REPRODUCTIVE HEALTH NOTES FOR NEET

 


                                  Reproductive Health

Reproductive health refers to not only physical well being but also to emotional, social and behavioural well being. It is important for the development of a country to have a reproductively healthy society.

Problems and Strategies related to Reproductive Health

There are various problems related to reproductive health such as increasing population, sexually transmitted diseases, female foeticide, infant and maternal deaths and many social evils. There are many measures taken to achieve reproductive health and control the population explosion.

  • RCH- Reproductive and child health care programmes are run to improve the reproductive health of society
  • Family planning programmes were introduced in 1951 with the aim to control the population
  • Reproduction related awareness is being created using print and digital media
  • Sex education in school should be promoted so that teenagers get the first-hand information and clear their doubts about any misconceptions or myths
  • Awareness about birth control measures, pre and postnatal care, educating people about sexual organs and hygiene, safe sexual practices and STDs (sexually transmitted diseases) has helped people leading healthy reproductive life
  • Sex-determination is banned to stop female foeticide. Sex determination by amniocentesis or Ultrasonography has been made a criminal offence
  • Awareness regarding the menstrual process and reproduction process has helped in eradicating social evils, where a female was blamed for giving birth to a female child and other related issues
  • Amniocentesis and other screening techniques have helped in determining genetic disorders in the growing foetus, e.g. haemophilia, down syndrome, sickle cell anaemia, etc.

Measure for Birth Control

The world population is increasing rapidly. Technological advancement has increased the quality of life but has also increased population growth. The main causes are:

  • Increased life expectancy and declining death rate
  • Declining infant and maternal mortality rate, i.e. IMR and MMR, respectively
  • Increase in the number of people having reproducible age

There are various measures taken to control the population explosion. They are:

  • Promoting smaller families by creating awareness, birth control measures and giving incentives
  • By raising the legal age of marriage, i.e. female- 18 yrs and male- 21 yrs

Birth control measures or contraceptives should be easy to use, accessible, effective but without side effects. They are effective in delaying pregnancy or spacing between two children. They can be categorised in the following groups:

  1. Natural:
    1. Periodic abstinence during the fertile period, i.e. 10th to 17th day of the menstrual cycle
    2. Withdrawal or coitus interruptus to prevent insemination
    3. Lactational amenorrhea after parturition, i.e. six months after delivery when there is no menstruation and ovulation
  2. Barrier: Disposable condoms and reusable cervical caps, diaphragms and vaults block the entry of sperm and prevent conception. Contraceptive efficiency is increased by using spermicidal creams, foams and jellies.
  3. Intrauterine devices (IUDs): Various IUDs are available and are the most widely used contraceptive measures. They are inserted through the vagina in the uterus. IUDs work by suppressing motility, fertilising capacity and increasing phagocytosis of sperms.
    1. Non-medicated IUDs- Lippes loop
    2. IUDs releasing Cu- CuT, Multiload 375, Cu7
    3. IUDs releasing hormone- Progestasert, LNG-20
  4. Oral Contraceptives: They are popularly known as pills. They have to be administered for 21 days starting from the fifth day of the menstrual cycle. After a gap of 7 days, the course has to be repeated for the entire period when you don’t want to get pregnant. Oral contraceptives contain a combination of progestogen-estrogen or progestogens, which prevent ovulation. They also inhibit implantation and sperm entry by thickening the cervical mucus. Saheli is a non-steroidal oral contraceptive pill developed in CDRI Lucknow. It has to be taken once a week and found to be very effective with very few side effects.
  5. Injectable and Implants: These are effective emergency contraceptives and to be taken within 72 hrs of unprotected intercourse. Progestogens or its combination with estrogen can be injected or implanted under the skin.
  6. Surgical methods: Surgical methods of sterilization are advised as a terminal method for birth control. They are highly effective but the reversal is difficult.
    1. Vasectomy- Male sterilization, a small portion of vas deferens is tied and cut
    2. Tubectomy- Female sterilization, a small portion of the fallopian tubes is tied and cut

All the contraceptive methods are able to check the uncontrolled growth of population but there are side effects linked to them, e.g. nausea, pain, irregular and heavy menstrual bleeding, etc. In rare cases, it may even lead to breast cancer.

Medical Termination of Pregnancy (MTPs)

It is used to prevent unwanted pregnancies or if the pregnancy can be harmful to mother or foetus.

  • It refers to the induced abortion or voluntary termination of unwanted pregnancy
  • MTP was made legal in 1971 but with strict conditions to avoid its misuse for female foeticide
  • In 2017, the MTP amendment act came into force to further reduce illegal abortion and maternal mortality. According to the act, pregnancy may be terminated before 12 weeks on the advice of one registered practitioner. If it is to be done after 12 weeks of pregnancy, then you need to refer to two doctors and it has to be terminated before 24 weeks. After which it is not safe for the mother to terminate the pregnancy.

Sexually Transmitted Diseases or Infections (STDs or STIs)

Diseases or infections which are transmitted by sexual intercourse are referred to as STIs, reproductive tract infections (RTIs) or venereal diseases (VD).

  • The common STIs include:

Viral infections- AIDS (HIV infection), herpes, genital wart, cervical cancer (human papillomavirus, HPV infection), hepatitis B

Bacterial infections- Syphilis, gonorrhoea, chlamydia

  • AIDS and hepatitis-B can also get transmitted by surgical instruments or infected needles during a blood transfusion or may pass to the foetus from the infected mother
  • There have been vaccines developed to prevent hepatitis-B, HPV. Other than AIDS, genital herpes and hepatitis-B, other infections are curable if detected early and treated
  • Early symptoms include vaginal discharge, itching, pain and swelling in the genital region
  • If not treated properly, it may lead to various complications, e.g. infertility, ectopic pregnancies, abortions, stillbirths, PIDs (pelvic infertility diseases) or even lead to cancer
  • To avoid infections it is important to maintain the hygiene of external genital organs and not have unprotected sex and avoid multiple or unknown partners. One should not hesitate to see a doctor in case of any doubt

Infertility

Inability to produce children is termed as infertility. Infertility may be congenital, physical, psychological, hormonal or due to diseases and drugs.

  • Using various assisted reproductive technologies (ART), it is now possible to have children for those couples also, who were unable to conceive even after corrective treatments
  • Test tube baby or IVF (in-vitro fertilization): It involves fertilization of gametes outside the body under controlled conditions and then the transfer of the embryo to the uterus, i.e. embryo transfer (ET). Either zygote or early embryo (up to 8 blastomeres) is transferred to the fallopian tube, i.e. zygote intra fallopian transfer (ZIFT) or an embryo with more than 8 blastomeres is directly transferred to the uterus, i.e. intrauterine transfer (IUT)
  • Embryo with in-vivo fertilization can also be used for the transfer
  • Gamete intrafallopian transfer (GIFT): The transfer of ovum from the donor to another female, who can provide an optimal environment for fertilization and further development but cannot produce an ovum
  • Intracytoplasmic sperm injection (ICSI): In this process, sperm is directly injected to the ovum in the lab
  • Artificial insemination (AI): Healthy sperm of the husband or the donor is injected into the female vagina or uterus, i.e. intrauterine insemination (IUI)

 


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