Chapter 4 REPRODUCTIVE HEALTH

Reproductive Health: Problem and Strategies

 India was amongst the first countries in the world to initiate the programme “Family
Planning” in 1951.
 Reproductive health in a society forms a crucial part of general health.
 Improved programs covering wider reproduction-related areas are currently in
operation under the popular name ‘Reproductive and Child Healthcare (RCH)
program.’
 Health and education of young people and marriage and child bearing during more
mature stages of life are important attributes to the reproductive health of a society.
Measures taken by Goverenment :
 Through the help of audio-visuals & print media.
 Even family members, close relations are involved in the awareness.
 Sex education was introduced in schools to provide awareness
 Proper information about reproductive organs, adolescence & related changes , safe
& hygienic sexual practices, sexually transmitted diseases, AIDS etc.
Amniocentesis – It is a technique used to find out chromosomal abnormalities in developing
embryo by using amniotic fluid.
 It is also misused for foetal sex determination based on the chromosomal pattern in
the amniotic fluid surrounding the developing embryo.
Population Explosion and Birth Control
Improved quality of life of people, increased health facilities and better living condition had
an explosive impact on explosion of population.

 Rapid decline in death rate, MMR (Maternal Mortality Rate) and IMR (Infant
Mortality Rate) along with increase in population of reproductive age is the main
reason for population explosion.
 Steps to overcome population explosion-
1. Using various contraceptive methods.
2. Educating people about the demerits of large family.
3. Increasing the marriageable age of female to 18 years and male to 21 years.
4. Providing incentive to parents having 1or 2 children.
 Contraceptive methods are used to prevent the unwanted pregnancy and modifying
the menstrual cycle.
 An ideal contraceptive should be-
1. User friendly
2. Easily available
 3. Effective
4. Reversible
5. Having no side effect
6. Non interfering with sexual desire and sexual act.
Contraceptive methods could be divided into following categories-

a) Natural or traditional methods

b) Barrier methods
c) IUDs
d) Oral contraceptive methods
e) Injectables
f) Implants
g) Surgical methods.

 Natural methods works on the principle of avoiding chances of ovum and sperm
meeting. It includes-
a) Periodic abstinence– the couples avoid coitus from day 10 to 17 of menstrual
cycle as chances of fertilisation are very high during this period, it is called the fertile
period.
b) Withdrawal or coitus interruptus – male partner withdraws penis from vagina
just before ejaculation to avoid insemination .
c) Lactational Amenorrhea – absence of menstruation after parturition and due to
intense milk feeding and no ovulation in this period , chances of fertilisation is nil.
 In Barrier methods, ovum and sperms are prevented from physical meeting with
help of barrier. This includes-
a) Condoms– used by male, barrier made of rubber or latex sheet used to cover penis
or vagina and cervix of female. It also prevents from STDs.

Condom for male

condom for female

b) Diaphragms, cervical cap and vaults are barrier made of rubber that is inserted into
the female reproductive tract during coitus.
 Spermicidal creams, jellies and foams are usually used along with these barriers to
increase their contraceptive efficiency.
  Advantages of barrier methods:
1. They are disposable.
2. They can be self –inserted.
3. They are reusable.
4. Prevents conception by blocking entry of sperm through cervix.
 Intra uterine Devices– inserted by doctor or trained nurse into the female uterus
through vagina. IUCDs may be non-medicated IUDs (e.g., Lippes loop), copper
releasing IUDs (CuT, Cu7, Multiload 375) and the hormone releasing IUDs
(Progestasert, LNG-20)
 IUCDs increase the phagocytosis of sperm in uterus and copper reduce the motility
and fertility capacity of sperms .The hormone releasing IUDs make the uterus
unsuitable for implantation and the cervix hostile to the sperms. It is ideal for female
who wants to delay pregnancy and spacing between two children.
 Oral Pills are progesterone or progesterone-estrogen combination used by females in
form of tablets. They inhibit ovulation and implantation as well as change the quality
of cervical mucus to prevent/ retard entry of [Link] of progesterone or
progesterone-estrogen combination within 72 hours of coitus is found to be very
effective as emergency contraceptive.
 Surgical method – This method is also called sterilisation.
 It is used as terminal method of contraception in male and female to prevent any more
pregnancy.

Vasectomy Tubectomy

 Vasectomy is the surgical method in male; a small part of the vas deferens is removed
or tied up through a small incision on the scrotum to prevent release of sperms.
 Tubectomy is the surgical method in females in which small part of fallopian tube is
removed surgically.
 These techniques are highly effective but their reversibility is very poor.
Side effects of contraceptive method:
• It is very important that the selection of contraceptive method should be taken under the
consultation of the doctors.
• They have ill-effects like nausea, abdominal pain, breakthrough bleeding, irregular
menstrual bleeding or even breast cancer.
Medical Termination of Pregnancy
Voluntary termination of pregnancy before full term is called MTP (medical termination of
pregnancy) or induced abortion. It plays important role in decreasing population by aborting
unwanted pregnancy.

 In India, MTP is legalized in 1971 with some restriction to prevent its misuse such as
indiscriminate and illegal female foeticides.
MTP is used to:
 Get rides of unwanted pregnancy due to unprotected intercourse or failure of
contraceptives used during coitus or rapes.
 When pregnancy continuation could be harmful or even fetal to mother or foetus.
MTPs are considered relatively safe during first trimester or up to 12 weeks of pregnancy.
Second trimester MTPs are much more riskier.
Sexually Transmitted Disease (STDs)
Diseases or infections which are transmitted through sexual intercourse are collectively called
sexually transmitted disease or venereal disease (VD) or reproductive tract infection (RTI).

 Some common STDs are Gonorrhea, syphilis, genital herpes, chlamydiasis, genital
warts, trichomoniasis, hepatitis-Ba and AIDS.
 Hepatitis-B and HIV is also transmitted by sharing of injection needles, surgical
instruments with infected person, transfusion of blood, or from infected mother to
foetus.
 Except genital herpes, HIV and hepatitis-B are completely curable if detected earlier
and treated properly.
 Timely detection and proper treatment of STDs are very important otherwise it could
lead to complications later, which include pelvic inflammatory diseases (PID),
abortions, still births, ectopic pregnancies, infertility or even cancer of the
reproductive tract.
 Infections of STDs can be prevented by-
a) Avoid sex with unknown partners/multiple partners.

b) Always use condoms during coitus.

c) Go to a qualified doctor in case of doubt for early detection and get complete treatment if
diagnosed.
List of common STDs with symptoms and treatment

Disease How you get Symptoms Treatment Partners

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Diseases that are transmitted sexually

Chlamydia By having Women often Antibiotics. Recent sexual

Bacterial vaginal or have no partners need
infection of anal sex symptoms or treatment.
genitals can without a may have Don't have sex
lead to condom with pain with until 7 days
inflammatory someone who sexual after starting
disease (PID) in has the intercourse, treatment and
women and infection; lower until sexual
infertility in men from mother- abdominal contacts have
and women. to-baby (eye pain, changes been treated.
and chest in bleeding
infection) pattern. Men
may have no
symptoms or
may have
watery or
thick
discharge
from penis,
pain or
urinating.

Gonorrhoea By having Women Antibiotics. Sexual

Bacterial vaginal, anal usually have partners must
infection of or oral sex no symptoms, be tested and
genitals, throat without a but may have treated if
or anus, can condom with pain with sex, positive. Avoid
lead to infertility someone who vaginal sex until 7
particularly in has the discharge, days after
women. infection; lower treatment is
from mother- abdominal completed.
to-baby (eye pain. Men Condoms
Disease How you get Symptoms Treatment Partners
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infections). may have no provide some

symptoms or protection, but
discharge not total.
from penis,
discharge
from anus,
pain in
testicles, pain
on urinating.

Syphilis By having Painless ulcer Antibiotics with Sexual

Bacterial vaginal, anal (chancre) follow-up blood partners must
infection or oral sex usually on tests. be tested and
entering the without a genitals; treated if
body through condom with later swollen positive.
breaks in skin or someone who glands, rash, Current health
linings of the has the hair loss. regulations
genital area; infection; advise no sex
over time, goes from mother- until you are
on to damage to-baby cleared.
internal organs across
(heart, brain, placenta
spinal cord) during
pregnancy
(congenital
syphilis).

Genital warts HPV Fleshy or flat Visible warts can Condoms

Human transmitted lumps on or be treated, but provide some
papillomavirus by direct skin- around the infection protection, but
(HPV) causes to-skin genitals, cannot be not total.
fleshy or flat contact, anus, groin or cured. On 1
lumps – may be usually during thigh. January 2017, HPV
present even if sex; from immunisation
not visible mother-to- became free for
baby. everyone, male
Disease How you get Symptoms Treatment Partners
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Sometimes no and female, aged

identifiable 9 to 26, including
source of non-residents
transmission. under the age of
18.

Genital herpes Close skin Painful, red Anti-herpes drugs Partners may
Herpes simplex contact with blisters, little and pain relief can or may not
virus causes someone with sores or be given to treat catch herpes.
skin infection the virus; ulcers, flu-like symptoms, but Do not have
usually on from mother- symptoms, the infection sex when open
mouth and lips to-baby. and cannot be cured. sores are
(cold sores) or sometimes a Some may need present.
on genitals. discharge. medication to Condoms
prevent further provide some,
outbreaks. but not
complete,
protection.

Non-specific Can be Women Antibiotics. Partners need

urethritis caused by usually have to be examined
(NSU) chlamydia or no symptoms. and treated.
Infections that by bacteria, Men have
cause viruses or discharge
inflammation of other from the
the urethra. organisms. penis, pain on
urinating, but
sometimes
there are no
symptoms.

Trichomoniasi During sexual Women may Antibiotic tablets Treat with

s intercourse have no and/or vaginal antibiotics to
Trichomonas with an symptoms, avoid re-
Disease How you get Symptoms Treatment Partners
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vaginalis, a infected but there may pessaries. infection.

small parasitic person. be a yellowy- Don't have sex
organism, green frothy until 7 days
causes irritation vaginal after starting
in the vagina in discharge. treatment and
women and can Men usually until sexual
cause an have no contacts have
irritation inside symptoms. been treated.
the penis in
men.

Diseases that can be transmitted sexually or may be transmitted in other

ways

Hepatitis A Mainly Often no Immunisation for Immunisation

Viral infection through symptoms, or prevention. Good for prevention
which affects contaminated may have hygiene and hand- and avoid anal
the liver. food or water mild flu-like washing. Avoid sexual
or not hand- illness, or alcohol and drugs. practices until
washing after vomiting, Eat a well- recovered.
toilet, before abdominal balanced low-fat
food etc. Can pain, dark diet.
be through urine and
anal sex and yellowing of
oral-to-anal the skin and
contact whites of the
(rimming). eyes.

Hepatitis B By having May have no Rest, exercise and Always use a

Viral infection vaginal, anal symptoms or avoid alcohol, condom if
which affects or oral sex mild flu-like drugs and partner is not
the liver. without a illness or smoking. Eat a immunised.
condom with vomiting, well-balanced low- Protection is
Disease How you get Symptoms Treatment Partners
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someone who abdominal fat diet. Check offered to

has the pain, dark any prescribed or babies on the
infection; urine and over-the-counter immunisation
form mother- yellowing of medicines are schedule and
to-baby. By the skin and safe to take. to children
sharing whites of the under 16
needles, eyes. years. Free
syringes, immunisation
toothbrushes, is available for
razors and household and
unsterilized sexual
instruments contacts.
that pierce
the skin.
Blood
transfusion in
countries that
do not pre-
test blood for
transfusion.

Hepatitis C After contact Often no Rest, exercise and Sexual and

Viral infection with infected symptoms or avoid alcohol, needle-sharing
which affects blood or by may have drugs and partners can
the liver. sharing mild, flu-like smoking. Eat a have a blood
needles or illness or well-balanced low- test to check
syringes or vomiting, fat diet. for Hep C
possibly abdominal antibodies.
through pain, dark
sexual urine and
contact. Blood yellowing of
transfusion in the skin and
countries that whites of the
doe no pre- eyes.
test blood for
transfusion.
Disease How you get Symptoms Treatment Partners
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HIV HIV is Usually no No immunisation Practice safer

Human transmitted obvious or cure available sex to prevent
Immunodeficien through symptoms for although some transmission.
cy Virus attacks blood, semen many years. secondary Partners should
the white blood and vaginal infections can be ask for an HIV
cells and causes fluids, sharing treated or test.
damage to the needles and prevented.
immune system from mother- Keeping well for
so that it can be to-baby. Blood longer is possible
difficult to fight transfusion in with good care.
off infections. countries that Women with
do not pre- HIV/AIDS need a
test blood for cervical smear
transfusion. yearly.

Pelvic Usually by Pain during Antibiotics and Need to check

inflammatory having sex, sore rest. for STIs and be
disease (PID) vaginal sex abdomen or treated to
An infection of without a back, heavy, avoid
the womb and condom with irregular or reinfection. No
fallopian tubes someone who painful sex until
that can cause has periods, treatment is
infertility. gonorrhoea or spotting, high completed and
chlamydia. temperature, until sexual
feeling sick; contacts have
sometimes no been treated.
symptoms.

Pubic lice – By close body Intense Special shampoo, Treat partners

crabs contact, itching in the cream or spray of the last 3
Small lice that usually during pubic area, applied to pubic months in the
live in the pubic sex with an small nits area. Wash all same way at
hair and cause infected (eggs) on clothing and bed the same time.
irritation. person. Can pubic hair. linen.
be spread via
infected
Disease How you get Symptoms Treatment Partners
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bedding and
clothing.

Scabies By close body Itching, worse Special lotion, Treat partners

Small mites that contact, at night, and cream or of the last 3
burrow into the sometimes a rash on the ointment. Wash months in the
skin cause during sex. body. all clothing and same way at
irritation. Can be spread bed linen. the same time.
by sharing
clothes or
bedding.

Infections that are not sexually transmitted but can affect the genital area

Thrush or Yeast Women have Creams and Need

candidiasis overgrowth vaginal or pessaries for local treatment if
Irritation of may occur vulval itching treatment. Anti- showing
mucous when and a thick, fungal tablets may symptoms.
membranes antibiotics are whitish be given in severe
from a yeast used, during vaginal cases. Salt water
organism. It can pregnancy, discharge. baths for men are
occur in or with diabetes, Men have usually effective.
around the or when itching and
vagina, and on immunity is may have a
the tip of the lowered. It red rash on
penis. can occur the head of
after sex, but the penis or a
also without discharge
sex. under the
foreskin.

Cystitis Bacteria from Burning Antibiotics after

Disease How you get Symptoms Treatment Partners
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Bacteria cause around the sensation urine test if

inflammation of anus getting when symptoms last
the bladder into the urinating, longer than a day,
lining; can urethra and needing to drink plenty of
spread to bladder, not urinate water, use pain
kidneys and emptying the urgently and relief and using
cause damage bladder more often alkalisers, e.g.
to kidney properly. than usual, Ural®,
function. Much more cloudy, Citravesent®, etc
common in bloodstained
women than or smelly
men. urine, aching
in lower
abdomen or
back.

Bacterial It may be brought on by Greyish white, Oral tablets

vaginosis anything that changes the smelly vaginal and/or
If the control of balance in the vagina, eg, discharge. vaginal
the normal new sexual partners, pessaries.
bacteria in a increased sexual activity.
healthy vagina
fails, an
overgrowth of
certain bacteria
can occur. The
acid/alkaline
balance is upset
and irritation
results.

Infertility : The couples which are unable to reproduce children inspite of unprotected sexual
cohabitation are called infertile.
The reasons for this could be many-physical, congenital, diseases, drugs, Immunological or
even Psychological.
Infertile couples can be assisted to have children through certain special techniques
commonly called assisted reproductive technologies (ART) ,which includes-

a) In vitro fertilisation (IVF)-

-Fertilisation outside the body followed by embryo transfer, which is commonly called test
tube baby program.
-The ovum from wife/donor and sperms from husband/ donor are collected and induced to
fertilize in laboratory conditions.
-The zygote or early embryo (8 blastomeres) could be transferred into fallopian tube called
ZIFT (zygote infra fallopian transfer).
-Embryo with more than 8 blastomeres could be transferred into the uterus to complete the
further development. IUT (intra uterine transfer)

b) GIFT (gamete intra fallopian transfer) –transfer of gametes collected from a donor into
fallopian tube of another female who do not produce ovum.

Intra cytoplasmic sperm injection (ICSI)-specialized procedure to form an embryo in

laboratory in which sperm is directly injected into ovum.

c) Artificial insemination-
-Infertility cases in which male partner is unable to produce healthy sperms are treated by this
technique in which semen collected from donor is artificially introduced into vagina or into
uterus, IUI ( intra uterine insemination) of the female.
-All these techniques require extremely high precision handling by specialized professional
and expensive instruments.

Therefore, their benefits are limited to certain countries and people.

Emotional, religious and social factors also prevent the adoption of these methods.