Reproductive Health

Key Concepts

Definition and Significance

According to the World Health Organisation (WHO), reproductive health means a total well-being in all aspects of reproduction: physical, emotional, behavioural, and social. A reproductively healthy society consists of people with physically and functionally normal reproductive organs and healthy social interactions.

Reproductive Health – Problems and Strategies

• National Programmes: India was among the first to initiate 'family planning' in 1951. Currently, these are known as Reproductive and Child Health Care (RCH) programmes.
• Awareness: Creating awareness about reproduction, adolescence, safe sexual practices, and STIs through media and education.
• Amniocentesis: A fetal sex-determination test based on the chromosomal pattern in the amniotic fluid. It is legally banned in India to prevent female foeticide, though it is used medically to detect genetic disorders like Down syndrome.
• Saheli: A new non-steroidal oral contraceptive for females developed by CDRI, Lucknow.

Population Stabilisation and Birth Control

• Population Explosion: Improved health facilities and living conditions led to a rapid decline in death rate, MMR (Maternal Mortality Rate), and IMR (Infant Mortality Rate), causing a population surge.
• Contraceptive Methods:
  • Natural/Traditional: Periodic abstinence (avoiding coitus during days 10-17 of the cycle), withdrawal (coitus interruptus), and lactational amenorrhea.
  • Barrier: Condoms (also protect against STIs/AIDS), diaphragms, cervical caps, and vaults.
  • Intra Uterine Devices (IUDs):
    • Non-medicated (Lippes loop).
    • Copper-releasing (CuT, Cu7, Multiload 375) - Cu ions suppress sperm motility.
    • Hormone-releasing (Progestasert, LNG-20).
  • Oral Contraceptives: 'Pills' containing progestogens or progestogen-estrogen combinations.
  • Injections and Implants: Long-term hormonal protection under the skin.
  • Surgical Methods (Sterilisation): Vasectomy in males (tying/removing part of vas deferens) and Tubectomy in females (tying/removing part of fallopian tube).

Medical Termination of Pregnancy (MTP)

• Voluntary termination of pregnancy before full term.
• Legalised in India in 1971 with strict conditions.
• Relatively safe during the first trimester (up to 12 weeks).
• MTP Amendment Act (2017): Allows termination based on medical opinion to reduce illegal abortions and maternal mortality.

Sexually Transmitted Infections (STIs)

• Diseases transmitted through sexual intercourse (also called Venereal Diseases or RTIs).
• Examples: Gonorrhoea, syphilis, genital herpes, chlamydiasis, hepatitis-B, HIV/AIDS.
• Prevention: Avoid sex with unknown/multiple partners, use condoms, and seek early medical detection.

Infertility

Inability to produce children even after 2 years of unprotected sexual cohabitation.

• Assisted Reproductive Technologies (ART):
  • IVF (In Vitro Fertilisation): Fertilisation outside the body, followed by Embryo Transfer (ET).
  • ZIFT (Zygote Intra Fallopian Transfer): Transfer of zygote (up to 8 blastomeres) into the fallopian tube.
  • IUT (Intra Uterine Transfer): Transfer of embryo (more than 8 blastomeres) into the uterus.
  • GIFT (Gamete Intra Fallopian Transfer): Transfer of ovum from a donor into the fallopian tube of another female.
  • ICSI (Intra Cytoplasmic Sperm Injection): Sperm is directly injected into the ovum.
  • AI (Artificial Insemination): Semen from husband/donor is introduced into the vagina or uterus (IUI).
• Adoption: A legal and noble method for attaining parenthood.