According to the World Health Organisation (WHO), reproductive health means a total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural and social. Hence, a society in which people are having physically and functionally normal reproductive organs, and have normal emotional and behavioural interactions in all sex-related aspects can be said to be reproductively healthy.
PROBLEMS AND STRATEGIES
In 1951, India initiated action plans and programmes under the term ‘family planning’ to attain total reproductive health as a social goal. At present, ‘Reproductive and Child Health Care (RCH)’ programmes are under operation to encompass wider reproduction related areas. The government and non-governmental agencies use various audio-visual and print media to create awareness among the people about reproduction related aspects. The government has also been creating infrastructural facilities, professional expertise and material support to bring improvement in this area.
POPULATION EXPLOSION AND BIRTH CONTROL
The population of India has been growing exponentially in the last century. At present, every one out of six people in the world are an Indian. This has become possible due to various reasons; like improvement in food supplies, medical care, and decline in death rate, maternal mortality rate (MMR) and infant mortality rate.
Given the scarcity of resources, there is an urgent need to check the growth of population. The government has been taking several steps to achieve this goal. The government increased the marriageable age of the female to 18 years and that of males to 21 years. Couples with small families are given incentives. Some commonly used contraceptives are distributed for free by government agencies.
Methods of Contraception
Natural Methods: These methods work on the principle of avoiding the chances of insemination. Periodic abstinence is one such method. In this method, the couples avoid coitus from day 10 to 17 of the menstrual cycle when ovulation could be expected. As this period is considered to be the fertile period, abstinence during this period can reduce the chances of pregnancy. Coitus interruptus is another method in which the male partner withdraws his penis from the vagina just before ejaculation in order to avoid insemination. Another natural method is lactational amenorrhea; or absence of menstruation during the intense period of lactation after parturition. Ovulation and menstrual cycle do not happen during this period, and hence chances of conception are almost nil during this period. Natural methods of contraception are free of side effects. However, these methods cannot be termed as 100% foolproof.
Barrier Methods: In this method, ovum and sperms are prevented from physically meeting; by creating a barrier. Condoms, diaphragms and cervical caps are examples of barrier method. Condoms are available for both male and female. Cervical caps and diaphragms are inserted into the vagina before coitus. Condoms are also effective in preventing STDs and AIDS. Spermicidal creams, jellies and foams are generally used along with these barriers to increase the efficiency of these contraceptive tools.
Intra Uterine Devices (IUDs): These devices are inserted in the uterus through vagina; by doctors or expert nurses. IUDs prevent the ovum from entering the isthmus and also reduce sperm motility. IUDs also increase phagocytosis of sperms within the uterus. IUDs are available in the form of non-medicated IUDs (e.g. Lippes Loop), copper releasing IUDs (CuT, Cu7, Multiload 375) and the hormone-releasing IUDs (Progestasert, LNG-29). These devices are ideal for couples who want to space children.
Oral Pills: These pills contain hormones (either progestogens or progestogen-estrogen combination). These pills need to be taken by the female; for a period of 21 days starting within the first five days of menstrual cycle. A gap of 7 days is observed during menstruation and the pills need to be repeated for the next cycle. The hormonal pills inhibit ovulation and implantation. They also alter the quality of cervical mucus to prevent or retard entry of sperms. Saheli is a new oral contraceptive for females. It contains a non-steroidal preparation. It is more convenient because it needs to be taken once a week.
Progestogens alone or in combination with estrogen can also be used by females as injections or implants under the skin. Injection or implant provide protection for a longer duration; compared to the oral pills.
Surgical Methods: These methods are advised when the couple needs to stop further child births altogether. Sterilization procedure in the male is called vasectomy. In vasectomy, a small part of the vas deferens is removed or tied up. This method in the female is called tubectomy. In this method, a small part of fallopian tube is removed or tied up. Surgical methods are highly effective but their reversibility is very poor.
MEDICAL TERMINATION OF PREGNANCY (MTP)
Intentional or voluntary termination of pregnancy before full term is called medical termination of pregnancy (MTP). The Government of India legalized MTP in 1971; with some strict conditions to avoid its misuse. MTP is helpful in case of unplanned pregnancy. It also helps when the foetus has congenital deformities or any other abnormality. MTP is relatively safe during the first trimester, but becomes highly risky in the second trimester. Majority of MTPs are performed illegally by unqualified quacks and also to abort the female foetus.
SEXUALLY TRANSMITTED DISEASES (STDS)
Diseases which are transmitted through sexual intercourse are called sexually transmitted diseases (STDs). They are also known as venereal diseases (VD) or reproductive tract infections (RTI). Examples of STDs are; gonorrhea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B, AIDS, etc. Hepatitis-B and AIDS can also be transmitted through transfusion of blood or from an infected mother to the foetus. Hepatitis-B, herpes and AIDS are incurable. Other venereal diseases can be cured if timely medical care is given. Early symptoms of most of these are minor and include itching, fluid discharge, slight pain, swellings, etc., in the genital region. Infected females may often be asymptomatic and hence, may remain undetected for long. People often avoid consulting a doctor because of less or no symptoms, and also because of the social stigma attached to STDs. If these diseases are not treated in time, they can lead to future complications; like Pelvic Inflammatory Diseases (PID), abortions, still births, ectopic pregnancies, infertility, or even cancer of the reproductive tract. People in the age group 15-24 years are highly susceptible to STDs.
Prevention of STDs:
- Avoid sex with unknown partners/multiple partners.
- Always use condoms during coitus.
- In case of doubt, go to a qualified doctor for early detection and get complete treatment if diagnosed with disease.
When a couple is unable to produce children in spite of unprotected sexual cohabitation, it is a case of infertility. Infertility can be due to many reasons; like physical, congenital, diseases, drugs, immunological or even psychological.
Sometimes, simple treatment or even proper counseling can help in overcoming the problem of infertility. In other cases, couples may have to resort to Assisted Reproductive Technologies (ART); in order to have children.
In Vitro Fertilisation (IVF): When fertilization is carried out outside the body, it is called in-vitro fertilization. IVF is followed by Embryo Transfer (ET). This method is popularly known as Test Tube Baby programme. In this method, ova from the female and sperms from the male are collected and are induced to form zygote under simulated conditions in the laboratory. After that, the zygote or early embryo (up to 8 blastomeres) is transferred into the fallopian tube. This method of zygote transfer is called ZIFT (Zygote Intra Fallopian Transfer). When an embryo with more than 8 blastomeres is transferred into the uterus, it is called IUT (Intra Uterine Transfer).
GIFT (Gamete Intra Fallopian Transfer): When ovum from a donor is transferred into the fallopian tube of another female (who is unable to ovulate), it is called GIFT.
ICSI (Intra Cytoplasmic Sperm Injection): When a sperm is directly injected into the ovum in laboratory to carry out fertilization, it is called ICSI. This method is useful when the male partner is unable to inseminate the female due to very low sperm counts in the ejaculate.
Inta Uterine Insemination: When semen collected from the husband or from a healthy donor is artificially induced either into the vagina or into the uterus, it is called Intra Uterine Insemination.