According to World Health Organisation (WHO), Reproductive health is total well-being in all aspects of reproduction i.e., physical, emotional, behavioral & social.

REPRODUCTIVE HEALTH: PROBLEMS & STRATEGIES

India initiated reproductive health programmes (family planning) in 1951. Now wider reproduction-related areas are in operation under Reproductive & Child Health Care (RCH) programs. Such programs deal with the following:

▪ Give awareness about reproduction-related aspects for creating a reproductively healthy society.

▪ Educate people about birth control, care of pregnant mothers, post-natal care of mother and child, the importance of breastfeeding, equal opportunities for male & female children, etc.

▪ Awareness of problems due to population explosion, social evils like sex abuse and sex-related crimes, etc.

Aims and needs of sex education in schools

▪ To provide the right information about sex-related aspects. It helps to avoid sex-related myths and misconceptions.

▪ To give proper information about reproductive organs, adolescence, and related changes, safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS, etc.

POPULATION STABILIZATION & BIRTH CONTROL

• In 1900, the world population was about 2 billion. By 2000, it rocketed to about 6 billion and 7.2 billion in 2011.

• In India, the population was nearly 350 million at the time of independence. It reached 1 billion by 2000 and crossed 1.2 billion in May 2011. It means every sixth person in the world is an Indian.

• According to the 2011 census report, our population growth rate was less than 2% (i.e. 20/1000/year), a rate at which our population could increase rapidly.

Reasons for population explosion

• Increased health facilities and better living conditions.
• Rapid decline in death rate, maternal mortality rate (MMR) and infant mortality rate (IMR).
• Increase in number of people in reproducible age.

Control measures

• Motivate smaller families by using contraceptive methods.
• Aware people about the slogan Hum Do Hamare Do (we two, our two). Many couples have adopted a ‘one child norm’.
• Statutory rising of marriageable age of females (18 years) and males (21 years).

Properties of an ideal contraceptive

• User-friendly, easily available, effective and reversible.
• No or least side-effects.
• It should not interfere with sexual drive, desire & sexual act.

CONTRACEPTIVE METHODS

1. Natural/Traditional methods :- Avoid chances of ovum and sperms meeting. It includes

• Periodic abstinence: Avoid coitus from day 10 to 17 (fertile period) of the menstrual cycle to prevent conception. The fertile period is the period having chances of fertilization.
• Coitus interruptus (withdrawal): Withdraw penis from the vagina just before ejaculation to avoid insemination.
• Lactational amenorrhea: It is the absence of menstrual cycle & ovulation due to intense lactation after parturition. Fully breastfeeding increases lactation. This method helps to prevent conception. This is effective up to 6 months following parturition.

Natural methods have no side effects. But chances of failure are high.

2. Barriers

They prevent the physical meeting of sperm & ovum. E.g.

a. Condoms (E.g. Nirodh):

Made of rubber/latex sheath. Condoms for males: Cover the penis.
Condoms for females: Cover the vagina & cervix. Condoms are used just before coitus. They prevent the entry of semen into the female reproductive tract.
Condoms are very popular because:

• It protects the user from STDs and AIDS.
• Easily available and disposable.
• It can be self-inserted and thereby give privacy to users.
  

b. Diaphragms, cervical caps, and vaults:

• Made of rubber and are inserted into the female a reproductive tract to cover the cervix during coitus.
• They block the entry of sperms through the cervix.
• They are reusable.

c. Spermicidal creams, jellies & foams

Are used along with these barriers to increase contraceptive efficiency.

3. Intra Uterine Devices (IUDs)

These are inserted by doctors or nurses in the uterus through the vagina. IUDs are the ideal method to delay pregnancy or space children.

Mechanism of functioning of IUDs

▪     It increases phagocytosis of sperms within the uterus

▪     Cu ions released suppress sperm motility and the fertilizing capacity of sperms

Types of IUDs:

• Non-medicated IUDs: They retard sperm motility. Also have a spermicidal effect.
  E.g. Lippes loop.
• Copper releasing IUDs: Cu ions suppress motility and fertilizing capacity of sperms.
  E.g. CuT, Cu7, Multiload 375.
• Hormone releasing IUDs: They make the uterus unsuitable for implantation and the
  cervix hostile to the sperms. E.g. Progestasert, LNG-20.

4. Oral contraceptives

• Oral administration of progestogens or progestogen– oestrogen combinations in the form of tablets (pills).

o   Mechanism of action of pills:

•  Inhibit ovulation and implantation
•  Alter the quality of cervical mucus to prevent/retard entry of sperms

o   Dosage of pills:

•    Daily for 21 days of the menstrual cycle.
•    It should start within the first five days of the menstrual cycle.
•    Then a gap of 7 days (during menstruation).
•    This cycle is to be repeated till the time the female wants to prevent conception.

Saheli :

• Oral contraceptive pill developed by CDRI ( Central Drug Research Institute) Lucknow
•  Non-steroidal in nature
•  Low side effect with high contraceptive value
• Needs to be taken only once a week.

5. Injections or implants under the skin :

•   Composition: Progestogens alone or in combination with estrogen
•    Mode of action: Similar to pills
•    Benefit: effective periods are much longer than pills

Emergency contraceptives

•    Female can take progesterone or estrogen-progesterone combination preparations.
•    It must be taken within 72 hours of coitus.
•    Useful to prevent pregnancy in cases of rape or casual unprotected intercourse.

6.   Surgical method/Sterilisation

• Terminal method of contraception
• Non-reversible
• There will be no more pregnancy

o  Mechanism: Surgical procedure blocks the gamete transport and thereby prevents conception.

Vasectomy

• Sterilisation method in male.
•  A small portion of the vas deferens is removed or cut and tied.
• The surgery is performed by making an incision in the scrotum.

Tubectomy

• Sterilisation method in female.
•  A small portion of the fallopian tube is removed or cut and tied.

 Ill effects of artificial contraceptives

• Nausea
• Abdominal pain
•  Breakthrough bleeding
•  Irregular menstrual bleeding
• Breast cancer

Medical Termination of Pregnancy (MTP)

 Also known as induced abortion.Intentional or voluntary termination of pregnancy before full term (complete development of fetus).

Why MTP is required?

• To get rid of unwanted pregnancies either due to casual unprotected intercourse, failure of the contraceptive used during coitus, rapes
•  In case the continuation of the pregnancy could be harmful or even fatal either to the mother or to the fetus or both.

When MTPs are performed

Safe in the first trimester (up to 12 weeks of pregnancy) Riskier in the second trimester.

 Misuse of MTPs

Amniocentesis is misused to determine the sex of the unborn child. In case the fetus is found to be female – MTP is performed – female foeticide.

Sexually Transmitted Infections (STIs)

Also known as venereal diseases (VD) or reproductive tract infections (RTI) or sexually transmitted diseases (STDs).

STIs caused by Bacteria:

• Gonorrhea
• Syphilis
• Chlamydiosis

 STIs caused by Protozoa:

• Trichomoniasis

 STIs caused by viruses:

• Genital herpes
• Genital warts
•  Hepatitis-b
• Aids

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.

Most of these STIs are completely curable except for hepatitis-B, genital herpes, and HIV infections.

Early symptoms of STIs include the following in the genital region: itching, fluid discharge, slight pain, swellings, etc.,

In case proper treatment is done at the early stages of infection it could lead to complications such as:

• Pelvic inflammatory diseases (PID)
•  Abortions
•  Stillbirths
• Infertility
•  Even cancer of the reproductive tract

Ectopic pregnancies (pregnancy in which the embryo attaches outside the uterus / extrauterine pregnancy)

 Simple principles to prevent STIs:

•  Avoid sex with unknown partners/multiple partners.
•  Always try to use condoms during coitus.
•  In case of doubt, one should go to a qualified doctor for early detection and get complete treatment if diagnosed with the infection.

Infertility

Reasons of Infertility:- physical, congenital, diseases, drugs, immunological, or even psychological.

Infertility Clinics: Specialized health care units that could help in diagnosis and corrective treatment of infertility.

Assisted Reproductive Technologies (ART)

Special techniques to help infertile couples to have children.

Method 1: (Test tube baby program)

IVF is followed by ET

 IVF- In vitro fertilization: fertilization outside the body

ET – Embryo Transfer

Mechanism:

• Ovum is collected from wife/donor female
• Sperm is collected from husband/donor male
• The collected ova and sperm are then fertilized in the laboratory.
• The zygote is then placed back in the female by either of the two following techniques:

 ZIFT (zygote intra fallopian transfer)

the zygote or early embryos (with up to 8 blastomeres) transferred to the fallopian tube.

IUT (Intra Uterine Transfer)

• An embryo with more than 8 blastomeres is transferred to the uterus.
• Embryos formed by in-vivo fertilization also could be used for such transfer to assist those females who cannot conceive.
• In-Vivo fertilization – a fusion of gametes within the female

Method 2: GIFT (gamete intrafallopian transfer)

Condition: If a female cannot produce ovum, but can provide a suitable environment for fertilisation

 Mechanism:

•  Ovum is collected from a donor.
• Then it is transferred into the female who cannot produce the ovum.
• The further development continues as in normal individuals.

Method 3: ICSI (Intracytoplasmic sperm injection)

Sperm is directly injected into the ovum to create the embryo in the laboratory condition.

Method 4: AI (Artificial Insemination)

Condition: If the reason of infertility is due to either one of the following reasons:

• The inability of the male partners to inseminate
• Very low sperm count

Mechanism:

• Semen is collected from the husband / healthy donor.
• It is artificially introduced either in the vagina or into the uterus (IUI – intra-uterine insemination) of the female.

 Possible drawbacks of ART

• These facilities are presently available only in very few centers in the country.
•  High cost associated.
•  Many may not accept these methods due to emotional, religious, and social factors.

Legal adoption is one of the best alternative methods for infertile couples looking for parenthood.

INFERTILITY IN HUMAN: Causes &Consequences :-

IN MALES	IN FEMALES
Oligospermia: Low sperm count	Anovulation: Absence of ovulation.
Azospermia: Absence of sperm.	Oligoovulation: Deficient ovulation.
Asthenozoospermia: Low sperm motility.	Hyperprolactinemia: Ovum remain trapped inside the follicle.
Teratozoospermia: Defective sperm morphology.	Idiopathic Infertility: Failure or abnormal fertilization.
Cryptorchidism:Failure of Testes to descend in the scrotal sac.	Tubal Infertility: Damaged/ligated fallopian tube

COMMON SEXUALLY TRANSMITTED DISEASES (STDs)

S.no	STD	CAUSAL AGENT
1	CHLAMYDIOSIS	Chlamydia trachomatis
2	GONORRHOEA	Neisseria gonorrhea
3	TRICHOMONIASIS	Trichomonas vaginalis
4	GENITAL HERPES	Herpes simplex virus
5	SYPHILIS	Treponema pallidum
6	GENITAL WART	Human papilloma virus
7	HEPATITIS-B	Hepatitis –B virus
8	AIDS	HIV