Chapter 3: Reproductive Health

Introduction

The term simply refers to healthy reproductive organs with normal functions. However, it has a broader perspective and includes the emotional and social aspects of reproduction. 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.

Need for Reproductive Health

India is among the first countries in the world to initiate action plans and programmes at a national level to attain total reproductive health as a social goal. These programmes, called ‘family planning’, were initiated in 1951. Creating awareness about sex-related aspects, providing sex education in schools, and preventing sex abuse and sex-related crimes are primary steps toward a reproductive healthy society.

Amniocentesis

Amniocentesis is a fetal sex determination and disorder diagnostic test based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo. There is a statutory ban on amniocentesis for sex determination to legally check increasing female foeticides. However, it is a crucial test for detecting genetic disorders like Down syndrome, haemophilia, sickle-cell anemia, etc., to determine the survivability of the fetus.

Population Explosion and Birth Control

With rapid advancements in medicine and an increase in life expectancy, the world population has grown rapidly. To check population growth rate, it is crucial to motivate smaller families by using various contraceptive methods.

Methods of Contraception

An ideal contraceptive should be user-friendly, easily available, effective, and reversible with no or least side effects.

1. Natural/Traditional Methods: Work on the principle of avoiding chances of ovum and sperms meeting (e.g., Periodic abstinence, withdrawal method, lactational amenorrhea).
2. Barrier Methods: Sperms are prevented from physically meeting with the ovum with the help of barriers (e.g., Condoms, diaphragms, cervical caps, vaults). Condoms also protect against Sexually Transmitted Diseases (STDs) and AIDS.
3. Intra Uterine Devices (IUDs): Inserted by doctors into the uterus through the vagina. These include non-medicated IUDs, copper-releasing IUDs (CuT, Cu7), and hormone-releasing IUDs. They increase phagocytosis of sperms within the uterus or suppress sperm motility.
4. Oral Contraceptives: Small doses of either progestogens or progestogen–estrogen combinations generally taken by females in the form of pills. They inhibit ovulation and implantation.
5. Injectables and Implants: Progestogens alone or in combination with estrogen can be used by females as injections or implants under the skin.
6. Surgical Methods: Terminal methods to block gamete transport, thereby preventing conception. Vasectomy in males and Tubectomy in females.

Medical Termination of Pregnancy (MTP)

Intentional or voluntary termination of pregnancy before full term is called Medical Termination of Pregnancy (MTP) or induced abortion. MTP is essential in cases where continuation of pregnancy could be harmful or fatal either to the mother or to the foetus. MTP is considered relatively safe during the first trimester (up to 12 weeks of pregnancy).

Sexually Transmitted Diseases (STDs)

Diseases or infections which are transmitted through sexual intercourse are collectively called sexually transmitted diseases (STD) or venereal diseases (VD) or reproductive tract infections (RTI). Examples include gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B, and HIV (leading to AIDS). Prevention:

1. Avoid sex with unknown partners/multiple partners.
2. Always try to use condoms during coitus.
3. In case of doubt, consult a qualified doctor for early detection and get complete treatment if diagnosed.

Infertility and Assisted Reproductive Technologies (ART)

Infertility is the inability to conceive or produce children even after 2 years of unprotected sexual cohabitation. When corrective treatments aren’t possible, couples can be assisted via ART.

• In Vitro Fertilisation (IVF): Fertilisation outside the body in almost similar conditions as that in the body, followed by embryo transfer. Known as the “test tube baby” programme.
  • ZIFT: Zygote Intra Fallopian Transfer - Transfer of early embryos (up to 8 blastomeres) into the fallopian tube.
  • IUT: Intra Uterine Transfer - Transfer of embryos with more than 8 blastomeres into the uterus.
• GIFT: Gamete Intra Fallopian Transfer - Transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce one but can provide a suitable environment for fertilisation.

Competency Based Questions

Q1. According to the WHO index of contraceptive failures, the Pearl Index represents the number of pregnancies per 100 women-years of exposure. If a new oral pill was tested on 500 women for 2 years, and 10 women became pregnant in that timeframe, what is the Pearl Index of this pill?

(A) 1
(B) 2
(C) 5
(D) 10

Q2. Lactational amenorrhea is effective only up to a maximum of six months following parturition. Why is it not a guaranteed method of contraception beyond this period?

Q3. Differentiate between ZIFT and GIFT as Assisted Reproductive Technologies.

Q4. A copper-releasing IUD like CuT is inserted into a patient’s uterus. Explain the mechanism by which it prevents pregnancy.

Q5. Explain why amniocentesis is strictly regulated in many countries, yet remains an essential diagnostic tool for specific high-risk pregnancies.