Reproductive Health-Quick Revision

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Problems of reproductive health in India

1. Over population
2. Early marriage
3. Health of mothers
4. Deformities
5. Maternal mortality rate (MMR) and infant mortality rate (IMR)
6. Sexually transmitted diseases (STDs)
7. Career

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Population explosion

1. Population explosion refers to the rapid and dramatic rise in world population that has occurred over the last few hundred years.

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Reasons for rise in world human population

The six main reasons for the sharp rise in world human population in the recent past are as follows:1. Better medical facility (hospitals, health care centres, doctors etc.) for all age group lead to decrease in death rate.
2. There are fewer deaths due to better vaccination programmes and more patients are getting cured and so they live longer.
3. Green revolution has helped in minimizing food shortage, leading to very few starvation death.
4. Due to rise in health awareness, the nutrition intake of the children and people has been improved.
5. Vaccination and immunisation facilities have helped in curing and preventing fatal diseases thereby lowering the death rate.
6. There are fewer infant death due to improved medical technology.
Since, more and more children are reaching the reproductive age, they contribute to population growth.

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Fighting against social ills

1. Social evils like sex determination and female foeticide are common due to the development of medical diagnostic tests.
2. The techniques like ultrasound are beneficial to know the foetal viability but it is misused for sex determination which provokes female foeticide.
3. The medical technique can be used to detect genetic disorders.

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Strategies for maintaining reproductve health in India

1. Family planning programme
2. Awareness about reproduction
3. Sex education
4. Knowledge of growth of reproductive organs and STDs
5. Birth control devices and care of mother and child
6. Prevention of sex abuse and sex related crime
7. Information about reproduction related problems
8. Research in reproductive health area
9. Medical facilities
10. Amniocentesis

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Amniocentesis

1. Amniocentesis is a technique used to diagnose fetal abnormalities by drawing a sample of amniotic fluid by a hypodermic needle inserted through the mother’s abdomen into the uterus.

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Sexually transmitted disease

1. Disease or infections which are transmitted through sexual intercourse with infected persons are collectively called sexually transmitted diseases.
2. For example, HIV-AIDS, gonorrhea, syphilis etc.

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Mode of transmission of STDs

1. Sexual intercourse with infected person.
2. Sharing of injection needles, surgical instruments etc.
3. Transfusion of blood.
4. Infected mother to foetus.

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Medical termination of pregnancy (MTP)

1. MTP is usually done during the first few months of pregnancy.
2. It is usually done by dilation and curettage, vacuum aspiration and by administration of prostaglandin.

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Natural methods of birth control

Natural methods of birth control are as follows:
1. Safe period
2. Coitus interruptus (withdrawal or pull-out method)
3. Lactational amenorrhea method

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Artificial methods of birth control

Artificial methods of birth control are as follows:
1. Barrier method (spermicides, condoms, femidoms, diaphragms, cervical caps, vaults, IUD)
2. Physiological devices (mini pills, combined pills, emergency contraceptive pills)
3. Injection or implants

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Permanent methods of birth control

1. Vasectomy: Removal of short segment of each vas deferens, in male.
2. Tubectomy: Removal of short segment of each fallopian tube, in female.
The surgical operations are minor and are usually performed under local anaesthesia.

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Assisted reproductive technologies (ARTs)

Inability to produce children is known as infertility. It can be treated with the means of Assisted Reproductive Technologies (ARTs) that make it possible for childless couples to bear children. This involves:
1. In vitro fertilization (IVF)/Test Tube Baby – Here gametic fusion occurs outside the body in sterile conditions. After the embryo is developed, Embryo Transfer (ET) occurs. ET can be done by:
Zygotic Intra Fallopian Transfer (ZIFT) – Zygote or embryo with =< 8 blastomeres is directly transferred into the fallopian tube or uterus.

2. Gametic Intra Fallopian Transfer (GIFT) – It involves the transfer of gametes from a donor female into the body of a female who can house it but cannot produce an ovum.
3. Intra Cytoplasmic Sperm Injection (ICSI) – Direct injection of sperm into the ovum.
4. Artificial Insemination (AI) – Sperm from a donor is  inserted into the vagina or uterus of a female.

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Reproductive and Child Health (RCH) Programme

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2 Children Policy – Hum Do Hamare Do

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National Rural Health Mission (Encouraging Nuclear Family)

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Male Condom

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Female Condom

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Diaphragm

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Non-medicated IUDs – Lippes Loop

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IUDs – Copper-T

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Hormone Releasing IUDs – Progestasert

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Implants

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Contraceptive Hormone Pills

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Vasectomy

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Tubectomy

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Reproductive Health Problems, Strategies and Population Explosion Reproductive Health It refers to the physical, social and mental well being of a person and his/her reproductive organs. Problems and Strategies

• RCH – Reproductive and Child Healthcare programme.
• To control the increasing population, family planning programmes were implemented in 1951.
• Sex education encouraged in schools to clarify any misconceptions students have.
• Print and digital media is used to create awareness.
• Sex education is necessary to create awareness about prevention of STDs, promote hygienic practices and safe sexual practices.
• Sex determination of the unborn baby by amniocentesis has been banned to keep a check on increasing female foeticides.

Population Explosion

• Increased health facilities have had an explosive impact on growth.
• World population escalated from 2 billion in 1900 to 6 billion by 2000.
• There is a rapid decline in death rate, maternal mortality rate (MMR) and infant mortality rate (IMR)
• Growth rate is still around 1.7%/year.
• Alarming growth rate could lead to scarcity of basic requirements.
• “Hum do hamare do” slogan was promoted for population control promotion.
• Raising of marriageable age to 18 years for females and 21 years for males helps the cause.

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Medical Termination of Pregnancy (MTP) and STDs Medical Termination of Pregnancy (MTP)

• It refers to voluntary termination of unwanted pregnancy.
• It may be done in cases where the pregnancy poses risk to the mother or child.
• It was legalized in 1971.
• Rules and regulations are strict to prevent female foeticide.
• MTP is considered safe in the 1st trimester i.e. upto 12 weeks.
• MTP act of 1971 was amended in 2020.
• The amendment included that pregnancy can be terminated upto 20 weeks. If the period exceeds 20 weeks, upto 24 weeks it could be terminated only if medical practitioners believe that: a) The pregnancy would bear risk to the health of the woman. b) The unborn child is at a risk of serious physical/mental abnormality.

Sexually Transmitted Diseases (STDs)

• Diseases transmitted through sexual intercourse.
• Also calledvenereal diseases(VD) or reproductive tract infections (RTI).
• Common STDs are:
  1. Chlamydia
  2. Gonorrhoea
  3. HIV AIDS

4. Genital Warts 5. Syphilis

• AIDS and Hepatitis B are also transmitted through blood transfusion and sharing infected needles.
• Symptoms: Itching, swelling, pain, fluid discharge, etc.
• If condition progresses, it may lead to, infertility, ectopic pregnancy and abortions.
• One should always see a doctor incase of any doubt related to STDs.

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Birth ControlBirth control prevents unwanted pregnancies. It also offers protection against STDs.

The methods or devices facilitating birth control are called contraceptivesIdeal contraceptives are/have:

1. User-friendly
2. Easily available
3. Effective
4. Least side effects.

• Non- interfering with the sexual drive of a person.

Methods of Contraception 1. Natural Methods

• Periodic Abstinence – Refraining from intercourse during day 10 to day 17 of the menstrual cycle.
• Coitus Interruptus – Retraction of penis before ejaculation to prevent insemination
• Lactational Amenorrhoea – Usually till 6 months after the delivery of a baby, there is no ovulation due to breastfeeding.

2. Barrier Methods They block the entry of the sperms into the female genital tract, and hence prevent fertilization.

• Condoms
• Cervical caps
• Diaphragms
• Vaults
• Spermicidal creams, foams, jellies

3. Intrauterine Devices These are inserted into the uterus through the vagina. These are the most commonly used contraceptives. These work by reducing sperm motility, causing phagocytosis of sperms and decreasing fertilising ability.

• Copper T
• Lippes Loop
• Progestasert

4. Oral Contraceptives

• These are oral pills.
• They are taken from the 5th day of menstrual cycle till the 26th day.
• After a gap for menstruation, the dose has to be repeated for the next cycle similarly.
• These work by preventing ovulation or implantation.
• Saheli is a non-steroidal pill developed by CDRI Lucknow.

5. Injectables and Implants

• These are emergency contraceptives, which need to be administered within 72 hours of unprotected intercourse.
• Progesterone or combination hormones can be injected or placed under skin to act as a contraceptive.

6. Sterilisation/Surgical Methods These are terminal methods of contraception, i.e., they offer permanent and irreversible contraception. The male or female ducts are cut and tied to prevent the release of gametes.

• Vasectomy – A portion of the vas deferens is cut and tied.
• Tubectomy – A portion of the fallopian tubes is cut and tied.

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Infertility

• Inability to produce children is known as infertility.
• Reasons for infertility may be:

1. Physical
2. Congenital
3. Psychological
4. Hormonal
5. Diseases and drugs

Assisted Reproductive Technologies (ART) Assisted Reproductive Technologies (ART) make it possible for childless couples to bear children. These are of the following types:
1. In vitro fertilization (IVF)/Test Tube Baby – Here gametic fusion is carried outside the body in sterile conditions. After the embryo is developed, Embryo Transfer (ET) is done.

2. Zygotic Intra Fallopian Transfer (ZIFT) – Zygote or embryo with =< 8 blastomeres is directly transferred into the fallopian tube or uterus.

3. Gametic Intra Fallopian Transfer (GIFT) – It involves the transfer of gametes from a donor female into the body of a female who can house it but cannot produce an egg. 4. Intra Cytoplasmic Sperm Injection (ICSI) – Direct injection of sperm into the ovum. 5. Artificial Insemination (AI) – Sperm from a donor is inserted into the vagina or uterus of a female.