WEIGHTAGE OF

REPRODUCTIVE HEALTH

·,; ·.·· ·.·: r r I /

Reproductive Health

According to the World Health Organisation

(WHO)~ ne~ reproductive health means a total
well-being m all aspects of reproduction, i.e.,
• Physical /
• Emotional /
• Behavioural /
• Social. /

Reproductively Healthy Society

A society with people having -

physically and functionally normal reproductive organs and
normal emotional and behavioral interactions among them in
all sex-related aspects might be called reproductively healthy
society.

Reproductive Health - Problems and Strategies

• India was amongst the first countries in the world to initiate

action plans and ~rogrames at a national level to attain total
reproductive health as a social goal. These programes called
' family planning' were initiated in 1951.
• Improved programes covering wider reproduction-related
areas are currently in operation under the popular name
l Reproduct1ve and child Health care (RCH) f rograms'.
 Objectives of Reproductive and Child
Health Care (RCH) Programmes

Awareness about reproduction-related aspects

41
• With the help of audio-visual and the print-media,
governmental and nongovernmental agencies have taken
various steps to create awareness.
• A major role is also played by -
parents, close relat ives. t eachers,~ .
• Introduction of sex education in schools should also be
encouraged.

Proper information should be provided

about-
• Reproductive organs
• Adolescence and related changes . /
• Safe and hygienic sexual practices
• Sexually transmitted diseases (STD)
• AIDS

Strategies-
People, especially fertile couples and those in marriageable age
group, should be educated about-
• Available birth control options (contraceptive methods)
• Care of pregnant mothers. ✓
• Postnatal care of the mother and child . /
• Importance of breast feeding.../ /
• Equal opportunities for the male and the female child.
• Awareness of problems due to uncontrolled population
 • Awareness of problems due to uncontrolled population
growth.
• Social evils like sex-abuse and sex-related crimes

Successful Implementation

Successful implementation of various action plans to attain-

• Infrastructural facilities. . /
• Professional expertise . /
• Material support/

These are essential to provide medical assistance and care to people

in reproduction-related problems like-
• Pregnancy, delivery, STDs, abortions, contraception, menstrual

- - .
problems, infertmty, etc:-

Implementation of better techniques-

• Statutory ban on amniocentesis for sex-determination
to legally check increasing menace of female foeticides,
massive child immunization, etc., are some programes
that merit mention in this connection.

/ Amniocentesis-

• A procedure performed during pregnancy to obtain

amniotic fluid to test for chromosomal abnormalities 13
and fetal infections.

Conditions it may diagnose: This procedure is used to test for the

presence of certain genetic disorders such as, down syndrome.
4'
haemopHHa. sjckle-cell anemia, muscular dystrophy etc., and
determine the survivability of the foetus.

~ isuse of Amniocentesis -
It is being used to kill the normal female foetus.
Procedure -
l Jltr ,J'>(lllllll tr .~1)'.dlll ,·r
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The test usually done tl ', t• llt't'( fl ,,' ,, p,1th

a 14-18 weeks of gestation ,\r11r11,it1< f lt11d

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'Sahe Ii' a new oral contraceptive for the females-was develope

by scientists at Central Drug Research Institute (CORI) in Lucknow,
India. ~ ~
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Indicators of improved reproductive health of the

society-

• Better awareness about sex related matters. . /

• Increased number of medically assisted deliveries. /
• Better postnatal care leading to decreased maternal ao /
infant mortality rates.
• Increased number of couples with small families/
• Better detection and cure of STDs.../
• Overall increased medical facilities for all sex-relat: 1 /
problems.
 Population Explosion-
.
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.;zj.,,.
Populatio n-
• Total no of individual of aS
_/
./
~3 _1·
-~~ 1
present in a ~ a t a particula ~
• World P o p u l ~11 Jul~ ·,·.:. ·,;,..:,t~~
~► .~
-{ 1} .8%
.........~
,
97.511/o

...~ • 'f.~ 1-:: 'r y .. .

~ I ,. ,. fr ••
Demography - .·}. t
Study of po ulation. / Sl:XRATIO
I , , I '• f " j ~ t,>J( l /11 I) \ I

Unit of population Individual

• "-' II '
. .,.
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Official counting of population - fensus /

-
(undertaken every 10 years)
In India -
1st census - 1872 /
Last census - 2011 ( NC/!A 1)

~;,_~I

0
The world population which was around -
In 1900 -/ 2 billion (2000 million)]
In 2000 - 6 billion
E In 2011 - 7.2 billion.

The India population - which was

approximately(350 million) at the time of our
lnde en ence ~
In 2000 illion
( In 20111.2 billion

Ratio of world : India 6 :1 (according to

census)
(Every sixth person in the world is an Indian)

• According to the ~1 _census report, the population

• According to the 2001 census report, the population
growth rate was stii"iaround /1.7 per centJi.e.,
Ci
•
--
17/1000/yea r.

According to the 2011 census report, the population

growth rate was lessthen)2 per cent,/i.e.,
20/1000/yea r.
- --

Reasons for Population Explosion- GI

(1) A rapid decline in-
1. Death rate .../
II. Maternal mortality rate (MMR) . /
Ill. Infant mortality rate (IMR) ../

(2) Increase in number of people in ( eproducible age)

Population growth rate depend upon - G

1. Birth rate (Fertility rate) /
2. Death rate (Mortality rate) /
3. Migration ../
4. Age and Sex ratio . /
 (1) Birth rate-
Ci
No. of live birth / 1000 individuals in a year.
It never -ve, while growth rate may be -ve.

(2) Death rate (M ortality rate)

No. of Death / 1000 individuals in a year.

(3) M igration-
/efa A
>-; . ~...
·. ,.
t

Immigration ~~
Emigration - - - - - - - - - - - - - , 1_,0,~ \J (ii) "' '1,

(4) Age and Sex ratio j

• Pre reproductive
• Reproductive - - - [ I 5-~ Y YeoJl~J ~
• Post Reproductive t
~~ ·
Note - The no. of female individuals in a activej
reproductive age (15-44 years) influences the
birth rate.
-.p

NOTE-
J~ - - - - -,. . . . .
Demographic Transition - [zero population Growth J
a
CS(

( BR= DR ] _ ____
_l_
B_R_+_l_m_m
- ig-ration =DR+ Emigration ]

)it BR> DR= +ve population growth

\ If BR < DR = - ve population growth
The most impor tant step to overcome this problem

• Motiv ate smaller families by using various

contraceptive methods.
• You might have seen advertisements in the media as
well as posters/bills, etc., showing a happy couple
with two children with a slogan \Hum Do Hamare Do
(we two, our two). €)_
J
~

• Many couples, mostly the young, )

urban, worki ng ones have even 'I--..
G
adopted an 'one child norm'.
• Statutory raising of marriageable age
of the female to f18 years/ and that of
males to 21 years, and incentives
given to coup es wit small families.
• Let us describe some of the
commonly used contraceptive
methods, which help prevent
unwanted pregnancies

-I Ill
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9777 ?rt · sf ! m
 Property of Ideal contraceptive

• User-friendly, ~
• Easily available
• Effective and reversible with no or least side-effects.
■ It also should i; ; ;way interfere with the sexual drive/
desire.

(A) Temporary Method- 41

(1) Natural Methods of Contraception

These work on the principle of avoiding chances of

ovum and sperms meeting ( 01 1 0 1. . )
x vurn-- 1 enn 1llQh1 En--)
• Rhythm Method or Safe ~ riod or Periodic
abstinence or Calendar Method
• Withdrawal Method~ Coitus lnterruptus (High
~ eRa®) _ _,
• lactational Amenorrhoea /

Rhythm Method or Safe period or Periodic J 0 ~"'rri ~ 3d°o/)

abstinence or Calendar Method
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Lactational Amenorrhea
Lactational Amenorrhea
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(2) Barrier Methods- (?xvcm~ i+,112qtie-n)

In barrier methods, ovum and sperms
are prevented f rom physically meeting
with the help of barriers,

._/ Condoms ( "Inn'(JVn\il e)

J Fem Shield (Female Condoms)(=f'Y\-('ro\~1\J:]
✓ Cervical Cap (Reusable)J
v4 Diaphragm(Reusable) ReV"'l ~-,hle
v' Vault (Reusable)

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{3) Chemical M ethod -

(Spermicidal Agents)

• These are available in the form of

cream I jellies, foams, 11 vaginal II I
tablets.
• These contain chemicals like c1 ric
I
acid, boric acid ~nd inc sulphate
etc.
• It kill the sperm by disrupting the
membrane.

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TBA~K> Yotr
Population Explosion-
l <J UI

Population-
■ Total no of individual of a species
present in a given area at a particular time.
• World Population Day- 11 July/

Demography -
Study of population.
Unit of population -Individual
1,387,712,829
( 1.38 billion) "P"' : : ·

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Cl
, . -- ~
- ·- ' , uo Intra Uterine
l '
C per "LNg

,u"o" 1·•·w Devices (IUDs)

Strings

IUDs Cl
 IUDs C$J
/ '
uterus .
through vagina. --
- 0 hese devices are inserted by doctors or expert nurses in the

• IUDs increase phagocytosis of sperms within the uterus and

the Cu ions released suppr~ss sperm motility and the
fertilizing capacity of sperms. 8
• IUDs are ideal contraceptives for the females who want to
delay pregnancy and/or space children.
~

-
• It is one of most widely accepted methods of contraception
in India.

Types of Intra Uterine Devices-

!. Non-medicated IUDs (e.g., Lippe's

loop)
/_5W Ce?. \
2. Copper releasing IUDs (Cul, Cu7,
Multiload 375) = Cu -G-o~i
3. Hormone releasing IUDs ~
(Progestasert, LNG-2O) · ~~~
1
y -J/'
&.\h aru - j{o\<..-ri Cnl.mi~ .

Copper releasing IUDs _Cl

• Copper IUDs commonly called Copper-
Ts have ionised copper which slowly
diffuses at the rate of(some 50 ug/dai)
1
• It has a local antifertility effect by
bringing about / release of toxic )
( cytokines.) They suppress sperm
motility and their ability to fertilize the
;J
ovum.
e.g., Cu T 200, Multiload Cu T 250,
Multiload Cu T 375, Cu T 380, c~
Hormone releasing IUDs

Hormone releasing IUDs include progesterone

G
IUD (e.g., Progestasert) and levonorgestrel IUD
(e.g.,LNG-20).

These make the uterus unsuitable for -

• Implantation ✓
• Changes in cervical mucus (cervix hostile to
the sperms). ✓
• Anovulation ✓
• Insufficient luteal activ~

..3}-fnhi~1 ~
u1cnu,-t.

· -J)-Th!Gknin~
~ Ctno-.c~<J
tlll~

Oral Contraceptive
Pills(OCPs)

(1) Oral Contraceptive Pills(OCPs)

 (1) Oral Contraceptive Pills(OCPs) r\iY'·,

• They are preparation containing~ ither progestogens} r <y,\\ ~ ·

I f
progestogen - estrogen ~ mbinations.
6
■ They are synthetic products. The most commonly use~ctf'\;'"'c.
progestin is levonorgestrel nd most common oestrogen ~,\\~ . .
is ethinyl oestradiol. 1. 0
nrk,,"'1
2)(:rl\,t ti, I
~

~n~dic: &T.

The pills are taken orally fo 21 days in a menstrual cycle starting

froml;thhda~ and ending on 25th ay. However, it is advisable to
Cl
restart t e course after a gap o 7 days.
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Camb·11\e~
Vill:t-, l3//

Hormonal pills act by four ways Cl

• Inhibition of ovulation . ../
• Altera~ion in _uterine e~dometrium to /
make 1t unsuitable for implantation. ✓
• Changes in cervical mucus impairing /
its ability to allow passage and
transport of sperms.
• Inhibition of motility and secretory /
activity of fallopian tubes ✓

(2) lnjectables (DEPO- PROVERA) -

Cl
(2) lniectabl es (DEPO-PROVERA) -

• Progestogens alone or In combinatio n with

estrogen can alsobe used by females as
injections.
• They are depot-medr oxy progesterone

-
acetate (DEMPA) effective for three month.
-
(3) Implants -

• These are progrstin containing devices which are implanted sub

dermal! for providing long term contraception@-s years).\
• Nor lant s progestin only containing devise has six small silicone
(permeable) capsules containinalevonorgesterol)lnd these are
inserted under skin of left upper arm (5 years). -

(4) Emergency Contraception- 41

• Administration of progestogens or progestogen-estrogen
combinations or IUDs within 72 hours of coitus have been
found to be very effective as emergency contraceptives
(morning after pills) as they could be used to ayoid possible
pregnancy due to rape or casual unprotected intercourse.
• Mifepristone (RU486) (antiprogrsterone) js a single pill
treatment. It has very high affinity for progesterone
receptors.

Side effects of Contraceptive Methods

Cl
 Side effects of Contraceptive Methods

Their possible side-effects are

• Nausea . /
• Abdominal pain / ./
• Breakthrough bleeding
• Irregular menstrual bleedin1/
• Breast cancer
../

(B) Permanent Methods/ Sterilisation

Techniques/ Terminal Methods
G
• Surgical intervention blocks gamete transport and
thereby prevent conception.
• These techniques are highly effective but their
reversibility is very poor
20

(1) Vasectomy G
• _lftis a permanent method of
contraception for males.
_ 0oth vas deferens are ligated and cut.
~ a minor surgical procedure and
done free of cost at government
hospitals
• Sperm production continues after
vasectomy but ejaculated semen is
without sperms.
• It is not effective immediately.

G
(2) Tubectomy
• It is a permanent method of
contraception for females.
• A small part of fallopian tubes is
removed or tied up through a small
incision in the abdomen (laparotomy)
or through vagina.
• It is effective immediately.
• Menstrual cycle continues after
tubectomy.
• The released oocyte is destroyed by
phagocytes.

Previous Year Questions

and
Conceptual Questions

Insertion of LNG ;>O w1!11111 /'/ t1rJtw; of UJ1'.1 J'; :,ill

(1) Prov1dt• dft•ct1vt' co11 tr; 1c;ept1on frir rni1rJ1 lriWJf!r
penod
(2) Provide permanent contraception
1
\3l Serve as emergency contraceptive
,4 \ r-.1a1nly prevent physical meeting of ovurr and
sperms