Reproductive Health Chapter 4

Reproductive Health

• Reproductive health refers to a total well-being in all aspects of reproduction, including physical, emotional, behavioural, and social aspects.
• A society with people having physically and functionally normal reproductive organs and normal emotional and behavioural interactions among them in all sex-related aspects is considered reproductively healthy.
• India initiated family planning programmes in 1951, which were later revamped as Reproductive and Child Health Care (RCH) programmes to create awareness about various reproduction-related aspects.

Reproductive Health – Problems and Strategies

• Awareness about reproduction-related aspects is essential to maintain reproductive health.
• Effective dissemination of information about reproductive organs, adolescence, and related changes, safe and hygienic sexual practices, sexually transmitted diseases (STDs), AIDS, etc. can help prevent problems.
• Educating people, especially fertile couples and those in marriageable age group, about available birth control options, care of pregnant mothers, post-natal care of the mother and child, importance of breast feeding, equal opportunities for the male and the female child, etc. can address the importance of bringing up socially conscious healthy families of desired size.
• Successful implementation of various action plans to attain reproductive health requires strong infrastructural facilities, professional expertise, and material support.

Population Explosion and Birth Control

• The world population grew from 2 billion in 1900 to 6 billion in 2000, and India's population reached 1 billion in 2000, with a growth rate of 1.7% per year.
• Uncontrolled population growth can lead to scarcity of food, shelter, and clothing, despite significant progress in those areas.
• Motivating smaller families through various contraceptive methods, such as natural, barrier, IUDs, oral contraceptives, injectables, implants, and surgical methods, can help control population growth.
• An ideal contraceptive should be user-friendly, easily available, effective, and reversible, with no or least side-effects, and not interfere with sexual drive, desire, or act.

Contraceptive Methods

• Natural methods: periodic abstinence, withdrawal, and lactational amenorrhea.
• Barrier methods: condoms (male and female), diaphragms, cervical caps, and vaults, which prevent sperm and ovum from meeting.
• IUDs (Intra Uterine Devices): non-medicated, copper releasing, and hormone releasing, which increase phagocytosis of sperms and make the uterus unsuitable for implantation.
• Oral contraceptives: pills, which inhibit ovulation and implantation, and alter cervical mucus to prevent entry of sperms.
• Injectables and implants: progestogens alone or in combination with estrogen, which have longer effective periods.
• Surgical methods: vasectomy (male) and tubectomy (female), which block gamete transport and are generally advised as a terminal method.

Medical Termination of Pregnancy (MTP)

• MTP is the intentional termination of pregnancy before full term, often due to casual unprotected intercourse, failure of contraceptive, or rape.
• India legalised MTP in 1971 with strict conditions to avoid misuse, and it is considered relatively safe during the first trimester.
• Illegal MTPs are often performed by unqualified quacks and are unsafe, and the misuse of amniocentesis to determine the sex of the foetus is dangerous and illegal.

Sexually Transmitted Diseases (STDs)

• STDs are diseases or infections transmitted through sexual intercourse, such as gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B, and HIV leading to AIDS.

• Early symptoms of most STDs are minor and include itching, fluid discharge, slight pain, and swellings in the genital region.

• Except for hepatitis-B, genital herpes, and HIV infections, other STDs are completely curable if detected early and treated properly.### Reproductive Health

• Refers to a total well-being in all aspects of reproduction, including physical, emotional, behavioral, and social.

• Involves counseling and creating awareness about reproductive organs, adolescence, and associated changes, safe and hygienic sexual practices, and sexually transmitted diseases (STDs) including AIDS.

Sexually Transmitted Diseases (STDs)

• Can lead to complications such as pelvic inflammatory diseases (PID), abortions, stillbirths, ectopic pregnancies, infertility, and cancer of the reproductive tract.
• Prevention and early detection are crucial, and can be achieved by avoiding sex with unknown/multiple partners, using condoms during coitus, and seeking medical attention if symptoms arise.

Infertility

• Defined as the inability to conceive or produce children even after 2 years of unprotected sexual cohabitation.
• Can be caused by physical, congenital, diseases, drugs, immunological, or psychological factors.
• Can be addressed through assisted reproductive technologies (ART), including in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and intrauterine insemination (IUI).

Assisted Reproductive Technologies (ART)

• Include techniques such as IVF, GIFT, and IUI to assist infertile couples in having children.
• IVF involves fertilization outside the body, followed by embryo transfer into the female genital tract.
• GIFT involves transferring an ovum collected from a donor into the fallopian tube of another female.
• IUI involves artificially introducing semen into the vagina or uterus of the female.

Reproductive and Child Health Care Programmes

• Aim to provide medical facilities and care to address problems related to menstrual irregularities, pregnancy, delivery, medical termination of pregnancy, STDs, birth control, infertility, and post-natal child and maternal management.
• Have led to an overall improvement in reproductive health, as indicated by reduced maternal and infant mortality rates, early detection and cure of STDs, and assistance to infertile couples.

Contraception

• Various methods are available, including natural, traditional, barrier, IUDs, pills, injectables, implants, and surgical methods.
• Medical termination of pregnancy is legalized in India, and is often performed to get rid of unwanted pregnancy due to rapes, casual relationships, or when the continuation of pregnancy could be harmful or fatal to the mother, foetus, or both.

Importance of Reproductive Health

• Significance of reproductive health in a society lies in its impact on overall well-being, population growth, and economic development.
• Special attention needs to be given to aspects such as sex education, awareness about STDs, and access to reproductive health services, particularly in rural areas.
• Improvement in reproductive health has been observed in the past 50 years, with reduced maternal and infant mortality rates, and increased access to reproductive health services.