BIOLOGY

CHAPTER 3
REPRODUCTIVE HEALTH
NOTES:
INTRODUCTION:
 Reproductive health refers to having healthy reproductive organs with
normal functions.

 The concept also includes emotional and social aspects of reproduction.

 According to the World Health Organisation (WHO), reproductive health is

total well-being in all aspects of reproduction:

 Physical
 Emotional
 Behavioral
 Social

 A reproductively healthy society consists of:

 Individuals with physically and functionally normal reproductive organs

 People with normal emotional and behavioural interactions in all sex-related
matters

REPRODUCTIVE HEALTH – PROBLEMS AND STRATEGIES:

India’s Efforts in Promoting Reproductive Health:

 India was among the first countries to start national-level action plans for
reproductive health.
  Family planning programmes began in 1951 and have been periodically
assessed.
 Currently, broader programmes called Reproductive and Child Health Care
(RCH) are in operation.

Key Goals and Activities under RCH Programmes:

 Creating awareness on reproduction-related topics.

 Providing facilities and support to build a reproductively healthy society.
 Awareness campaigns use audio-visual and print media.
 Governmental and non-governmental agencies play major roles.

Role of Family and Education:

 Parents, relatives, teachers, and friends help spread correct information.

 Sex education in schools is important to:
o Provide accurate information.
o Dispel myths and misconceptions.

Topics to Be Covered in Awareness Programmes:

 Structure and function of reproductive organs.

 Adolescence and related changes.
 Safe and hygienic sexual practices.
 Sexually transmitted diseases (STDs) and AIDS.
 Birth control options.
 Pregnancy care and post-natal care for mother and child.
 Importance of breastfeeding.
 Gender equality (equal opportunities for boys and girls).

Addressing Social Issues:

  Awareness about:
o Uncontrolled population growth.
o Sexual abuse and sex-related crimes.
 Encourage people to take steps to build a socially responsible society.

Requirements for Successful Implementation:

 Strong infrastructure, professional expertise, and material support.

 Necessary to treat issues like:
o Pregnancy, delivery, STDs, abortions, contraception.
o Menstrual problems and infertility.

Advanced Measures:

 Use of better techniques and new strategies over time.

 Statutory ban on amniocentesis for sex determination to reduce female
foeticide.

Amniocentesis Details:

 Involves collecting amniotic fluid to test fetal cells and dissolved substances.
 Used to detect genetic disorders like:
o Down syndrome
o Hemophilia
o Sickle-cell anemia
 Also used to assess foetal survivability.

Research and Innovations:

 Ongoing research is encouraged and supported by both government and

NGOs.
  Example: ‘Saheli’, a non-steroidal oral contraceptive for females, was
developed by CDRI, Lucknow.

Indicators of Improved Reproductive Health:

 Better sex-related awareness.

 Increase in medically assisted deliveries.
 Better post-natal care.
 Decreased maternal and infant mortality.
 More small families.
 Improved STD detection and treatment.
 Enhanced medical care for sex-related issues.

POPULATION STABILISATION AND BIRTH CONTROL:

📈 Population Growth and Its Impact:

 Quality of life improved in the last century due to all-round development.

 Better health and living conditions led to explosive population growth.
 World population:
o ~2 billion in 1900 → ~6 billion by 2000 → 7.2 billion in 2011.
 India’s population:
o ~350 million in 1947 → ~1 billion by 2000 → 1.2 billion by 2011.
 Main causes:
o Decline in death rate, maternal mortality rate (MMR), infant mortality
rate (IMR).
o Increase in reproductive-age population.

Efforts to Control Population Growth:

  Reproductive and Child Health (RCH) programme helped slow growth, but
only marginally.
 2011 Census: Growth rate ~2% (20/1000/year), still high.
 Risks of high growth:
o Scarcity of food, shelter, clothing despite progress.

Government Measures:

 Promote smaller families through contraceptive methods.

 Popular slogan: Hum Do Hamare Do (We two, our two).
 Some couples adopt one-child norm.
 Other steps:
o Raise marriage age (Females: 18 years, Males: 21 years).
o Incentives for small families.

Characteristics of an Ideal Contraceptive:

 User-friendly, available, effective, reversible.

 No/least side effects.
 No interference with sexual activity.

Types of Contraceptive Methods

1. Natural/Traditional Methods:

 Goal: Prevent meeting of ovum and sperm.

 Examples:
o Periodic abstinence (avoid coitus from day 10–17 of menstrual
cycle).
o Withdrawal method (coitus interruptus).
 o Lactational amenorrhea (no ovulation during intense breastfeeding
for ~6 months).
 Advantage: No side effects.
 Disadvantage: High failure rate.

2.Barrier Methods:

 Prevent physical meeting of ovum and sperm.

 Examples:
o Male/Female condoms (e.g., Nirodh – male condom).
o Diaphragms, cervical caps, vaults (inserted into female tract).
o Often used with spermicidal creams, jellies, foams for more
effectiveness.
 Advantages:
o Easy to use, disposable, safe from STDs and AIDS.

3. Intrauterine Devices (IUDs):

 Inserted by doctor/nurse into uterus via vagina.

 Types:
o Non-medicated (e.g., Lippes Loop).
o Copper-releasing (CuT, Cu7, Multiload 375).
o Hormone-releasing (Progestasert, LNG-20).
 Mechanism:
o Phagocytosis of sperm, suppression of motility and fertilization.
o Prevent implantation and make cervix hostile to sperm.
 Best for: Delaying or spacing pregnancies.

4. Oral Contraceptives (Pills):

  Contain progestogen or progestogen–estrogen.
 Taken daily for 21 days, with 7-day break for menstruation.
 Inhibits ovulation, implantation, and sperm entry.
 Saheli: Non-steroidal weekly pill with few side effects.

5. Injectables and Implants:

 Long-term contraceptive effect.

 Contain progestogens or combined hormones.
 Administered as injections or implanted under skin.
 Emergency contraceptive use: Within 72 hours of coitus to prevent
pregnancy (e.g., after rape or unprotected intercourse).

6. Surgical Methods (Sterilisation):

 Permanent method of contraception.

 Male: Vasectomy – small portion of vas deferens is cut/tied.
 Female: Tubectomy – small portion of fallopian tube is cut/tied.
 Highly effective, but irreversible or with poor reversibility.

Important Considerations:

 Always consult a medical professional before choosing a contraceptive.

 Contraceptives are not required for general reproductive health.
 Used to delay or prevent pregnancy for personal reasons.
 Side effects (though rare): Nausea, pain, bleeding issues, possible link to
breast cancer.
 Despite risks, they are crucial in controlling population growth.
MEDICAL TERMINATION OF PREGNANCY (MTP):

 Definition: Intentional or voluntary termination of pregnancy before full term.

 Global Statistics: About 45–50 million MTPs occur annually (around 1/5th of
all pregnancies).

 Legalization in India: Legalized in 1971 under strict conditions to prevent

misuse.

 Purpose of MTP:

 To end unwanted pregnancies (due to unprotected sex, contraceptive failure,

or rape).
 To protect mother’s or foetus’s health/life if the pregnancy is dangerous.

 Safe Period: Considered safe if done during the first trimester (up to 12
weeks).

 Risks:

 Second trimester MTPs are riskier.

 Many MTPs are done illegally by unqualified people, which is dangerous
and can be fatal.

 Female Foeticide:

 Amniocentesis is misused to determine sex of the foetus.

 Female foetuses are often aborted illegally – this is unethical and illegal.

 Solutions:
  Provide effective counselling on safe sex and dangers of illegal abortion.
 Improve healthcare access to reduce unsafe MTPs.

SEXUALLY TRANSMITTED INFECTIONS (STIS):

 What are STIs?

Infections transmitted through sexual intercourse; also called:

 Venereal Diseases (VD)

 Reproductive Tract Infections (RTIs)

 Examples of Common STIs:

o Gonorrhoea
o Syphilis
o Genital herpes
o Chlamydiasis
o Genital warts
o Trichomoniasis
o Hepatitis-B
o HIV/AIDS
 Other Modes of Transmission (besides sex):
o Sharing infected needles
o Surgical instruments
o Blood transfusion
o Infected mother to foetus
 Curability:
o Curable STIs: Gonorrhoea, syphilis, chlamydiasis, etc.
o Incurable/STI control only: Hepatitis-B, genital herpes, HIV/AIDS
  Early Symptoms:
o Itching
o Fluid discharge
o Mild pain
o Swellings in genital region
o Females may show no symptoms (asymptomatic)
 Why STIs are Dangerous (if untreated):
o Pelvic Inflammatory Disease (PID)
o Abortions or stillbirths
o Ectopic pregnancies
o Infertility
o Reproductive tract cancers
 Most Affected Age Group:
o 15–24 years
 Prevention of STIs:

1. Avoid sex with unknown or multiple partners

2. Use condoms during coitus
3. Visit a qualified doctor for early diagnosis and full treatment if
suspected.

INFERTILITY:

 Inability to produce children despite unprotected sexual cohabitation.

 Affects many couples globally, including in India.
 Causes can be:
o Physical
o Congenital
 o Due to diseases or drugs
o Immunological
o Psychological
 In India, women are often blamed, though the problem may lie with the
male.
 Infertility clinics help diagnose and treat some causes of infertility.

Assisted Reproductive Technologies (ART):

Used when natural conception is not possible.

1. IVF – In Vitro Fertilisation (Test Tube Baby Technique)

 Fertilisation occurs outside the body under lab conditions.

 Ova (from wife/donor) and sperms (from husband/donor) are fused to form a
zygote.
 Embryo is transferred to the female reproductive tract:
o ZIFT (Zygote Intra Fallopian Transfer) – Zygote/early embryo
with up to 8 blastomeres is transferred into the fallopian tube.
o IUT (Intra Uterine Transfer) – Embryo with more than 8
blastomeres is transferred into the uterus.
 In vivo-formed embryos (natural fertilisation) can also be transferred.

2. GIFT – Gamete Intra Fallopian Transfer

 Ovum from a donor is transferred into the fallopian tube of a woman who
can't produce ova but can support fertilisation and embryo development.

3. ICSI – Intra Cytoplasmic Sperm Injection

  A single sperm is directly injected into an ovum in the lab to form an
embryo.

4. AI – Artificial Insemination

 Semen is collected from the husband or a healthy donor.

 Introduced into:
o Vagina, or
o Uterus (IUI – Intra Uterine Insemination)

Limitations and Concerns:

 ART techniques require:

o High precision
o Skilled professionals
o Expensive equipment
 These are available only in a few centres in India.
 Often not affordable to most people.
 Social, religious, and emotional issues may prevent adoption of these
methods.

Legal Adoption:

 An alternative to ART for couples wanting children.

 Legal in India.
 Helps orphaned and destitute children find families