Reproductive Health

• WHO (World Health Organisation): Reproductive health means total well being i.e. physical, emotional, behavioural and social.
• Reproductively healthy: People having physically and functionally normal reproductive organs and normal emotional and behavioral interaction among them in all aspects.

Reproductive Health:

• India is amongst first countries to initiate action plans and programmes to attain total reproductive health as social goal- Family planning (1951)
• Other programmes: Reproductive and Child Health Care (RCH).
• Amniocentesis: Amniotic fluid of developing foetus is taken to analyse fetal cells to test presence of genetic disorder- down syndrome, haemophilia, sickle cell anemia etc. But its used for sex-determination which is increasing female foeticides.
• Improved reproductive society: Increased no. of medically assisted deliveries, better post natal care, decreased infant and maternal mortality rate, increased no. of couples with small families, better detection and cure for STD’s.

Population Stabilisation and Birth Control:

• World population: 2 billion in 1900 to 6 billion in 2000 to 7.2 billion in 2011.
• India population: 350 million in 1947 to 1 billion in 2000 to 1.2 billion in May 2011.
• Its due to decline in death rate, maternal mortality rate and infant mortality rate.
• According to 2011 census, population growth rate was less than 2% i.e. alarming growth rate which would lead to scarcity of even basic requirements.
• Steps to overcome: Raising of marriageable age of female to 18 years and male to 21 years and advertisement of ‘Hum Do Humare Do’.

Contraceptives:

• Should be user friendly, easily available, effective, reversible, no or least side effects.

1. Natural Method: Avoid chances of ovum and sperm meeting.

(a) Periodic Abstinence: Couples avoid coitus from day 10 to 17 of menstrual cycle (when ovulation is expected). This period is fertile period.

(b) Withdrawal/Coitus interrupts: Male partner withdraws penis from vagina before ejaculation to avoid insemination.

(c) Lactational amenorrhea: Menstrual cycle don’t occur during intense lactation, so chances of conception are almost nil but its effective upto 6 months following parturition.

• Nil side effects but high chances of failure.

2. Barrier Method: Ovum and sperm are prevented from meeting by help of barriers, available for both male and female.

(a)   Condoms: Made of thin rubber later sheath, protects user from STIS and AIDS.

• Cover penis in males or vagina and cervix in females just before coitus to prevent conception.
• ‘Nirodh’: Popular brand of condom for males.

• These are disposable and can be self inserted so gives privacy to user.

(b)   Diaphragms, cervical caps and vaults: Made of rubber, reusable.

• Inserted in female reproductive tract to cover cervix during coitus.

• Block entry of sperm through cervix.

(c)   Spermicidal creams, jellies and foams

3. Intra Uterine Devices (IUDs): Most widely accepted method.

• Inserted by doctors in uterus through vagina.

(a) Non-medicated IUDs: eg. Lippes loop.

(b) Copper releasing IUDs: eg. CuT, Cu 7, Multiload 375 increase phagocytosis of sperm within uterus, suppress sperm motility and fertilising capacity of sperms.

(c) Hormone releasing IUDs: eg. Progestasert, LNG-20 make uterus unsuitable for implantation and cervix hostile to sperms.

• They are ideal contraceptives to delay pregnancy.

4. Oral Contraceptives: Used in form of tablets so, also called pills.

• Small doses of either progestrone or progestrone-estrogen combination.
• Inhibit ovulation, implantation and alter quality of cervical mucus.
• Very effective with less side effects.
• Taken daily for 21 days starting within first five days of menstrual cycle.
• After 7 days of menstruation, its repeated till female desires to prevent conception.
• Saheli: Oral contraceptive, non-steroidal preparation, few side effects.
• also called ‘Once a week’ pill.
• developed at Central Drug Research Institute (CDRI), Lucknow.

5. Injectables and Implants: Similar to pills but longer effective period.

• Have only progestrone or combination of progestrone and estrogen.
• Very effective as emergency contraceptives to avoid pregnancies due to rape or unprotected intercourse by administration of progestrons or progestrone-estrogen within 72 hours of coitus.

6. Surgical Methods: Also Sterilisation, terminal method.

• Block gamete transport to prevent pregnancy.
• Highly effective but poor reversibility.

(a)   Vasectomy: In males.

• Small part of vas deferens is removed or tied up through small incision on scrotum.

(b)   Tubectomy: In females.

• Small part of fallopian tube is removed or tied up through small incision in abdomen.

III effects of contraceptives:

• Nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding, breast cancer.
• They are not regular requirements.

Medical Termination of Pregnancy (MTP): Induced abortion.

• 45-50 million MTP in a year all over world are performed which is 1/ 5th of total conceived pregnancies.
• Legalised in 1971 in India.
• It is performed to get rid of unwanted pregnancies due to casual unprotected intercourse, rape, when continuation of pregnancy is fatal for mother or foetus.
• Safe during first trimester but risky in second trimester.
• Sometimes its performed by unqualified quacks and also misuse of amniocentesis occur (female foeticide).

Sexually Transmitted Infections (STls): Infections transmitted through sexual intercourse, also venereal diseases (VD) or reproductive tract infections (RTI).

• eg. Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B, HIV (most dangerous).
• Except for hepatitis B, genital herpes and HIV all are completely curable in early stage.
• Hepatitis B and HIV can be transmitted by sharing needles, surgical instruments etc. with affected person.
• Early symptoms: Itching, fluid discharge, slight pain, swelling etc. in genital region.
• Infected female may often be asymptomatic and remain undetected for long. It can lead to complications like pelvic inflammatory diseases (PID), abortion, still birth, ectopic pregnancies, infertility or cancer.
• High among age group 15-24 years.
• To avoid STIS: Avoid sex with unknown partners, use condoms during coitus, in case of doubt contact qualified doctor for early detection and treatment.
• Infertility: Unable to produce children inspite of unprotected sexual co-habitation.
• Can be due to physical, congenital diseases, drugs, immunological etc.
• Mostly in males.
• They are assisted to have children through special technique- assisted reproductive techniques (ART).

1. In vitro fertilisation (IVF) followed by embryo transfer:

• Test tube baby programme: Ova from wife/donor and sperm from husband/donor are collected and induced to form zygote, under suitable conditions.
• Zygote/early embryo upto 8 blastomeres is transferred into fallopian tube - Zygote intra fallopian transfer (ZIFT)
• Embryo with more than 8 blastomeres is transferred into uterus - intra uterine transfer (IUT).
• They assist females who can’t conceive.

2. Gamete Intra Fallopian Transfer (GIFT): Transfer of ovum from donor into fallopian tube of another female who can’t produce ovum but can provide suitable condition for fertilisation and further development.

3. Intra Cytoplasm Sperm injection (ICSI): Sperm is directly injected into ovum.

4. Artificial insemination: Semen collected either from husband or donor is introduced in vaginal uterus artificially-Intra uterine Insemination (IUI), due to inability of male partner to inseminate or due to very low sperm counts in ejaculates.