Reproductive health

• Reproductive health


  Healthy reproductive organs with normal functions, including emotional and social aspects of reproduction
• World Health Organisation (WHO) definition of reproductive health

  Total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural and social
• India was amongst the first countries to initiate action plans and programmes at a national level to attain total reproductive health as a social goal
• Reproductive and Child Health Care (RCH) programmes

  1. Creating awareness among people about various reproduction related aspects

  2. Providing facilities and support for building up a reproductively healthy society
• Successful implementation of various action plans to attain reproductive health requires strong infrastructural facilities, professional expertise and material support
• Statutory ban on amniocentesis for sex-determination to legally check increasing menace of female foeticides, massive child immunisation are some programmes
• Research on various reproduction-related areas are encouraged and supported by governmental and non-governmental agencies
• Improved programmes covering wider reproduction-related areas are currently in operation under the popular name 'Reproductive and Child Health Care (RCH) programmes'
• Introduction of sex education in schools should also be encouraged to provide right information to the young so as to discourage children from believing in myths and having misconceptions about sex-related aspects
• Proper information about reproductive organs, adolescence and related changes, safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS, etc., would help people, especially those in the adolescent age group to lead a reproductively healthy life
• Educating people, especially fertile couples and those in marriageable age group, about available birth control options, care of pregnant mothers, post-natal care of the mother and child, importance of breast feeding, equal opportunities for the male and the female child, etc., would address the importance of bringing up socially conscious healthy families of desired size
• Awareness of problems due to uncontrolled population growth, social evils like sex-abuse and sex-related crimes, etc., need to be created to enable people to think and take up necessary steps to prevent them and thereby build up a socially responsible and healthy society
• The world population which was around 2 billion (2000 million) in 1900 rocketed to about 6 billion by 2000 and 7.2 billion in 2011
• Our population which was approximately 350 million at the time of our independence reached close to the billion mark by 2000 and crossed 1.2 billion in May 2011
• Through our Reproductive Child Health (RCH) programme, though we could bring down the population growth rate, it was only marginal
• According to the 2011 census report, the population growth rate was less than 2 per cent, i.e., 20/1000/year, a rate at which our population could increase rapidly
• The most important step to overcome this problem is to motivate smaller families by using various contraceptive methods
• Contraceptive methods


  • Natural/Traditional
  • Barrier
  • IUDs
  • Oral contraceptives
  • Injectables
  • Implants
  • Surgical methods
• Periodic abstinence


  Couples avoid or abstain from coitus from day 10 to 17 of the menstrual cycle when ovulation could be expected
• Withdrawal or coitus interruptus


  The male partner withdraws his penis from the vagina just before ejaculation so as to avoid insemination
• Lactational amenorrhea


  Ovulation and therefore the cycle do not occur during the period of intense lactation following parturition
• Condoms


  Barriers made of thin rubber/latex sheath that are used to cover the penis in the male or vagina and cervix in the female, just before coitus so that the ejaculated semen would not enter into the female reproductive tract
• Diaphragms, cervical caps and vaults


  Barriers made of rubber that are 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, increase phagocytosis of sperms, suppress sperm motility and the fertilising capacity of sperms, make the uterus unsuitable for implantation and the cervix hostile to the sperms
• Oral contraceptives (pills)


  Inhibit ovulation and implantation as well as alter the quality of cervical mucus to prevent/retard entry of sperms
• Progestogens alone or in combination with estrogen as injections or implants


  Similar mode of action as pills, effective periods are much longer
• Vasectomy


  Surgical intervention that blocks gamete transport and thereby prevent conception in the male
• Tubectomy


  Surgical intervention that blocks gamete transport and thereby prevent conception in the female
• Intentional or voluntary termination of pregnancy before full term is called medical termination of pregnancy (MTP) or induced abortion
• Nearly 45 to 50 million MTPs are performed in a year all over the world which accounts to 1/5th of the total number of conceived pregnancies in a year
• Contraceptives are not regular requirements for the maintenance of reproductive health. In fact, they are practiced against a natural reproductive event, i.e., conception/pregnancy. One is forced to use these methods either to prevent pregnancy or to delay or space pregnancy due to personal reasons.
• The widespread use of contraceptive methods have a significant role in checking uncontrolled growth of population. However, their possible ill-effects like nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding or even breast cancer, though not very significant, should not be totally ignored.
• Medical Termination of Pregnancy (MTP)


  Intentional or voluntary termination of pregnancy before full term
• Nearly 45 to 50 million MTPs are performed in a year all over the world which accounts to 1/5th of the total number of conceived pregnancies in a year.
• Whether to accept / legalise MTP or not is being debated upon in many countries due to emotional, ethical, religious and social issues involved in it.
• Government of India legalised MTP in 1971 with some strict conditions to avoid its misuse. Such restrictions are all the more important to check indiscriminate and illegal female foeticides which are reported to be high in India.
• Reasons for MTP


  To get rid of unwanted pregnancies either due to casual unprotected intercourse or failure of the contraceptive used during coitus or rapes. MTPs are also essential in certain cases where continuation of the pregnancy could be harmful or even fatal either to the mother or to the foetus or both.
• MTPs are considered relatively safe during the first trimester, i.e., upto 12 weeks of pregnancy. Second trimester abortions are much more riskier.
• A majority of the MTPs are performed illegally by unqualified quacks which are not only unsafe but could be fatal too. Another dangerous trend is the misuse of amniocentesis to determine the sex of the unborn child. Frequently, if the foetus is found to be female, it is followed by MTP- this is totally against what is legal.
• The Medical Termination of Pregnancy (Amendment) Act, 2017 was enacted by the government of India with the intension of reducing the incidence of illegal abortion and consequent maternal mortality and morbidity.