REPRODUCTIVE HEALTH

Reproductive health is defined as healthy reproductive organs with normal functions. (or) according to
world health organisation (WHO) reproductive health means a total well being in all aspects of reproduction
i.e., physical, emotional, behavioural and social aspects of reproduction.
A reproductively healthy society is a society with people having physically and functionally normal
reproductive organs and normal emotional, behaviour interactions among them in all sex related aspects.
Reproductive health - problem and strategies
Problems- following are the major problems in reproductive health.
1. Myths and misconceptions about sex
related aspects.
2. Improper information about reproductive organs, adolescent
3. Unsafe and unhydric sexual practises and sexually
and related body changes.
transmitted diseases.
4. Population growth
5. Sex abuse
6. Sex related crimes
7. Unwanted and teenage pregnancy leading to
physical and emotional stress and other serious
problems.
Strategies:
India is the first country to initiate action plans or
health.
programmes at the national level to achieve reproductive

These programmes are called family planning programmes and

were initiated in 1951. Later they have been
improved to include more reproductive related areas and are
health care (RCH) programmes. currently called as reproductive and child

The major strategies are

1. Wide publicity to create awareness among people
about reproductive related aspects
2. Take help of audio visual and print media
3. Sex education in schools should also be
encouraged to give the right information to the young minds
to save them myths and misconception about sex
related aspects.
4. Proper information regarding sex organs, adolescent
stage and hormonal changes in the body.
5. Giving knowledge about safe and hygienic sexual practice
6. Knowledge about unsafe and sexually transmitted diseases.
7. To provide strong infrastructure facilities,
professional experts and material support for successful
implantation for various action plans to achieve reproductive health
8. Creating awareness about reproductive related
problems like pregnancy, delivery abortion,
contraception, menstrual problems, infertility.
9. Educating the people about available birth
- natal care of mother and child,
control options, care of pregnant mothers, deliveries, post
importance of breast feeding, child immunization and equal
opportunities for male and female child.
Amniocentesis
 it is a fietal sex detemination test based on the chromosomal pattern in the amniotic fluid surrounding the
developing embryo. It is legally banned to avoid female foeticide (kiling of female foetus). Research on
various aspeets of reprduction is encouraged to develop the effective methods of contraception.

For eg. Saheli, a new oral contraceptive for females was developed by scientist at central drug research
institute(CDRI) in Lucknow.
Population explosion
The enomous and abnomal inerease in the growth rate of population is called population explosion.
Inereased health tacilities along with better living conditions had on explosive impact on the growth of
population.

i. The world population which was around 2billion in 1900 rocketed to about 6 billions by 2000.
i. India's population which was approximately 350 million at the time of our independence reached
close to the billion mark by 2000 and erossed one billion in may 2000. That means every 6th person
in the world isan Indian.

Aperson decline in death rate, maternal mortality rate (MMR), and infant mortality rate (IMR) as well as an
in inerease in number of people in reproducible age are probable reasons for this.
According to 2001 census report, the population growth rate was about 1.7 % (17/1000 per year). At this
rate the population is expected to double in 33 years.
Such an alarming growth rate could lead to an absolute scarcity of even the basic requirements, food, shelter
and clothing etc. In spite of significant progress made in those areas.
Therefore, the government was take up various majors to check this population growth.
The most important step to overcome this problem is to motivate smaller families by using various
contraceptive methods.

Birth control:It is the voluntary or deliberate prevention of pregnancy. The method of limit the number
of children by using various contraceptives is called family planning. It is one of the most important step to
control population growth. Other steps including rising of marriageable age of female to 18 years and that of
males to 2lyears, and incentives given to couples with small families.
Birth control is essential

To control over population

To maintain healthy family
To provide better education
To avoid pollution

Contraception: The birth control methods which deliberately prevent fertilization/pregnancy are referred
as contraception.Contraceptive methods should be user friendly, easily available, effective and reversible
with no or least side effects. It also should not interfere with the sexual drive or
desire.
Contraceptive methods: Contraceptive methods are grouped into following method
i. Natural/Traditional contraception
 ii.
Barrier methods
iv.
Intra uterine devices (IUD'S)
Oral contraceptives
vi.
Injectables and implants
Surgical methods sperms meeting
chances of ovum and
Natural methods principle of avoiding
:These methods work on the
there by are of three types,
preventingfertilization and conception. These
a. Periodic abstinence
b. Coitus interrupts (withdrawal method) to 17
C. Lactational amenorrhea. abstain from coitus from day 10
couples avoid or during
a) Periodic abstinence:It is a method in which the occur and chance of fertilization is very high
of menstrual cycle. When ovulation is expected to
this period, it is called the fertile period
abstaining by coitus during this period, conception could be prevented.
Iherefore, by vagina by the
interruptus: It involves withdrawal of the penis from the
b) Withdrawal method or coitus
as to avoid insemination.
male partner just before ejaculation. So following child
amenorrhea:Absence of menstruation
during the period of intense lactation,
c) Lactational
birth is called lactational amenorrhea.
conception are almost nil. However this method is considered
chances of
As ovulation does not occur,
months after delivery (Parturition)
effective only upto a maximum period of 6
between ovum
methods:Barriers are the mechanical obstructions preventing the physical contact
Barrier females.
preventing fertilization. These methods are available for both males and
and the sperm,thereby
condoms etc.
Eg: Diaphragm, cervical caps, vaults,
in the
cervical caps and vaults are the barriers made of rubber that are fitted on the cervix
Diaphragms,
into the uterus. These devices are reusable,
vagina before ciotus (intercourse). To check the entry sperms
diaphragms, cervical caps, generally smeared by spermicidal
jelly or cream each time they are used to
increase their efficiency.
before the coitus.
Condoms are barriers made of thin rubber latex sheath that are used to cover the penis just
They collect the semen and thus prevents the entry of sperms into the vagina thereby prevents conception. It
also reduces the risk of sexually transmitted disease (STD).
It is given free by government under the trade name Nirodh. Spermicidal creams and jellies may enhance
the contraceptive efficiency.
Intra uterine devices (IUD'S):These are the mechanical devices made by metal or plastic are placed in
uterus of the female by a doctor or expert nurses. They prevent fertilization, implantation and conception.
These are of mainly three types. They are
a) Non - mediated IUD's

These IUD'S increase phagocytosis of sperms within the uterus.

Eg: Lippers loop
 Wasect
b) Copper releasing IUD'S
motility as well as their fertil1z1ng capacity
nese l0D'Srelease the copper ions; it suppresses sperm
Eg: Copper- T(CuT ), Copper -&(Cu7), multiload- 375etc
c) Hormone releasing IUD'S:These IUD'S bring changes in the uterus making it unsuitable for
implantation and the cervix hostile to the sperm
Eg: LNG- 20, Progestasert
1UD's are the most ideal contraceptive to maintain the space between children and it is most widely
accepted method in India.

Oral contraceptives/pill method: This includes the use of contraceptive pills in the form of tablets by
women. These contraceptive pills inhibit ovulation. Hence no ova are released thereby prevents conception
The pills contain synthetic hormones like progestogen and estrogens which prevents the secretion of FSH
and LH.

Pills are normally taken daily for a period of 21 days starting preferably within the first $th days of menstrual
cycle. Pills are very effective with less side effects. They inhibit ovulation and implantation and
also modify
the quality of cervical mucus to prevent/retard the entry of sperms.
A new oral contraceptive called Saheli, contain non- steroidal preparation.
It is once a week pill with very
few side effects and high contraceptive value.
Injectable and implants: Progestogens - estrogen combination or progestogens alone are used by
as injections or implants under the skin. females

Their mode of action is similar to that of pills and their effective period is
much longer.
Administration of progestogens within 72 hours of coitus have been found very effective in
case of rape or
casual unprotected intercourse.
Surgical methods/ sterilization or terminal methods
These are advised for male or female partner as terminal methods to
prevent any more further pregnancy.
They block the gamete transport and thereby prevent conception
Eg: Vasectomy and tubectomy
Vasectomy - This is amethod of male sterilization. It involves surgical removal of a small portion of
each
vas deferens and cut ends are tie. It can be done through a small incision on
the scrotum. It prevents the
reaching of a sperms into the urethra.
Tubectomy - This is a method of female sterilization. It involves the surgical removal of
each fallopian tube and cut ends are tied. It prevents the reaching of the sperm into the egg.
 ascetomy and tubcetonny tcclniquCs are hiphly cllective bt thcir revesibility is very poor.
Ialleptu ( e

Var deleena

gure 4.4a Vanctomy iguro 4.4 (b) "Tubectoy

The wide spread use of above mcthods have a significant role in checking uncontrollcd growth of
population. However thcir possible ill etfects like nausca abdominal pain break through bleeding irregular
menstrual bleeding may expressed.
Medical termination of pregnancy (MTP): Intentional or voluntary termination of pregnancy
before full term is called MIP or induced abortion.

MTP is done to get ridof' unwanted pregnancies due to failure of contraceptive used during coitus, casual
unprotected intereourse, rapes and thrcat to the lifecither mother or to the foetus or both.
Nearly 4s - 50 million MTP's are done per year throughout the world; which accounts to 1/5 of the total
number of conceived pregnancies in a year. Hence it hasa significant role in decreasing the population.
Government of India legalized (1971) in avoid its misuse. Such restrictions are necessary to check
indiscriminate and illegal female foeticide which are reported to be high in India.
MTP'sare consideredsafe during 1"trimester of pregnancy (up to 12 weeks).
However they are much more risky in lI trimester of pregnancy
In India majority of MTP'Sare performed illegally by unqualified persons. These are unsafe and may result
in death of mother.

Sexually transmitted diseases (STD'S) Diseases or infectious which are transmitted mainly through sexual
intercourse are collectively called as STD's or venereal diseases (VD) or reproductive tract infections (RTI).
These diseases are reported to be high among individuals of age group 15 to 24 years.
Eg: AID's, Hepatitis - B, Gonorrhoea, Syphilis, Genital herpes, Genital warts, Trichomoniasis,
Chlanydiasis etc.
Among these AID's genital herpes and Hepatitis -B are incurable while other are curable.
Mode of transmission
Sexual contact with infected person
ii. Transmission of contaminated blood
i. Sharing of injection needles, surgical instruments with infected persons.
iv. STD'scan also be transmitted from an infected mother to the foetus.
 region.
swellings etc. In
the genital
Symptoms discharge, slight pain,
Itching, fluid for long. diseases (PTD),
symptoms include
undetected
Early asymptomatic and
may remain pelvic
inflammatory

reproductive tract.
remain include
STD's may Which
ii. complications later. cancer of
to infertility or even
the
ii. This could lead ectopic
pregnancy,
abortions, still
births,

Preventive measures:
partners/multiple partners.
i Avoid sex with unknown intercourse (coitus)
during
ii. Always use condoms transfusion
blood
iii. Avoiding the infected qualified doctor without delay.
one must concern a
iv. In case of doubt

Infertility cohabitation is called

unprotected sexual
produce children even after two years of
Couples are unable to
infertility
Reasons for infertility
are responsible
drugs, immunological or even psychological reasons
a) Physical, congenital, diseases,
units
for infertility.
diagnosed by specialists working in specialized health care
be
b) The infertility disorders can
called infertilityclinics. corrective treatment. However
there are some
disorders can be cured through
c) Some of this infertility possible. In such cases, couples are
to have children
corrective treatment is not
disorders where such reproductive technology.
certain special techniques commonly known as assisted
through

Assisted reproductive technology (ART)

techniques which assist infertile couples to have children.
This includes a number of special
tube baby) technique
Invitro fertilization and embryo transfer (test
ii. Gamete intra fallopian transfer (GIFT)
ii. Zygote intra fallopian transfer (ZIFT)
iv. Intra cytoplasmic sperm injection (1CSI)
V. Artificial insemination (AI)
vi. Intra uterine transfer (1UT) etc.
i. Invitro fertilization and embryo transfer (IVF andET technique)
a) Ovulation is induced by injecting gonadotropin
b) The ova are collected using laproscope.
c) The ova are transferred to nutrient medium present in glass petridish
) 1he sperms are collected from her male partner/donor and mixed with ova and are induced to form
zygote.
e) Here fertilization occurs in culture medium under laboratory conditions. So, it is called invitro
fertilization