Introduction

 According to the World Health Organisation (WHO), reproductive health means a

total well-being in all aspects of reproduction, i.e., physical, emotional,
behavioural and social.
 To attain total reproductive health as social goal, action plans and programs at a
national level are initiated at national level. These programs are called family
planning initiated in 1951.
 Improved programmes covering wider reproduction-related areas are currently in
operation under the popular name ‘Reproductive and Child Health Care (RCH)
programmes’. Creating awareness among people about various reproduction
related aspects and providing facilities and support for building up a
reproductively healthy society are the major tasks under these programmes.
 Proper information about reproductive organs, adolescence and related changes,
safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS,
etc., would help people to lead a reproductively healthy life.
 Amniocentesis is a foetal sex determination test based on chromosomal pattern in
amniotic fluid surrounding the developing embryo. This procedure is used to test
for the presence of certain genetic disorders such as, Down syndrome,
haemoplilia, sickle-cell anemia, etc., determine the survivability of the foetus.
 Saheli’–a new oral contraceptive for the females–was developed at Central Drug
Research Institute (CDRI) in Lucknow, India.
 Better awareness about sex related matters, increased number of medically
assisted deliveries and better post-natal care leading to decreased maternal and
infant mortality rates, increased number of couples with small families, better
detection and cure of STDs and overall increased medical facilities for all sex-
related problems, etc. all indicate improved reproductive health of the society.
POPULATION STABILISATION AND BIRTH CONTROL:-

 Improved quality of life of people, increased health facilities and better living
conditions had an explosive impact on population.
 Rapid decline in death rate, MMR(maternal mortality rate) and IMR(infant
mortality rate) along with increase in population of reproductive age group is the
main reason for population explosion.
 Steps to overcome population explosion-
a) Using various contraceptive methods
b) Educating people about the demerits of large family
c) Increasing the marriageable age of female & male
d) Providing incentive to parents having 1 or 2 children.
 Contraceptive methods are used to prevent unwanted pregnancy and modifying
the menstrual cycle. An ideal contraceptive should be-
a) User friendly
b) Easily available
c) Effective
d) Reversible
e) No side effects
f) No way interferes with sexual desire and sexual act
 Contraceptive methods could be divided into following categories:-
a) Natural or traditional method
b) Barrier methods
c) IUDs
d) Oral contraceptive methods
e) Injectable
f) Implants
g) Surgical methods
 Natural methods work on the principle of avoiding chances of ovum and sperms
meeting. Periodic abstinence - couples avoid or abstain from coitus from day 10
 to 17 of the menstrual cycle when ovulation could be expected. As chances of
fertilization are very high during this period, it is called the fertile period.
 Withdrawal or coitus interruptus is another method in which the male partner
withdraws his penis from the vagina just before ejaculation so as to avoid
insemination.
 Lactational amenorrhea (absence of menstruation) method is based on the fact
that ovulation and therefore the cycle do not occur during the period of intense
lactation following parturition. Therefore, as long as the mother breast-feeds the
child fully, chances of conception are almost nil. However, this method has been
reported to be effective only upto a maximum period of six months following
parturition.
 Barrier methods:- They are mechanical devices which prevent the deposition of
sperms into vagina and their passage into uterus. Such methods are available for
both males and females.
1. Condoms- are barriers made of thin rubber/latex sheath that are used to
cover the penis in the male or vagina and cervix in the female, just before
coitus so that the ejaculated semen would not enter into the female
reproductive tract. Also provides protection against STIs like AIDS.
Nirodh’ is a popular brand. Fem shield-female condom
2. Diaphragms, cervical caps and vaults are also barriers made of rubber that
are inserted into the female reproductive tract to cover the cervix during
coitus. They prevent conception by blocking the entry of sperms through
the cervix. They are reusable.
3. Spermicidal creams, jellies and foams are usually used along with these
barriers to increase their contraceptive efficiency. They commonly contain
lactic acid, boric acid, citric acid etc.
 Intra Uterine Devices:- they are devices made of plastic, metal or a combination
of the two which is inserted into the uterus to prevent conception. They are called
loops, spirals, rings, bows, shields, Ts depending upon their shape.
i. non-medicated IUDs - Lippes loop
ii. copper releasing IUDs - CuT, Cu7, Multiload 375,
 iii. hormone releasing IUDs - Progestasert, LNG-20.
4. IUDs increase phagocytosis of sperms within the uterus and the Cu ions
released suppress sperm motility and the fertilising capacity of sperms.
hormone releasing IUDs make the uterus unsuitable for implantation and
the cervix hostile to the sperms. IUDs are ideal contraceptives for the
females who want to delay pregnancy and/or space children.
 Oral contraceptives:- Oral administration of small doses of either progestogens or
progestogen–estrogen combinations is another contraceptive method used by the
females. Pills have to be taken daily for a period of 21 days starting preferably
within the first five days of menstrual cycle. After a gap of 7 days (during which
menstruation occurs) it has to be repeated in the same pattern till the female
desires to prevent conception.
 They inhibit ovulation and alteration in uterine endometrium to make it unsuitable
for implantation as well as alter the quality of cervical mucus to prevent/retard
entry of sperms. Pills are very effective with lesser side effects and are well
accepted by the females. Saheli- once a week’ pill- contains a non-steroidal
preparation.
 Combined pills contain estrogen & progestogen. Estrogen is anovulatory by
inhibiting FSH production while progestogen is anovulatory by inhibiting LH
production.
 Progestogens alone or in combination with estrogen can also be used by females
as injections or implants under the skin. Their mode of action is similar to that of
pills and their effective periods are much longer.
 Administration of progestogens or progestogen-estrogen combinations or IUDs
within 72 hours of coitus have been found to be very effective as emergency
contraceptives as they could be used to avoid possible pregnancy due to rape or
casual unprotected intercourse.
 Surgical methods:- Sterilisation. Advised for the male/female partner as a
terminal method to prevent any more pregnancies. Surgical intervention blocks
gamete transport and thereby prevent conception. Sterilisation procedure in the
male is called ‘vasectomy’ and that in the female, ‘tubectomy’.
  Vasectomy - a small part of the vas deferens is removed or tied up through a small
incision on the scrotum so that sperms are unable to pass down the male
reproductive system. Conventional vasectomy(scalpel surgery) & No-scalpel
vasectomy.
 Tubectomy- a small part of the fallopian tube is removed or tied up through a
small incision in the abdomen or through vagina. The procedure is reversible as
the cut ends can be rejoined but effectiveness of reversibility is poor.
 These techniques are highly effective but their reversibility is very poor.
 Possible ill-effects like nausea, abdominal pain, breakthrough bleeding, irregular
menstrual bleeding or even breast cancer.
 Intentional or voluntary termination of pregnancy before full term is called
medical termination of pregnancy (MTP) or induced abortion. 45 to 50 million
MTPs are performed in a year all over the world which accounts to 1/5th of the
total number of conceived pregnancies in a year. Government of India legalised
MTP in 1971.
 MTPs are considered relatively safe during the first trimester, i.e., upto 12 weeks
of pregnancy. Second trimester abortions are much more riskier.

SEXUALLY TRANSMITTED INFECTONS(STIs)

 Infections or diseases which are transmitted through sexual intercourse are

collectively called sexually transmitted infections (STI) or venereal diseases (VD)
or reproductive tract infections (RTI).
 Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis,
hepatitis-B and HIV leading to AIDS.
 Hepatitis–B and HIV can also be transmitted by sharing of injection needles,
surgical instruments, etc., with infected persons, transfusion of blood, or from an
infected mother to the foetus too.
 Except for hepatitis-B, genital herpes and HIV infections, other diseases are
completely curable if detected early and treated properly.
  Early symptoms of most of these are minor and include itching, fluid discharge,
slight pain, swellings, etc., in the genital region. Infected females may often be
asymptomatic and hence, may remain undetected for long.
 complications later, which include pelvic inflammatory diseases (PID), abortions,
still births, ectopic pregnancies, infertility or even cancer of the reproductive tract.
 Though all persons are vulnerable to these infections, their incidences are reported
to be very high among persons in the age group of 15-24 years.

INFERTILITY

 Reasons –physical, congenital, diseases, drugs, immunological or even

psychological.
 Assisted reproductive technologies (ART)
 In vitro fertilisation (IVF–fertilisation outside the body in almost similar
conditions as that in the body) followed by embryo transfer (ET).
 In this method, popularly known as test tube baby programme, ova from the
wife/donor (female) and sperms from the husband/donor (male) are collected and
are induced to form zygote under simulated conditions in the laboratory. The
zygote or early embryos (with upto 8 blastomeres) could then be transferred into
the fallopian tube (ZIFT–zygote intra fallopian transfer) and embryos with more
than 8 blastomeres, into the uterus (IUT – intra uterine transfer), to complete its
further development.
 Embryos formed by in-vivo fertilisation (fusion of gametes within the female)
also could be used for such transfer to assist those females who cannot conceive.
 Transfer of an ovum collected from a donor into the fallopian tube (GIFT –
gamete intra fallopian transfer) of another female who cannot produce one, but
can provide suitable environment for fertilization.
 Intra cytoplasmic sperm injection (ICSI) is another specialised procedure to form
an embryo in the laboratory in which a sperm is directly injected into the ovum.
 Artificial insemination (AI) technique. In this technique, the semen collected
either from the husband or a healthy donor is artificially introduced either into the
vagina or into the uterus (IUI – intra-uterine insemination) of the female.