Reproductive Health

Reproductive Health: Problem and Strategies

 India was amongst the first countries in the world to initiate to the
programmed “family planning” initiated 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
health care (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 Government:
 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 to check 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:

 Using various contraceptive methods.

 Educating people about the demerits of large family.
 Increasing the marriageable age of female and male.
 Providing incentive to parents having 1or 2 children.
Contraceptive methods:
Contraceptive methods are used to prevent the unwanted pregnancy and
modifying the menstrual cycle.

An ideal contraceptive should be:

 User friendly
 Easily available
 Effective
 Reversible
 No side effects
 No way interferes with sexual desire and sexual act.

Contraceptive methods could be divided into following categories:

 Natural or traditional methods.
 Barrier methods.
 IUDs.
 Oral contraceptive methods.
 Injectable.
 Implants.
 Surgical methods.

Natural methods:

Natural methods work on the principle of avoiding chances of ovum and sperm
meeting.
It includes:
 Periodic abstinence: The couples avoid coitus from day 10 to 17 of
menstrual cycle as chances of fertilization are very high during this period,
it is called the fertile period.
 Withdrawal or coitus interruptus: Male partner withdraws penis from
vagina just before ejaculation to avoid insemination.

 Lactational Amenorrhea: Absence of menstruation after parturition and

due to intense milk feeding and no ovulation in this period, chances of
fertilization is nil.

In Barrier methods:
In Barrier methods, ovum and sperms are prevented from physical meeting
with help of barrier.
 This includes:

Condoms for male: 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 female: 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:

 They are disposable.

 They can be self-inserted.
 They are reusable.
 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)
 Hormone releasing IUDs (Progestasert, LNG-20): Make the uterus unsuitable
for implantation and the cervix hostile to the sperms.

 IUDs increase phagocytosis of sperms. The Cu ions suppress motility

and fertilising capacity of sperms.
 IUDs are ideal contraceptives for the females who want to delay
pregnancy or space children.

Oral Pills:-
 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 sperms.
 Pills are very effective with lesser side effects.
Saheli: New oral contraceptive pill for the females. It contains a non-steroidal
preparation. It is a ‘once a week’ pill with very few side effects and high contraceptive
value.
Injectables:-
- Progestogens alone or in combination with oestrogen are used by females as injections
or implants under skin.
- Their mode of action is similar to that of pills and their effective periods are much longer.

Progestogens or progestogen-oestrogen combinations and IUDs are used within 72

hours of coitus as emergency contraceptives. It avoids pregnancy due to rape or casual
intercourse.

Surgical methods (sterilization)

- To block gamete transport and thereby prevents conception. It is very effective but
reversibility is poor.
Vasectomy: Sterilization procedure in males. In this, a small part of the vas deferens is
removed or tied up through a small incision on the scrotum.
Tubectomy: Sterilization procedure in females. In this, a small part of the fallopian tube
is removed or tied up through a small incision in the abdomen or through vagina.
Side effects of anti-natural contraceptives:
Nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding, breast
cancer etc.
 Medical Termination of Pregnancy (MTP):

 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 fatal to
mother or foetus.
 MTPs are considered relatively safe during first trimester or up
to 12 weeks of pregnancy. Second trimester MTPs are much riskier.

Importance of MTP
 To avoid unwanted pregnancies due to casual intercourse or failure of the
contraceptive used during coitus or rapes.
 Essential in cases where continuation of the pregnancy could be harmful to the
mother or to the foetus or both.
 MTPs are safe during the first trimester, (up to 12 weeks of pregnancy). 2nd
trimester abortions are very risky.

Problems related with MTPs

 Majority of the MTPs are performed illegally.
 Misuse of amniocentesis (a foetal sex determination test based on the
chromosomal pattern in the amniotic fluid).
 If the foetus is female, it is followed by MTP. Such practices are dangerous for
the young mother and foetus.

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:

 Avoid sex with unknown partners/ multiple partners.

 Always use condoms during coitus.
 Go to a qualified doctor in case of doubt for early detection and
get complete treatment if diagnosed

Infertility:

The couples which are unable to reproduce children in spite of

unprotected sexual cohabitation are called infertile. The reasons for this could
be many-physical, congenital, diseases, drugs, Immunological or even
Psychological.

Assisted reproductive technologies (ART):

Infertile couples can be assisted to have children through certain special

techniques commonly called assisted reproductive technologies (ART).

1. In vitro fertilisation (IVF– test tube baby programme):-

In this method, ova from the wife/donor and sperms from the husband/donor are
collected and are induced to form zygote under simulated conditions in the
laboratory. This is followed by Embryo transfer (ET). It is 2 types:
 Zygote Intra Fallopian Transfer (ZIFT): Transfer of zygote or early embryos
(with up to 8 blastomeres) into fallopian tube.
 Intra Uterine Transfer (IUT): Transfer of embryos with more than 8
blastomeres into the uterus.

Embryo formed by in vivo fertilisation (fertilisation within the female) is also used for
such transfer to assist those females who cannot conceive.
 2. Gamete Intra Fallopian Transfer (GIFT): Transfer of an ovum from a donor into the
fallopian tube of another female who cannot produce ovum, but can provide
suitable environment for fertilization and development.
3. Intra cytoplasmic sperm injection (ICSI): A laboratory procedure in which a single
sperm (from male partner) is injected directly into an egg (from female partner).
Then the fertilised egg is implanted into the woman’s uterus.
4. Artificial insemination (AI) technique: The semen collected from the husband or a
healthy donor is artificially introduced into the vagina or the uterus (IUI – intra-
uterine insemination) of the female.
This technique is useful for the male partner having inability to inseminate female
or low sperm counts etc.
5. Surrogacy: Here, a woman (surrogate mother) bears a child for a couple unable to
produce children, because the wife is infertile or unable to carry. The surrogate is
impregnated either through artificial insemination or through implantation of an
embryo produced by in vitro fertilisation.

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Important Questions
 Multiple Choice Questions:
1. The method of directly injecting a sperm into ovum in assisted reproductive technology is
called:
a) GIFT
b) ZIFT

c) ICSI
d) ET
2. 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.
3. 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.
4. Sterilisation techniques are generally foolproof 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/drive.

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
5. 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.
6. 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
7. Choose the right one among the statements given below:
a) lUDs are generally inserted by the user herself

b) lUDs increase phagocytosis reaction in the uterus

c) lUDs suppress gametogenesis
d) lUDs once inserted need not be replaced.
8. The following statements are given regarding MTP. Choose the correct options given below:
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
a) i and iii
b) ii and iii

c) i and iv
d) i and ii
9. 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
10. 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.

11. 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.

12. The correct surgical procedure as a contraceptive method is:

a) Ovariectomy
b) Hysterectomy
c) Vasectomy
d) Castration.

13. 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

a) i and ii
b) i and iii
c) i, ii and iii
d) iii and iv
14. A procedure that finds use in testing for genetic disorders, but is also misused for female
foeticide is:
a) Lactational amenorrhea

b) Amniocentesis
c) Artificial insemination
d) Parturition