INTRODUCTION
- Definition:-
According to WHO. reproductive health means a total well being in all aspects of reproduction, emotional, social and behavioural. - Key components of reproductive health:-
(i) Access to Information and Education: Access to accurate and comprehensive information about reproductive anatomy, physiology, contraception, sexually transmitted infections (STIs), and family planning methods is essential for making informed decisions about sexual and reproductive health.
(ii) Maternal and Newborn Health: Ensuring access to quality maternal and newborn health care services, including prenatal care, skilled attendance at childbirth, postnatal care, and neonatal care, promotes safe motherhood and reduces maternal and infant mortality and morbidity.
(iii) Infertility Prevention and Treatment: Addressing infertility issues through early detection, diagnosis, and treatment options can help individuals and couples achieve their reproductive goals and improve their overall well-being.
(iv) Prevention of Gender-based Violence: Efforts to prevent and respond to gender-based violence, including sexual assault, intimate partner violence, and harmful traditional practices, are crucial for promoting reproductive autonomy, bodily integrity, and overall well-being.
(v) Reproductive Rights: Recognizing and upholding reproductive rights, including the right to make autonomous decisions about one’s body, sexuality, reproduction, and family formation, is essential for ensuring that individuals can exercise control over their reproductive lives free from discrimination, coercion, and violence.
Note:- Overall, reproductive health is a fundamental component of overall health and well-being, with implications for individual dignity, human rights, gender equality, and sustainable development. It encompasses a holistic approach to sexual and reproductive well-being that encompasses physical, emotional, social, and cultural dimensions.
POPULATION STABILISATION
- According to 2011 census report, our population growth rate was less than 2 percent i.e 20/1000/year.
Year World Population Indian Population
1900 2 billion 350 million
2000 6 million 1 billion
2011 7.2 billion 1.2 billion - Reasons For increase in Population Size:-
• Decline in death rate.
• Rapid decline in maternal mortality rate (MMR).
• Decrease in infant mortality rate (IMR).
• Increase in number of people in reproducible age.
• Increase in health facilities. - Measures Taken By Government To Check Population Growth Rate.
• Motivate-smaller families by using various contraceptive methods with slogans “Hum do Hamare do” advertisements and posters.
• Urban couples adopting: “One child norm”
• Statutory raising of marriageable age:
• Female to 18 years • Male to 21 years
• Incentives given to coupes with small families.
BIRTH CONTROL/CONTRACEPTION
- Features of an ideal contraceptive:
• User-friendly
• Easily available
• Effective
• Reversible
• No/least side-effects
• No interference with libido and act of coitus - There are two principle methods of birth control:
• Natural methods
• Artificial methods
REPRODUCTIVE HEALTH: PROBLEMS AND STRATEGIES
- India was amongst the first countries in the world to initiate action plans to attain total reproductive health such as family planning programmes (FPP) in 1951.
- Tasks performed by “Reproductive and Child Health care (RCH) programmes.”
• Helping adolescents by providing information about reproductive organs hygienic sexual practices and STls.
• Awareness regarding social evils such as sex-abuse and sex related crimes.
• Importance of equal opportunities for male and female child.
• Educating the people about birth control options
• Benefits of families with small size.
• Introduction of sex education in schools.
• Benefits of massive child immunisation.
• Role of NGOs, audio-visual and print media in creating awareness regarding sex related aspects.
• Discouraging children from believing in myths and having misconceptions about sex related aspects.
• Creating awareness about care of pregnant mother, post natal care of mother and child.
• Importance of breast feeding.
NATURAL/TRADITIONAL METHODS
- Work on the principle of avoiding physical meeting of the egg and sperms.
- Chances of failure are high.
Method Mode of Action (MoA)
• Periodic-abstinence : Couples abstain from coitus from day
10 to 17 of the menstrual cycle
i.e fertile period.
• Withdrawal method/ : Insemination is avoided as the male
Coitus interruptus partner withdraws his penis from the
vagina just prior to ejaculation.
• Lactational amenorrhea Absense of menstruation upto 6 months
during period of intense lactation
following parturition.
ARTIFICIAL METHODS
- The various methods of contraception are enlisted below:-
(i) Barrier methods
(ii) Spermicidal jellies
(iii) IUDs
(iv) Oral pills
(v) Injections and implants
(vi) Emergency contraceptives
(vii) Surgical methods
ARTIFICIAL METHODS
(i) Barrier Methods:-
- Prevent ovum and sperm from physically meeting.
- Self inserted and offer privacy to user.
(a) Condoms and its types
Made up of rubber or thin latex ↓
↓
|__________________|
Parameter Males Female
• Region covered • Penis • Vagina and cervix
• Provides protection • Yes • Yes
from STIs
(b) Diaphragms, cervical caps, vaults
• Rubber barriers that cover the cervix during coitus.
• Reusable
• Do not protect from STIs
• Used by females only.
(ii) Spermicidal jellies, foams and creams
• Kill the sperms by creating acidic pH.
• Used along with barrier methods to increase their efficiency.
(iii) Intra Uterine devices (IUDs)
• Inserted by doctors or expert nurses in uterus
• IUDs are one of the most widely accepted method of contraception in India.Types
|________________________________|
• Non medicated IUDs • Medicated IUDs
• Example: Lippes |____________↓________|
Parameter Hormone release IUDs Copper coated IUDs
• Examples • Progestasert, LNG-20 Cu7, Multiload 375
• Mode of Action • Make the uterus • Increase phagocytoisis
unsuitable of sperms within uterus
for implantation and • Cu ions suppress sperm
cervix hostile to the motility and fertilising
sperms. capacity of sperms.
ARTIFICIAL METHODS (cont…)
(iv) Oral Contraceptive pills (OCP) or tablets
___________↓________
↓ ↓
Parameter Non-Stroidal Steroidal
• Example or SAHELI Progestogens (Prg)
alone
composition or combination of Prg and
Estrogens (Est).
• Mode of action Interferes with Inhibit ovulation and implantation;
implantation also alter the quality of cervical
mucus to retard entry of sperms
• Dosage ‘Once a week’ pill Pills have to be taken daily for a
period of 21 days starting
preferably within first 5 days of
menstrual cycle
• Effectiveness High contraceptive Pills are very effective with lesser
value with very few side effects and well accepted
side effects by female
Note:- SAHELI was developed at CDRI, Lucknow, Uttar Pradesh.
(V) Implants
• Placed under skin
• Effective periods are much longer
• Composition: Progestogens alone/Combination of progestogens and
Estrogens.
• Mode of Action (MoA)
• Inhibit ovulation and implantation
• Alter the quality of cervical mucus to retard entry of sperms
• Injections usually share similar MoA and composition as implants.
(VI) Emergency contraceptives
________________↓_________
↓ ↓
Types Characteristics
• Progestogens alone • Effective within 72 hrs of coitus • Combination of Prg • Used to prevent conception
+Est resulting from rape or unprotected
intercourse.
• IUDs (Intrauterine devices)
ARTIFICIAL METHODS (cont…)
(VII) Surgical/Sterilisation method
> Poor reversibility but highly effective
> Mode of action
Blocks gamete transport
Types
__________↓______________
↓ ↓
Tubectomy Vasectomy
> In females >In male
> Cut and tie fallopian tube > Cut and tie vas deferens
> Incision in abdomen or > Small incision on the scrptum
through vagina
MEDICAL TERMINATION OF PREGNANCY (MTP)/INDUCED ABORTION
- MTP:- Intentional or voluntary termination of pregnancy before full term.
- MTP was legalised in India in 1971.
- When can MTP be performed?
> Unwanted preganancy due to rape, failure of contraception, casual unprotected intercourse.
> If continuation of pregnancy could harm the mother or foetus or both
> Permission of how many medical practitioners is needed for MTP depending on duration of gestation
____________↓______________
↓ ↓
1 2
• Les than/upto 12 weeks • More than 12 but less than 24 weeks
• Intention behind MPT amendment act 2017 (GoI)
• Reducing the incidence of illegal abortion
• Decrease consequent maternal mortality and morbidity
• MTPs are safe upto 12 weeks but riskier in 2nd trimester yet both are legal
• Amniocentesis and MTPs have been misused in context of female foeticide.
AMNIOCENTESIS
- Analyse fetal cells and dissolved substances from amniotic fluids.
- Technique used to check for genetic disorders such as Down’s syndrome, hemophilia, sickle-cell anemia etc.
- Statutory ban on this technique in India to prevent female foeticide.
SEXUALLY TRANSMITTED INFECTIONS (STIs)
- •Alternately named:– Venereal diseases (VD) or reproductive tract infections (RTIs).
- High vulnerability/risk group:– 15-24 years
- Mode of transmission (MoT):- Sexual intercourse.
Category Disease
Bacterial – Gonorrhoea, Syphilis, Chlamydiasis
Protozoan- Trichomoniasis
Viral – Genital herpes, Hepatitis-B, Genital
warts, AIDS.
> Bacterial and protozoan diseases are completely curable if detected early and treated properly.
> Other MoT for hepatities-B virus and HIV infection include:-
• Sharing of injection needles, surgical instrument with infected persons.
• Transfusion of blood.
• From an infected mother to foetus.
• Symptoms and complications of STIs
____________↓________________
↓ ↓
Early detection Late detection
↓ symptoms ↓Complications
Itching, fluid discharge, Pelvic inflammatory diseases (PIDs)
slight pain, swellings in abortions, srill births, ectopic
the genital region pregnancies ,infertility, cancer of
reproductive tract.
> preventive measures to avoid STIs:-
• Avoid sex with unknown partners/ multiple partners.
• Always try to use condoms during coitus.
INFERTILITY
- Infertile couple: Unable to produce children inspite of 2 years of unprotected sexual co-habitation.
- Reasons for infertility:-
• Physical • Congenital • Infertility as a problem could be with
either the male or female partner.
• Diseases • Immunological • In India, female is blamed often than
male for the couple being childless.
• PsychologicalHelp For Infertile Couples Comes in The Form of
ASSISTED REPRODUCTIVE TECHNOLOGIES
___________↓________________
↓ ↓
Parameter In-vitro fertilisation In-vivo fertilisation
• site of – outside the body in stimulated In the female
fertilisation conditions in lab. reproductive tract
• Can female – yes No/Yes
produce ova
• Embryo transfer – Yes No
• Example
of techniques – ZIFT, IUT, ICSI GIFT, AI, IUI
Site of embryo transfer (ET)
based on number of blastomeres
↓
___________________________________________
↓ ↓
Parameter Upto 8 blastomeres more than blastomeres
• Location- in fallopian tube in uterus
•Techniques- ZIFT: zygote intra fallopian transfer IUT: Inta uterine tranfer
Help For Infertile Couples Comes in The Form of
ASSISTED REPRODUCTIVE TECHNOLOGIES (cont….)
- Other details of ART involved:-
> ICSI:- Intr cytoplasmic sperm injection
> Sperm injected directly into the egg - Artificial Insemination (AI):-
> Semen introduced in vagina or uterus
> Low sperm count or inability of male to inseminate female.
> IUI:– Intra uterine insemination
> GIFT :- Gamete intra fallopian transfer
> Female can provide conditions for fertilisation and further development. - Note:- Test tube baby programme involves technique with
in-vitro fertilisation.
FAQs:-
- Reproductive health refers to the state of physical, mental, and social well-being related to the reproductive system and its functions throughout all stages of life. It encompasses a wide range of issues, including family planning, maternal health, sexually transmitted infections (STIs), infertility, and sexual health.
- Reproductive health is essential for individuals and communities to lead healthy and fulfilling lives. It impacts various aspects of physical and emotional well-being, as well as social and economic development. Access to reproductive health services and information is fundamental to achieving gender equality, promoting human rights, and reducing health disparities.
- Reproductive health care services encompass a broad range of preventive, diagnostic, and treatment interventions. These may include family planning counseling and methods, prenatal and postnatal care, screening and treatment for STIs, infertility evaluation and treatment, safe abortion services, and sexual health education.
- Family planning is an integral component of reproductive health, focusing on the ability of individuals and couples to plan and space pregnancies according to their desires and circumstances. Family planning services provide access to a variety of contraceptive methods and information to support informed decision-making about reproductive choices.
- Common reproductive health challenges include unintended pregnancies, maternal and newborn complications, infertility, STIs including HIV/AIDS, unsafe abortion, gender-based violence, and barriers to accessing reproductive health services, particularly for marginalized populations.
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