Reproductive Health

Reproductive health means a state of complete physical, mental and social well-being in all matters relating to reproduction — not just the absence of disease. A society with good reproductive health has people who are well informed about reproduction, free of sexually transmitted diseases, able to have healthy children when they wish, and supported by good medical care.

India was one of the first countries to start a national programme for reproductive health, originally called family planning (begun in 1951) and now run under the wider banner of Reproductive and Child Health Care (RCH) programmes. These programmes aim to spread awareness through education (in schools, through health workers and the media), provide medical help to couples, improve the care of mothers and infants, and tackle problems such as sex abuse and sex-related crimes.

A major reason these programmes matter is the rapid growth of the human population. A fast-rising population strains food, water, housing, jobs and the environment. Population growth can be slowed by raising the marriageable age, encouraging smaller families with incentives, educating people (especially women), and making contraceptive (birth-control) methods widely available. Good reproductive health, therefore, helps both the individual family and the nation as a whole.

To plan families and space children, couples use birth-control (contraceptive) methods — ways to prevent unwanted pregnancy. An ideal contraceptive should be safe, effective, easy to use and reversible. The main types are:

• Natural methods — based on avoiding the chance of the sperm meeting the egg, e.g. the rhythm method (avoiding intercourse around the fertile period of the cycle). These have no side effects but are less reliable.
• Barrier methods — physically stop the sperm reaching the egg, e.g. condoms and diaphragms. Condoms also help prevent sexually transmitted infections.
• Hormonal methods — such as the oral contraceptive pill, which uses hormones to prevent ovulation.
• Intra-uterine devices (IUDs) — small devices placed in the uterus by a doctor.
• Surgical methods (sterilisation) — a permanent method: vasectomy in males (cutting/tying the vas deferens) and tubectomy in females (cutting/tying the fallopian tubes).

Sometimes a pregnancy is ended deliberately for medical or personal reasons; this is Medical Termination of Pregnancy (MTP), or induced abortion. In India MTP is legal under certain conditions to protect the health of the mother and to avoid the misuse of the procedure. A serious misuse is sex-selective abortion (aborting female foetuses), which is illegal; the law also bans determining the sex of the unborn child (the PCPNDT Act) to prevent female foeticide.

Sexually transmitted infections (STIs), also called sexually transmitted diseases (STDs), are infections that spread mainly through sexual contact. Common examples include gonorrhoea, syphilis, genital herpes, hepatitis B and HIV/AIDS. Some, like HIV and hepatitis B, can also spread through infected blood, shared needles, or from an infected mother to her baby.

Many STIs can be cured with early treatment, but some (like AIDS) have no complete cure, so prevention is most important. STIs can be avoided by: avoiding sex with unknown or multiple partners, using condoms, not sharing needles, and getting early diagnosis and treatment. Untreated STIs can lead to serious problems such as pelvic infections, infertility, and even cancer; this is why awareness, especially among young people, is so important.

Infertility is the inability of a couple to have children even after trying for a long time, despite normal sexual life. It can be due to problems in the male, the female, or both (for example, low sperm count, blocked tubes, or hormonal problems). Today several medical techniques, grouped as Assisted Reproductive Technologies (ART), can help such couples. These include IVF (in-vitro fertilisation) — the so-called "test-tube baby" method, where the egg and sperm are united outside the body and the early embryo is then placed in the womb — and related techniques. Adoption is another caring option for childless couples. These advances mean that infertility, once seen as hopeless, can often now be helped.

Besides IVF, several other Assisted Reproductive Technologies (ART) help infertile couples: ZIFT (Zygote Intra-Fallopian Transfer), in which the early zygote is placed in the fallopian tube; GIFT (Gamete Intra-Fallopian Transfer), in which an egg (or eggs) is transferred to the fallopian tube of a woman who cannot produce eggs; and ICSI (Intra-Cytoplasmic Sperm Injection), in which a single sperm is injected directly into the egg. Amniocentesis is a test that examines the fluid around the foetus to detect genetic or chromosomal disorders before birth; although medically useful, it is misused for illegal sex determination, which is why such use is banned to prevent female foeticide.