Unit 3: Reproductive Health

Reproductive Health - Problems and Strategies

Introduction to Reproductive Health

According to the World Health Organization (WHO), reproductive health means a total well-being in all aspects of reproduction, including physical, emotional, behavioural, and social well-being. A societally and emotionally healthy society with people having physically and functionally normal reproductive organs is said to have good reproductive health.

Definition: Reproductive health refers to the total well-being in all aspects of reproduction covering physical, emotional, behavioural and social well-being.

Problems and Major Strategies in India

India was amongst the first countries in the world to action plans and programmes at a national level to attain total reproductive health as a social goal. These programmes are called family planning programs, initiated in 1951, and are periodically assessed and currently operating under the popular name Reproductive and Child Health Care (RCH) programmes.

• Mass Awareness: Creating awareness among people about various reproduction-related aspects using audio-visual and print media.
• Sex Education: Introduction of sex education in schools to provide right information to the youth so as to discourage myths and misconceptions about sex-related aspects.
• Educating the Youth: Educating young people about birth control options, care of pregnant women, postnatal care of the mother and child, importance of breast feeding, and equal opportunities for the male and female child.
• Awareness of Health Hazards: Educating people about unchecked population growth, social evils like sex-abuse, and sex-related crimes.
• Medical Facilities: Providing professional assistance and medical facilities like a statutory ban on amniocentesis for sex determination to legally check female foeticide.

Exam-Oriented Note: Amniocentesis is a foetal sex determination test based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo. Although legally banned to prevent female foeticide, it was originally developed to detect genetic disorders like Down syndrome, hemophilia, and sickle-cell anemia.

Common Mistakes

Students often confuse reproductive health solely with the absence of disease. Remember that it encompasses physical, emotional, behavioural, and social well-being.

Population Stabilization and Birth Control

Population Explosion and Its Causes

Rapid increase in population over a relatively short period is termed population explosion. In India, the population which was approximately 350 million at the time of independence reached close to a billion by 2000 and has continued to grow. The primary reasons for this growth include:

• Decline in death rate (mortality rate).
• Decline in maternal mortality rate (MMR).
• Decline in infant mortality rate (IMR).
• An increase in the number of people in reproducible age groups.

Measures for Population Stabilization

To check this population growth rate, motivating smaller families by using various contraceptive methods is crucial. An ideal contraceptive should be user-friendly, easily available, effective, and reversible with no or least side-effects.

Types of Contraceptive Methods

Contraceptive methods are broadly grouped into several categories:

• Natural / Traditional Methods: Work on the principle of avoiding chances of ovum and sperm meeting.
  • Periodic abstinence: Couples avoid or abstain from coitus from day 10 to 17 of the menstrual cycle when ovulation is expected.
  • Withdrawal or coitus interruptus: The male partner withdraws his penis from the vagina just before ejaculation to avoid insemination.
  • Lactational amenorrhea: Absence of menstruation during intense lactation following parturition. As ovulation does not occur during this period, chances of conception are practically nil up to six months following child-birth.
• Barrier Methods: Ovum and sperm are prevented from physically meeting with the help of barriers. Available for both males and females.
  • Condoms: Barriers made of thin rubber/latex sheath used to cover the penis in males or vagina and cervix in females. (e.g., Nirodh). They also protect the user from STIs and AIDS.
  • Diaphragms, Cervical caps, and Vaults: Barriers made of rubber that are inserted into the female reproductive tract to cover the cervix during coitus.
• Intra Uterine Devices (IUDs): These devices are inserted by experts through the vagina into the uterus.
  • Non-medicated IUDs: Lippes loop.
  • Copper releasing IUDs: CuT, Cu7, Multiload 375 (copper ions suppress sperm motility and fertilizing capacity of sperms).
  • Hormone releasing IUDs: Progestasert, LNG-20 (make the uterus unsuitable for implantation and the cervix hostile to sperms).
• Oral Contraceptive Pills (OCPs): Small doses of either progestogens or progestogen-estrogen combinations used by females in the form of tablets. They inhibit ovulation and implantation as well as alter the quality of cervical mucus to prevent/retard entry of sperms. (e.g., Saheli - a non-steroidal oral pill developed by CDRI, Lucknow).
• Injectables and Implants: Progestogens alone or in combination with estrogen can also be used by females as injections or implants under the skin. Their mode of action is similar to that of pills.
• Surgical Methods / Sterilization: Terminal methods block gamete transport and thereby prevent conception.
  • Vasectomy: A small part of the vas deferens is removed or tied up through a small incision on the scrotum in males.
  • Tubectomy: A small part of the fallopian tube is removed or tied up through a small incision in the abdomen or through vagina in females.

Comparison of Birth Control Methods

Medical Termination of Pregnancy (MTP)

Definition and Legal Status

Definition: Intentional or voluntary termination of pregnancy before full term is called Medical Termination of Pregnancy (MTP) or induced abortion.

Government of India legalized MTP in 1971 with some strict conditions to avoid its misuse (such as illegal female foeticide). Amendments were later made in 2021. According to the Act, a pregnancy may be terminated on certain considered grounds:

• Up to 12 weeks (first trimester) on the advice of one registered medical practitioner.
• Between 12 and 24 weeks, the requirement of the opinion of two registered medical practitioners is mandatory.

Significance and Risks

MTPs are crucial to get rid of unwanted pregnancies due to unprotected intercourse or failure of the contraceptive used during coitus, or when continuation of the pregnancy could be harmful or even fatal to the mother or the foetus. However, MTPs are not meant for population control; illegal MTPs performed by unqualified quacks are unsafe and can be fatal.

Sexually Transmitted Infections (STIs)

Overview of STIs

Infections or diseases which are transmitted through sexual intercourse are collectively called Sexually Transmitted Infections (STIs) or Venereal Diseases (VDs) or Reproductive Tract Infections (RTIs). Examples include:

• Gonorrhoea
• Syphilis
• Genital herpes
• Chlamydiasis
• Genital warts
• Trichomoniasis
• Hepatitis-B
• Human Immunodeficiency Virus (HIV) leading to AIDS

Transmission and Vulnerability

Transmission can occur through sharing of injection needles, surgical instruments with infected persons, transfusion of blood, or from infected mother to the foetus. Except for Hepatitis-B, Genital herpes, and HIV infections, other diseases are completely curable if detected early and treated properly.

Prevention and Control

Early symptoms include itching, fluid discharge, slight pain, swellings in the pelvic region. Complications of untreated STIs include Pelvic Inflammatory Disease (PID), abortions, still births, ectopic pregnancies, infertility, or even cancer of the reproductive tract. Prevention rules include:

Avoid sex with unknown partners/multiple partners.
Always use condoms during coitus.
Consult a qualified doctor for early detection and complete treatment if symptoms appear.

Infertility and Assisted Reproductive Technology (ART)

Understanding Infertility

Inability to produce children in spite of unprotected sexual co-habitation is called infertility. The reasons for this could be many: physical, congenital, diseases, drugs, immunological, or even psychological. In India, often the female is blamed for the childlessness, but the fault may lie with either the male or the female partner. Specialized health care units called infertility clinics can help in diagnosis and corrective treatments.

Assisted Reproductive Technologies (ART)

Specialized techniques known as Assisted Reproductive Technologies (ART) assist couples to have children when corrective treatments are not feasible.

• In Vitro Fertilization (IVF): Fertilization outside the body in almost similar conditions as that in the body, followed by embryo transfer (ET).
  Zygote Intra Fallopian Transfer (ZIFT): Transfer of a zygote or early embryo (with up to 8 blastomeres) into the fallopian tube.
  Intra Uterine Transfer (IUT): Transfer of embryos with more than 8 blastomeres directly into the uterus.
• Gamete Intra Fallopian Transfer (GIFT): Transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce one, but can provide suitable conditions for fertilization and further development.
• Intracytoplasmic Sperm Injection (ICSI): A laboratory procedure in which a single sperm is injected directly into the cytoplasm of an ovum to form an embryo.
• Artificial Insemination (AI): Infertility cases where the male partner is unable to inseminate the female or due to very low sperm counts in the ejaculate could be corrected by artificial insemination. Semen collected either from the husband or a healthy donor is artificially introduced into the vagina or into the uterus (Intra-Uterine Insemination - IUI).

Real-World Applications

ART techniques have transformed modern medicine, allowing millions of couples struggling with infertility to build biological families, though they require high-precision laboratory infrastructure and skilled medical professionals.