Reproductive Health

Learning Outcomes

1. Understanding reproductive health and its broader implications.
2. Exploring the challenges and strategies to promote reproductive well-being.
3. Identifying methods of population control and the role of birth control.
4. Learning about medical termination of pregnancy (MTP) and its regulations.
5. Recognizing sexually transmitted infections (STIs) and their prevention.
6. Gaining insights into infertility and assisted reproductive technologies (ART).

Reproductive health encompasses the complete well-being in all aspects of reproduction—physical, emotional, behavioral, and social. India, one of the pioneers in initiating reproductive health programs, has actively promoted awareness and healthcare services through various strategies. These strategies target improved reproductive health, birth control measures, and address issues like sexually transmitted diseases (STIs) and infertility. Let’s delve deeper into these areas.

Reproductive Health: Problems and Strategies

India’s national efforts to achieve reproductive health started early with family planning programs in 1951. These were designed to foster a healthy and reproductive society, aiming to enhance awareness and provide facilities that support individuals and families. Over the decades, these programs evolved, culminating in the Reproductive and Child Health Care (RCH) programs, which are more holistic and widespread today.

Key strategies for promoting reproductive health are:

1. Awareness Creation: Through the use of print, television, and other media, both governmental and non-governmental organizations have made significant efforts to educate the public on reproductive health. It is crucial to combat myths and misconceptions about sex and related issues. Teaching sex education in schools is another significant initiative aimed at helping young people develop a healthy understanding of their bodies, safe sexual practices, and awareness about sexually transmitted diseases (STIs).
2. Health Education: There’s a focus on educating fertile couples about birth control methods and the importance of caring for pregnant mothers and their children. Equally important is providing guidance on safe sexual practices, postnatal care, breastfeeding, and ensuring equal opportunities for both boys and girls.
3. Infrastructural Development: To implement effective action plans, there is a need for strong infrastructure, professional expertise, and material support. This is particularly crucial in offering medical assistance related to pregnancy, delivery, abortions, STDs, and infertility. Continuous advancements in reproductive health techniques and strategies are required to enhance care and support services.
4. Legislative Actions: Legislation such as the ban on amniocentesis for sex determination has been enacted to curb the practice of female foeticide. Massive child immunization and other initiatives have been undertaken as well to improve societal health standards.

Important Note
Amniocentesis is a diagnostic technique where a sample of the amniotic fluid from a developing fetus is taken to detect genetic disorders like Down syndrome, sickle-cell anemia, and others.

5. Research and Innovation: Government agencies have supported research in reproductive health. For example, India developed ‘Saheli,’ an oral contraceptive for women that offers a once-a-week dosage with minimal side effects. This was developed by the Central Drug Research Institute (CDRI) in Lucknow.

India’s achievements in reproductive health include a reduction in maternal and infant mortality rates, increased awareness of STIs, and improved healthcare infrastructure, which collectively signify the country’s progress.

Population Explosion and Birth Control

With advancements in healthcare and living conditions, the population has exploded over the last century. India’s population, which was around 350 million at the time of independence, reached 1.2 billion by 2011. This growth, attributed to a decline in death rates, infant mortality rates, and an increase in the reproductive age group, poses significant challenges.

To address this issue, the government has taken several measures:

1. Promoting Smaller Families: Encouraging families to have only two children is critical, exemplified by the popular slogan Hum Do, Hamare Do (We two, our two). Many young, urban couples have also embraced the ‘one-child norm’.
2. Contraceptive Methods: A wide range of contraceptive options is available, which fall into various categories:

• Natural Methods: These include periodic abstinence, where couples avoid coitus during the fertile period of a woman’s menstrual cycle (days 10-17), and withdrawal (coitus interruptus) where the male partner withdraws before ejaculation. Another method is lactational amenorrhea, where ovulation is naturally suppressed during breastfeeding, though this is only effective for about six months post-partum.
• Barrier Methods: This method prevents sperm and ovum from meeting. Condoms are the most common barrier method, available for both men and women, and also help prevent STIs like AIDS. Diaphragms and cervical caps are other barrier devices that block sperm from entering the cervix.
• Intrauterine Devices (IUDs): IUDs are small devices inserted into the uterus. They are categorized into non-medicated IUDs (Lippes loop), copper-releasing IUDs (Copper T, Cu-7, Multiload 375), and hormone-releasing IUDs (Progestasert, LNG-20). Copper IUDs inhibit sperm mobility, while hormone IUDs make the uterus unsuitable for implantation.
• Oral Contraceptives (Pills): These are a combination of progestogens or progestogen-estrogen combinations. Pills are effective in inhibiting ovulation and preventing fertilization. Saheli is an example of a weekly oral contraceptive developed in India.

1. Surgical Methods (Sterilization): Vasectomy for males involves removing or tying a portion of the vas deferens, while tubectomy for females involves tying the fallopian tubes. These procedures are highly effective but are usually irreversible.

Important Note
Contraceptive Use: It is essential to consult a qualified medical professional when selecting a contraceptive method. While they are effective in controlling population growth, contraceptives can also have side effects, such as nausea, abdominal pain, and menstrual irregularities.

Medical Termination of Pregnancy (MTP)

Medical Termination of Pregnancy (MTP), commonly known as abortion, refers to the intentional termination of a pregnancy before it reaches full term. In India, MTP was legalized in 1971, with restrictions to prevent misuse, particularly for illegal female foeticide.

1. Reasons for MTP: MTP is performed for several reasons, including unwanted pregnancies, such as those resulting from unprotected intercourse, rape, or failed contraceptive measures. MTP is also essential in cases where continuing the pregnancy may endanger the life of the mother or fetus.
2. Safety of MTP: MTP is relatively safe during the first trimester (up to 12 weeks). Abortions in the second trimester are much riskier and less common. The government has imposed strict regulations to curb illegal and unsafe abortions performed by unqualified individuals.

Important Note
Misuse of Amniocentesis: In India, the misuse of amniocentesis for determining the sex of the fetus has often led to female foeticides, which is illegal.

Sexually Transmitted Infections (STIs)

Sexually Transmitted Infections (STIs), also known as venereal diseases (VDs) or reproductive tract infections (RTIs), are diseases that are transmitted through sexual contact. Common STIs include gonorrhea, syphilis, genital herpes, chlamydia, genital warts, trichomoniasis, and hepatitis-B. HIV, which leads to AIDS, is one of the most dangerous and widely discussed STIs.

1. Transmission: In addition to sexual contact, infections like hepatitis-B and HIV can also be transmitted through the sharing of needles, surgical instruments, transfusion of infected blood, and from mother to fetus.
2. Symptoms and Treatment: Early symptoms include itching, discharge, and pain in the genital area. Females may be asymptomatic, leading to delayed diagnosis and treatment, which can result in complications like pelvic inflammatory disease (PID), infertility, or cancer.

Important Note
Prevention: STIs can be avoided by limiting sexual partners, using condoms, and seeking medical help at the first sign of infection.

Infertility

Infertility is defined as the inability to conceive or produce children even after two years of unprotected sexual cohabitation. Infertility can be due to several factors, including physical, congenital, immunological, or psychological reasons. Often, in India, women are blamed for infertility, although men may be equally responsible.

To assist infertile couples, several assisted reproductive technologies (ART) are available:

1. In Vitro Fertilization (IVF): IVF involves fertilizing the egg outside the body, followed by the transfer of the embryo into the uterus (known as test-tube baby program). The zygote or early embryos can be transferred into the fallopian tube (ZIFT) or uterus (IUT) for further development.
2. Gamete Intra-Fallopian Transfer (GIFT): In this method, an ovum is collected from a donor and placed into the fallopian tube of a female who cannot produce one.
3. Intra-Cytoplasmic Sperm Injection (ICSI): ICSI involves directly injecting a sperm into the ovum to form an embryo, often used for male infertility.
4. Artificial Insemination (AI): AI involves introducing sperm from either the husband or a donor into the vagina or uterus to facilitate fertilization.

Important Note
Adoption: Adoption is a legal option in India and remains one of the best solutions for couples who wish to become parents but face challenges with ART.

MCQ
Which of the following is not a method of contraception?
A. Copper T
B. Oral Pills
C. Amniocentesis
D. Condoms
Answer: C