According to World Health Organization (WHO), reproductive health means ‘a total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural and social’.
Reproductive Health - Problems and Strategies
Problems:
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There is little knowledge of personal hygiene and hygiene of reproductive organs. This causes sexually transmitted diseases (STDs).
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Early marriages lead to high maternal and infant mortality rates.
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Due to lack of awareness, there has been a rapid increase in population size.
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People encourage beliefs in myths and misconceptions about sex-related issues.
Strategies:
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'Family planning' programmes were initiated as early as 1951.
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'Reproductive and Child Health Care' (RCH) programmes were launched in 1997 for:
a. Creating awareness among people about various reproduction related aspects.
b. Providing facilities and support for building up a reproductively healthy society.
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With the help of audio-visual aids and print-media, both government and non-government agencies are engaged in creating awareness among people about reproduction-related aspects.
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Encouraging sex education in schools to give the right information to young minds and save them from myths and misconceptions about sex-related aspects.
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Proper information about reproductive organs, adolescence and related changes, safe and hygienic sexual practices and sexually transmitted diseases (STDs) should be given.
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Educating people about available birth control options, care for pregnant mothers, post-natal care of the mother and child, importance of breast feeding, equal opportunities for the male and female child.
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Awareness of problems due to uncontrolled population growth and social evils like sex-abuse and sex-related crimes, etc.
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Statutory ban on amniocentesis (a foetal sex-determination test based on the chromosome pattern in the cells found in amniotic fluid surrounding the developing embryo) for sex-determination to legally check increasing female foeticides.
Population Explosion
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The tremendous / drastic increase in size and growth rate of population is called population explosion.
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The world population was about 2 billion in 1900 and it was 6 billion in 2000.
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Population of India at the time of Independence was about 350 million and it crossed I.2 billion in May 2011. (133.92 crores in 2017).
Reasons for High Population Growth
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Rapid decline in death rate.
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Decline in maternal mortality rate (MMR).
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Decline in infant mortality rate (IMR).
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Increase in number of people in reproducible age.
According to 2011 census report, the population growth rate was about 2 per cent, i.e.,
20/1000/year in India-a rate at which our population could double in 33 years.
Steps to Curb Population Growth
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Statutory raising marriageable age of girls to 18 years and of boys to 21 years.
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Incentives should be given to couples with small family.
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By motivate smaller families by using various contraceptive methods.
Contraceptives
A device or drug or method serving to prevent the pregnancy (control the birth) is called contraceptive.
An ideal contraceptive should be:
a. User-friendly.
b. Easily available.
c. Effective and reversible with no or least side-effects.
d. non-interfering with the sexual drive/desire and/or the sexual act of the user.
Methods of Birth Control (Contraceptives)
The wide range of contraceptive methods presently available which could be broadly grouped into the following categories:
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Natural/traditional methods
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Barrier methods
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Intra uterine devices (IUDs)
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Oral contraceptives
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Injections and implants
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Surgical methods
1. Natural/traditional methods
These are natural methods that work on the principle of avoiding the meeting of ovum and sperm.
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Periodic abstinence: is a method in which a couple avoids or abstains from coitus from day 10-17 of the menstrual cycle, when ovulation is expected to occur.
As a chance of fertilization are very high during this period, it is called the fertile period. -
Coitus interruptus: or withdrawal is a method in which male partner withdraws his penis from the vagina just before ejaculation so as to avoid insemination.
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Lactational amenorrhea: (Absence of menstruation) is based on the principle that during the period of lactation after parturition, ovulation does not occur.
2. Barrier methods
These methods prevent the contact of sperm and ovum with the help of barriers. such methods are available for both males and females.
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Condoms: are barriers made of thin rubber/latex sheath used to cover the penis in the male or vagina and cervix in females, it prevents the deposition of ejaculated semen into the vagina of the female.
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Diaphragms, cervical caps and vaults: are the barriers made of rubber that are inserted into the female reproductive tract to cover the cervix during coitus. They prevent the entry of sperms through cervix.
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Spermicidal creams, jellies and foams: are used along with these barriers to increase their contraceptive efficiency.
3. Intra uterine devices (IUDs)
These devices are inserted by doctors or expert nurses in the uterus through vagina.
There are three types of IUDs available:
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Non-medicated IUDs: These increase phagocytosis of sperms within the uterus, e.g., Lippes loop.
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Copper releasing IUDs: Along with phagocytosis of sperms, the Copper (Cu) ions released suppress sperm motility and fertilising capacity of sperms, e.g., CuT, Cu7, Multiload 375.
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Hormone releasing IUDs: These make the uterus unsuitable for implantation and the cervix hostile to sperms, e.g., Progestasert, LNG-20 (Levonorgestraol – is a hormonal medication is used in number of birth control methods).
4. Oral contraceptive
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This involves uptake of hormonal preparations of either progestogens or progestogen-estrogen combinations in the form of pills by females.
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They inhibit ovulation and implantation as well as alter the quality of cervical mucus to prevent entry of sperms.
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'Saheli', an oral contraceptive for females containing a non-steroidal preparation was developed by scientists at Central Drug Research Institute (CDRI) in Lucknow.
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Pills have high contraceptive value and few side effects.
5. Injections and implants
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Progestogens or progestogen-estrogen combination can also be used by females as injections or implants under the skin.
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Their mode of action is similar to that of pills but their effective periods are longer.
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Administration of progestogens or progestogens-estrogen combinations or IUDs within 72 hours of coitus have been found to very effective.
6. Surgical methods (Sterilisation)
These are terminal and permanent methods which block the transport of gametes, thereby preventing conception (pregnancy).
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In males, a small part of the vas deferens is removed and tied up through a small incision on the scrotum. This is called vasectomy.
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In females, a small part of the fallopian tube is removed and tied up through a small incision in the abdomen or vagina. This is called tubectomy.
Medical Termination of Pregnancy (MT P)
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It is defined as intentional or voluntary termination of pregnancy before full term.
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MTP was legalised by Government of India in 1971 under strict conditions to avoid misuse.
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MTP is done in the following situations:
a. Failure of contraceptive used during coitus or rapes.
b. When continued pregnancy is harmful or fatal to either mother or foetus or both.
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It is safe during first trimester, i.e., up to 12 weeks of pregnancy.
Sexually Transmitted Diseases (STDs)
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Infections or diseases that are transmitted through sexual intercourse are collectively called sexually transmitted diseases (STDs) or venereal diseases (VD) or reproductive tract infections (RTI).
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These include gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis_B, HIV.
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Early symptoms: Itching, fluid discharge, slight pain and swellings in the genital region.
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Complications due to chronic STDs: Pelvic inflammatory diseases (PID), abortions, still births, ectopic pregnancies, infertility, or even cancer of the reproductive tract.
Transmission of hepatitis-B and HIV occurs by the following ways:
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Sharing of injection needles or surgical instruments with infected persons;
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Sexual contact with infected person / multiple partners.
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Transfusion of infected blood;
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Transfer from infected mother to the foetus through placenta.
By following simple principles, STDs can be prevented:
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Avoid sex with unknown partners/multiple partners.
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Always use condoms during coitus.
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Contact a qualified doctor for any doubt, in early stage of infection.
Infertility
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It is the inability to produce children in spite of unprotected sexual cohabitation.
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The reasons of infertility could be physical, congenital diseases, drugs, immunological, or even psychological.
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Specialised health-care units called infertility clinics could help in diagnosis and corrective treatment of some of these disorders.
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The infertile couples could be assisted to have children through certain special techniques called assisted reproductive technologies (ART).
Assisted reproductive technologies (ART):
1. Test Tube Baby Programmes
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In this method, ova from the wife/donor (female) and the sperms from the husband/donor (male) are collected and induced to form zygote under simulated conditions in the laboratory. This process is called in-vitro fertilisation (IVF).
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The zygote or early embryo with up to 8 blastomeres is transferred into the fallopian tube (process is called zygote intra fallopian transfer or ZIFT) and embryo with more than 8 blastomeres is transferred into the uterus (process is called intra uterine transfer or IUT).
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In females who cannot conceive, embryos formed by fusion of gametes in another female (called in vivo fertilisation) are transferred.
2. Gamete Intra Fallopian Transfer (GIFT)
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It is the transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce one, but can provide suitable environment for fertilisation and further development of the embryo
3. Intra Cytoplasmic Sperm Injection (ICSI)
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It is a procedure to form an embryo in the laboratory by directly injecting the sperm into an ovum.
3. Artificial Insemination (Al)
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In this method, the semen collected either from the husband or a healthy donor is artificially introduced into the vagina or into the uterus (intra uterine insemination or IUI).
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This technique is used in cases where the male is unable to inseminate sperms in the female reproductive tract or due to very low sperm counts in the ejaculation.