Reproductive Health

 1.1 Introduction:

Reproductive:

Reproductive means which are the organs that participate in reproduction and its process.

Health:

A state of complete physical, mental and social well-being is called Health.

• According to medical term:

The condition of an organism or one of its parts in which it performs its vital functions normally or properly is called Health.

• According to biology:

Health was defined as the absence of disease and free from illness/injuries.

1.2 Reproductive Health:

Reproductive health means where reproductive organs are free from disease, illness and perform its vital function normally.

• According to WHO:

Reproductive health means a total well-being in all aspects of reproduction i.e., physical, emotional, behavioural and social.

• According to UNO:

Reproductive health deals with the reproductive processes, functions and system at all stages of life.

1.3 Reproductive Health: Problems and Strategies:

1.3.1 Problems:

• Over population- explosion in population causes a scarcity of every basic need and hence affects the well-being of reproductive health.

• Lack of Sex education- due to lack of sex education people are not concerned about safe and hygienic sexual practice.

• Adolescence related changes- the changes which take place in adolescence can lead to sex abuse and hence can affect reproductive health.

• Sexually transmitted diseases- sexually transmitted diseases can affect reproductive health.

• Sex abuse and sex related crimes- sex abuse can cause physical injury, unwanted pregnancy, vaginal discharge, pelvic pain etc.

• Female foeticides- a gender-selective abortion where a female foetus is illegally terminated solely based on the reason that the foetus is a girl. Female foeticides can affect the reproductive and sexual health of a woman.

• Child Marriage- Early marriage, or child marriage, is defined as the marriage or union between two people in which one or both parties are younger than 18 years of age.

• No idea about misconceptions and contraceptive methods for Younger’s.

1.3.2 Strategies:

• India was amongst the first countries in the world to initiate the program “family planning” in the year 1951.
• Family planning is the concept or a program of limiting the size of families through the spacing or prevention of pregnancies. It is now called “Reproductive and Child Health Care (RCH) programmes”.
• Advertisements in the media, along with posters and billboards, often depict a cheerful couple with two children, accompanied by the slogan "Hum Do, Hamare Do" (We Two, Our Two).
• Awareness about reproduction and social evils- Government and non-government agencies have taken various steps to create awareness about consequences of uncontrolled population growth, social evils like sex abuse, sex related crimes etc., with the help of audio-visual and the print-media.
• Introduction of sex- education in schools and colleges is another step to provide right information to the youth.
• Awareness about sexually Transmitted Diseases (STDs) like AIDS.
• Statutory ban on sex determination test (is amniocentesis) in mother womb. Giving equal importance to males and females.
• Statutory rising of marriageable age of the female to 18 years for while males to 21 years.
• Giving the knowledge about contraceptives, safe and hygienic sexual practices.
• Better detection and cure of STDs in early stages.
• Overall increased medical facilities for all sex related problems including delivery and Post-natal care.
• Providing information and awareness to care of pregnant mothers, postnatal care of the mother and child.

1.3.3 Significance of Reproductive Health in a Society:

• A reproductively healthy society assures a normal life.
• Reproductive health assures that all individuals in the reproductive age group are fertile and will be able to carry on the human race.
• Education on reproductive health is essential for a society's well-being, promoting informed choices and preventing sexual violence.

1.4 Population Explosion:

• Population is defined as a group of organisms of the same species which occupy a given area.

• Population growth is measured as the annual average growth rate.

• The annual average rate of change of population size, for a given country, territory, or geographic area, during a specified period is known as Population Growth Rate.

• A sudden uncontrolled increase in population or number of the species is known as population explosion.

• The rapid increase in human population size over a relatively short period is called human population-explosion.

1.4.1 Causes of Human Population Explosion:

• Increased health facilities and better living conditions are the cause behind population explosion.

• Rapid decline in death rate, Maternal Mortality rate (MMR) and Infant Mortality Rate (IMR) are major causes of population growth.

• Increased Life Expectancy.

• Increases in the number of people in reproducible age.

• Lack of sex education for few individuals to conceive more children.

Note:

• The world population which was around 2 billion (2000 million) in 1900 rocketed to about 6 billion by 2000 and 7.2 billion in 2011.

• India's population which was approximately 350 million at the time of our Independence reached close to the billion mark by 2000 and crossed 1.2 billion in May 2011.

• According to the 2011 census report, the population growth rate was less than 2 percent, i.e., 20/1000/year.

• According to the 2021 census report, the population growth rate was reduced to 0.8 percent, i.e., 8/1000/year.

• At present world population is 8.1 billions as pre 2024 census.

• At present the Indian population is 1.44 billion as pre 2024 census.

• Uttar Pradesh is the most populated state of India around 237 million.

1.4.2 Effects of Human Population Explosion:

• Increases demand on food.

• Increases utilization of water more.

• Increase demand for shelter.

• Crime rates increase due to economic problems.

• Destruction of ecosystem and food chain imbalance.

• Introducing pollutants into the environment.

1.4.3 Conclusion Human Population Explosion:

• After understanding the effects of Human Population Explosion needs to be controlled or population stabilization should take place.
• Humans are responsible for deforestation and introducing pollutants into the environment.
• Population stabilization is achieved when a population's size remains relatively constant over time. This balance occurs when the number of births and immigrants equals the number of deaths and emigrants, resulting in zero population growth.

1.5 Amniocentesis:

• It is a technique used to find chromosomal abnormalities in developing embryos by using amniotic fluid.
• Amniotic fluid: The amniotic fluid is the protective liquid or fluid contained by the amniotic sac. This fluid serves as a cushion for the growing foetus.
• It serves to facilitate the exchange of nutrients, water, and biochemical products between mother and foetus.
• It also protects the foetus from shocks or injury and temperature change.
• It is made up of water, antibodies, hormones and electrolytes.
• Advantage: This procedure is used to test for the presence of certain genetic disorders such as, down syndrome, haemophilia, sickle-cell anaemia, etc., determine the survivability of the foetus.
• Disadvantage: It is also misused to check foetal sex determination based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo.

1.6 Birth control:

Birth control is a remedy of one/more actions, devices/medications followed in order to prevent /reduce women becoming pregnant.

1.6.1 Characteristics of ideal contraceptive:

• User friendly.

• Easily available.

• Effective

• Nor or least side –effects and

• No way interferes with sexual drive.

1.6.2 Types of Birth-control/Contraceptive methods:

1. Natural/Traditional Method

2. Barrier

3. IUDs (Intrauterine Devices)

4. Oral contraceptives

5. Inject-able

6. Implants

7. Emergency Contraceptives

8. Surgical Methods

1.6.2 1 Natural/Tradition Methods:

This is a method, where avoiding chances of ovum and sperms meeting.

Based on avoiding meeting of sperm and ovum is four types;

1. Abstinence

2. Periodic Abstinence

3. Withdrawal

4. Lactational Amenorrhea

i. Abstinence: There is no contact of penis and vagina at the time of coitus.

ii. Periodic Abstinence: Periodic Abstinence is one such method in which the couples avoid/ abstain from coitus from day 10 to 17 of the menstrual cycle when ovulation could be expected.

Note:

• The fertile period, or fertile window, is the time in a woman's menstrual cycle when she is most likely to conceive or to get pregnant. This period typically occurs around the middle of the cycle, usually between days 10 and 17.
• Sperm Viability: Sperm can survive in the female reproductive tract for up to 5 days.

iii. Lactational Amenorrhea: Even we can say this method in an absence of menstruation. This method is based on the fact that ovulation and the cycle do not occur during the period of as the mother breast feeds. (Only 6 months after baby is born there is an absence of menstruation).

iv. Withdrawal: It is also called coitus interruptus. In this method, the male partner withdraws his penis from the vagina just before ejaculation (removing sperm outside or avoiding insemination).

Risks/side effects:

In these methods, no using medicines/devices, therefore no side effects.

Efficiency of Pregnancy avoids:

1. Abstinence: 100% avoiding pregnancy and STD. (Sexually Transmitted Diseases)

2. Periodic Abstinence: chance of pregnancy nearly 20% and STD transfer.

3. Lactational Amenorrhea: Chance of pregnancy nearly 10% and STD transfer.

4. Withdrawal: Chance of pregnancy nearly 60% and STD transfer.

1.6.2. 2 Barrier Method: Barrier Means separates two different systems. Barrier Method means ovum and sperms are prevented from physically meeting with the help of barriers.

Based on the gender, it is divided into two types as follows;

1. Male Barriers

2. Female Barriers

a) Male Barriers Method: In this method the barriers cover the penis in the male. So there is no contact of sperm with vagina and ovum.

Ex: Condom (‘Nirodh’ is a popular brand of condom for the male.)

Male Condoms are barriers made of thin rubber latex sheath that are used to cover the penis in the male.

Efficiency of avoiding pregnancy:

• 90% to 96% avoid pregnancy and even not transmit STDs.

• Use of condoms has increased in recent years due to its additional benefits like avoiding pregnancy and not transferring STDs.

• To increase contraceptive efficiency of barrier methods used along with these spermicidal creams, jellies and foams.

Risks/side effects: No Side effects.

b) Female Barrier Methods:

In this method, the barrier covers vagina and cervix in the female and prevents the entry of sperm into the female reproductive tract.

Based on reusable/disposable female barrier methods are divided into two types as follows;

• Disposable

• Reusable

i) Disposable:

It is also called one time use. Both male and female condoms are called Disposable.

Female condom is a barrier made with thin rubber latex sheath that is used to cover the vagina and cervix in the female. It is also known as Femidom.

Common meaning for condom:

Condom is a barrier made with thin rubber latex sheath that is used to separate both male and female reproductive systems at the time of coitus.

Efficiency of avoiding pregnancy:

80% to 90% avoid pregnancy and not transmit any STDs and PID (Pelvic Inflammatory Diseases). It does not have any side effects.

Pelvic inflammatory disease or pelvic inflammatory disorder (PID):

• It is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, ovaries, and inside of the pelvis.
• Causes‎: ‎Bacteria that spread from the vagina
• Symptoms: It's marked by pain in the abdomen, especially during urination or sex.

ii) Reusable:

This barrier can be used more than one time.

Diaphragms, Cervical Caps and vaults are also barriers made up of rubber that are inserted into the female reproductive tract to cover the cervix during coitus.

Note:

• The diaphragm is a barrier that covers the cervix, stopping sperm from joining an egg. It must be used with spermicidal (a cream or gel that kills sperm).

• The cervical cap and vaults is a birth control (contraceptive) device that prevents sperm from entering the uterus.

Efficiency of avoiding pregnancy:

70 to 75% avoiding pregnancy and transmit STDs and PIDs

Side Effects: Observe allergies and rashes.

1.6.2.3 IUD: (Intrauterine Device):

A device inserted into the uterus (womb) to prevent conception (pregnancy). This device is called IUD.

Function of IUD: It increases phagocytosis of sperm within the uterus and avoids implantation in the uterus.

IUDs further divided into two types:

1. Non Medicated IUDs

2. Copper Releasing IUDs and

3. Hormone Releasing IUDs

i) Non Medicated IUDs: They are made of plastic or stainless steel only. It causes a sterile inflammatory response by producing a tissue injury of minor degree but sufficient enough to be spermicidal. It also contours of the uterine cavity reducing the incidence of expulsion and attracts macrophages. Ex: Lippes loop.

ii) Copper Releasing IUDs: These IUDs release copper ions in a uterus and decrease the motility rate of Sperm. EX: CuT, Cu7, Multiload Cu 375.

iii) Hormone Releasing IUDs :Hormone like Progestogen makes the uterus unsuitable for implantation, Cervix hostile to the sperms and even stops ovulation. Ex: Progestasert, LNG-20, Levonorgestrel, Minera

Efficiency of avoiding pregnancy:

65% to 70% avoid pregnancy and transmit STDs and PIDs.

Side Effects: Imbalance in Menstrual Cycle, Allergies, Rashes and chances of uterus damage.

Hormonal IUD

Note: Copper Releasing IUDs and Hormonal Releasing IUDs are the type of Medicated IUDs.

1.6.2.4 Oral Contraceptive:

Oral contraceptives are tablets which are usually taken by women on a daily basis to avoid pregnancy.

Based on Steroidal / Non-steroidal, it is divided into two types:

• Steroidal oral contraceptives called Pills. It has to take place on a daily basis for around 21 days.

• This is made up of hormones.

• They contain either two hormones combined (progestogen and estrogen) or a single hormone (progestogen).

• This prevents ovulation (releasing of egg) and Implantation.

• Side effects: nausea, headaches, changes in weight and menstrual bleeding more.

• Non-Steroidal oral contraceptives called Saheli. It is developed by scientists at Central Drug Research Institute (CDRI) in Lucknow.

• It is a ‘once a week’ pill

• It is not made of hormones.

• It contains a drug (Centchroman / Ormeloxifene) that blocks estrogen.

• Side Effects: delays in menstrual Cycle and less side effects when compared to Steroidal Oral Contraceptive.

• This drug is even used for breast pain/breast tumors to treat.

Note: Oral contraceptives prevent Ovulation and Implantation in females.

1.6.2.5 Inject-able contraceptive:

• Progesterone alone/in combination with estrogen is used by females as injections under the skin.

• Injection every 3 months, that slowly releases hormones.

• This method  prevents ovulation and Implantation.

• Side effects: nausea, headaches, changes in weight and menstrual bleeding more (as like Pills).

1.6.2.6 Contraceptive Implant:

• It is a type of hormonal birth control. It releases Progesterone hormone or combination of Estrogen into the body to prevent pregnancy.

• The implant itself is a very small plastic rod about the size of a matchstick.

• A doctor/nurse inserts it into the upper arm, right under the skin.

• It is available in two brands Nexplanon and Implanon

• Side effects: nausea, headaches, changes in weight and menstrual bleeding more (as like Pills) but much longer.

1.6.2.7 Emergency Contraceptive:

• This method is used within 72 hours of coitus, casual in unprotected intercourse or rape cases.

• Administration of progesterone / progesterone-estrogen combination more concentrate pill.

• In a few cases, place IUDs within 72 hrs of coitus.

• Side Effects: Nausea, vomiting, Dizziness, Abdominal pain, Fatigue, Breast tenderness, Headache Delayed Periods, Early Periods, and continues taking leads to sterile or infertility.

• Ex: i-pill and unwanted 72

1.6.2.8 Surgical method:

• This method is also called the sterilization / permanent / terminal method.

• It is used as a terminal method of contraception in male and females to prevent any more pregnancy.

• This method done under the presence of Doctor and/or Nurse

• These methods block the transport of gametes and prevent conception.

a) Vasectomy is the surgical method in male; a small part of the vas deferens is removed or tied up through a small incision on the scrotum to prevent release of sperms.

b) Tubectomy is the surgical method in females in which a small part of the fallopian tube is removed surgically or tied up through a small incision in the abdomen or through vagina.

• Vasectomy and Tubectomy techniques are highly effective but their reversibility is very poor. Unfertilized eggs are reabsorbed by fallopian tubes before reaching the uterus.

Side effects of contraceptive method:

They have ill-effects like nausea, abdominal pain, breakthrough bleeding, and irregular menstrual bleeding only a few months for females.

1.7 MTP:

• Intentional or voluntary termination of pregnancy before full term is called Medical Termination of Pregnancy (MTP) or Induced Abortion.

• The Government of India legalized MTP in 1971 with some strict conditions to avoid its misuse. 

• The Medical Termination of Pregnancy (Amendment) Act, 2017 was enacted by the government of India with the intention of reducing the incidence of illegal abortion and consequent maternal mortality and morbidity.

• According to this Act, a pregnancy may be terminated on certain considered grounds within the first 12 weeks of pregnancy in the opinion of one registered medical practitioner.

• If the pregnancy has lasted more than 12 weeks, but fewer than 24 weeks, two registered medical practitioners must be of the opinion, formed in good faith.

Why MTP?

• MTP is done to get rid of unwanted pregnancies due to casual unprotected intercourse or failure of the contraceptive used during coitus or rape.

• MTPs are also essential in certain cases where continuation in pregnancy could be harmful or even fatal to the mother or to the fetus or both or in ectopic pregnancy.

• There is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.

When is MTP safe?

Before 12 weeks of pregnancy/first trimester.

When MTP is not Safe?

After 12 weeks of pregnancy/second trimester onwards.

Note: Nearly 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.

1.8 Sexually transmitted Infections (STI’s):

• Diseases or infections transmitted through sexual intercourse with an infected person are called sexually transmitted diseases or infections.
• It is also called Venereal Diseases or Reproductive Tract Infections (RTI).
• Ex: Gonorrhea, Syphilis, Genital Herpes, Genital Warts, Hepatitis, AIDS, Trichomoniasis (protozoa), and Chlamydiasis

1.8.1 STI can transmit through:

• Sexual contact with infected persons.

• Transfusion of contaminated blood.

• Sharing of needles or surgical instruments contaminated with infected blood.

• STDs can also be transmitted from an infected mother to the foetus.

1.8.2 Preventions or Principles to free from STI’s:

• Avoid sex with unknown persons or multiple persons.

• Always use condoms during sex.

• In case of doubt, one should go to a qualified doctor for early detection and get complete treatment if diagnosed with infection.

1.8.3 Early Symptoms of STI:

Itching, fluid discharge, slight pain, swellings occur in the genital regions, one must consult a doctor.

1.8.4 Late Symptoms of STI: (Untreated)

Pelvic inflammatory diseases (PID), abortions, stillbirths, ectopic pregnancies, infertility or even cancer of the reproductive tract.

Note:

• Stillbirth is typically defined as fetal death at or after 20 to 28 weeks of pregnancy.
• For STIs affected more by 15-24 years age group individuals.
• Hepatitis-B, Genital Herpes and HIV can not be cured completely even after early detection.

Note:

Genital Herpes:

• It causes herpetic sores or herpes simplex virus, which are painful blisters (fluid-filled bumps) that can break open and ooze fluid.
• This disease can affect both men and women.
• Pain, itching and small sores appear first. They form ulcers and scabs.
• After initial infection, genital herpes lies dormant in the body.

Chlamydiosis:

• Chlamydiosis is a sexually transmitted disease in humans caused by the bacterium Chlamydia trachomatis.
• Chlamydiosis is a major infectious cause of human genital and eye diseases.
• Chlamydiosis was once the most important cause of blindness.
• This infection can spread from eye to eye by fingers, shared towels, eye seeking flies, etc.

1.9 Infertility:

Infertility is the inability of a person, animal, or plant to conceive offspring naturally.

Or

Infertility is a disease of the reproductive system by the failure to produce offspring.

Based on the type of gender, infertility is divided into two types as follows;

1. Male Infertility.

2. Female Infertility.

1.9.1 General Infertility Reasons for Young Couples:

• Physical aspects,

• Congenital diseases,

• Using of Drugs,

• Immunological or Psychological aspects.

1.10 Assisted Reproductive Technology (ART):

The couples who are incapable of fertilizing could be assisted to have their own child through certain special techniques called Assisted Reproductive Technologies.

ART future divided into two types based on fertilization takes place;

1. In-Vitro Fertilization and

2. In-Vivo Fertilization

1.10.1 In-Vitro Fertilization (IVF):

In-vitro fertilization is also known as test tube baby. The fertilization takes place outside the body under laboratory conditions by collecting sperm and ovum from parents/donors.

IVF further divides into two types as follows;

• The zygote is transferred into the fallopian tube (with up to 8 blastomeres) called Zygote Intrafallopian Transfer (ZIFT).
• If the embryo is with more than 8 blastomeres, it is transferred into the uterus called Intra Uterine Transfer (IUT).
• Intra-Cytoplasmic Sperm Injection (ICSI) is another specialized procedure to form an embryo in the lab in which a sperm is directly injected into the ovum.

1.10.2 In-Vivo Fertilization (IvF): 

The fertilization takes place inside the female body by collecting sperm from the husband/donor.

IvF future divides into two types as follows;

• Gamete intra fallopian transfer (GIFT): Here, ovum is collected from a donor female and is transferred into the fallopian tube of another female who cannot produce ovum, but can provide a suitable environment for fertilization and further development of embryo.

• Artificial Insemination (AI): In this technique, the semen collected either from the husband or a healthy donor is artificially introduced into the vagina or into the uterus of the female (female is normal).

• IUI: The semen artificially introduce into the uterus of the female called IUI (Intrauterine Insemination).
• This method is generally used in case of male partners who have sperm production issues like production of less sperm or unable to produce healthy sperms.

1.11 ART Conclusion:

• These methods are expensive and have side effects more to the parents, especially for females. So, don’t prefer this kind of technique.

• Legal Adoption is a good method that can be done from an orphanage or destitute children looking for parenthood.

• Human Population Explosion causes so many problems in nature; these all techniques' end result is to produce children.

Difference between ZIFT and GIFT:

ZIFT	GIFT
The fusion of sperm and ovum takes place outside, in lab conditions.	The fusion of sperm and ovum takes place inside the female body.
Zygote is transferred to the fallopian tube.	Female gamete is transferred to the fallopian tube.