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• India initiated national action plans and programmes for total reproductive health in 1951. • • These programmes, known as 'family planning', have been periodically assessed over the years. • • Currently, 'Reproductive and Child Health Care (RCH) programmes' operate in wider reproduction-related areas. • • These programmes aim to create awareness about reproduction-related aspects and provide facilities and support for a reproductively healthy society. • • Public and non-governmental agencies have taken steps to create awareness about reproduction-related aspects.
• Parents, close relatives, teachers, and friends play a major role in disseminating information about reproduction-related aspects. • • Education about reproductive organs, adolescence, safe sexual practices, sexually transmitted diseases (STD), AIDS, etc., is encouraged. • • Awareness of problems due to uncontrolled population growth and social evils like sex-abuse and sex-related crimes is created to enable people to take necessary steps to prevent them. • •Successful implementation of action plans requires strong infrastructural facilities, professional expertise, and material support.
• Research on various reproduction-related areas is encouraged and supported by governmental and non-governmental agencies. • • Improved reproductive health, increased medically assisted deliveries, and better post-natal care have led to decreased maternal and infant mortality rates, increased couples with small families, better detection and cure of STDs, and overall increased medical facilities for all sex-related problems.
• Global population growth from 2 billion in 1900 to 7.2 billion in 2011. • • India's population, initially around 350 million, reached close to the billion mark by 2000 and crossed 1.2 billion in May 2011. • • Rapid decline in death rate, maternal mortality rate, and infant mortality rate. • • Reproductive Child Health (RCH) programme could only marginally reduce population growth rate. • • 2011 census report shows population growth rate was less than 2%, a rate that could lead to scarcity of basic necessities.
• Government measures include motivating smaller families with various contraceptive methods, raising marriageable age, and providing incentives for couples with small families. • • Commonly used contraceptive methods include Natural/Traditional, Barrier, IUDs, Oral contraceptives, Injectables, Implants, and Surgical methods.
Natural Methods • • Periodic abstinence: Couples avoid coitus from day 10 to 17 of the menstrual cycle to prevent conception. • • Withdrawal or coitus interruptus: Male partners withdraw penis from the vagina before ejaculation to avoid insemination. • • Lactational amenorrhea: The absence of menstruation during intense lactation following parturition reduces chances of conception. • • Barrier methods: Ovum and sperms are prevented from physically meeting with barriers. • • Condoms: Thin rubber/latex sheaths used to cover the penis in the male or vagina and cervix in the female.
• Diaphragms, cervical caps, and vaults: Rubber barriers inserted into the female reproductive tract to cover the cervix during coitus. • • Intra Uterine Devices (IUDs): Devices inserted by doctors or expert nurses in the uterus through vagina. • • Oral administration of small doses of progestogens or progestogen-estrogen combinations: Tablets taken daily for 21 days, starting within the first five days of menstrual cycle. • • Saheli: A new oral contraceptive for females with a non-steroidal preparation. • • Surgical methods: Surgical intervention blocks gamete transport and thereby prevents conception.
• Selection of a suitable contraceptive method should be undertaken in consultation with qualified medical professionals. • • Contraceptives are not regular requirements for reproductive health maintenance but are practiced against a natural reproductive event, conception/pregnancy. • • Widespread use of these methods has a significant role in checking uncontrolled population growth, but potential ill-effects like nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding, or breast cancer should not be ignored.
• MTP refers to the intentional or voluntary termination of pregnancy before full term, accounting for 1/5th of all conceived pregnancies worldwide. • The debate on MTP legalization is influenced by emotional, ethical, religious, and social issues. • India legalized MTP in 1971 with strict conditions to prevent misuse and check high indiscriminate and illegal female foeticides. • MTPs are essential in cases where continuation of the pregnancy could be harmful or fatal to the mother or the foetus. • MTPs are considered safe during the first trimester, up to 12 weeks of pregnancy.
• Many MTPs are performed illegally by unqualified quacks, which can be unsafe and potentially fatal. • Misuse of amniocentesis to determine the sex of the unborn child is a dangerous trend. • The Medical Termination of Pregnancy (Amendment) Act, 2017 aims to reduce the incidence of illegal abortion and maternal mortality and morbidity. • The Act allows termination of a pregnancy within the first 12 weeks of pregnancy on certain grounds.
• STIs are diseases transmitted through sexual intercourse, including gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B, and HIV leading to AIDS. • HIV is the most dangerous STI. • STIs can also be transmitted through sharing of injection needles, surgical instruments, blood transfusion, or from an infected mother to the foetus. • Other diseases are curable if detected early and treated properly. • Early symptoms include itching, fluid discharge, slight pain, swellings, etc., in the genital region. • Social stigma and absence of symptoms deter infected individuals from seeking timely detection and treatment.
• STIs pose a major threat to a healthy society. • Prevention is crucial under reproductive health-care programs. • Prevention can be achieved by avoiding sex with unknown partners/multiple partners, using condoms during coitus, and seeking medical help if diagnosed with infection.
Infertility and its Causes • Many couples worldwide, including India, are infertile due to unprotected sexual co-habitation. • Causes include physical, congenital, diseases, drugs, immunological, or psychological factors. • In India, the male partner often causes the infertility, but specialized healthcare units can diagnose and treat these disorders. Assisted Reproductive Technologies (ART) • In vitro fertilisation (IVF) followed by embryo transfer (ET) is one method. • Embryos from the wife/donor and sperms from the husband/donor are collected and induced to form zygote.
• Embryos with up to 8 blastomeres are transferred into the fallopian tube (ZIFT) or into the uterus (IUT). • Embryos formed by in-vivo fertilisation can also be used for transfer. Transfer of Ovum • GIFT is another method. • Intra cytoplasmic sperm injection (ICSI) is another specialized procedure. Artificial Insemination (AI) Technique • AI technique corrects infertility due to inability of the male partner to inseminate the female or low sperm counts in the ejaculates. • AI technique involves artificially introducing semen into the vagina or uterus of the female.
Challenges and Limitations • High precision handling and expensive instrumentation are required, making these facilities only available in few centers. • Emotional, religious, and social factors also deter adoption of these methods. • Legal adoption is one of the best methods for couples looking for parenthood in India.
• Reproductive health encompasses physical, emotional, behavioral, and social well-being. • The country initiated national action plans to achieve a reproductively healthy society. • Primary steps include counseling and awareness about reproductive organs, adolescence, safe sexual practices, and sexually transmitted infections (STIs). • Medical facilities and care are provided for issues like menstrual irregularities, pregnancy, delivery, medical termination of pregnancy, STIs, birth control, infertility, and post-natal child and maternal management.
• Improvements in reproductive health include reduced maternal and infant mortality rates, early detection and cure of STIs, and assistance to infertile couples. • Legalization of medical termination of pregnancy is a common practice. • Early detection of Sexually Transmitted Diseases (STIs) and prevention measures like avoidance of sexual intercourse with unknown partners and use of condoms during coitus are crucial. • Infertility, a condition resulting from unprotected sexual cohabitation, is addressed through methods like In Vitro fertilisation and the 'Test Tube Baby' Programme.
