Reproductive health

Reproductive health means a total well being in all aspects of reproduction. India
initiated reproductive health programmes (family planning) in 1951.

Reproductive & Child Health Care (RCH) programmes

▪ Create awareness among people about various reproduction related aspects

▪ Introduce sex Education in schools

▪ Provide proper information to adolescents such as responsible sexual behavior,

HIV/AIDS, sexuality, family planning.

▪ Provide Facilities and Support.

▪ Prevention of STD/ HIV/AIDS;

Aims and needs of sex education in schools

▪ To provide right information about sex-related aspects.

▪ To avoid sex-related myths and misconceptions.

▪ Proper information about reproductive organs, Adolescence and related changes,

safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS etc.

POPULATION EXPLOSION & BIRTH CONTROL

According to the 2001 census report, the population growth rate was still around 1.7%
(i.e. 17/1000/year), a rate at which our population could double in 33 years.
Reasons for population explosion

1. A rapid decline in death rate.

2. Decline in maternal mortality rate (MMR) .
3. Decline in infant mortality rate (IMR) .
4. Increase in number of people in reproducible age .

Impacts of population explosion

Scarcity of basic requirements (e.g. food, shelter & clothing).

Control measures
▪ Motivate smaller families by using contraceptive methods.

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▪ Aware peoples about a slogan Hum Do Hamare Do (we two,our two). Many couples
have adopted a ‘one child norm’.

▪ Statutory raising of marriageable age of the female (18 years) and males (21 years).

▪ incentives given to couples with small families

Contraceptives

An ideal contraceptive should be

▪ User-friendly,

▪ Easily available,

▪ Effective and reversible

▪ No side-effects.

▪ It should not interfere with sexual drive, desire & sexual act.

Birth control

▪ 1. Natural 2. Barrier 3. IUD 4. Hormonal (Pills) 5. Surgical

1.Natural Birth Control

1. Periodic Abstinence-. From day 10 to 17 of the menstrual cycle is the fertile period
when ovulation could be expected. During the fertile period, coitus is avoided.

2. Withdrawal (Coitus Interrupus)-withdraws penis before ejaculation to avoid

insemination

3. Lactational amenorrhea-Ovulation does not occur during the period of intense

lactation period. Pregnancy can be prevented by breastfeeding the child. This is
effective up to 6 months following parturition.
▪ Advantages of natural methods:- Side effects are nil, No prescription
necessary

▪ Disadvantage:- Chances of failure, is high. Offers no protection against

sexually transmitted infections

2.BARRIER METHOD

1.Prevents pregnancy by blocking the egg and sperm

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meetingUsed for spacing or giving a gap between children

Eg:-male condoms, female condom, diaphragm,

cervical caps,vaults

Made of rubber/latex sheath. It is used to cover the

penis in the male or vagina and cervix in the female.
▪ Prevent the semen enter into female reproductive tract.

Advantage of Condoms :-

Protection against sexually transmitted infections like AIDS.

It is disposable.

Give privacy to user.

IUDs (INTRA UTERINE DEVICES (IUCD):

▪ These are inserted by doctors or expert nurses in the uterus through vagina.

▪ prevents implantation. It is the best spacing method

▪ I:-non medicated eg:- lippe’s loop

▪ Ii :- copper releasing iuds eg:-cu t, cu7, multiload 375

▪ Iii:- hormone releasing eg:-progestasert, lng-20

How does the IUD work?-

▪ Increase the phagocytosis of sperms within the uterus.

▪ Cu ions released suppress sperm motility and fertilizing capacity.

▪ Hormone releasing IUCD make the uterus unsuitable for implantation

3.Hormonal Methods

▪ a) Oral Contraceptives (Birth Control Pill)

▪ b) Implants (Norplant I & II)

a)ORAL CONTRACEPTIVES

▪ Oral administration of progestogens or progestogen-estrogen combinations in the

form of tablets (pills).
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Pills are taken daily for 21 days starting within the first five days of menstrual cycle.
After a gap of 7 days it has to be repeated in the same pattern

Saheli: New oral contraceptive for the females developed by scientists at Central
Drug Research Institute (CDRI) in Lucknow
It contains a non-steroidal preparation. It is a ‘once a week’ pill with very few side
effects and high contraceptive value.

How does the pill work?

▪ Suppresses ovulation

▪ Thickens cervical mucus, thus slows motility of sperm

▪ Thins endometrium

Disadvantages

▪ The pill offers no protection from STD’s

▪ Causes mood Changes, depression, anxiety

▪ Side effects Nausea, breast tenderness, Weight gain

Emergency pill Must be taken within 72 hours of the act of unprotected

intercourse or failure of contraception method.
It avoids pregnancy due to rape or casual intercourse.
Implants

▪ Progestogens alone or in combination with oestrogen

are used by females as injections or implants under skin..

▪ A hormone-carrying, thin flexible plastic rod, about the

size of a matchstick inserted under the skin of arm.

▪ Constantly releases progestin to suppress ovulation

4.SURGICAL METHOD (STERILIZATION)

TERMINAL OR PERMANENT METHOD ie. a permanent stopping of conception by a

surgery and block the gamete transport.

Used by couples who have completed their family.

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TUBAL LIGATION (Tubectomy)

▪ Surgical procedure performed on a woman

▪ Fallopian tubes are cut & tied, prevents eggs from reaching sperm

VASECTOMY

▪ Male sterilization procedure

▪ The ‘vas deferens’ is isolated and cut.

Medical Termination of Pregnancy(MTP)

▪ Voluntary termination of pregnancy before full term is called medical termination

of pregnancy(MTP) or induced abortion.

▪ Because of emotional, ethical, religious and social issues many countries have
not legalised MTP.

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 ▪ Government of India legalised MTP in 1971 with some strict conditions to check
indiscriminate and illegal female foeticides which are reported to be high in India.

Problems related with MTPs

▪ Majority of the MTPs are performed illegally.

▪ Misuse of amniocentesis -If the foetus is female, it is followed by MTP. Such

practices are dangerous for the young mother and foetus.

▪ The mtps performed by unqualified persons is unsafe

▪ MTPs are safe during the first trimester, (up to 12 weeks of pregnancy). 2nd
trimester abortions are very risky

Importance- to avoid unwanted pregnancies and harmfull pregnacies

Abortion is the right of the woman and legalized in India under the Medical
Termination of Pregnancy Act

MTP is needed in such cases,

▪ Continuation of pregnancy could be harm full to the physical or mental

health of woman

▪ physical or mental abnormalities in the fetus

▪ Pregnancy caused by rape

▪ Contraceptive failure in married couple.

▪ However having an abortion based only on the gender of the foetus is common in
our country…

Amniocentesis

▪ A sex determination technique based on the chromosomal pattern in the

amniotic fluid surrounding the developing embryo.

▪ Uses:- for sex determination, find out genetic disorders etc.

▪ Misuses widely for female foeticides.

▪ Banned in India.

Sexually transmitted diseases

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 or venereal diseases (VD)

Or reproductive tract infections (RTI).

▪ Diseases which are transmitted through sexual intercourse

▪ Common STDs are Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital

warts, trichomoniasis, hepatitis B, AIDS

Major symptoms of STD

▪ Itching

▪ Fluid discharge

▪ Slight pain

▪ Swellings in genital region

▪ Later stages it may lead to pelvic inflammatory diseases (PID), abortions, Still
births, ectopic pregnancies,

infertility, cancer of the reproductive tract etc.

▪ Very high among persons in the age group of 15-24 years.

Prevention:

▪ i. Avoid sex with unknown partners/multiple partners

▪ ii. Always use condoms during coitus.

▪ iii. In case of doubt, go to a qualified doctor for early detection and get complete
treatment

INFERTILITY

▪ It is the inability of male or female to produce children.

▪ The reasons for this may be physical, congenital, diseases, drugs, immunological
or even psychological.

ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

▪ These are the techniques which help infertile couples to conceive & bear
children.
▪ They are offered to them at fertility centers

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1. In vitro fertilisation (IVF– test tube baby programme):
▪ In this method, ova/sperm from the donor are collected and are induced to form
zygote under simulated conditions in the laboratory. This is followed by Embryo
transfer (ET).

Basic Steps in IVF

• Ovary stimulation

• Egg Collection

• Sperm Collection-

• Induce Fertilization to form zygote

• Then Embryo transfer

2.Zygote Intra Fallopian Transfer (ZIFT):Transfer of zygote or early embryos

(with up to 8 blastomeres) into fallopian tube.
3.Intra Uterine Transfer (IUT): Transfer of embryos with more than 8
blastomeres into the uterus.
4.Gamete Intra Fallopian Transfer (GIFT): Transfer of an ovum from a donor into
the fallopian tube of another female
DONE IN CASES OF:
• Low motility for sperms
• Increased cervical mucus
• In those who cannot produce ovum, but can provide suitable environment for
fertilization and development.
5.Intra cytoplasmic sperm injection (ICSI): A single sperm is injected directly into an
egg .Then the fertilised egg is implanted into the woman’s uterus.
Uses in such cases inability of sperm to fertilize the egg due to the lack of
acrosomal enzyme
6. Artificial insemination (AI) technique:
• The semen collected from the husband or a healthy donor is artificially introduced
into the vagina or the uterus. 2 types

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 • IUI – intra-uterine insemination.
• IVI intra vaginal insemination
• Useful for the male partner having inability to inseminate female or low sperm
counts etc.
7. Surrogacy:
• - Here, a woman (surrogate mother) bears a child for a couple unable to produce
children, because the wife is infertile or unable to carry.
• - The surrogate is impregnated either through artificial insemination or through
implantation of an embryo produced by in vitro fertilisation.

Problems of ART
• It requires high precision handling by specialized professionals and expensive
instrumentation. Therefore, these facilities are available only in very few centres.
• Emotional, religious and social problems.
Legal adoption is one of the best methods for couples looking for parenthood.
Previous questions
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1.Expand the following abbreviations which are commonly used in reproductive health
(1)
a)ART b)ZIFT

2.One of our neighbour is suffering from itching, fluid discharge, slight pain and
swelling in the genital region (2)
a)What do you think the disease he is suffering from? b)What measures are to be
taken to prevent such disease

3.Suggest the ART which may be successful in the following conditions (3)
a)A female cannot produce an ovum, but can provide suitable environment for
fertilization and further development b)Male partner is unable to inseminate the female
or has very poor sperm count c)Fusion of gamete and zygote formation doesnot occur
within the body of female

4.Mothers milk is considered essential for new born infants (1)

a)Name the fluid secreted by mother from breast during the initial days of lactation
b)What type of immunity it provides

5.Some techniques commonly used for infertility treatment are given below. Read them
carefully and answer the question (3)
ZIFT,GIFT,ICSI,IUI,IVF a)which of the above techniques is used for the collection of
sperm from the husband or a healthy donor and artificially introduced into the vagina or
uterus of the female? b)Distinguish between ZIFT and GIFT c)Write the common term
used to denote the techniques given below ?

6. Amniocentesis for sex determination is banned in our country? Is this Ban

necessary? Comment one use of amniocentesis? (2)
7. Sterilization and IUDs are effective birth control measures, but lactational
amenorrhoea may not be so effective
a)How the sterilization procedure of male differ from that of female in preventing
pregnancy? (2) b) Which part of the female reproductive organ is utilized for the IUD
procedure? How this procedure prevents pregnancy? (2) c)Why the lactational
amenrrhoea is not so effective? (1)
8. Find out the odd one from the following, write the reason (1)
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a)Cu T, b)Cu 7 c)LNG-20 d)Multiload-375

9. One couple came to know that they have a girl child during fourth month of
pregnancy and they decided to do MTP (2)
a)What is MTP?
b)At which stage of pregnancy MTP relatively safe?
c)How will you respond to the decision of female foeticide by the couple?

10.Note the relationship between first two terms and suggest a suitable terms for the
fourth place (1)
a)Progesteron : Corpus luteum
HCG : ........................
b)GIFT : Gamete
ZIFT : ........................
11. “STDs present a major health concern in both industrialization and developing
countries”(3)
a) What you meant by STD? b) Name two STDs? c) Suggest two preventive
measures?
12. The total population in India is alarmingly increased to 1 billion according to 2001
censes. The population growth rate was still around 1.7%, a rate at which our
population could be double in 33 years
Cite the probable reasons for such an increase in population growth rate? (2)

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