Chapter 8: Reproductive Health

Features of reproductive health

• Physical and functional health: Reproductive organs function normally.
• Healthy interactions: People show normal behavioural and emotional interactions in sex-related aspects.
• Broad meaning: It includes social and emotional well-being, not only the absence of disease.

Reproductive and Child Health (RCH) programmes

• National initiative: India was among the first countries to launch national programmes for reproductive health as a social goal.
• Purpose: Build awareness of reproductive organs, accessory organs, secondary sexual characters, adolescence and STDs, and provide appropriate services and support.
• Key services: Maternal and child health care and family planning are important components of health-care centres.

Strategies to achieve reproductive health

• Family planning: Promote informed planning of family size and birth control.
• Sex education: Provide accurate information in schools to correct myths and misconceptions about sex-related matters.
• Birth control and care: Inform fertile couples and people of marriageable age about contraceptive devices, pregnancy care, postnatal care and breastfeeding.
• Equal value: Emphasise equal importance of male and female children.
• Safety and awareness: Address uncontrolled population growth, sex abuse and sex-related crimes; encourage steps to prevent them.
• Health services: Provide infrastructure, trained professionals and material support for menstrual problems, infertility, pregnancy, delivery, contraception, abortions and STDs; use improved techniques and strategies.

Uses and misuse

• Medical use: Helps detect certain genetic disorders, including Down syndrome, haemophilia and sickle-cell anaemia, and assess fetal survivability.
• Sex determination: Chromosomal analysis can reveal fetal sex, but using the test for this purpose is legally banned.
• Misuse: Sex determination has been misused to abort normal female fetuses, contributing to female foeticide.

Causes and effects

• Causes: Better health facilities and living conditions lowered death rate, maternal mortality rate (MMR) and infant mortality rate (IMR); the reproductive-age population also increased.
• RCH programmes: Reproductive and Child Health programmes brought down population growth marginally.
• Concern: Even a growth rate below 2% (about 20 per 1,000 people per year) could rapidly increase population and cause scarcity of food, shelter and clothing.

Measures to stabilise population

• Smaller families: Promote contraception and the two-child norm, commonly expressed as “Hum Do Hamare Do”; some couples adopt a one-child norm.
• Marriage age: The statutory minimum marriageable age is 18 years for females and 21 years for males.
• Incentives: Couples with small families may receive incentives.

Principles and ideal features

• Targets: Contraception may prevent sperm transport to the ovum, ovulation, or implantation of the early embryo.
• Ideal method: User-friendly, easily available, effective and reversible, with minimal side effects and no interference with sexual drive, desire or the sexual act.
• Main groups: Temporary methods postpone or space births; permanent methods are intended to prevent further pregnancies.

1. Natural methods

• Principle: Avoid the meeting of sperm and ovum. No medicines or devices are used, so side effects are absent; failure rates are comparatively high.

• Spermicides: Creams, jellies and foams are inserted into the vagina before intercourse to prevent sperm from entering the uterus; they are often combined with barriers to improve effectiveness.
• Examples listed: Lactic acid, citric acid, boric acid, zinc sulphate and potassium permanganate.
• Other products: “Today” sponge is a foam suppository or tablet containing nonoxynol; Delfin is a cream. These are relatively unreliable; avoid them if allergic to the spermicide.

IUCD limitations

• Expulsion: Unnoticed expulsion occurs in about 10–15% of users and can leave them at risk of pregnancy.
• Other risks: Uterine perforation, infection, excessive menstrual bleeding and pain.

• Composition: Small doses of progestogen alone or a progestogen–estrogen combination, taken as tablets.
• Combined pills: Contain synthetic progesterone and estrogen; examples include Mala D and Mala N.
• Mini pills: Contain progestin only, without estrogen; the lecture lists Saheli as an example. Saheli itself contains the non-steroidal compound centchroman.
• Saheli history: Introduced by CDRI, Lucknow, in 1991 as the world's first non-steroidal oral contraceptive; taken once a week.

Pill use and action

• Schedule: Take pills daily for 21 days, preferably starting within the first five days of the menstrual cycle; pause for seven days, then repeat while contraception is desired.
• Action: Pills inhibit ovulation and implantation and alter cervical mucus, making sperm entry difficult.
• Effectiveness: Generally very effective, with fewer side effects, and well accepted by users.

Risks and side effects

• Important risk: Oral pills increase the risk of intravascular clotting; they are not recommended for women with clotting disorders, cerebral blood-vessel damage, hypertension or heart disease.
• Possible effects: Acne, weight gain, depression, hypertension, leukorrhea, reduced menstrual flow, breast pain (mastalgia), nausea, vomiting and melasma.
• Saheli: Centchroman inhibits implantation. Its non-steroidal nature means it does not cause effects such as nausea, vomiting and weight gain; delayed menstruation occurs in about 8% of women.
• Other Saheli points: Described as safe for long-term use and beneficial for dysfunctional uterine bleeding, breast pain and benign breast tumours.

• Hormones used: Progestogens alone or combined with estrogen may be given by injection or implanted under the skin.
• Action: Like oral contraceptives, they block ovulation and thicken cervical mucus to hinder sperm transport.
• Injectables: DMPA (depot medroxyprogesterone acetate) and NET-EN (norethisterone enanthate) are convenient and highly effective; occasional heavy menstrual bleeding may occur.
• Emergency contraception: Progestogens, progestogen–estrogen combinations or IUCDs used within 72 hours of coitus can help prevent pregnancy after rape or unprotected intercourse.

Implants

• Design and duration: Six matchstick-sized steroid capsules are placed under the skin of the inner arm above the elbow; they release synthetic progesterone for about five years.
• Features: Implants are safe, convenient, effective and long-lasting.

Scale and legal status

• Global scale: About 45–50 million MTPs are performed worldwide each year—approximately one-fifth of all pregnancies conceived annually.
• India: MTP was legalised in 1971, subject to strict conditions intended to prevent misuse.
• Safeguard: Restrictions are especially important because indiscriminate and illegal female foeticide is reported to be high in India.

When MTP may be considered

• Unwanted pregnancy: May result from unprotected intercourse, contraceptive failure during coitus, or rape.
• Medical reasons: MTP may be necessary when continuing the pregnancy could harm the mother, the foetus, or both.

Unsafe practices and prevention

• Illegal procedures: The majority of MTPs are performed illegally by unqualified practitioners; these procedures are unsafe and can be fatal.
• Sex determination misuse: Using amniocentesis to determine foetal sex and then terminating a female foetus is dangerous and should be avoided.
• Prevention: Effective counselling can reduce unprotected intercourse and help people avoid the risks of illegal abortions.

Transmission and health effects

• Transmission: Sexual intercourse with an infected person; sharing injection needles or surgical instruments; infected blood transfusion; and transmission from an infected mother to the fetus.
• Early symptoms: Itching, swellings, fluid discharge and slight pain.
• Untreated infection: May lead to abortion, stillbirth, ectopic pregnancy, infertility, reproductive-tract cancer or pelvic inflammatory disease.
• Higher incidence: STIs can affect anyone, but reported incidence is especially high among people aged 15–24 years.

• Partners: Avoid sex with unknown or multiple partners.
• Condoms: Always use condoms during coitus.
• Medical care: If infection is suspected, consult a qualified doctor promptly; complete the prescribed treatment if diagnosed.

Key IVF Milestone

• First test-tube baby: Louise Joy Brown was born in 1978 to Lesley and Gilbert Brown.
• Doctors: The procedure was developed with Dr. Patrick Steptoe and Dr. Robert Edwards; Edwards received the 2010 Nobel Prize for developing the technique.