Unit 1: Reproduction - Chapter 3: Reproductive Health

1.3 Reproductive Health

Definition, Importance, RCH Programs

Reproductive Health refers to a state of complete physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. It implies that people are able to have a responsible, satisfying, and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so.

Importance of Reproductive Health:

Responsible Parenthood: Enables individuals to make informed decisions about family size and spacing of children.
Prevention of STDs: Reduces the incidence of sexually transmitted diseases.
Maternal and Child Health: Improves the health of mothers and children, reducing maternal and infant mortality rates.
Population Control: Helps in managing population growth.
Awareness: Promotes awareness about reproductive organs, adolescence, safe and hygienic sexual practices.

Reproductive and Child Health (RCH) Programs:

Initiated by the Government of India in 1951 (Family Planning Programs).
Aim to create awareness among people about various aspects of reproductive health and provide facilities and support for building a reproductively healthy society.
Key Objectives:
- Creating awareness about reproductive health.
- Providing support for safe and hygienic sexual practices.
- Offering facilities for birth control.
- Managing and preventing STDs.
- Providing care for pregnant mothers and children.

Population Explosion and Control Measures

Population Explosion: The rapid and alarming increase in the human population, particularly after the mid-20th century, due to a sharp decline in death rates (improved healthcare, sanitation) and a relatively high birth rate.

Consequences: Scarcity of resources (food, water, housing), increased poverty, unemployment, environmental degradation.

Control Measures:

Motivational Measures:
- Small Family Norms: Promoting the idea of smaller families (e.g., "Hum Do Hamare Do" slogan).
- Incentives: Providing incentives to couples with smaller families.
- Raising Marriageable Age: Legally raising the marriageable age for females to 18 years and for males to 21 years.
- Education: Educating people, especially women, about the benefits of small families and family planning methods.
Contraceptive Methods: (Discussed in detail below)

Contraception: Natural, Artificial

Contraception refers to methods used to prevent unwanted pregnancies. An ideal contraceptive should be user-friendly, easily available, effective, reversible with no or minimal side effects, and should not interfere with sexual drive.

1. Natural Methods (Barrier-free, no medicines/devices)

Periodic Abstinence (Rhythm Method): Avoiding coitus from day 10 to 17 of the menstrual cycle when ovulation is expected. High chances of failure.
Coitus Interruptus (Withdrawal Method): Male withdraws penis from vagina just before ejaculation to prevent insemination. High chances of failure.
Lactational Amenorrhea: Absence of menstruation during intense lactation (after parturition). Prevents conception for up to six months due to high prolactin levels suppressing ovulation. Effective only if the mother breastfeeds fully and exclusively.

2. Artificial Methods

a. Barrier Methods: Prevent physical meeting of sperm and ovum.
- Condoms: Thin rubber/latex sheaths used to cover the penis (male condom) or line the vagina/cervix (female condom). Prevent deposition of semen in the vagina. Also protect against STDs.
- Diaphragms, Cervical Caps, Volts: Reusable rubber barriers inserted into the female reproductive tract to cover the cervix during coitus. Used with spermicidal creams/jellies.
b. Intrauterine Devices (IUDs): Devices inserted by doctors into the uterus.
- Non-medicated IUDs: (e.g., Lippes Loop) Increase phagocytosis of sperm within the uterus.
- Copper-releasing IUDs: (e.g., CuT, Cu7, Multiload 375) Release copper 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.
c. Oral Contraceptives (Pills):
- Combined Pills: Contain progestogen and estrogen combination. Taken daily for 21 days, starting within the first 5 days of the menstrual cycle, followed by a 7-day gap.
- Progestogen-only Pills (Mini-pills): Contain only progestogen.
- Mechanism: Inhibit ovulation and implantation, and alter the quality of cervical mucus to prevent sperm entry.
- Saheli: A new oral contraceptive for females, developed by CDRI, Lucknow. It is a non-steroidal preparation, taken once a week, with very few side effects.
d. Implants: Progestogen or progestogen-estrogen combinations inserted under the skin. Effective for longer periods.
e. Surgical Methods (Sterilization): Terminal methods, highly effective, but irreversible.
- Vasectomy (Male Sterilization): A small part of the vas deferens is cut or tied up, preventing sperm from reaching the urethra.
- Tubectomy (Female Sterilization): A small part of the fallopian tube is cut or tied up, preventing the ovum from reaching the uterus and preventing sperm from reaching the ovum.

Medical Termination of Pregnancy (MTP): Definition, Reasons

Medical Termination of Pregnancy (MTP) or induced abortion is the intentional or voluntary termination of pregnancy before full term.

Legal Status: Legalized in India in 1971 with strict conditions to prevent its misuse.
Reasons for MTP:
- Unwanted Pregnancies: Due to unprotected intercourse, failure of contraceptives, or rape.
- Risk to Mother's Life: If continuation of pregnancy is dangerous to the mother's physical or mental health.
- Fetal Abnormalities: If the fetus is diagnosed with severe abnormalities that would lead to a handicapped child.
Safety: MTPs are relatively safe during the first trimester (up to 12 weeks of pregnancy). Second-trimester abortions are riskier.
Misuse: MTP is often misused for illegal female foeticide, which is illegal and punishable.

Sexually Transmitted Diseases (STDs): Types, Symptoms, Prevention

Sexually Transmitted Diseases (STDs), also known as Venereal Diseases (VD) or Reproductive Tract Infections (RTI), are infections that are primarily transmitted through sexual contact.

Common STDs:
- Bacterial: Syphilis (Treponema pallidum), Gonorrhoea (Neisseria gonorrhoeae), Chlamydiasis (Chlamydia trachomatis).
- Viral: Genital Herpes (Herpes Simplex Virus - HSV), Genital Warts (Human Papillomavirus - HPV), Hepatitis B (Hepatitis B Virus - HBV), AIDS (HIV).
- Protozoal: Trichomoniasis (Trichomonas vaginalis).
Symptoms:
- Early symptoms are often minor and may include itching, fluid discharge, slight pain, swellings, etc., in the genital region.
- Many infected persons may be asymptomatic, especially females, leading to delayed detection and complications.
- Complications (if untreated): Pelvic inflammatory diseases (PID), abortions, stillbirths, ectopic pregnancies, infertility, cancer of the reproductive tract.
Prevention:
- Avoid Sex with Unknown Partners/Multiple Partners: Practice monogamy.
- Use Condoms: During coitus.
- Avoid Sharing Needles: Especially for drug users.
- Avoid Sharing Razors/Toothbrushes: If contaminated with blood.
- Early Detection and Treatment: Consult a qualified doctor for early diagnosis and complete treatment.
- Awareness: Educate people about STDs and their prevention.

Amniocentesis

Amniocentesis is a fetal sex determination and disorder detection test based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo.

Procedure: A small amount of amniotic fluid is withdrawn from the uterus of a pregnant woman. Fetal cells present in the fluid are cultured, and their chromosomes are analyzed.
Purpose:
- Detection of Chromosomal Abnormalities: (e.g., Down's syndrome, Klinefelter's syndrome, Turner's syndrome).
- Detection of Genetic Disorders: (e.g., haemophilia, sickle-cell anemia, cystic fibrosis).
Misuse: Often misused for illegal female foeticide, leading to a ban on sex determination tests in India.

Infertility and Assisted Reproductive Technologies (ART)

Infertility is the inability to conceive or produce children even after 1-2 years of unprotected sexual cohabitation. The causes can be in male or female partners, or both.

Assisted Reproductive Technologies (ART): Techniques used to help infertile couples have children.

In Vitro Fertilization (IVF) - Test-tube Baby Program:
- Definition: Fertilization of ovum by sperm outside the body, in a laboratory setting.
- Application: For females who cannot conceive due to blocked fallopian tubes or males with low sperm count.
- Process: Ova are collected from the female and sperm from the male. Fertilization is induced in vitro. The zygote or early embryo (up to 8 blastomeres) is then transferred.
Embryo Transfer (ET):
- Zygote Intrafallopian Transfer (ZIFT): Transfer of zygote or early embryo (up to 8 blastomeres) into the fallopian tube.
- Intra Uterine Transfer (IUT): Transfer of embryo with more than 8 blastomeres into the uterus.
Gamete Intrafallopian Transfer (GIFT):
- Definition: Transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce ova but can provide a suitable environment for fertilization and development.
- Application: For females who cannot produce ova.
Intracytoplasmic Sperm Injection (ICSI):
- Definition: A specialized procedure to form an embryo in the laboratory in which a sperm is directly injected into the ovum.
- Application: For males with very low sperm count or inability to fertilize the ovum.
Artificial Insemination (AI):
- Definition: Semen collected from the husband or a healthy donor is artificially introduced into the vagina or uterus of the female.
- Application: For males with very low sperm count or inability to inseminate the female.
- Intra Uterine Insemination (IUI): Semen is directly injected into the uterus.

These technologies have provided hope for many infertile couples to have children. However, they are expensive and require specialized medical professionals and facilities.

Reproductive Health

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