REPRODUCTIVE HEALTH – NOTES

Class 12 Biology, Chapter 3 (NCERT) – Exam-ready point summary

1. Reproductive Health – Meaning

• Definition (WHO): total well-being (physical, emotional, behavioural, social) in all aspects of
reproduction.
• Reproductively healthy society = normal, functional reproductive organs + normal
emotional/behavioural interactions in sex-related matters.
• India: first country to start national-level action plans/programmes (Family Planning, 1951).
• Current programme: Reproductive and Child Health Care (RCH).

2. Strategies / Reproductive Health Care Programmes (RCH)

(a) Creating Awareness
• Through audio-visual & print media – govt. and NGOs.
• Role of parents, relatives, teachers, friends in spreading information.
• Sex education in schools – gives correct information, removes myths/misconceptions among
youth.
• Topics to be covered: reproductive organs, adolescence & changes, safe/hygienic sexual practices,
STIs, AIDS, contraceptive options, pregnancy care, post-natal care, breast feeding, equal
opportunities for male & female child.
• Awareness against: uncontrolled population growth, sex-abuse, sex-related crimes → builds
socially responsible society.
(b) Providing Facilities & Support
• Need: strong infrastructure, professional expertise, material support.
• Medical assistance for: pregnancy, delivery, STDs, abortions, contraception, menstrual problems,
infertility.
• Statutory ban on amniocentesis for sex determination – to check female foeticide.
• Amniocentesis: amniotic fluid of foetus analysed for fetal cells/chemicals – detects genetic
disorders (Down’s syndrome, haemophilia, sickle-cell anaemia); misused for sex determination →
illegal female foeticide.
• Massive child immunisation programmes.
(c) Research
• Saheli: new oral contraceptive for females, developed by CDRI (Central Drug Research Institute),
Lucknow.
(d) Indicators of Improved Reproductive Health
• Better awareness of sex-related matters.
• Increased medically assisted deliveries & better post-natal care.
• Decreased Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR).
• Increased couples with small families.
• Better detection & cure of STDs.

3. Population Stabilisation and Birth Control

Population Data
• World population: ~2 billion (1900) → ~6 billion (2000) → 7.2 billion (2011).
• India’s population: ~350 million (Independence) → ~1 billion (2000) → crossed 1.2 billion (May
2011).
 • 2011 census growth rate: < 2% i.e. 20/1000/year – still alarming.
Causes of Population Explosion
• Rapid decline in death rate, MMR and IMR.
• Increase in number of people in reproductive age.
Government Measures
• Slogan: “Hum Do Hamare Do” (we two, our two); some couples adopt ‘one child norm’.
• Statutory marriageable age: female – 18 years, male – 21 years.
• Incentives to couples with small families.
• Promotion of contraceptive methods via RCH programme.
Ideal Contraceptive – Characteristics
• User-friendly, easily available, effective, reversible.
• No / least side effects.
• Should not interfere with sexual drive, desire or act.
Categories of Contraceptive Methods
• Natural/Traditional, Barrier, IUDs, Oral contraceptives (pills), Injectables, Implants, Surgical
methods.

4. Contraceptive Methods – Details

(i) Natural / Traditional Methods
• Principle: avoid meeting of ovum and sperm.
• Periodic abstinence: avoid coitus from day 10–17 of menstrual cycle (fertile period – high chance
of fertilisation).
• Withdrawal (coitus interruptus): male withdraws penis before ejaculation to avoid insemination.
• Lactational amenorrhea: ovulation/cycle absent during intense lactation; effective up to ~6 months
after parturition.
• No medicines/devices → almost no side effects, but high failure rate.
(ii) Barrier Methods
• Principle: physically prevent ovum-sperm meeting; available for males & females.
• Condoms: thin rubber/latex sheath; cover penis (male) or vagina/cervix (female); ‘Nirodh’ – popular
male condom brand; also protect against STIs/AIDS; disposable, self-inserted, give privacy.
• Diaphragms, cervical caps, vaults: rubber barriers inserted into female reproductive tract to cover
cervix; reusable.
• Spermicidal creams/jellies/foams used with barriers to increase efficacy.
(iii) Intra Uterine Devices (IUDs)
• Inserted by doctor/nurse into uterus through vagina.
• Types: Non-medicated (Lippes loop); Copper-releasing (CuT, Cu7, Multiload 375); Hormone-
releasing (Progestasert, LNG-20).
• Mechanism: increase phagocytosis of sperm in uterus; Cu ions suppress sperm motility & fertilising
capacity; hormone-releasing IUDs make uterus unsuitable for implantation & cervix hostile to
sperm.
• Best suited to delay pregnancy / space children.
• Most widely accepted contraceptive method in India.
(iv) Oral Contraceptives (Pills)
• Small doses of progestogens or progestogen-estrogen combinations, taken daily.
 • Schedule: 21 days starting within first 5 days of menstrual cycle → 7-day gap (menstruation) →
repeat.
• Action: inhibit ovulation & implantation; alter cervical mucus to block sperm entry.
• Very effective, fewer side effects, well accepted.
• Saheli: non-steroidal, ‘once a week’ pill, very few side effects, high contraceptive value.
(v) Injectables and Implants
• Progestogen alone or with estrogen, given as injection or implant under skin.
• Mode of action similar to pills; effective for much longer periods.
(vi) Emergency Contraceptives
• Progestogen / progestogen-estrogen pills or IUDs used within 72 hours of coitus.
• Useful after rape or casual unprotected intercourse to avoid pregnancy.
(vii) Surgical Methods (Sterilisation)
• Vasectomy (male): small part of vas deferens removed/tied via small incision in scrotum.
• Tubectomy (female): small part of fallopian tube removed/tied via small incision in abdomen or
vagina.
• Blocks gamete transport → prevents conception.
• Highly effective, but reversibility very poor.
Points to Remember
• Contraceptives are NOT a regular requirement – used to prevent/delay/space pregnancy.
• Possible side effects: nausea, abdominal pain, breakthrough/irregular bleeding, (rarely) breast
cancer.
• Selection & use must be under guidance of qualified medical professional.

5. Medical Termination of Pregnancy (MTP)

• Definition: intentional/voluntary termination of pregnancy before full term = induced abortion.
• ~45–50 million MTPs performed/year worldwide = 1/5th of total conceived pregnancies.
• Debated due to emotional, ethical, religious, social issues.
• Legalised in India in 1971, with strict conditions to prevent misuse.
Reasons for MTP
• Unwanted pregnancy: casual unprotected intercourse, contraceptive failure, or rape.
• When continuation of pregnancy is harmful/fatal to mother and/or foetus.
Safety
• Relatively safe in 1st trimester (up to 12 weeks); 2nd trimester abortions much riskier.
• Problem: majority of MTPs done illegally by unqualified quacks – unsafe, can be fatal.
• Misuse: amniocentesis used to determine sex → female foetus aborted (illegal female foeticide).
MTP (Amendment) Act, 2017
• Aim: reduce illegal abortions and resulting maternal mortality/morbidity.
• Up to 12 weeks: opinion of 1 registered medical practitioner needed.
• 12–24 weeks: opinion of 2 registered medical practitioners (in good faith) needed.
• Grounds for termination: (i) risk to life or grave physical/mental injury to the woman; (ii)
substantial risk of serious physical/mental abnormality in the child.

6. Sexually Transmitted Infections (STIs)

• Also called Venereal Diseases (VD) or Reproductive Tract Infections (RTI).
 • Examples: gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis,
hepatitis-B, HIV (leads to AIDS – most dangerous).
• Other modes of spread (hepatitis-B, HIV): shared needles/surgical instruments, blood transfusion,
infected mother to foetus.
• Curability: all STIs curable if detected early & treated, EXCEPT hepatitis-B, genital herpes and
HIV.
• Early symptoms: itching, fluid discharge, slight pain, swelling in genital region.
• Females often asymptomatic → remain undetected.
• Social stigma → delays treatment → complications: PID (pelvic inflammatory disease), abortion, still
birth, ectopic pregnancy, infertility, cancer of reproductive tract.
• Highest incidence in 15–24 years age group.
Prevention of STIs
• Avoid sex with unknown/multiple partners.
• Always use condoms during coitus.
• Consult a qualified doctor early for detection & complete treatment if infected.

7. Infertility
• Definition: inability of a couple to produce children despite unprotected cohabitation.
• Causes: physical, congenital, diseases, drugs, immunological or psychological factors.
• In India, female often wrongly blamed – problem more often lies with male partner.
• Infertility clinics: help in diagnosis & corrective treatment.
• ART = Assisted Reproductive Technologies – used when correction is not possible.
ART Techniques
• IVF (In Vitro Fertilisation) – ‘Test Tube Baby’: fertilisation outside the body under lab conditions;
ova (wife/donor) + sperm (husband/donor) → zygote.
• ZIFT: zygote / early embryo (≤ 8 blastomeres) transferred into fallopian tube.
• IUT: embryo with > 8 blastomeres transferred into uterus.
• Embryos formed by in-vivo fertilisation can also be transferred to assist females who cannot
conceive.
• GIFT (Gamete Intra Fallopian Transfer): donor ovum transferred into fallopian tube of recipient
female who cannot produce her own ovum.
• ICSI (Intra Cytoplasmic Sperm Injection): sperm directly injected into ovum in the laboratory.
• AI (Artificial Insemination): semen from husband/donor introduced into vagina or uterus (IUI –
Intra Uterine Insemination); used for low sperm count or male’s inability to inseminate.
Limitations & Alternative
• ART needs high precision, specialised professionals, expensive equipment – available in few
centres, costly.
• Emotional, religious & social factors also limit adoption of ART.
• Legal adoption – best alternative; helps orphaned/destitute children too.

Quick Recap – Key Terms

• MMR / IMR: Maternal / Infant Mortality Rate.
• RCH: Reproductive and Child Health Care programme.
• MTP: Medical Termination of Pregnancy (legalised 1971; Amendment Act 2017).
• STI/STD: Sexually Transmitted Infection/Disease; also VD, RTI.
• ART: Assisted Reproductive Technology – IVF, ZIFT, IUT, GIFT, ICSI, AI/IUI.
• Sterilisation: Vasectomy (male), Tubectomy (female) – permanent, poor reversibility.
• Saheli: non-steroidal, once-a-week oral pill (CDRI, Lucknow).