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Chapter 3 - Reproductive Health

Reproductive health is defined as the complete normal functioning of all reproductive organs, from the
viewpoint of WHO it is complete social, mental, behavioral and reproductive well being of a person.

REPRODUCTIVE HEALTH – PROBLEMS AND STRATEGIES

India was amongst the first countries in the world to initiate action plans and programmes at a national level
to attain total reproductive health as a social goal.

In 1951 family planning programmes were introduced to control the overpopulation of india.

‘Reproductive and Child Health Care (RCH) programmes’ were introduced creating awareness among people
about various reproduction related aspects and providing facilities and support for building up a
reproductively healthy society.

● Use media and agencies to educate about reproductive health.

● Encourage parents, teachers, and peers to share accurate information.
● Introduce sex education in schools to dispel myths and misconceptions.
● Educate on reproductive organs, adolescence, safe sex, STDs, and AIDS.
● Inform about birth control, prenatal/postnatal care, breastfeeding, and gender equality.
● Highlight the effects of uncontrolled population growth and social evils like sexual abuse.
● Ensure infrastructure, expertise, and materials for addressing reproductive health issues like
pregnancy, STDs, and contraception.

Amniocentesis is a technique in which amniotic fluid of a mother is taken out in which stem cells of embryo
are present through which any general abnormality in foetus is detected. This test is illegal for sex
determination.

POPULATION STABILIZATION AND BIRTH CONTROL

The world population was around 2 billion in the 1900s which became 6 billion in the 2000s and finally 7.2
billion in 2011, whereas in India it took drastic changes after independence like it was 350 million in 1947 and
became 1 billion in 2000 and 1.2 billion in 2011.

Rapid decline in death rate, maternal mortality rate (MMR), and infant mortality rate (IMR) contributed to an
increase in the population of reproductive age. Despite efforts through the Reproductive Child Health (RCH)
programme, the reduction in population growth rate was marginal.

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The 2011 census reported a population growth rate of less than 2%, which could lead to rapid population
increase and scarcity of basic necessities like food, shelter, and clothing. Due to the alarming growth rate, the
government took serious measures to curb population growth and address potential scarcity issues.

Promoting smaller families through contraceptive methods, such as "Hum Do Hamare Do" campaigns, and
statutory increases in marriageable ages are key measures to address population growth.

Implementing statutory increases in the marriageable age of females to 18 years and males to 21 years, along
with providing incentives to couples with small families or other measures aimed at tackling this problem.

CONTRACEPTION

It is the prevention of pregnancy and contraceptives are the methods of preventing pregnancy. An ideal
contraceptive should have the least side effects, easy to use, budget friendly and reversible. the methods of
contraception are:-

● Natural Methods - here pregnancy can be prevented without using external chemicals and devices.
they have high failure rates and don't prevent STDs.

Withdrawal or coitus interruptus is method in which the male partner withdraws copulatory organ
from vagina before ejaculation to prevent insemination.

In periodic abstinence 10 to 17th day of menstrual cycle is considered to be unsafe and if unprotected
coietus is prevented these days, pregnancy can be prevented.

The lactational amenorrhea method relies on the absence of ovulation during intense lactation after
childbirth, making conception unlikely as long as the mother fully breastfeeds the child. However, its
effectiveness lasts only up to six months postpartum, with minimal side effects due to no medication
or devices used. Yet, its failure rate is relatively high.

● Barrier Methods - prevent the meeting of ovum and sperm through physical barriers. Condoms, made
of thin rubber/latex sheath, cover the penis or vagina/cervix to prevent semen from entering the
female reproductive tract, thereby preventing conception and offering protection against STIs and
AIDS. Diaphragms, cervical caps, and vaults are reusable barriers inserted into the female
reproductive tract to cover the cervix during coitus. They block sperm entry, often used with
spermicidal creams, jellies, or foams to enhance contraceptive effectiveness.

● Intra Uterine Devices (IUDs) - inserted by doctors or expert nurses into the uterus through the vagina,
come in non-medicated, copper-releasing, and hormone-releasing types. They increase phagocytosis
of sperm and suppress sperm motility and fertilizing capacity.

Hormone-releasing IUDs also make the uterus unsuitable for implantation and the cervix hostile to
sperm, ideal for women wanting to delay or space pregnancies. Oral contraceptives, known as pills,
contain progestogens or progestogen–estrogen combinations, inhibiting ovulation and altering

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cervical mucus to prevent sperm entry. Pills are effective with few side effects and are well accepted.
Saheli, a new weekly oral contraceptive with minimal side effects, is available. Progestogens alone or
in combination with estrogen can be administered through injections or implants under the skin,
with longer effective periods. Emergency contraceptives include progestogens, progestogen-estrogen
combinations, or IUDs, effective within 72 hours of unprotected intercourse to prevent possible
pregnancy.

● Sterilization - Surgical methods, serve as terminal methods to prevent further pregnancies by

blocking gamete transport. Vasectomy is the male sterilization procedure, involving the removal or
tying of a small part of the vas deferens, while tubectomy is the female procedure, removing or tying a
portion of the fallopian tube. These methods are highly effective but have poor reversibility. It's
essential to consult qualified medical professionals when choosing a contraceptive method, as
contraceptives are used against natural reproductive events and may have side effects like nausea,
abdominal pain, or irregular bleeding, albeit not significant. Despite this, their widespread use plays a
crucial role in controlling population growth.

MEDICAL TERMINATION OF PREGNANCY (MTP)

It is the medical termination of pregnancy. 20% of pregnancies have been aborted worldwide and 40 to 50
million MTPs are done per year. This is the voluntary ending of pregnancy.

The Medical Termination of Pregnancy (Amendment) Act, 2017 was enacted by the government of India with
the intension of reducing the incidence of illegal abortion and consequent maternal mortality and morbidity.

According to this Act, a pregnancy may be terminated on certain considered grounds within the first 12 weeks
of pregnancy in the opinion of one registered medical practitioner. If the pregnancy has lasted more than 12
weeks, but fewer than 24 weeks, two registered medical practitioners must be of the opinion, formed in good
faith, that the required ground exists. The grounds for such termination of pregnancies are:

(i) The continuation of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury
physical or mental health; or

(ii) There is a substantial risk that of the child were born, it would suffer from such physical or mental
abnormalities as to be seriously handicapped.

SEXUALLY TRANSMITTED INFECTIONS (STIs)

● Sexually transmitted infections (STIs), also known as venereal diseases (VD) or reproductive tract
infections (RTI), are diseases transmitted through sexual intercourse.
● Common STIs include gonorrhea, syphilis, genital herpes, chlamydia, genital warts, trichomoniasis,
hepatitis-B, and HIV/AIDS.

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● Some infections like hepatitis-B and HIV can also spread through sharing injection needles, surgical
instruments, blood transfusions, or from an infected mother to the fetus.
● Most STIs are curable if detected early and treated properly, except for hepatitis-B, genital herpes, and
HIV/AIDS.
● Early symptoms include itching, fluid discharge, pain, and swelling in the genital region, but infected
females may be asymptomatic.
● Social stigma and less significant early symptoms often deter timely detection and treatment, leading
to complications like pelvic inflammatory diseases, abortions, infertility, or reproductive tract cancer.
● Prevention or early detection and treatment are essential under reproductive health-care programs.
● Incidences of STIs are high among individuals aged 15-24.
● Prevention includes avoiding sex with unknown or multiple partners, using condoms during
intercourse, and seeking early detection and treatment from a qualified doctor if there are doubts
about infection.

INFERTILITY

The inability to produce viable offspring in spite of unprotected coietus. This infertility can be reversed.

Specialised health care units (infertility clinics, etc.) could help in diagnosis and corrective treatment of some
of these disorders and enable these couples to have children. However, where such corrections are not
possible, the couples could be assisted to have children through certain special techniques commonly known
as assisted reproductive technologies (ART).

In vivo fertilization- if female produces normal gamete or they can't conceive and sperm count is low or it
lack the normal mobility; then the methods used are :

1. Intra cytoplasmic sperm injection - in which a sperm is directly injected into the ovum.
2. Gamete intra fallopian transfer - Transfer of an ovum collected from a donor into the fallopian tube of
another female who cannot produce one, but can provide suitable environment for fertilisation and
further development is another method attempted
3. Artificial Insemination- semen collected either from the husband or a healthy donor is artificially
introduced either into the vagina or into the uterus of female.

In-vitro fertilization- it occurs outside the body either in the laboratory. In this method, popularly known as
test tube baby programme, ova from the wife/donor (female) and sperms from the husband/donor (male) are
collected and are induced to form zygote under simulated conditions in the laboratory.

If a zygote is having 8 blastomeres then it is transferred into the fallopian tube called zygote intra fallopian
transfer, and if the zygote has more than 8 blastomeres then it is transferred into uterus termed as Intra
Uterine Transfer.

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"Challenges and Considerations in Advanced Reproductive Techniques and Adoption”

Advanced reproductive techniques require precise handling by specialized professionals and expensive
instrumentation, limiting their availability to very few centers in the country.

Affordability is a concern, making these benefits accessible to only a limited number of people.

Emotional, religious, and social factors act as deterrents in adopting these methods.

India has many orphaned and destitute children, suggesting adoption as a viable option for couples seeking
parenthood.

Legal adoption is permitted by Indian laws and remains one of the best methods for couples looking to
become parents.

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