In this chapter we deals with important descriptive revision notes of REPRODUCTIVE HEALTH,for helping students prepare for neet,board examinations
According to the World Health Organisation (WHO), reproductive health means a total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural and social. Therefore, 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
4.1 REPRODUCTIVE HEALTH – PROBLEMS AND STRATEGIES
India was amongst the first countries in the world to initiate action plans and programmes at a national level to attain total reproductive health as a social goal. These programmes called ‘family planning’ were initiated in 1951 and were periodically assessed over the past decades. Improved programmes covering widerreproduction-related areas are currently in operation under the popular name ‘Reproductive and Child Health Care (RCH) programmes’. Creating awareness among people about various reproduction related aspects and providing facilities and support for building up a reproductively healthy society are the major tasks under these programmes. With the help of audio-visual and the print-media governmental and non-governmental agencies have taken various steps to create awareness among the people about reproduction-related aspects. Parents, other close relatives, teachers and friends, also have a major role in the dissemination of the above information. Introduction of sex education in schools should also be encouraged to provide right information to the young so as to discourage children from believing in myths and having misconceptions about sex-related aspects. Proper information about reproductive organs, adolescence and related changes, safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS, etc., would help people, especially those in the adolescent age group to lead a reproductively healthy life.
Educating people, especially fertile couples and those in marriageable age group, about available birth control options, care of pregnant mothers, post-natal care of the mother and child, importance of breast feeding, equal opportunities for the male and the female child, etc., would address the importance of bringing up socially conscious healthy families of desired size. Awareness of problems due to uncontrolled population growth, social evils like sex-abuse and sex-related crimes, etc., need to be created to enable people to think and take up necessary steps to prevent them and thereby build up a socially responsible and healthy society. Successful implementation of various action plans to attain reproductive health requires strong infrastructural facilities, professional expertise and material support. These are essential to provide medical assistance and care to people in reproduction-related problems like pregnancy, delivery, STDs, abortions, contraception, menstrual problems, infertility, etc.
Implementation of better techniques and new strategies from time to time are also required to provide more efficient care and assistance to people. Statutory ban on amniocentesis for sex-determination to legally check increasing menace of female foeticides, massive child immunisation, etc., are some programmes that merit mention in this connection. In aminocentesis some of the amniotic fluid of the developing foetus is taken to analyse the fetal cells and dissolved substances. This procedure is used to test for the presence of certain genetic disorders such as, down syndrome, haemoplilia, sickle-cell anemia, etc., determine the survivability of the foetus. Research on various reproduction-related areas are encouraged and supported by governmental and non-governmental agencies to find out new methods and/or to improve upon the existing ones. ‘Saheli’–a new oral contraceptive for the females–was developedby scientists at Central Drug Research Institute (CDRI) in Lucknow,
Better awareness about sex related matters, increased number of medically assisted deliveries and better post-natal care leading to decreased maternal and infant mortality rates, increased number of couples with small families, better detection and cure of STDs and overall increased medical facilities for all sex-related problems, etc. all indicate improved reproductive health of the society.
4.2 POPULATION STABILISATION AND BIRTH CONTROL
In the last century an all-round development in various fields significantly improved the quality of life of the people. However, increased health facilities along with better living conditions had an explosive impact on the growth of population. The world population which was around 2 billion (2000 million) in 1900 rocketed to about 6 billion by 2000 and 7.2 billion in 2011. A similar trend was observed in India too. Our population which was approximately 350 million at the time of our independence reached close to the billion mark by 2000 and crossed 1.2 billion in May 2011. A 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 are probable reasons for this. Through our Reproductive Child Health (RCH) programme, though we could bring down the population growth rate, it was only marginal. According to the 2011 census report, the population growth rate was less than 2 per cent, i.e., 20/1000/year, a rate at which our population could increase rapidly. Such an alarming growth rate could lead to an absolute scarcity of even the basic requirements, i.e., food, shelter and clothing, in spite of significant progress made in those areas. Therefore, the government was forced to take up serious measures to check this population growth rate. The most important step to overcome this problem is to motivate smaller families by using various contraceptive methods.
showing a happy couple with two children with a slogan Hum Do Hamare Do (we two, our two). Many couples, mostly the young, urban, working ones have even adopted an ‘one child norm’. Statutory raising of marriageable age of the female to 18 years and that of males to 21 years, and incentives given to couples with small families are two of the other measures taken to tackle this problem.
make the uterus unsuitable for implantation and the cervix hostile to the sperms. IUDs are ideal contraceptives for the females who want to delay pregnancy and/or space children. It is one of most widely accepted methods of contraception in India.Oral administration of small doses of either progestogens or progestogen–estrogen combinations is another contraceptive method used by the females. They are used in the form of tablets and hence are popularly called the pills. Pills have to be taken daily for a period of 21 days starting preferably within the first five days of menstrual cycle. After a gap of 7 days (during which menstruation
occurs) it has to be repeated in the same pattern till the female desires to
prevent conception. They inhibit ovulation and implantation as well as
alter the quality of cervical mucus to prevent/retard entry of sperms. Pills
are very effective with lesser side effects and are well accepted by the females.
Saheli–the new oral contraceptive for the females contains a non-steroidal
preparation. It is a ‘once a week’ pill with very few side effects and high
contraceptive value.
Progestogens alone or in combination with estrogen can also be used
by females as injections or implants under the skin . Their mode of action is similar to that of pills and their effective periods are
much longer. Administration of progestogens or progestogen-estrogen
combinations or IUDs within 72 hours of coitus have been found to be
very effective as emergency contraceptives as they could be used to avoid
possible pregnancy due to rape or casual unprotected intercourse.
Surgical methods, also called sterilisation, are generally advised for
the male/female partner as a terminal method to prevent any more pregnancies. Surgical intervention blocks gamete transport and thereby
prevent conception. Sterilisation procedure in the male is called ‘vasectomy’and that in the female, ‘tubectomy’. In vasectomy, a small part of the vasdeferens is removed or tied up through a small incision on the scrotum
whereas in tubectomy, a small part of the fallopian tube is
removed or tied up through a small incision in the abdomen
or through vagina. These techniques are highly effective but their
reversibility is very poor.
It needs to be emphasised that the selection of a suitable contraceptive
method and its use should always be undertaken in consultation with
qualified medical professionals. contraceptives are not regular requirements for the maintenance of
reproductive health. In fact, they are practiced against a natural
reproductive event, i.e., conception/pregnancy. One is forced to use these
methods either to prevent pregnancy or to delay or space pregnancy due
to personal reasons. .
4.3 MEDICAL TERMINATION OF PREGNANCY (MTP)
Intentional or voluntary termination of pregnancy before full term is called
medical termination of pregnancy (MTP) or induced abortion. Government of India legalised MTP in 1971 with some strict conditions
to avoid its misuse. Such restrictions are all the more important to check
indiscriminate and illegal female foeticides which are reported to be high
in India
to get rid of unwanted pregnancies either due to casual unprotected intercourse or failure of the contraceptive used during coitus or rapes. MTPs are also essential in certain cases where continuation of the pregnancy could be harmful or even fatal either to the mother or to the foetus or both.
Such practices should be avoided because these are dangerous both for
the young mother and the foetus. Effective counselling on the need to
avoid unprotected coitus and the risk factors involved in illegal abortions
as well as providing more health care facilities could reverse the mentioned
unhealthy trend.
4.4 SEXUALLY TRANSMITTED INFECTIONS (STIS)
Infections or diseases which are transmitted through sexual intercourse
are collectively called sexually transmitted infections (STI) or venereal
diseases (VD) or reproductive tract infections (RTI). Gonorrhoea, syphilis,
genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B
and of course, the most discussed infection in the recent years, HIV leading
to AIDS are some of the common STIs. Some of these infections like hepatitis–B and HIV can also be transmitted by sharing of injection needles, surgical instruments, etc., with infected persons, transfusion of blood, or from an infected mother to the foetus too. Except for hepatitis-B, genital herpes and HIV infections, other diseases are completely curable if detected early and treated properly. Early symptoms of most of these are minor and include itching, fluid discharge, slight pain, swellings, etc., in the genital region. Infected females may often be asymptomatic and hence, may remain undetected for long. This could lead to complications later, which include pelvic inflammatory diseases (PID), abortions, still births, ectopic pregnancies, infertility or even cancer of the reproductive tract. STIs are a major threat to a healthy society.
Therefore, prevention or early detection and cure of these diseases are
given prime consideration under the reproductive health-care
programmes. Though all persons are vulnerable to these infections, their
incidences are reported to be very high among persons in the age group
of 15-24 years – the age group to which you also belong. There is no
reason to panic because prevention is possible. One could be free of these
infections by following the simple principles given below:
(i) Avoid sex with unknown partners/multiple partners.
(ii) Always try to use condoms during coitus.
(iii) In case of doubt, one should go to a qualified doctor for early
detection and get complete treatment if diagnosed with infection.
4.5 INFERTILITY
A discussion on reproductive health is incomplete without a mention of
infertility. A large number of couples all over the world including India
are infertile, i.e., they are unable to produce children inspite of unprotected
MTPs are considered relatively safe during the first trimester, i.e., upto
12 weeks of pregnancy. Second trimester abortions are much more riskier.
One disturbing trend observed is that a majority of the MTPs are performed
illegally by unqualified quacks which are not only unsafe but could be
fatal too. Another dangerous trend is the misuse of amniocentesis to
determine the sex of the unborn child. Frequently, if the foetus is found
to be female, it is followed by MTP- this is totally against what is legal.
Specialised health care units (infertility clinics, etc.) could help in diagnosis and corrective treatment of some of these disorders and enable these couples to have children. However, where such corrections are not possible, the couples could be assisted to have children through certain special techniques commonly known as assisted reproductive technologies (ART).
In vitro fertilisation (IVF–fertilisation outside the body in almost
similar conditions as that in the body) followed by embryo transfer (ET)
is one of such methods. In this method, popularly known as test tube
baby programme, ova from the wife/donor (female) and sperms from the
husband/donor (male) are collected and are induced to form zygote under
simulated conditions in the laboratory. The zygote or early embryos (with
upto 8 blastomeres) could then be transferred into the fallopian tube
(ZIFT–zygote intra fallopian transfer) and embryos with more than
8 blastomeres, into the uterus (IUT – intra uterine transfer), to complete
its further development. Embryos formed by in-vivo fertilisation (fusion
of gametes within the female) also could be used for such transfer to assist
those females who cannot conceive.
Transfer of an ovum collected from a donor into the fallopian tube
(GIFT – gamete intra fallopian transfer) of another female who cannot
produce one, but can provide suitable environment for fertilisation and
further development is another method attempted. Intra cytoplasmic
sperm injection (ICSI) is another specialised procedure to form an embryo
in the laboratory in which a sperm is directly injected into the ovum.
Infertility cases either due to inability of the male partner to inseminate
the female or due to very low sperm counts in the ejaculates, could be
corrected by artificial insemination (AI) technique. In this technique,
the semen collected either from the husband or a healthy donor is artificially introduced either into the vagina or into the uterus (IUI – intra-uterine insemination) of the female.
