Reproductive Health

1. Reproductive Health

What is Reproductive Health?

• Healthy reproductive organs with normal functions.
• Also includes emotional and social aspects.
• According to WHO: Reproduction health is total well-being in physical, emotional, behavioral, and social aspects of reproduction.

Reproductive Health – Problems and Strategies

• India’s Initiatives:
  • First country to start national action plans for reproductive health.
  • Programs began in 1951 as “family planning.”
  • Now called “Reproductive and Child Health Care (RCH) programs.”
• Creating Awareness:
  • Use of audio-visual and print media.
  • Role of parents, relatives, teachers, and friends.
  • Introduction of sex education in schools.
• Key Information for Awareness:
  • Reproductive organs and adolescence changes.
  • Safe and hygienic sexual practices.
  • Sexually transmitted diseases (STDs) and AIDS.
  • Birth control options.
  • Care for pregnant mothers and post-natal care.
  • Importance of breastfeeding.
  • Equal opportunities for male and female children.
• Addressing Social Issues:
  • Problems of uncontrolled population growth.
  • Social evils like sex-abuse and sex-related crimes.

Implementation Needs:

• Strong infrastructure, professional expertise, and material support.
• Medical assistance for pregnancy, delivery, STDs, abortions, contraception, menstrual problems, infertility.
• New techniques and strategies for better care.
• Statutory ban on amniocentesis for sex determination to prevent female foeticides. (learn more about amniocentesis below).
• Massive child immunization programs.

Research and Development:

• Encouraged by governmental and non-governmental agencies.
• Example: “Saheli” – a new oral contraceptive developed by CDRI, Lucknow.

Benefits of Improved Reproductive Health:

• Better awareness about sex-related matters.
• Increased medically assisted deliveries.
• Better post-natal care.
• Decreased maternal and infant mortality rates.
• More couples with small families.
• Better detection and cure of STDs.
• Improved medical facilities for all sex-related problems.

1.2 Population Explosion and Birth Control

Population Growth (Explosion):

• Better health facilities and living conditions led to population growth.
• World population: 2 billion in 1900 to 6 billion in 2000.
• India’s population: 350 million at independence to over 1 billion by 2000.
• Causes: Lower death rates, maternal and infant mortality rates, more people of reproductive age.

Measures to Control Population:

• Family Planning and RCH Programs:
  • Initiated in 1951 to control population growth.
  • Aim to create awareness and provide facilities for reproductive health.
• Creating Awareness:
  • Use of media, posters, and education.
  • Importance of smaller families (“Hum Do Hamare Do”).
  • Sex education in schools to correct myths and misconceptions.

Contraceptive Methods:

• Natural Methods:
  • Periodic Abstinence: Avoiding sex during fertile period (day 10-17 of menstrual cycle).
  • Withdrawal (coitus interruption) Method: Male pulls out his penis from the vagina just before ejaculating to prevent insemination.
  • Lactational Amenorrhea: Breastfeeding prevents ovulation up to 6 months and thus provides a safe period for intercourse.
• Barrier Methods:
  • Condoms: Prevents sperm from entering the female reproductive tract. Also available for females.
  • Diaphragms, Cervical Caps, Vaults: Blocks sperm entry into cervix.
  • Often used with spermicidal creams/jellies for better effectiveness as these are capable to kill sperms.

• Intrauterine Devices (IUDs):
  • Inserted into the uterus by doctors.
  • Types and action mechanism:
    • Non-medicated – Prevent sperm motility, Prevent fertilization.
    • Copper-releasing – Prevent sperm motility, Phagocytosis of sperm, Prevent fertilization, Prevent implantation.
    • Hormone-releasing – Prevent fertilization, Prevent implantation.

• Oral Contraceptives (Pills):
  • Contains Levonorgestrel or Progestogens or Progestogen-Estrogen combinations.
  • Prevents ovulation and alters cervical mucus, eventually inhibiting implantation.
  • Types:
    1. Emergency Contraceptive Pills (ECPs): Taken within 72 hours of coitus (unprotected intercourse).
       • Prevents possible pregnancy due to rape or unplanned sex.
    2. Combined Oral Contraceptives (COCs): Taken daily or for 21 days, followed by a 7-day break.
    3. Others – Progestin-Only Pills (POPs), Extended-Cycle Pills.
• Injectables and Implants:
  • Progestogens alone or combined with estrogen.
  • Long-term contraception similar to pills.

• Surgical Methods (Sterilization):
  • Vasectomy: Male sterilization by cutting vas deferens.
  • Tubectomy: Female sterilization by cutting fallopian tubes.
  • Permanent methods, highly effective but have low reversibility.

Choosing Contraceptives:

• Always consult with medical professionals.
• Contraceptives are not regular health needs but used to control or space pregnancies.
• They help control population growth but can have minor side effects like nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding or even breast cancer.
• An ideal contraceptive should have some features as discussed below.

1.3 Medical Termination of Pregnancy (MTP)

What is MTP?

• MTP stands for Medical Termination of Pregnancy or induced abortion.
• It means ending a pregnancy before it reaches full term.

Statistics:

• Around 45 to 50 million MTPs are done every year worldwide.
• This is about 1/5th of all pregnancies.

Legal and Ethical Issues:

• MTP can reduce population growth, but that’s not its main purpose.
• Many countries debate whether to legalize MTP due to emotional, ethical, religious, and social reasons.
• In India, MTP was legalized in 1971 with strict conditions to prevent misuse.

Why is MTP Done?

• To end unwanted pregnancies from casual unprotected intercourse, contraceptive failure, or rape.
• When continuing the pregnancy could harm or be fatal to the mother, foetus, or both.

Safety and Risks:

• MTP is safer during the first trimester (up to 12 weeks).
• Second trimester (after 12 weeks) abortions are riskier.
• Many MTPs are done illegally by unqualified people, which is unsafe and can be fatal.

Misuse and Dangers:

• Misuse of amniocentesis (a test to determine the sex of the unborn baby) leads to illegal MTPs if the baby is female.
• This practice is illegal and dangerous for the mother and the foetus.

Preventive Measures:

• Effective counselling to avoid unprotected intercourse.
• Educating on the risks of illegal abortions.
• Providing better health care facilities to stop these unhealthy practices.

1.4 Sexually Transmitted Diseases (STDs)

Sexually Transmitted Diseases (STDs)

What are STDs?

• STDs are diseases or infections spread through sexual intercourse.
• Also called venereal diseases (VD) or reproductive tract infections (RTI).

Common STDs:

• Gonorrhoea
• Syphilis
• Genital herpes
• Chlamydiasis
• Genital warts
• Trichomoniasis
• Hepatitis-B
• HIV/AIDS (most dangerous)

Other Transmission Methods:

• Sharing needles or surgical instruments with infected persons.
• Blood (infected donor’s) transfusions.
• From infected mother to foetus.

Curability:

• Most STDs are curable if detected early and treated properly.
• Hepatitis-B, genital herpes, and HIV are not completely curable.

Early Symptoms:

• Itching
• Fluid discharge
• Slight pain
• Swellings in the genital area
• Infected females may have no symptoms and remain undetected.

Complications:

• If untreated, STDs can cause:
  • Pelvic inflammatory diseases (PID)
  • Abortions
  • Still births (Dead baby)
  • Ectopic pregnancies (Learn more below)
  • Infertility
  • Cancer of the reproductive tract

Prevention and Early Detection:

• Important for a healthy society.
• High incidence in people aged 15-24 years.

Prevention Tips:

1. Avoid sex with unknown or multiple partners.
2. Always use condoms during sex.
3. If in doubt, visit a doctor for early detection and complete treatment.

1.5 Infertility

What is Infertility?

• Inability of couples to have children despite unprotected sex.

Causes of Infertility:

• Physical issues
• Congenital (from birth) problems or Genetic factors.
• Diseases
• Effects of drugs
• Immunological factors
• Psychological factors

Common Misconceptions:

• In India, females are often blamed for childlessness😞, but the issue can also be with the male partner.🤔

Help for Infertile Couples:

• Infertility Clinics: Specialized health care units to diagnose and treat infertility.
• Assisted Reproductive Technologies (ART): Special techniques to help couples have children.

Assisted Reproductive Technologies (ART):

• In Vitro Fertilisation (IVF):
  • Also known as the test tube baby program.
  • Eggs from the female and sperm from the male are combined outside the body (in-vitro) to form a zygote.
  • Zygote Intra Fallopian Transfer (ZIFT): Zygote with up to 8 cells is placed in the fallopian tube.
  • Intra Uterine Transfer (IUT): Embryo with more than 8 cells is placed in the uterus.
• Gamete Intra Fallopian Transfer (GIFT):
  • Egg from a donor is placed in the fallopian tube of another woman who can provide a suitable environment for fertilization.
• Intra Cytoplasmic Sperm Injection (ICSI):
  • Sperm is directly injected into an egg in the laboratory to form an embryo.
• Artificial Insemination (AI):
  • Sperm from the husband or a donor is introduced into the vagina or uterus (Intra Uterine Insemination – IUI) of the female.

Challenges:

• High precision handling and expensive equipment needed.
• Available in limited centers.
• Emotional, religious, and social issues.

Alternative Solution:

• Adoption: Legal adoption is a good option for couples looking to become parents and helps orphaned children.

Chapter Summary:

• Reproductive health means total well-being in physical, emotional, behavioral, and social aspects of reproduction.
• India was the first country to start national action plans for reproductive health.
• Key steps include counseling and awareness about:
  • Reproductive organs
  • Adolescence and changes
  • Safe and hygienic sexual practices
  • Sexually transmitted diseases (STDs) including AIDS

Medical Facilities and Care

• Important aspects include:
  • Menstrual irregularities
  • Pregnancy and delivery
  • Medical termination of pregnancy
  • STDs and birth control
  • Infertility
  • Postnatal child and maternal care

Improvement in Reproductive Health

• Indicators of improvement:
  • Reduced maternal and infant mortality rates
  • Early detection and cure of STDs
  • Assistance to infertile couples

Population Growth and Contraceptives

• Population growth due to better health facilities and living conditions.
• Need for promoting contraceptive methods:
  • Natural and traditional methods
  • Barrier methods
  • IUDs
  • Pills
  • Injectables and implants
  • Surgical methods
• Contraceptives are used to avoid, delay, or space pregnancies.

Medical Termination of Pregnancy (MTP)

• MTP is legal in India.
• Reasons for MTP:
  • Unwanted pregnancy due to rape or casual relationships
  • Pregnancy harmful to mother or fetus

Sexually Transmitted Diseases (STDs)

• STDs are infections transmitted through sexual intercourse.
• Complications include:
  • Pelvic inflammatory diseases (PIDs)
  • Stillbirth
  • Infertility
• Prevention and early detection:
  • Avoid sex with unknown/multiple partners
  • Use condoms

Infertility

• Infertility: Inability to conceive after 2 years of unprotected sex.
• Methods to help infertile couples:
  • In vitro fertilization (IVF) and embryo transfer (Test Tube Baby Programme)