban have even adopted an ‘one child norm’
➢ Statutory raising of marriageable age of the female to 18 years and that of males to 21 years
➢ Incentives given to couples with small families
➢ Promotion to use effective contraceptives

Contraceptives
➢ Are used to prevent unwanted pregnancies.
➢ Wide range of contraceptive methods are available
➢ Common categories are
o Natural/Traditional
o Barrier methods
o IUDs
o Oral contraceptives
o Injectables
o Implants and Surgical methods.
Characteristics of ideal contraceptive.
➢ User friendly.
➢ Easily available.
➢ Effective
➢ Nor or least side – effects.
➢ No way interferes with sexual drive.

Birth Control Methods:

Natural methods:
Work on the principle of avoiding chances of ovum and sperms meeting.
Periodic abstinence:
• Avoid or abstain from coitus form day 10 to 17 of the menstrual cycle when ovulation could be
expected.
• Chance of fertilization is very high in this period.
• It is called fertile period.
Withdrawal or coitus interruption:
• The male partner withdraws his penis from the vagina just before ejaculation, so as to avoid
insemination into the vagina.
Lactational amenorrhea:
• No menstruation during lactation period.
• Chance of fertilization is nil.
• It is effective upto six month.
Barrier methods:
• Principle of working: prevents physical meeting of sperm and ovum.
• Such methods available both for male and female.
Condoms:
• Barriers made of thin rubber/latex sheath.
• Used to cover the penis in male or vagina and cervix in the female.
• Used just before coitus so that semen not entered into the female reproductive tract.
 • Male and female condoms are disposable.
• Prevents AIDS and STDs.
Diaphragm, cervical caps and vaults:
• Barriers made of rubber.
• Inserted into the female reproductive tract to cover the cervix.
• Prevents conception by blocking the entry of sperm through cervix.
• They are reusable.
Intra Uterine Devices:
• These devices are only used by female.
• Inserted by doctor or by expert nurses in the uterus through vagina.
• Non-medicated IUDs e.g. Lippes loop.
• Copper releasing IUDs (CuT, Cu7, Multiload 375)
• Hormone releasing IUDs (Progestasert, LNG-20)
Principle of working:
• Increase phagocytosis of sperm within the uterus.
• Cu ion released suppresses sperm motility and fertilizing capacity of sperm.
• Hormone releasing IUDs make the uterus unsuitable for implantation and the cervix hostile to
the sperm.
Oral contraceptives:
• This methods used by female only.
• Used in the form of tablets hence popularly called pills.
• Pills contain progestogens or progestogen-estrogen combination.
• Pills have to be taken daily for a period of 21 days.
• Started within first five days of menstruation.
• Pills are very effective with lesser side effect.
• Saheli- a non steroidal preparation used as oral contraceptive pills.
Principle of working:
• Inhibit ovulation.
• Inhibit implantation.
• Alter the quality of cervical mucus to prevent/retard entry of sperms.

Injections or implants:
• Progestogens alone or in combination with estrogen used as injections or implants under the skin
by female.
• Mode of action is similar as in pills
• It is very effective for long periods.

Emergency contraceptives:
• These methods are used within 72 hours of coitus, rape or casual unprotected intercourse.
• Administration of progestogens or progestogen-estrogen combination.
• Use of IUDs.

Surgical methods:
• It is also called as sterilization method.
• Advised to both male and female partner.
• Permanent or terminal method to prevent pregnancy.
• Sterilization process in male is called ‘vasectomy,
• Sterilization process in female is called ‘Tubectomy’
• In vasectomy, a small part of the vas deferens is removed or tied up.
 • In Tubectomy a small part of the fallopian tube is removed.
• Reversibility is very poor.

Medical Termination Of Pregnancy:

• Intentional or voluntary termination of pregnancy before full term is called medical termination of
pregnancy (MTP) or induced abortion.
• MTP has significant role in decreasing population.
• It accounts for 1/5th of the total number of conceived pregnancies.
• Legal restriction only to reduce female foeticide.
• This method is safe within 1st trimester.

Sexually Transmitted Diseases:

• Diseases or infections which are transmitted through sexual intercourse.
• Also known as Venereal diseases (VD) or reproductive tract infections (RTIs)
• Gonorrhea, Syphilis, Genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B and
HIV are some common STDs.
• Except hepatitis-B, genital herpes and HIV infections, others are curable.
Symptoms:
• Itching, fluid discharge, slight pain, swelling in the genital region.
• STDs remain asymptomatic in female and remain undetected for long.
• In the later stage it may leads to Pelvic inflammatory diseases (PID), abortion, still births, ectopic
pregnancy, infertility or even cancer in RT.
Preventions:
• Avoid sex with unknown partners/ multiple partners.
• Always use condoms during coitus.
• In case of doubt, consult with a qualified doctor for early detection.
• Get complete treatment if diagnosed with disease.
Method of transmission:

➢ Sexual contact with infected persons.

➢ Transfusion of contaminated blood and blood products.
➢ Sharing infected needles as in intravenous drug user.
➢ From infected mother to the foetus through placenta.

Diagnosis: ELISA (enzyme linked Immuno-sorbent assay)

Infertility:
• The couple unable to produce children inspite of unprotected sex.
• The reason of infertility may be:-
• physical,
• congenital,
• diseases,
• drugs,
• immunological or
• Even psychological.
• Problems of infertility may be in male or female.
• Infertility clinic can diagnose and correct the cause of infertility.
• In case there no corrections are possible, some special technologies used to have children called
assisted reproductive technologies. (ART)
Assisted reproductive technologies:
(a) In vitro fertilization:
• Fertilization outside the body in the laboratory.
• Condition created in laboratory similar to the body.
(b) Embryo transfer:
• Popularly known as test tube baby programme.
• Ova from the wife/donor and sperm from the husband/donor are collected and induced to form
zygote under simulated conditions in the laboratory.
• The zygote or early embryos (with upto 8 blastomeres) could be transferred into the fallopian
tube.
• ZIFT- Zygote intra fallopian transfer.
• IUT- Intra Uterine transfer (embryo with more than 8 blastomeres).
• Further development taken place within the female body.
• Embryo formed by in-vivo fertilization can also be transfer to assist those female who cannot
conceive.
(c) Gamete intra fallopian transfer- GIFT
• Transfer of ovum collected from the donor into the fallopian tube of another female who cannot
produce it.
• Such female can provide suitable environment for fertilization and development.
(d) Intra cytoplasmic sperm injection (ICSI):
• The sperm is directly injected into the ovum.
• After in vitro fertilization either ZIFT or embryo transfer technique is followed.
(e) Artificial insemination (AI)
• Semen is collected either from the husband or donor is artificially introduced into vagina or into
the uterus (IUI-intra uterine insemination) of the female.
• Such technology is useful in cases either the male partner unable to inseminate the female or very
low sperm counts in the ejaculates.

Abbreviation:

IUCD: Intra Uterine Contraceptive Device RCH: Reproductive and Child Health care

STD: Sexually Transmitted Disease HIV: human Immuno deficiency virus.

AIDS: Acquired immuno deficiency syndrome CDRI: Central Drug Research Institute

MMR: Maternal Mortality Rate IMR: Infant mortality rate.

MTP: Medical Termination of Pregnancy VD: Venereal Disease

RTI: Reproductive Tract Infection PID: Pelvic Inflammatory Disease

ART: Assisted Reproductive Technologies IVF: In Vitro Fertilisation

ZIFT: Zygote Intra Fallopian Transfer AI: Artificial insemination

IUI: Interna uterine insemination. ET: Embryo transfer.

IUT: intra uterine transfer. ICSI: Intra Cytoplasmic Sperm Injection.