Comprehensive Notes on Reproductive Health and Human Population Control and Procedures and Problems

Reproductive Health: Definition, Significance, and WHO Perspective

• Definition: Reproductive health is traditionally defined as having healthy reproductive organs with normal functions. However, the World Health Organisation (WHO) provides a broader, more comprehensive definition.

• WHO Definition: Reproductive health means a total well-being in all aspects of reproduction, including:

  • Physical: Physically and functionally normal reproductive organs.

  • Emotional: Healthy emotional interactions and psychological states regarding sex-related aspects.

  • Behavioural: Normal and healthy interactions among individuals.

  • Social: A society where people maintain healthy sex-related interactions and social structures.

• Reproductively Healthy Society: This is a society where people possess physically and functionally normal reproductive organs and exhibit normal emotional and behavioural interactions in all sex-related aspects.

Reproductive Health – Problems and Strategies in India

• National Initiatives: India was among the first countries in the world to initiate national action plans and programmes to attain total reproductive health as a social goal.

• Family Planning:

  • Initiated in: $1951$.

  • These programmes have been periodically assessed and improved over the decades.

• Reproductive and Child Health Care (RCH) Programmes: These are improved, wider programmes currently in operation. The major tasks include: * Creating awareness among people about various reproduction-related aspects. * Providing facilities and support for building a reproductively healthy society.

• Methods of Disseminating Awareness:

  • Governmental and Non-Governmental Agencies: Utilise audio-visual and print media to create awareness.

  • Role of Individuals: Parents, close relatives, teachers, and friends play major roles in disseminating information.

  • Sex Education in Schools:

    • Encouraged to provide right information to the young.

    • Aims to discourage children from believing myths and having misconceptions about sex-related aspects.

    • Includes information about reproductive organs, adolescence and related changes, safe and hygienic sexual practices, and Sexually Transmitted Diseases (STDs) like AIDS.

• Targeted Education Topics:

  • Fertile Couples and Marriageable Age Group: Options for birth control, care of pregnant mothers, post-natal care, importance of breastfeeding, and providing equal opportunities for male and female children.

  • Societal Responsibility: Awareness of problems due to uncontrolled population growth, social evils like sex abuse, and sex-related crimes to enable people to take preventative steps.

• Requirements for Implementation:

  • Strong infrastructural facilities.

  • Professional expertise.

  • Material support.

  • These are essential for medical assistance in areas such as pregnancy, delivery, STDs, abortions, contraception, menstrual problems, and infertility.

• Statutory Regulations and Specific Programmes:

  • Amniocentesis: A foetal sex determination test based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo. It is used to analyze fetal cells and dissolved substances to test for genetic disorders ($\text{Down syndrome, haemophilia, sickle-cell anemia}$).

  • Statutory Ban on Amniocentesis: Implemented to legally check the increasing menace of female foeticides.

  • Child Immunisation: Massive programmes for child health.

• Research and Development:

  • Saheli: A new oral contraceptive for females. It was developed by scientists at the Central Drug Research Institute (CDRI) in Lucknow, India. It is a non-steroidal preparation with high contraceptive value and a "once a week" dosage.

• Indicators of Improved Reproductive Health:

  • Increased medically assisted deliveries.

  • Decreased maternal and infant mortality rates (MMR and IMR).

  • Increased number of couples with small families.

  • Better detection and cure of STDs.

Population Stabilisation and Birth Control

• Global Population Trends:

  • $1900$: Approximately $2\text{ billion}$ ($2000\text{ million}$).

  • $2000$: Approximately $6\text{ billion}$.

  • $2011$: Approximately $7.2\text{ billion}$.

• Indian Population Trends:

  • Time of Independence ($1947$): Approximately $350\text{ million}$.

  • $2000$: Reached close to the billion mark.

  • May $2011$: Crossed $1.2\text{ billion}$.

• Reasons for Population Growth:

  • Rapid decline in death rate.

  • Decline in Maternal Mortality Rate (MMR).

  • Decline in Infant Mortality Rate (IMR).

  • Increase in the number of people in reproducible age.

• Impact of Growth: An alarming growth rate could lead to an absolute scarcity of basic requirements: food, shelter, and clothing.

• Government Measures to Check Growth:

  • Motivational Slogans: "Hum Do Hamare Do" (We two, our two).

  • One Child Norm: Adopted by many young, urban, working couples.

  • Marriageable Age: Raised by statute to $18\text{ years}$ for females and $21\text{ years}$ for males.

  • Incentives: Given to couples with small families.

Contraceptive Methods

• Ideal Contraceptive Characteristics: User-friendly, easily available, effective, reversible, no or least side effects, and no interference with sexual drive, desire, or act.

• Natural/Traditional Methods:

  • Periodic Abstinence: Couples avoid coitus from day $10$ to $17$ of the menstrual cycle (the fertile period) when ovulation is expected.

  • Withdrawal (Coitus Interruptus): The male partner withdraws the penis from the vagina just before ejaculation to avoid insemination.

  • Lactational Amenorrhea: Based on the absence of menstruation and ovulation during intense lactation following parturition. Effective only up to a maximum period of six months post-partum.

• Barrier Methods:

  • Condoms: Thin rubber/latex sheaths. "Nirodh" is a popular brand for males. Male and female condoms are disposable, self-inserted, and provide privacy. They also protect against STIs and AIDS.

  • Diaphragms, Cervical Caps, and Vaults: Reusable rubber barriers inserted into the female tract to cover the cervix.

  • Spermicidal Agents: Creams, jellies, and foams used alongside barriers to increase efficiency.

• Intra Uterine Devices (IUDs): Inserted by doctors/nurses through the vagina into the uterus.

  • Non-medicated IUDs: e.g., Lippes loop.

  • Copper-releasing IUDs: e.g., CuT, Cu7, Multiload $375$. They release Cu ions that suppress sperm motility and fertilising capacity.

  • Hormone-releasing IUDs: e.g., Progestasert, LNG-$20$. They make the uterus unsuitable for implantation and the cervix hostile to sperms.

• Oral Contraceptives (Pills):

  • Small doses of progestogens or progestogen-estrogen combinations.

  • Taken daily for $21\text{ days}$ starting within the first five days of the menstrual cycle, followed by a $7$-day gap.

  • Saheli: A non-steroidal, once-a-week pill.

• Injectables and Implants: Progestogens or combinations used as injections or implants under the skin; longer effective periods.

• Emergency Contraceptives: Administration of progestogens or combinations/IUDs within $72\text{ hours}$ of unprotected coitus or rape.

• Surgical Methods (Sterilisation): Terminal methods to prevent pregnancy by blocking gamete transport.

  • Vasectomy: For males; removal or tying of a small part of the vas deferens via a scrotal incision.

  • Tubectomy: For females; removal or tying of a small part of the fallopian tube via abdomen or vagina.

  • Note: These methods have very poor reversibility.

• Side Effects: While checking population, possible ill effects include nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding, or breast cancer.

Medical Termination of Pregnancy (MTP)

• Definition: Intentional or voluntary termination of pregnancy before full term (induced abortion).

• Statistics: Approximately $45\text{ to }50\text{ million}$ MTPs are performed annually worldwide ($\frac{1}{5}\text{th}$ of total annual conceptions).

• Legal Status in India: Legalised in $1971$ with strict conditions to avoid misuse and check female foeticide.

• The Medical Termination of Pregnancy (Amendment) Act, 2017:

  • Up to $12\text{ weeks}$: Opinion of one registered medical practitioner required.

  • Between $12\text{ and }24\text{ weeks}$: Opinion of two registered medical practitioners required.

  • Grounds for MTP: Risk to the life of the pregnant woman/grave injury to physical or mental health, or substantial risk of serious physical or mental abnormalities in the child.

• Safety: MTPs are relatively safe during the first trimester ($12\text{ weeks}$). Second-trimester abortions are riskier.

Sexually Transmitted Infections (STIs)

• Definition: Infections transmitted through sexual intercourse; also known as Venereal Diseases (VD) or Reproductive Tract Infections (RTI).

• Common STIs: Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B, and HIV (leading to AIDS).

• Transmission: Sexual intercourse, sharing of injection needles/surgical instruments, blood transfusion, or mother-to-foetus.

• Curability: Most are curable if detected early, except for Hepatitis-B, genital herpes, and HIV infection.

• Symptoms: Genital itching, fluid discharge, slight pain, and swellings. Infected females are often asymptomatic.

• Complications of Untreated STIs: Pelvic Inflammatory Diseases (PID), abortions, stillbirths, ectopic pregnancies, infertility, or reproductive tract cancer.

• Vulnerability: Highest incidence in the age group of $15-24\text{ years}$.

• Prevention:

  1. Avoid sex with unknown/multiple partners.

  2. Use condoms during coitus.

  3. Consult a doctor immediately if infection is suspected.

Infertility and Assisted Reproductive Technologies (ART)

• Infertility Definition: Inability to produce children despite unprotected sexual cohabitation for a period (often defined as two years).

• Assisted Reproductive Technologies (ART):

  • In Vitro Fertilisation (IVF): Fertilisation outside the body in simulated laboratory conditions, followed by Embryo Transfer (ET) (popularly "test tube baby").

  • ZIFT (Zygote Intra Fallopian Transfer): Transfer of zygote or early embryo (up to $8\text{ blastomeres}$) into the fallopian tube.

  • IUT (Intra Uterine Transfer): Transfer of embryos with more than $8\text{ blastomeres}$ into the uterus.

  • GIFT (Gamete Intra Fallopian Transfer): Transfer of an ovum from a donor into the fallopian tube of another female who cannot produce one but can provide a suitable environment.

  • ICSI (Intra Cytoplasmic Sperm Injection): Direct injection of a sperm into the ovum in the laboratory.

  • AI (Artificial Insemination): Semen from husband or donor is introduced into the vagina or uterus (IUI – Intra-Uterine Insemination). Used for low sperm count or inability to inseminate.

• Social Aspects: In India, adoption is considered a viable and legal method for parenthood, providing homes for orphaned children.

Questions & Discussion

• Significance of Reproductive Health: Essential for a society to maintain physical, emotional, and social well-being while preventing STDs and overpopulation.

• Sex Education in Schools: Necessary to provide accurate information, prevent myths/misconceptions during adolescence, and promote safe practices.

• Use of Contraceptives Justification: Justified to check uncontrolled population growth and allow individuals to plan families based on personal and economic factors.

• Amniocentesis Ban: Necessary to prevent sex-selective abortion (female foeticide), despite its utility in detecting genetic disorders.

• Infertility Factors: Can be due to physical, congenital, immunological, psychological reasons, or diseases/drugs. In India, though females are often blamed, the problem frequently lies with the male partner.

• Surgical Methods Misconception: Surgical methods like vasectomy and tubectomy do not prevent gamete formation; they prevent gamete transport.