REPRODUCTIVE HEALTH

 It is the state of physical, emotional, behavioral and social

fitness for leading a reproductive life.
 According to WHO: A total well being in all aspects of
reproduction, i.e., physical, emotional, behavioral and
social.

Reproductive Health- Problems & Strategies

 India was among the 1st countries to initiate actions & plans to
attain total reproductive health as social goal.
 These programs are called as ‘ FAMILY PLANNING’-initiated in
1951.
 Improved programs covering reproduction related areas are in
operation- ‘Reproductive & Child Health Care Programs’ (RCH)
 Create awareness about various reproduction aspects & provide
facilities and support to build reproductively healthy society

POPULATION EXPLOSION AND BIRTH CONTROL

 The increase in size and growth of human population is called
population explosion.
 Indian population- 350 million at independence and crossed 1
billion in May 2000
 Alarming growth rate- scarcity of basic requirements (food,
shelter & clothing)
 The reason for high population explosion are,
1. Decline in death rate.
2. Longer life span.
3. Decline in maternal mortality rate (MMR)
4. Decline in infant mortality rate (IMR)
5. Some religious belief against birth control.
6. Lack of reproductive health knowledge.
 Some steps to overcome population explosion:
1. Motivate smaller families using contraceptive methods
2. Awareness through media, posters/ bills- Hum Do Hamare
Do (we two, our two)
3. Couples mostly young, urban, working ones adopted ‘one
child norm’
4. Statutory raising of marriageable age, female- 18, male- 21
5. Incentives to couples with small families
6. Contraceptive methods, to prevent unwanted pregnancies

Contraception
1) Natural methods:
It work on the principle of avoiding chances of ovum
and sperms meeting.
 a)Periodic abstinence: Is a method in which couple
avoid or abstain coitus form day 10 to 17 of the
menstrual cycle when ovulation could be expected.

b) Withdrawal or coitus interruptus: In this method

male partner withdraws his penis from the vagina
just before ejaculation to avoid insemination.

c) Lactational amenorrhea: Based on fact that

ovulation/cycle absent during intense lactation
following parturition. Hence chance of fertilization is
absent. Effective for 6 months, side effects are nil.
Chances of failure are high

2) Physical contraceptive or Barrier methods:

This method prevents contact of sperm and ovum

by barrier. Available both for male and female.

a) Condoms: Barriers made of thin rubber/ latex

sheath, self inserted & disposable. Covers penis in male
& vagina and cervix in female. It is used so that semen
do not enter the female reproductive tract. It also
prevents AIDS and STDs.
 b) Diaphragm, cervical caps and vaults: Barrier,
made of rubber latex. Inserted into the female
reproductive tract to cover the cervix. Block entry of
sperm through cervix, reusable. Spermicidal cream,
jellies, foams along with these barriers

3) Intra Uterine Devices (IUDs ): These

devices are only used by female. Inserted
by doctor or nurses in the uterus
through vagina.

They are available as :

a) Non-medicated IUDs e.g. Lippes loop :

Phagocytosis of sperm

b) Copper releasing IUDs (CuT, Multiload 375): Cu

ion released suppresses sperm motility and fertilizing
capacity of sperm. IUDs increases
phagocytosis of sperm within the uterus.

c) Hormone releasing IUDs

(Progestasert, LNG): make the uterus
unsuitable for implantation and the
cervix hostile to the sperm. IUDs are ideal for female- to
delay pregnancy/ space children. Widely accepted
contraception in India

4) Oral contraceptives : Oral administration of small

doses of progesterone or progesterone estrogen
combination. Female, tablets & so called pills, taken daily for
a period of
21 days.
Inhibit
ovulation &

implantation & alter the quality of cervical mucus to prevent

entry of sperm. Effective less side effects, Eg. Saheli- non
steroidal preparation, once a week.

5) Injections or implants : Progesterone alone or in

combination with estrogen used as injections or implants
under the skin of female. Action similar to pills, effective for
long periods. Progesterone or combination of progesterone
and estrogen or IUDs- within 72 hours of coitus are effective
as emergency contraceptives to avoid possible pregnancy
due to rape or unprotected intercourse

Emergency contraceptives: These methods are used

within 72 hours of coitus, casual in
unprotected intercourse.
Administration of progesterone or
progesterone-estrogen combination.

6) Surgical methods: It is also

called as sterilization method
advised to male/ female partner to prevent any future
pregnancy. Blocks gamete transport, thus prevent
conception. Sterilization in male is called-vasectomy &
female- ‘tubectomy’. Vasectomy- a small part of the vas
deferens is removed or tied up through incision made on
scrotum. Tubectomy- small part of fallopian tube is removed
or tied up through incision of abdomen/ vagina. Highly
effective, reversibility is very poor.
 MEDICAL TERMINATION OF PREGNANCY (MTP)

Intentional or voluntary termination of pregnancy is called

medical termination of pregnancy (MTP) or induced
abortion. 45 to 50 million MTPs/ year- world. Decreases
population- not meant for that purpose. Accept/ legalise is
debated due to emotional, ethical, religious & social issues.
Government of India legalized- 1971, with strict restrictions
to check indiscriminate & illegal female foeticide. MTP- rid of
unwanted pregnancy due to unprotected intercourse, failure
of contraceptive, rapes, pregnancy which may fatal to
mother or foetus. This method is safe within 1st trimester
(12 weeks), 2nd trimester abortions are riskier. Illegal-
unqualified quacks, unsafe & fatal- avoided by counselling.
Misuse of amniocentesis, followed by MTP- avoided

SEXUALLY TRANSMITTED DISEASES (STDs).

Diseases or infections which are transmitted through sexual

intercourse are called Sexually transmitted diseases (STDs)/
Venereal diseases (VD)/ Reproductive tract infections (RTI).
Gonorrhea, Syphilis, Genital herpes, Chlamydiasis, genital
warts, Trichomoniasis, hepatitis-B and HIV.

Mode of transmission- Hepatitis- B & HIV

1. Sexual contact with infected person

2. Sharing of injection needles

3. Sharing the unsterilized surgical instruments

4. Transfusion of blood from infected person to healthy

person

5. Infected mother to foetus

Except hepatitis-B, genital herpes and HIV infections, others

are curable.

Symptoms are minor- early stages:

1. Itching, fluid discharge, slight pain, swelling in the

genital region.

2. STDs remain asymptomatic in female and remain

undetected for long.
 3. In the later stage it may leads to Pelvic inflammatory
diseases (PID), abortion, still birth, ectopic pregnancy,
infertility or even cancer in reproductive tract.

Preventions:

1. Avoiding sex with unknown partners or multiple

partners.

2. Always using condoms during coitus.

3. In case of doubt, consult a doctor for early detection.

4. Getting complete treatment for diagnosed disease.

INFERTILITY
The couple unable to produce children in spite of
unprotected sex is due to Infertility. Problems of infertility
may be in male or female.

The reason of infertility may be:- physical, congenial,

diseases, drugs, immunological or even psychological.

• Female are blamed often in India

• Specialized Health care units like Infertility clinics-
diagnose, corrective treatments to have child

• When treatments are not enough, couple are assisted with

techniques called assisted reproductive technologies (ART)

• Methods of infertility control:

1) IVF- ET (In Vitro Fertilization- Embryo Transfer)

Test tube baby, fertilization takes place outside & embryo is

transferred. Female is induced to produce multiple egg/ ova.
Egg is then collected from wife/ donor & sperm collected
from husband/ donor. Incubated in culture medium-
fertilization & form zygote. It is then transferred to the
uterus of wife, implants & pregnancy continues.

TWO TYPES :

a) ZIFT (Zygote Intra fallopian Transfer)- Zygote/

Embryo with 8 blastomeres transferred to fallopian tube

b) IUT (Intra- Uterine Transfer)- Embryo transferred

at 32 celled stage to uterus
2) GIFT (Gamete Intra Fallopian transfer) : Ovum
collected from donor & transferred to female who
cannot produce one but provide suitable environment
for fertilization. Washed sperms & ova are transferred
to the ampulla of fallopian tube with the help of
laparoscope- fertilization & cleavage. Useful when
fimbriae fail to capture ovum & females having sperm
antibodies in their cervical secretion.
 3) Intra Cytoplasmic Sperm Injection (ICSI): Sperm
is directly injected into the ovum in culture medium .
Zygote or Embryo- transferred to fallopian tube or
uterus.
4) Artificial insemination (AI): It is useful in cases
either the male partner unable to inseminate the female
or very low sperm counts (oligospermia). Semen of
male partner/ donor is collected, concentrated &
introduced into vagina or uterus of female- intra
-uterine insemination (IUI)

Drawbacks:

1. These techniques are not possible with female with

damaged uterine wall.
2. Require high precision, specialized professional &
expensive instrumentation & so available in few centers &
available to few people only.
3. Raised several ethical, emotional, religious & moral issues
in the society.