CHAPTER 4: REPRODUCTIVE HEALTH

GIST OF MAJOR AND MINOR CONCEPTS

HEALTH – PROBLEMS AND STRATEGIES:

● The programme “family planning” was initiated in 1951.
 ● Reproductive and child health care (RCH) programmes to create awareness among the people
about reproduction related aspects
● Sexually transmitted diseases (STD).
● Introduction of sex education in schools should be encouraged to provide right information and
to remove myth and misconception about sex related aspects among the young
● Amniocentesis: A foetal sex determination test based on the chromosomal pattern in the
amniotic fluid surrounding the developing embryo.
● Saheli‟ an oral contraceptive for females, developed by CDRI.
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 mortality rate (MMR) and infant mortality rate (IMR) are
major causes of population growth.
● Indian population growth rate is around 1.7 percent.
Characteristics of ideal contraceptives.
● 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 from 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 the fertile period.
Withdrawal or coitus interruptus
● 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 for up to six months.
Barrier methods:
● Principle of working: prevents physical meeting of sperm and ovum.
● Such methods are available both for male and females.

Condoms:
● Barriers made of thin rubber/latex sheath.
● Used to cover the penis in male or vagina and cervix in females.
● Used just before coitus so that semen not enter 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 the cervix.
● They are reusable.
Intrauterine Devices:
● These devices are only used by females.
● Inserted by a doctor or by expert nurses in the uterus through vagina.
● Non-medicated IUDs e.g. Lippe’s 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 method is used by females 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 the first five days of menstruation.
● Pills are very effective with lesser side effects.
● 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 females.
● 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 the sterilization method.
● Advised to both male and female partners.
● 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 a 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 the 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)
● Gonorrhoea, 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 females 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.
INFERTILITY:
● The couple unable to produce children in spite of unprotected sex.
● The reason for infertility may be: physical, congenital, diseases, drugs, immunological or Even
psychological.
● Problems of infertility may be in male or females.
● Infertility clinics can diagnose and correct the cause of infertility.
● In case no corrections are possible, some special technologies used to have children are called
assisted reproductive technologies. (ART)
Assisted reproductive technologies:
(a) In vitro fertilization:
● Fertilization outside the body in the laboratory.
● Conditions created in the laboratory are similar to the body.
(b) Embryo transfer:
● Popularly known as the 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 up to 8 blastomeres) could be transferred into the fallopian
tube.
 ● ZIFT- Zygote intra fallopian transfer.
● IUT- Intrauterine transfer (embryo with more than 8 blastomeres).
● Further development took place within the female body.
● Embryo formed by in-vivo fertilization can also be transferred to assist those females 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 females can provide a 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 and is artificially introduced into vagina or
into the uterus (IUI-intrauterine insemination) of the female.
● Such technology is useful in cases either the male partner is unable to inseminate the female or
very low sperm counts in the ejaculates.

MCQs
Q.1. Tubectomy is a method of sterilization in which
(a) one fallopian tube is removed
(b) both fallopian tubes are removed
(c) small part of fallopian tube is removed
(d) small part of vas deferens is removed
Q.2. Following statements are given regarding MTP.
(i) MTPs are generally advised during first trimester
(ii) MTPs are used as a contraceptive method
(iii) MTPs are always surgical
(iv) MTPs require the assistance of qualified medical personnel

Choose the correct option.

(a) (ii) and (iii)
(b) (i) and (iii)
(c) (i) and (iv)
(d) (i) and (ii)
Q.3. The method of directly injecting a sperm into ovum in Assisted Reproductive Technology is
called
(a) GIFT
(b) ZIFT
(c) ICSI
(d) ET
Q.4. Increased IMR and decreased MMR in a population will
(a) cause rapid increase in growth rate
(b) result in decline in growth rate
(c) not cause significant change in growth rate
(d) result in an explosive population
Q.5. In-vitro fertilization involves transfer of ____ into the fallopian tube.
(a) embryo up to eight cell stage
(b) embryo of thirty-two cell stage
(c) zygote
(d) either zygote or embryo up to eight cell stage
Q.6. Intensely lactating mothers do not generally conceive due to the
(a) suppression of gonadotropins
(b) hyper secretion of gonadotropins
(c) suppression of gametic transport
(d) suppression of fertilisation
Q.7. Sterilisation techniques are generally fool proof methods of contraception with least side effects.
Yet, this is the last option for the couples because
(i) it is almost irreversible
(ii) of the misconception that it will reduce sexual urge
(iii) it is a surgical procedure
(iv) of lack of sufficient facilities in many parts of the country
Choose the correct option.
(a) (i) and (iii)
(b) (ii) and (iii)
(c) (ii) and (iv)
(d) (i), (ii), (iii) and (iv)
Q.8. Which of the following STDs are caused by bacteria?
(a) AIDS and Genital Herpes
(b) Syphilis and gonorrhoea
(c) Trichomoniasis and scabies
(d) All of these
Q.9. Which of the followings is example of hormone releasing IUDs?
(a) CuT and Multilobed 375
(b) LNG-20 and Progestasert
(c) Lippe’s loop
(d) Both (b) and (c)
Q10.A national level approach to build up a reproductively healthy society was taken up in our country
in
(a) 1950s
(b) 1960s
(c) 1980s
(d) 1990s
Q.11. Emergency contraceptives are effective if used within
(a) 72 hrs of coitus
(b) 72 hrs of ovulation
(c) 72 hrs of menstruation
(d) 72 hrs of implantation
Q.12. Choose the right one among the statements given below.
(a) IUDs are generally inserted by the user herself
(b) IUDs increase phagocytosis reaction in the uterus
(c) IUDs suppress gametogenesis
(d) IUDs once inserted need not be replaced
Q.13. IUDs release copper ions to
(a) prevent ovulation
(b) suppress mortality
(c) increase phagocytosis of sperm
(d) make the uterus unsuitable for implantation.
Q.14. From the sexually transmitted diseases mentioned below, identify the one which does not
specifically affect the sex organs.
(a) Syphilis
(b) AIDS
(c) Gonorrhoea
(d) Genital warts
Q.15. Condoms are one of the most popular contraceptives because of the following reasons.
(a) These are effective barriers for insemination
(b) They do not interfere with coital act
(c) These help in reducing the risk of STDs
(d) All of the above
Q.16. Which of the following is/are barrier method of contraception?
(a) Rhythm method/Periodic abstinence
(b) Lactational amenorrhea
(c) Withdrawal method
(d) None of these
Q.17. Which of the following is not a cause of population explosion in India?
(a) Better health care
(b) Increased IMR
(c) Decline MMR
(d) Increased population of reproductive age
Q.18. Choose the correct statement regarding the ZIFT procedure.
(a) Ova collected from a female donor are transferred to the fallopian tube to facilitate zygote
formation.
(b) Zygote is collected from a female donor and transferred to the fallopian tube
(c) Zygote is collected from a female donor and transferred to the uterus
(d) Ova collected from a female donor and transferred to the uterus
Q.19. The correct surgical procedure as a contraceptive method is
(a) ovariectomy
(b) hysterectomy
(c) vasectomy
(d) castration
Q.20. Diaphragms are contraceptive devices used by females. Choose the correct option from the
statements given below:
(i) They are introduced into the uterus
(ii) They are placed to cover the cervical region
(iii) They act as physical barriers for sperm entry
(iv) They act as spermicidal agents
Choose the correct option:
(a) (i) and (ii)
(b) (i) and (iii)
(c) (ii) and (iii)
(d) (iii) and (iv)
Q.21. Lactational amenorrhoea means
(a) absence of menstruation during pregnancy
(b) absence of menstruation during lactation
(c) excessive bleeding during menstruation
(d) no production and secretion of milk
Q.22. Medical Termination of Pregnancy is safe up to
(a) 8 weeks of pregnancy
(b) 12 weeks of pregnancy
(c) 18 weeks of pregnancy
(d) 24 weeks of pregnancy
ASSERTION-REASON QUESTIONS

Directions: In the following questions, a statement of assertion is followed by a statement of

reason.
Mark the correct choice as:
(a) If both Assertion and Reason are true and Reason is the correct explanation of Assertion.
(b) If both Assertion and Reason are true but Reason is not the correct explanation of Assertion.
(c) If Assertion is true but Reason is false.
(d) If both Assertion and Reason are false.
1. Assertion: Amniocentesis is often misused
Reason: Amniocentesis is meant for determining the genetic disorders in the foetus, but it is being
used to determine the sex of the foetus, leading to the death of the normal female foetus.
2. Assertion: Cu-T and Cu-7 do not suppress sperm-motility.
Reason: Hormones released by them do not affect sperm motility.
3. Assertion: Pills are very effective contraceptive methods with lesser side effects.
Reason: Pills inhibit ovulation and implantation as well as retard entry of sperms.
4. Assertion: In zygote intra fallopian transfer the zygote is transferred to the fallopian tubes of the
female.
Reason: ZIFT is an in vivo fertilisation method.
5. Assertion: Artificial insemination is the method of introduction of semen inside the female.
Reason: This technique is used in those cases where males have low sperm count.
6. Assertion: IUT is the transfer of embryo with more than 8 blastomeres into the fallopian tubes.
Reason: This is a very popular method of forming embryos in-vivo.
7. Assertion: Saheli, the new oral contraceptive for the females, contains a steroidal preparation.
Reason: It is “once in a day” pill with very few side effects.

SHORT ANSWER TYPE QUESTIONS

1. Lactational Amenorrhea is a method of contraception. Justify. What is the maximum
effectiveness of this method in terms of period/duration?
2. How are Copper releasing IUDs different from Hormone releasing IUDs?
3. Give another name for sexually transmitted diseases. Name two sexually transmitted diseases
which are curable and two diseases which are not curable.
4. Differentiate between Vasectomy and Tubectomy.
5. Mention the various precautions one has to take in order to protect himself/herself from STDs.
6. When is the medical termination of pregnancy advised by the doctors?
7. What are the important features of an ideal contraceptive?
8. Justify the statement, “All reproductive tract infections are sexually transmitted diseases, but all
sexually transmitted diseases are not reproductive tract infections.”
9. Justify the ban on amniocentesis in our country?
10. Name the hormone composition of oral contraceptives used by a human female. Explain how it
act as a contraceptive?
LONG ANSWER TYPE QUESTIONS

11. Why should sex education be introduced to school-going children? List any five reasons.
12. Suggest some methods to assist infertile couples to have children.
13. List the objectives of Reproductive and Child Health Care Programmes (RCH
ANSWER KEY
MCQs
1. C 2.C 3.C 4.C 5D 6.A..7. D.8. B 9.B 10A. 11.A.12.B 13B 14.B 15D.16D.17.D18. B19.C 20.C 21.
B 22.B
ASSERTION-REASON
1. A 2.D 3. B 4.C 5. A 6.D 7. D
 SHORT ANSWER QUESTIONS
1. (a) Ovulation and menstrual cycle do not occur during the period of intense lactation following
parturition. Therefore, as the mother breast feeds, chances of conception are nil.
(b) It is effective only up to a maximum period of six months following parturition.

2. (a) Copper releasing IUDs (CuT, Multiload 325) These increase phagocytosis of sperms within the
uterus and release copper ions which suppress sperm motility and fertilising capacity of sperm.
(c) Hormone releasing IUDs – Progestasert, LNG-20. These make the uterus unsuitable for
implantation and the cervix hostile to sperms.
3. Venereal disease (VD)/Reproductive tract infection (RTI). Curable-Syphilis, Gonorrhoea Non-
Curable – Hepatitis B, AIDS
4. Vasectomy – Method of sterilization in males. Vas deferens of both sides cut and tied. Prevents
movement of sperms at cut end
Tubectomy – Method of sterilisation in females. Fallopian tube of both sides cut and tied. Prevents
movement of egg at cut end.
5. (i) Avoid blood transfusion from an infected person. (ii) Avoid sex with an unknown partner and
multiple partners. (iii) Always use a condom. (iv) Avoid sharing injections needles and syringes
and surgical instruments.
6. The medical termination of pregnancy is advised under the following circumstances:
If the pregnancy endangers the health (physical/mental) of the woman.
If the child is malformed or handicapped
In cases of rape

If the girl is unmarried, consent of the guardian is required.

In the case of mentally ill mothers
7. It is safe
It lasts long
It is cost-effective
It is highly effective
Its effect can be reversed
It is independent of coitus
It can be administered easily
Does not require any medical supervision
8. The reproductive tract infections are transferred from one partner to another during sexual
intercourse. Hence called sexually transmitted diseases. For eg., gonorrhoea, genital herpes,
syphilis, etc. However, some sexually transmitted diseases such as hepatitis, AIDS are transferred
during sexual intercourse but do not cause any infections in the reproductive tract or genitals.
These are therefore not referred to as reproductive tract infections.
9. Amniocentesis is a technique in which the amniotic fluid is collected from the uterus with the help
of a needle to determine any genetic abnormalities in the foetus by analysing the chromosomal
patterns. This technique was being misused to know the gender of the foetus and if the foetus was
a girl, it was aborted. To stop the female foeticide, amniocentesis was banned under Prenatal
Diagnostics Technique Act in the year 1994.
10. Progesterone or progesterone- estrogen combination is used as an oral contraceptive by human
females.
These pills inhibit ovulation as well as implantation. They also alter the quality of cervical mucus
to prevent or retard entry of sperms.
 LONG ANSWER QUESTIONS

11. Sex education should be introduced to school going children for the following reasons:
To make the students aware that the bodily changes they are experiencing during puberty are
absolutely normal and natural.
To help them speak up when they face any sexual harassment in society.
The students will get to know about the facts of life from a supportive source instead of some
absurd show or movie.
They will be made aware of the risks involved in having sex.
12. There are numerous assisted reproductive technologies (ART) available that can bless infertile
couples with children.
They are:
IVF: In Vitro Fertilisation (Test-tube babies).
ET: Embryo Transfer
ZIFT: Zygote Intra Fallopian transfer.
GIFT: Gamete Intra Fallopian Transfer.
ICSI: Intracytoplasmic sperm injection.
IUI: Intrauterine Insemination.
13. Objectives of RCH are as follows:
Creating awareness about various reproduction-related problems.
Providing facilities and support for building up a reproductively healthy society.
Providing audio-visual and print media support to various government and non-government
organizations.
Educating the people and providing the right information to save them from myths and
misconceptions.
Providing proper education regarding reproductive organs, adolescence and related changes, safe
and hygienic sexual practices.
Providing information regarding the danger of sexually transmitted diseases, AIDS, etc.

DIAGRAM BASED QUESTION ANSWERS

QUESTIONS:
1. Given diagram is the surgical methods of birth control. Answer the following related questions:

(a) What does the above figure depict?

(b) Does vasectomy prevent spermatogenesis in male?
(c) Which structure is removed or tied up during vasectomy?
(d) What type of semen is ejaculated by vasectomy in male?
 2. Examine the given figure and answer the related questions that follows:

(a) What does the above figure depict?

(b) Does tubectomy prevent ovulation in females?
(c) Which structure of the fallopian tube is removed or tied up in tubectomy?
(d) How does tubectomy act as a contraceptive method in females?

ANSWERS:
1. (a) The figure depicts vasectomy in male human beings.
(b) No, vasectomy never prevents spermatogenesis but prevents the ejaculation of sperms.
(c) Two vasa deferens are interrupted by giving cuts or ligation.
(d) Nature of semen is azoospermia and discharge is only composed of seminal plasma i.e., sex
gland‟s secretion.

2. (a) The given figure depicts tubectomy.

(b) No, tubectomy never prevents ovulation in female human beings but it blocks the
movement of ovum toward the ampulla of fallopian tube or oviduct.
(c) Two oviducts or fallopian tubes are interrupted by giving cuts or ligation.
(d) It always prevents the passage of ovum to the ampulla i.e., site of fertilization. Thus,
prevent contraception.

Prepared by: AJAY MATHIYAN