Chapter at a Glance
- Reproductive health refers to total well-being in physical, emotional, behavioral, and social aspects of reproduction at all stages of life.
- Health is affected by: genetic disorders and deficiencies with which an individual is born; infections and lifestyle that includes – food and water, rest, exercise and habits.
- India was the first in the world to initiate various action plans/programs at the national level to attain total reproductive health as a social goal.
- The rapid increase in human population size over a relatively short period is called human population explosion.
- Causes of population explosion
- Reduced death rate
- Increased food production
- Improvement of public health and medical facility
- Increase in number of people in reproductive age.
- Decreased infant motility rate (IMR) and maternal mortality rate (MMR).
- Overpopulation has resulted in serious problems like depletion of natural resources, various socio-economic problems, energy crisis, and ecodegradation.
- Socio-economic problems are shortage of food supply, space, unemployment, essential goods, and poverty
- Energy crisis – The increase in population has created a greater demand for energy- fuel wood, fossil fuel, etc.
- Ecodegradation is pollution and sanitation.
BIRTH CONTROL
- The birth control methods that deliberately prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation are referred to as contraception.
- Contraceptive methods are preventive methods to help woman avoid unwanted pregnancies. These methods are of two types – temporary & permanent.
- Temporary methods include natural methods and barrier methods.
- Natural methods prevents the chances of sperm with ovum meeting. It can be acquired by safe period, coitus interruptus, abstinence, lactational amenorrhea.
- Safe period: A weak before & a week after the menses is considered the safe period (rhythm method) for sexual intercourse.
- Coitus interruptus involves the withdrawal of the penis by the male before ejaculation so that semen is not deposited in the vagina & there is no fertilization.
- Abstinence is a way to avoid conception by abstaining from sexual intercourse.
- The lactational amenorrhea (absence of menstruation) method is based on the fact that ovulation & therefore the cycle does not occur during the period of intense lactation following parturition. It is a temporary postnatal infertility.
- Barrier methods utilises a block or boundary, to keep sperm from penetrating the egg. It includes spermicides, condoms, diaphragms, cervical cap, intrauterine devices (IlJDs) etc.
- Spermicidal creams, jellies, and foams are chemical barriers. They are usually used along with these barriers to increase their contraceptive efficiency. They prevent conception by blocking the entry of sperm into the female body. These devices are reusable.
- Condom (Nirodh), a type of mechanical barrier, is a rubber sheath to cover the erect penis in males and the vagina and cervix in females just before the coitus to avoid insemination. This helps in preventing conception by blocking the meeting of sperm and ova. It is also a safeguard against AIDS & other sexual diseases.
- Diaphragms & cervical caps are rubber plastic covers that are fitted on the cervix & check the entry of sperms into the uterus.
- Intrauterine devices (IUDs) are plastic or metal devices placed in the uterus. They contain either copper or a common synthetic hormone used in oral contraceptives. These include loop, copper-T, spiral, etc. They prevent fertilization of the egg or implantation of the egg.
- Oral contraceptives (birth control pills) check ovulation by inhibiting the secretion of FSH & LH hormone that are necessary for ovulation.
- Most birth control pill contain small doses of either progesterone or progesterone estrogen combinations. Pills have to be taken daily for a period of 2 l days starting preferably within the first five days of the menstrual cycle.
- Contraceptive implant is made up of small thin flexible rod. They can be used under the skin. It consists of progesterone alone or in combination with oestrogen. Their action is similar to that of pills. It releases small amount of progestogen which stop ovulation and thicken the mucus in cervix (the entrance to uterus), making it difficult for sperm to get through and fertilise an egg.
- Permanent methods includes vasectomy in male and tubectomy in female.
- Vasectomy in males involves a cut in the scrotal sac, cutting or burning of the vas deferens (tubes that carry sperm) & blocking both the cut ends. A vasectomy prevents the passage of sperm into seminal fluid.
- Female sterilization (called tubectomy) prevents fertilization by interrupting the passage through the fallopian tube. Eggs continue to be produced but they fail to pass into the uterus.
- Medical termination of pregnancy (MTPs) or induced abortion is one of the most widely used methods of fertility control in the world.
MTP’s are considered relatively safe during the first trimester i.e. up to 12 weeks of pregnancy. - Amniocentesis is a prenatal diagnostic technique in which a sample of amniotic fluid from the womb of a pregnant woman is taken during the early stages of foetal development and the cells are cultured and analysed.
- By this method the chromosomal abnormalities, the sex of the foetus and development disorders could be detected. It is misused for female foeticides.
- Sexually transmitted diseases (STDs) are the diseases or infections which are transmitted through sexual intercourse with infected persons.
Common STDs includes AIDS, gonorrhoea, syphilis, genital herpes, hepatitis-B etc.
AIDS, genital herpes and hepatitis B cannot be cured while the others are curable STDs if detected early and treated properly.
INFERTILITY
- A large number of couples are infertile, i.e., they are unable to produce children in spite of unprotected intercourse. Hence, infertility may be defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one or two years.
- In cases where the corrective treatment of infertility is not possible, couples are assisted to have children through special programs called Assisted Reproduction Technologies (ART).
- ART program includes :
- Test tube baby program
- Gamete intrafallopian transfer (GIFT)
- Intracytoplasmic sperm injection (ICSI)
- Artificial insemination technique
- Test Tube Baby Programme: In this programme, the fusion of ovum and sperm is done outside the body of a woman to form a zygote which is allowed to divide to form an embryo. This embryo is then implanted in the uterus where it develops into a foetus which in turn develops into a child. This is called a test tube baby. In this method, ova from the wife or a donor female and the sperm from the husband or a donor are allowed to fuse under simulated conditions (as that of the body) in vitro fertilization.
- Gamete Intra Fallopian Transfer (GIFT): This method involves the transfer of an ovum collected from a donor female into another female, who cannot produce ova, but can provide suitable conditions for fertilization and further development of the fetus up to parturition.
- Intra Cytoplasmic Sperm Injection (ICSI): In this method, the sperm is directly injected into the ovum to form an embryo in the laboratory, and then embryo transfer is carried out.
- Artificial insemination: In this method, the semen collected from the husband or a healthy donor, is artificially introduced into the vagina or into the uterus (intra-uterine insemination) around the time of ovulation.
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