Reproductive Health

Reproductive health is defined by the World Health Organization as a state of total well-being — physical, emotional, behavioural and social — in all matters of reproduction, not merely the absence of disease. A society with reproductive health has people with healthy reproductive organs and normal behaviour, who can make informed choices about reproduction.

India was among the first countries in the world to launch national programmes to attain reproductive health on a large scale, starting family planning in 1951. These have been broadened over the years and are now run under the name Reproductive and Child Health Care (RCH) programmes. Their major strategies include: spreading awareness (through audio-visual and print media, and counselling); introducing sex education in schools to give correct information and remove myths; educating couples and people of marriageable age about available birth-control options, the care of mothers and children, and the dangers of sexually transmitted infections; and providing medical facilities and care for reproduction-related problems.

Better reproductive health is reflected in real outcomes: improved detection and treatment of STIs, increased use of contraceptives, better maternal and infant care leading to reduced maternal and infant mortality rates, and the detection and care of pregnancy-related problems. Statutory measures such as a legal marriageable age (18 for women, 21 for men) and incentives for small families also help.

One technology that became controversial is amniocentesis — a test of the amniotic fluid that can detect chromosomal/genetic disorders of the foetus. Because it was misused to determine the sex of the foetus (leading to female foeticide), its use for sex determination is legally banned, though it remains valuable for detecting genetic abnormalities. For NEET, fix the WHO definition, India's 1951 start and the RCH strategies (awareness, sex education, contraception, maternal/child care, STI control), the marriageable age, and the legitimate use versus banned misuse of amniocentesis.

A rapidly rising population strains resources, so contraception — the deliberate prevention of pregnancy — is a key part of reproductive health. An ideal contraceptive should be user-friendly, easily available, effective and reversible, with no or few side effects, and should not interfere with sexual drive. Since no single method is perfect, several types are used.

Natural (traditional) methods avoid meeting of sperm and ovum without devices or drugs. They include periodic abstinence (the rhythm method) — avoiding intercourse around ovulation (days 10–17 of the cycle); coitus interruptus (withdrawal); and the lactational amenorrhea method (no ovulation, hence no chance of conception, during intense breast-feeding up to about six months after childbirth). They have no side effects but a higher failure rate.

Barrier methods physically prevent sperm meeting the ovum, using condoms (for males and females; they also protect against STIs), the diaphragm, cervical caps and vaults. Intra-uterine devices (IUDs) are placed in the uterus by a doctor and are very effective: non-medicated (Lippes loop), copper-releasing (CuT, Cu7, Multiload 375 — the copper ions reduce sperm motility/fertilising capacity) and hormone-releasing (LNG-20, Progestasert, which make the uterus unsuitable for implantation and the cervix hostile to sperm).

Oral contraceptive pills contain progestogens (with or without oestrogen) taken daily; they mainly prevent ovulation. Saheli is a non-steroidal 'once-a-week' pill developed in India. Hormones can also be given as injectables or implants. Finally, surgical methods (sterilisation) are the most permanent: in the male, vasectomy cuts/ties the vas deferens; in the female, tubectomy cuts/ties the fallopian tubes. For NEET, fix the features of an ideal contraceptive and the categories with their examples — especially the IUD sub-types, the action of pills (block ovulation), Saheli, and which duct is cut in vasectomy vs tubectomy.

Medical termination of pregnancy (MTP), or induced abortion, is the intentional ending of a pregnancy before full term. India legalised MTP in 1971 with strict conditions to check its misuse. MTPs are considered relatively safe during the first trimester (up to 12 weeks); later abortions are riskier. MTP is important to remove unwanted pregnancies (from casual relationships, failure of contraceptives or rape) and where continuing the pregnancy could harm the mother or foetus. However, MTP is sometimes misused to abort normal female foetuses after illegal sex determination — a serious social problem the law tries to prevent.

Sexually transmitted infections (STIs), also called venereal diseases (VD) or reproductive tract infections (RTI), are diseases transmitted through sexual contact. Common STIs include gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B and HIV/AIDS. Of these, HIV/AIDS, hepatitis-B and genital herpes are considered incurable (only manageable), while the others can usually be cured if detected and treated early. Early symptoms are often minor (itching, fluid discharge, slight pain, swellings), so many people ignore them; untreated STIs can cause serious complications such as pelvic inflammatory disease (PID), infertility, stillbirths and even cancer.

STIs are a major threat to reproductive health, and prevention is emphasised because some have no cure. The key preventive measures are: avoid sex with unknown or multiple partners; always use condoms during intercourse; and get early detection and complete treatment if infection is suspected.

Spreading awareness, especially among the young, is central to control. For NEET, fix the year MTP was legalised (1971) and the relatively safe period (first 12 weeks), the misuse of MTP for female foeticide, the list of common STIs (with HIV/hepatitis-B/herpes as not fully curable), their complications (PID, infertility), and the three main preventive measures.

Infertility is the inability of a couple to produce children despite unprotected sexual cohabitation. The causes may lie in the male, the female, or both, and can be physical, congenital, hormonal, immunological or psychological. In many societies the woman is wrongly blamed, so awareness is important. Couples who cannot conceive naturally can often be helped to have children by special methods called assisted reproductive technologies (ART).

The best-known ART is in-vitro fertilisation (IVF), popularly the 'test-tube baby' programme. Here ova from the wife (or a donor) and sperm from the husband (or a donor) are collected and fertilised outside the body in the laboratory under conditions that mimic the body. The resulting early embryo is then transferred into the female. If an embryo of up to 8 blastomeres is transferred into the fallopian tube it is ZIFT (zygote intra-fallopian transfer); if a more advanced embryo is transferred into the uterus it is IUT (intra-uterine transfer).

Several other techniques target specific problems. GIFT (gamete intra-fallopian transfer) transfers an ovum collected from a donor into the fallopian tube of a woman who cannot produce an ovum but can provide a suitable environment. ICSI (intra-cytoplasmic sperm injection) is a specialised IVF in which a single sperm is injected directly into the ovum — useful when sperm count or motility is very low. Artificial insemination (AI) is used when the male has a low sperm count or low motility: semen is collected and introduced into the vagina or uterus (IUI — intra-uterine insemination).

These technologies are demanding and need very high skill and expensive facilities, so they are not yet available everywhere; adoption is another option for childless couples. For NEET, fix the definition of infertility (cause may be in either partner), and the ART methods with their exact meaning: IVF (test-tube baby), ZIFT vs IUT (where the embryo goes), GIFT (donor ovum into the tube), ICSI (single sperm injected into ovum) and AI/IUI (for low sperm count).