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Chapter 3 – Reproductive Health

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Reproductive Health: Problems and Strategies

  • Reproductive health implies a total well-being in all aspects of reproduction: physical, emotional, behavioral, and social.
  • India was the first country in the world to initiate Family Planning programs in 1951.
  • These programs were improved and renamed Reproductive and Child Health Care (RCH) programs.
  • Amniocentesis is a fetal sex-determination test based on the chromosomal pattern in the amniotic fluid; it is legally banned to prevent female foeticide.
  • “Saheli” is a new oral contraceptive for females developed by scientists at the Central Drug Research Institute (CDRI) in Lucknow.
  • Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) have decreased due to better healthcare facilities.
  • Statutory warning on marriageable age: 18 years for females and 21 years for males.

Contraceptive Methods

  • An ideal contraceptive should be user-friendly, easily available, effective, and reversible with no or least side effects.
  • Natural methods work on the principle of avoiding chances of ovum and sperm meeting.
  • Periodic abstinence involves avoiding coitus from day 10 to 17 of the menstrual cycle (the fertile period).
  • Withdrawal (Coitus interruptus) is the withdrawal of the penis from the vagina before ejaculation.
  • Lactational amenorrhea is the absence of menstruation during intense lactation after parturition (effective only up to 6 months).
  • Barriers like condoms prevent physical meeting of sperm and ovum; they also protect against STIs and AIDS.
  • Diaphragms, cervical caps, and vaults are reusable barriers for females.
  • Intrauterine Devices (IUDs) are inserted by doctors in the uterus through the vagina.
  • Non-medicated IUDs (e.g., Lippes loop) increase phagocytosis of sperm.
  • Copper-releasing IUDs (e.g., CuT, Cu7, Multiload 375) release Cu ions that suppress sperm motility and fertilizing capacity.
  • Hormone-releasing IUDs (e.g., Progestasert, LNG-20) make the uterus unsuitable for implantation and the cervix hostile to sperm.
  • Oral pills contain small doses of progestogens or progestogen–estrogen combinations.
  • Pills inhibit ovulation and implantation and alter the quality of cervical mucus.
  • Saheli is a “non-steroidal” pill taken once a week with very few side effects.
  • Injections and Implants are used by females under the skin for long-term contraception.
  • Emergency contraceptives (progestogens or IUDs) can be used within 72 hours of unprotected coitus to prevent pregnancy.
  • Surgical methods (Sterilization) are terminal methods to prevent any more pregnancies.
  • Vasectomy involves removing or tying a small part of the vas deferens in males.
  • Tubectomy involves removing or tying a small part of the fallopian tubes in females.

Medical Termination of Pregnancy (MTP)

  • MTP is the intentional or voluntary termination of pregnancy before full term (also called induced abortion).
  • The Government of India legalized MTP in 1971 with strict conditions to avoid misuse.
  • MTPs are considered relatively safe during the first trimester (up to 12 weeks of pregnancy).
  • Second-trimester abortions are much more risky.
  • MTP is used to get rid of unwanted pregnancies or when the pregnancy is harmful to the mother or fetus.

Sexually Transmitted Infections (STIs)

  • Infections transmitted through sexual intercourse are called STIs (or Venereal Diseases/Reproductive Tract Infections).
  • Common STIs include Gonorrhea, Syphilis, Genital herpes, Chlamydiasis, Genital warts, Trichomoniasis, Hepatitis-B, and HIV.
  • Hepatitis-B and HIV can also be transmitted by sharing injection needles or blood transfusion.
  • Except for HIV, Hepatitis-B, and Genital herpes, other STIs are completely curable if detected early.
  • Early symptoms include itching, fluid discharge, slight pain, and swellings in the genital region.
  • If left untreated, STIs can lead to Pelvic Inflammatory Diseases (PID), stillbirths, ectopic pregnancies, and infertility.

Infertility and Assisted Reproductive Technologies (ART)

  • Infertility is the inability to conceive or produce children even after 2 years of unprotected sexual cohabitation.
  • In vitro fertilization (IVF) involves fertilization outside the body in simulated conditions followed by embryo transfer (ET).
  • “Test-tube baby” program is a popular term for IVF-ET.
  • ZIFT (Zygote Intra Fallopian Transfer): Zygote or early embryo (up to 8 blastomeres) is transferred into the fallopian tube.
  • IUT (Intra Uterine Transfer): Embryos with more than 8 blastomeres are transferred into the uterus.
  • GIFT (Gamete Intra Fallopian Transfer): Transfer of an ovum from a donor into the fallopian tube of another female.
  • ICSI (Intra Cytoplasmic Sperm Injection): A sperm is directly injected into the ovum in the laboratory.
  • Artificial Insemination (AI): Semen is artificially introduced into the vagina or uterus of the female.
  • IUI (Intra-Uterine Insemination): Specifically involves introducing sperm into the uterus.
  • These techniques require extremely high precision and specialized professionals.
  • Social, emotional, and religious factors often hinder the adoption of these methods.
  • Legal adoption is one of the best methods for couples looking for parenthood.
  • The ultimate goal of all these technologies is to help infertile couples have children.
  • Questions count: 10
  • Passing grade: 4
  • Time limit: 30 minutes
  • Number of allowed attempts: 5
Start Quiz
1.

Discuss the Reproductive and Child Health Care (RCH) programs.

India was among the first countries to initiate action plans at a national level to attain total reproductive health.
These programs, currently called RCH, cover wider reproduction-related areas for public awareness.
Creating awareness among people about various reproduction-related aspects is a primary goal of RCH.
RCH actually encourages sex education in schools to provide right information and discourage myths.
Providing facilities and support for building a reproductively healthy society is a key objective.
Introduction of sex education in schools is discouraged by RCH to prevent students from being distracted.
Statutory ban on amniocentesis for sex determination is a legal measure to check female foeticide.
2.

Explain the use and significance of Amniocentesis.  

Amniocentesis is a fetal sex-determination and disorder test based on the chromosomal pattern.
It is legally banned for gender selection; it is only meant for detecting genetic disorders.
It involves taking a small amount of the amniotic fluid surrounding the developing embryo.
The fluid contains fetal cells and dissolved substances that can be analyzed for genetic abnormalities.
It is used to detect genetic disorders such as Down syndrome, hemophilia, and sickle-cell anemia.
This technique is legally permitted in India primarily to help parents choose the gender of their child.
Increasing misuse of this test for female foeticide led to its statutory ban for sex determination.
3.

Describe Natural Methods of Contraception.  

Natural methods work on the principle of avoiding the chances of the ovum and sperm meeting.
It is a temporary method and is effective only up to a maximum period of six months.
Periodic abstinence involves avoiding coitus from day 10 to 17 of the menstrual cycle.
This period is called the "fertile period" because the chances of fertilization are very high.
Withdrawal or coitus interruptus involves the male partner withdrawing the penis before ejaculation.
Lactational amenorrhea is based on the fact that ovulation does not occur during intense lactation.
Lactational amenorrhea is a highly reliable permanent method that works for up to three years after birth.
4.

Outline the role of Barrier Methods and Condoms.  

Barrier methods prevent the physical meeting of ovum and sperm with the help of barriers.
Condoms are barriers made of thin rubber/latex sheath used to cover the penis or vagina.
"Nirodh" is a popular brand of condoms for the male provided by the government.
Use of condoms provides the additional benefit of protecting the user from STIs and AIDS.
Diaphragms, cervical caps, and vaults are barriers made of rubber that are inserted into the male urethra.
Diaphragms, caps, and vaults are inserted into the female reproductive tract (cervix), not the male urethra).
These female barriers are reusable and act by blocking the entry of sperm through the cervix.
5.

Explain the function of Intrauterine Devices (IUDs).  

IUDs are devices inserted by doctors or expert nurses in the uterus through the vagina.
Non-medicated IUDs like Lippes loop increase the phagocytosis of sperm within the uterus.
Copper-releasing IUDs (CuT, Cu7) release copper ions that suppress sperm motility.
The copper ions also reduce the fertilizing capacity of the sperm.
Hormone-releasing IUDs (Progestasert, LNG-20) make the uterus unsuitable for implantation.
IUDs are the ideal contraceptive for females who want to increase their fertility immediately.
IUDs are for those who want to delay pregnancy or space children, not increase fertility.
6.

Discuss Oral Contraceptive Pills and "Saheli".  

Oral administration of small doses of progestogens or combinations is a popular contraceptive method.
They are used in the form of tablets and are hence popularly called "pills."
Pills inhibit ovulation and implantation as well as alter the quality of cervical mucus.
Saheli is a "once-a-week" pill, not a daily pill).
"Saheli" is a new oral contraceptive for females containing a non-steroidal preparation.
Saheli is a "daily pill" that must be taken every morning to be effective.
Saheli has very few side effects and a high contraceptive value.
7.

Detail the Surgical Methods of Sterilization.  

Surgical methods, also called sterilization, are generally advised as a terminal method.
These methods block gamete transport and thereby prevent conception.
In males, a small part of the vas deferens is removed or tied up through a small incision (Vasectomy).
Surgery does not stop gamete production or affect hormones; it only blocks their transport.
In females, a small part of the fallopian tube is removed or tied up (Tubectomy).
These techniques are highly effective, but their reversibility is very poor.
Sterilization surgery immediately changes the hormonal balance and stops the production of gametes.
8.

Explain Medical Termination of Pregnancy (MTP).  

MTP is the intentional or voluntary termination of pregnancy before full term.
Nearly 45 to 50 million MTPs are performed in a year all over the world.
MTP is not a method of birth control; it is for specific medical or emergency cases.
The Government of India legalized MTP in 1971 with strict conditions to avoid misuse.
MTPs are considered relatively safe during the first trimester (up to 12 weeks of pregnancy).
MTP is a legal and recommended method for regular birth control and population management.
It is used to get rid of unwanted pregnancies due to casual intercourse or failure of contraceptives.
9.

Discuss Sexually Transmitted Infections (STIs).  

Diseases or infections transmitted through sexual intercourse are collectively called STIs.
Common STIs include gonorrhea, syphilis, genital herpes, chlamydiasis, and HIV.
Hepatitis-B and HIV can also be transmitted by sharing injection needles or surgical instruments.
All STIs are completely curable if they are detected early and treated properly.
HIV, Hepatitis-B, and Genital herpes are not currently curable.
Except for HIV, hepatitis-B, and genital herpes, other diseases are completely curable.
Pelvic Inflammatory Diseases (PID), abortions, and stillbirths are complications of untreated STIs.
10.

Explain Assisted Reproductive Technologies (ART) like IVF and ZIFT.  

ART refers to special techniques used to help infertile couples have children.
In vitro fertilization (IVF) involves fertilization outside the body in laboratory conditions.
In the "test-tube baby" program, the zygote is transferred into the female's body (Embryo Transfer).
In ZIFT, the zygote is transferred into the fallopian tube, not the uterus.
ZIFT involves transferring a zygote or early embryo (up to 8 blastomeres) into the uterus.
IUT (Intra Uterine Transfer) involves transferring embryos with more than 8 blastomeres into the uterus.
GIFT involves the transfer of an ovum from a donor into the fallopian tube of another female.
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