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Reproductive health
Reproductive health
-Healthy reproductive organs with normal functions

Reproductive health (Problems & strategies)

-India was the first country in the world to initiate action

plans & programmes at national level to attain total
reproductive health as a social goal
-These programmes called family planning were initiated in
1951

Reproductive & child health care (RCH) programs

-Cover wide reproduction related area
-Improved programe

Objectives of RCH programmes

1) Awareness about reproduction related aspects
-With the help of audio, visuals & the print media
-Government & non-governmental agencies have taken
various steps to create awareness
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-A major role is also played by :

a) Parents
b) Close relatives
c) Teachers
d) friends
-Introduction of sex education in schools should also be
encouraged

2) Proper information should be provided about

-Reproductive organs
-Adolescence & related changes
-Safe & hygienic sexual practices
-Sexually transmitted disease (STD)
-AIDS

3) Strategies
-People, especially fertile couples & those in marriageable
age group, should be educated about :
a) Available birth control options (contraceptive methods)
b) Care of pregnant mothers
c) Post natal care of mother & child
d) Importance of breast feeding
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e) Equal opportunities for male & the females child

f) Awareness of problems due to uncontrolled population
growth
g) Social evils like sex-abuse & sex-related crimes

4) Successful implementation
-Successful implementation of various action plans to
attain :
a) Infrastructural facilities
b) Professional expertise (doctors)
c) Material support

These are essential to provide medical assistance & care

to people in reproduction related problems like :
-Pregnancy, delivery, STDs, abortions, contraceptions,
menstrual problems, infertility etc

5) Implementation of better techniques

-Statutory ban on amniocentesis for sex determination
that leads to female foeticides

AMNIOCENTESIS
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-Amniotic fluid of developing foetus is taken to test for

chromosomal abnormalities & fetal infections

Conditions it may diagnose

-This procedure is used to test for the presence of
certain genetic disorders such as - down syndrome,
haemophilia, sickle cell anemia, muscular dystrophy etc
-Determine the survivability of the foetus

Misuse of Amniocentesis
-It is being used to kill the normal female foetus

Procedure
-This test usually done at 14-18 weeks of gestation

SAHELI

-New oral contraceptive for female

-Develop by scientists at Central drug research institute
(CDRI), Lucknow
-Non-steroidal
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-Used once in a week

-Prevent implantation
-Centchroman present
a) Modulation of estrogen receptor

POPULATION EXPLOSION

Population
-Total no of individual of a species present in a given area
at a particular time
-World population day 11 july

Census
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-Official counting of population

-Undertaken every 10 years

In india
First census - 1872
Last census - 2011

The world population which are around :

-In 1900 - 2 billion (2000 million)
-In 2000 - 6 billion
-In 2011 - 7.2 billion

The india population

Which was approximately 350 million at the time of
independence
-In 2000 - 1 billion
-In 2011 - 1.2 billion

According to 2011 Census

-Ratio of world : India = 6:1
-Every sixth person in the world is an Indian
-According to 2011 census report, the population growth
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rate was still around 1.7 %

-Ex : 17/1000/year
-According to 2011 census report, the population growth
was less than 2%
-Ex : 20/1000/year

Reasons for population explosion

-A rapid decline in
a) Death rate
b) Maternal mortality rate (MMR)
c) Infant mortality rate (IMR)
-Increase in no of people in reproducible age

Population growth rate depend upon

a) Birth rate (fertility rate)
b) Death rate (Mortality rate)
c) Migration
d) Age & sex ratio

Alarming growth rate could leads to absolute scarcity of

even basic requirements
a) Food
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b) Clothing
c) Shelters

Steps to overcome this problem

-Motivate smaller families by using various contraceptive
methods
-Hum do hamare do (we 2, our 2)
-One child norm adopted by young & working ones
-Statutory raising of marriageable age groups female (18
years), males (21 years)

PROPERTY OF IDEAL CONTRACEPTIVE

-User friendly
-Easily available
-Effective & reversible
-No or least side effects
-No interference with sexual drive, desire & sexual act

TEMPORARY METHOD

1) Natural methods of contraception

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-These work on the principle of avoiding chances of ovum

& sperm meeting
-Rhythm method or safe period or periodic Abstinence or
calander method
-Withdrawal method or coitus interruptus (High failure
rate)
-Lactational amenorrhoea

Periodic Abstinence

-Life of sperm = 2-3 days

-Life of ova = 1 days
-Safe period before 10 & after 17 days
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-Avoid or abstain from coitus from day 10 to 17 of

menstrual cycle
-At this time ovulation can be expected

Withdrawal or Coitus Interruptus

-Male withdraws penis from vagina before ejaculation

Lactational Amenorrhoea
-Absence of menstruation
-Effective only upto 6 months
-Side effects nil, chances of failure high
-Ovulation & menstrual cycle absent during intensive
lactation
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BARRIER METHODS

-In barrier method, ovum & sperms are prevented from

physically meeting with the help of barrier
-Available for both male & female
1) Condoms (Irreversible)
2) Fem shield (female condoms) - Irreversible
3) Cervical caps (Reversible)
4) Diaphragm (Reversible)
5) Vault (Reversible)

Condoms & fem shield prevent from STD & AIDS

Condoms
-Made of thin rubber/latex sheath
-Cover penis in male or vagina & cervix in female
-Prevent conception

Nirodh
-Popular condom brand for male
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Use of condom increased because

-Prevent from STD & AIDS
-Condoms are disposable
-Can be self inserted
-Gives privacy

Diaphragm, Cervical caps, Vaults

-Made of rubber
-Inserted into female reproductive tract
-Covers cervix
-Reusable

Spermicidal creams, jellies & foams are used along with

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these barriers to increase contraceptive efficiency

CHEMICAL METHOD
(Spermicidal agents)
-These are available in the form of creams, jellies, foams,
vagina, tablets
-These contain chemicals like Citric acid, boric acid & zinc
sulphate etc
-It kill the sperm by disrupting the membrane
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INTRAUTERINE DEVICES (IUDs)

-These devices are inserted by doctors or expert nurses

in the uterus through vagina
-IUDs increase phagocytosis of sperm within the uterus
-Cu Ions released Supress sperm motility & fertilising
capacity of sperms
-Ideal contraceptive for female who want to delay
pregnancy/space children
-It is one of most widely accepted method of
contraception in india

Types of IUDs
1) Non-medicated IUDs (eg-Lippe's loop)
2) Copper releasing IUDs (CuT, Cu7, Multiload 375)
3) Hormone releasing IUDs (Progestasert, LNG-20)
-Make uterus unsuitable for implantation & cervix hostile
of the sperms

Copper releasing IUDs

-Copper IUDs commonly called Copper Ts have ionised
copper which slowly diffuses at the rate of some 50ug
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day
-It has a local antifertility effect by bringing about release
of toxic cytokines
-They supress sperm motility & their ability to fertlize the
ovum
-Ex : CuT200, Multiload CuT 250, Multiload CuT 375,
CuT 380, Cu7

Hormone releasing IUDs

-Hormone releasing IUDs include progesterone IUD
(eg-progestasert) & levonorgestral IUD (eg-LNG 20)
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These make the uterus unsuitable for

-Implantation
-Changes in cervical mucus (cervix hostile to the sperms)
-Anovulation
-Insufficient luteal activity

ORAL CONTRACEPTIVE PILLS (OCPs)

-Contain either progestogens or progestogen - estrogen

combination
-They are synthetic products
-Most commonly used progestin is levonorgestrel
-Most common oestrogen is ethinyl oestradiale
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-Used in form of tablets, popularly called the pills

-Pills are taken orally for 21 days in menstrual cycle
stating from 5th day & ending on 25th day
-However it is advisable to restart the course after a gap
of 7 days

Pills act by four ways

-Inhibit ovulation
-Inhibit Implantation
-Chages in cervical mucus to prevent/retard entry of
sperms
-Inhibition of motility & secretory activity of fallopian tube

Very effective, lesser side effects, well accepted by

females

INJECTABLES (Depo-provera)

-Progestogens alone or in combination with estrogen are

used by females as injections
-They are depot-medroxy progesterone acetate
(DEMPA) effective for 3 months
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IMPLANTS
-Progestin containing devices which are implanted
subdermenally for providing long term contraception (3-5
years)
-Norplant is progestin containing device
a) Has 6 small silicon (permeable) capsules containing
levonorgesterol
b) Inserted under skin of left upper arm (5 years)

EMERGENCY CONTRACEPTION

-Administration of progestogons or progestogen -

estrogen combination or IUDs within 72 hours of coitus
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-Very effective as emergency contraceptives (morning

after pills) as they avoid possible pregnancy due to rape or
casual unprotected intercourse
-Ex : Mifepristone (RU486) (anti progesterone) is single
pill treatment
-Has very high affinity for progesterone receptors

SURGICAL METHODS/STERILISATION

-Also called permanent methods, terminal methods

-Block gamete transport & prevent conception
-Very effective
-Very poor reversibility

Vasectomy
-Permanent method of contaception for males
-Both vas deferens are Tied up/ligated or cut
-It is minor surgical procedure & done free of cost at
government hospitals
-Sperm production continues after vasectomy but
ejaculated semen is without sperms
-Not effective immediately
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Tubectomy
-For Females
-Small part of fallopian tube is Removed or tied up
through small incision in abdomen (laparotomy) or through
vagina
-Menstrual cycle continues after tubectomy
-The released oocyte is destroyed by phagocytosis

Ill effects of these methods

-Nausea
-Abdominal pain
-Break through bleeding
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-Irregular menstrual cycle

-Ever breast cancer

MEDICAL TERMINATION OF PREGNANCY

-MTPs or Induced abortion

-Intentional or voluntary termination of pregnancy before
full time
-Approx 45 to 50 millions MTP's performed per year all
over the world, which accounts for 1/5th pf total no of
conceived pregnancies in a year
-Govt of india legalised MTP in 1971 with some strict
condition to avoid misuse
-MTPs considered safe during 1st trimester (upto 12
weeks of pregnancy), risk in 2nd trimester

Mediacal termination of pregnancy act (Amendment), 2017

-Introduced by govt of india
-To reduce illegal abortion & consequent maternal
mortality & morbidity
-Acc to this act within first 12 weeks of pregnancy
opinion of one medical practitioner is required for MTP
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-If pregnancy lasts more than 12 weeks but fewer than

24 weeks opinion of 2 registered medical practitioner is
required for MTP

Conditions for doing MTP

-If pregnancy would involve risk to life of pregnant women
or physical injury or mental health
-If child suffer from physical or mental abnormalities or
handicapped

SEXUALLY TRANSMITTED DISEASE

-Also called STD's or STI

-Infections which are transmitted through sexual
intercourse are called STI, pelvic inflammatory disease
(PID) or Veneral disease (VD) or reproductive tract
infections (RTI)
-Very high incidences reproted among persons in age
group of 15-24 years

How to avoid these infections

-Avoid sex with unknown partners, multiple partners
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-Always try to use condoms during coitus

-In case of doubt, one should go to qualified doctor for
early detection & get complete treatment if diagnosed with
infection

Sexually transmitted infections (STI's)

-Chlamydiasis
-Gonorrhoea
-Syphilis
-Chancroid
-Genital herpes
-Genital warts
-Hepatitis B
-AIDS
-Trichomoniasis

Except Hepatitis B, genital herpes & HIV infections other

diseases are curable if detected early & treated properly

STI Transmitted By
-Sharing of injection needles
-Surgical instrument
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-Transfusion of blood from infected mother to foetal too

Early symptoms of STI (minor)

-Itching
-Fluid discharge
-Slight pain
-Sweeling in genital region

Later symptoms of STI

-Leads to complications
-Pelvic ID
-Abortions
-Ectopic pregnancies (Pregnancy not in uterus)
-Infertility
-Even cancer of reproductive tract

INFERTILITY

-Inability to conceive or produce even after 2 years of

unprotected sex
-Large no of couples all over world including India are
infertile
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-Arise due to physical, congenital, diseases, drugs,

immunological or even psychological
-If no correction are possible can have children through
ART (Assisted reproductive technologies)

Assisted Reproductive technologies

⬋ ⬊
In vitro fertilisation (IVF) In vivo fertilisation
(Fertilisation outside body) (Inside body)

In vitro Fertilization (IVF)

(Embryo transfer)
⬋ ⬊
Test tube baby Intra cytoplasmic sperm
⬋ ⬊ injection (ICSI)
IVT ZIFT
(16 cells) -Zygote
-8 cells
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In Vivo fertilisation
(Gamete transfer)
⬋ ⬊
Male gamete transfer Female gamete transfer
⬋ ⬊ -Gamete intra fallopian
IVI AI transfer (GIFT)
(Intrauterine (Artificial
insemination) insemination)

Gamete intra fallopian transfer (GIFT)

-Transfer of an ovum collected from a donar into the
fallopian tube of another female who cannot produce ova
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but can provide suitable environment

Intra cytoplasmic sperm injection (ICSI)

-Sperm directly injected into ovum
-Used when inability of male to inseminate the female or
due to very low sperm count

Intra uterine insemination (IVI)

-Semen from husband (healthy donar) is artificially
introduced into vagina or uterus