REPRODUCTIVE HEALTH
CLASS 12
According to world Health Organisation (WHO) reproductive health means total well – being in all
aspects of reproduction, i.e physical, emotional, behavioural and social.
There , a society with people having physically and functionally normal reproductive organs and
normal emotional and behavioural interactions among them in all sex related aspects might be
called reproductively healthy.
REPRODUCTIVE HEALTH – PROBLEMS AND STRATEGIES
India initiated many action plans and programmes like ‘family planning’ (1951) at national level to
attain total reproductive health.
Current , Reproductive and Child Healthcare (RCH) programmes are under operation. RCH is an
initiative to create awareness among the people about reproduction related aspects and providng
facilities and support for building up a reproductive healthy society.
Introduction of sex education in schools is also being encouraged to provide right information to the
young, so as to discourage children from believes in myth and misconception about sex – related
aspects.
Proper information about reproductive organs, adolescene and related changes, safe and hygienic
sexual practices and sexually Transmitted Diseases (STDs) , it would help people to lead a
reproductively healthy life.
Successful implementation of various action plans have improved reproductive health as indicated
by better awareness about sex related matters, increased number of medically assisted deliveries,
better detection and cure of STDs , statutory ban on amniocentesis and overall increased medical
facilities for all reproduction related problems.
POPULATION STABILISATION AND BIRTH CONTROL
Increased health facilities, rapid decline in death rate , Maternal Mortality Rate (MMR) and Infant
Mortality Rate (IMR) as well as an increase in number of people in reproducible age and better living
conditions had an explosive impact on the growth of population. This population explosion could
lead to the scarcity of even basic requirements like food, shelter, etc.
The population growth can be controlled by motivating small families, by using various
contraceptive methods. Statutory raising of marriageable age of the female to 18 years and male to
21 years and incentives given to couples with small families are two other methods to tackle
population growth.
An ideal contraceptive should be user – friendly easily available, effective, reversible with no or least
side effects . It should also in no way interfere with sexual desire and sexual act of the user.
Contraceptive methods could be divided into following categories.
1. NATURAL METHODS
It works on the principle of avoiding chances of ovum and sperm meeting .It includes
o Periodic abstinence in which couples avoid coitus from day 10 to 17 of menstrual cycle, as
chances of fertilisation are very high during this period.
o Withdrawal or Coitus interruptus in which male partner withdraws penis from vagina just
before ejaculation to avoid insemination.
o Lactational amenorrhea method includes the absence of menstruation after parturition and
due intense lactation and no ovulation in this period, chances of fertilization is nil.
2. BARRIER METHODS
In this , ovum and sperms are prevented from physical meeting with the help of barriers. These
include
o Condoms are barriers made up of rubber or latex sheath used to cover the penis in the male or
vagina and cervix in the female. They also prevent from STDs.
o Diaphragm, cervical caps and vaults are barriers made of rubber that are inserted into the
female reproductive tract to cover the cervix during coitus.
o Spermicidal creams, jellies and foam are usually used along with these to increase their
contraceptive efficiency These help to kill the sperms.
3. INTRA UTERINE DEVICES (IUDs)
o These are inserted by doctor or trained nurse into the female uterus through vagina. IUDs may
be non –medicated ([Link] loop), copper releasing (Cu – T, Cu – 7 Multiload - 375 ) and
the hormone releasing (Progestasert, LNG - 20).
o These IUDs increase phagocytosis of sperms within the uterus, suppress the fertilising capacity
and motility of sperms and make the uterus unsuitable for implantation and the cervix hostile
to the sperms.
4. ORAL PILLS
o These are progesterone or progesterone – oestrogen combination used by females in the
form of tablets and hence popularly called the pills.
o They inhibit ovulation and implantation as well as change the quality of cervical mucus to
prevent / retard entry of sperms. For example, saheli, developed by scientists at Central Drug
Research Institute (CDRI) Lucknow, India, is once a week pill with non – steroidal
preparation.
o Administration of pills within 72 hours of coitus is found to be very effective as emergency
contraceptives.
5. INJECTABLE AND IMPLANTS
o These are the methods in which progesterone alone or in combination with oestrogen can
be used by females under the skin.
o Such injectables and implants are functionally similar to pills and their effective period is
much longer.
6. SURGICAL METHODS
It is also called sterilization. These are used as terminal method of contraception in male and female
to prevent any more pregnancy by blocking gamete transport.
These include.
o Vasectomy is the surgical method in male , a small part of the vas deferens is removed or tied
up through a small incision on the scrotum to prevent release of sperms.
o Tubectomy is the surgical method in females in which small part of fallopian tube is removed
surgically. These techniques are highly effective but poorly reversible.
MEDICAL TERMINATION OF PREGNANCY (MTP)
An intentional or voluntary termination of pregnancy before full term or before the foetus
becomes viable is called Medical Termination of Pregnancy (MTP) or induced abortion.
Nearly 45 to 50 million, MTPs are performed in a year all over the world which accounts to 1/5th
of the total number of conceived pregnancies in a year.
Government of India legalised MTP in 1971 with some strict conditions to avoid its misuse,
especially to check indiscriminate and illegal female foeticides , which are reported to be high in
India.
The medical Termination of Pregnancy (Amendment)Act, 2017 was enacted by the government
of India with the intension of reducing the incidence of illegal absortion 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 on 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 exist.
The grounds for such termination of pregnancies are
o The continuation of the pregnancy would involve a risk to the life of the pregnant woman or
of grave injury physical or mental health.
o 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 INFECTION (STIs)
Disease which are transmitted through sexual intercourse are called sexually Transmitted
Infections (STIs) or Veneral Diseases (VDs) or Reproductive Tract Infections (RTIs).
Genital herpes, syphilis, gonorrhoea , chlamydiasis, genital warts, hepatitis –B and AIDS
(caused by HIV) are some common STIs.
STIs like hepatitis – B HIV can also be transmitted by the following
o Sharing of contaminated injection needles , surgical instrument , etc, with infected persons.
o Transfusion of blood.
o From infected mother to foetus.
Except for hepatitis – B, genital herpes and HIV infections , all other disease are completely
curable, if detected early and treated properly.
The early symptoms of STIs are minor and include itching, fluid discharge, slight pain, swelling
etc., in the genital region.
Infected females may often be asymptomatic and hence amy remain undected for long.
The patients remain undetected due to the following reasons
o The absence or less significant symptoms in early stages of infection
o Social stigma attached to the STIs.
o The late detection leads to complications like pelvic inflammatory Disease (PIDs),
abortions, still births ectopic pregnancies , infertility or even cancer of the reproductive
tract.
o One should not panic because prevention from STIs is possible and one could be free of these
infections , by following these simple principles as given below.
(i) Avoid sex with unknown/ multiple partners.
(ii) Always use condoms during coitus.
(iii) In case of doubt , consult a doctor as early as possible for early detection and get
completely treated if diagnosed with disease.
INFERTILITY
Couples who are not able to produce children inspite of unprotected sex are considered infertile .
The reason for this could be many physical , congenital diseases, drugs or even psychological.
Various methods are now available to help such couples. These techniques are together called
Assited Reproductive Technologies (ARTs).
In Vitro Fertilisation (IVF) is the fertilization outside the body followed by embryo transfer, which
is commonly called test tube baby programme.
o The zygote or early embryo (upto 8 blastomeres) could be transferred intofallopian tube called
ZIFT (Zygote intra fallopian Transfer) and embryo with more than 8 blastomeres into the the
uterus called IUT (Intra Uterine Transfer) to complete its further development.
Embryos formed by in vivo fertilization (fertilization within the female body)also could be used for
such transfer to assist those females who cannot conceive.
o GIFT (Gamete Intra Fallopian Transfer) is the transfer of gametes collected froma donor into
Fallopian tube of another female who do not produce Ovum.
o ICSI (Intra Cytoplasmic Sperm Injection) is specialized procedure to form an embryo in
laboratory in which sperm is directly injected into the ovum.
o Artificial Insemination (AI) used in the infertility cases in which male partner is unable to
inseminate the female or have a very low sperm counts (azospermia) in the ejaculates. In this
technique, semen collected from donor is artificially introduced into the vagina or uterus of the
femal by IUI (Intra Uterine Insemination).
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