4.

1 Reproductive Health Problems and

Strategies
According to World Health Organisation (WHO),
“Reproductive health is a total well-being in all aspects of
reproduction including physical, emotional, behavioural
and social”.
A society with people having physically and functionally
normal reproductive organs and normal emotional and
behavioural interactions among them in all sex-related
aspects might be called reproductively healthy.
India was amongst the first countries in the world to initiate
action plans and programmes at a national level to attain
total reproductive health as a social goal.
India initiated reproductive health programmes (family
planning) in 1951.

Family planning

Wider reproduction-related areas are in operation under

the Reproductive and Child Health Care (RCH)
programmes. Creating awareness among people about
various reproduction related aspects and providing
facilities and support for building up a reproductively
healthy society are the major tasks under these
programmes.
PROBLEMS
India is facing a challenge of overpopulation.
Early marriages are prevalent, with children marrying at
age close to puberty.
Early marriages result in poor health for mothers and an
increased risk of diseases.
Children of early marriages often have physical
deformities.
High maternal and infant mortality rates are seen in
cases of early marriages.
Lack of knowledge about reproductive health leads to a
higher incidence of sexually transmitted diseases in
individuals who married early.

REPRODUCTIVE HEALTH STRATEGIES

Awareness about reproduction with the help of print
media, governmental and non-governmental
organizations.
Introduction of sex education in school provide to the right
information about sex-related aspects.
It helps to discourage children to believe on sex-related
myths and misconceptions.
To give proper information about reproductive organs,
adolescence and related changes, safe and hygienic
( )
 sexual practices, sexually transmitted diseases (STD),
AIDS, etc.
Strong infrastructural facilities, material support,
implementation of new strategies and professional
expertise are needed for implementing different action
plans to achieve reproductive health. All of these provide
care and assistance to people in need of reproduction-
related issues such as pregnancy, abortion, delivery,
contraception, STDs, infertility and menstrual problems, etc.
Extensive research on reproductive related areas is
encouraged and supported by government and NGOs to
develop new effective methods of birth control for e.g.,
Saheli, oral contraceptive for females developed by
Central Drug Research Institute (CDRI) Lucknow, India.

AMNIOCENTESIS AND CHORIONIC VILLUS

SAMPLING (CVS)
Statutory ban on amniocentesis for sex determination is
one such programme that has essentially helped in
stopping female foeticide (NEET 2023).
It is a sex-determination test which is based on the
chromosomal pattern in the amniotic fluid surrounding the
developing embryo (NEET-I 2016).
As it can also detect some abnormalities in chromosome
numbers, it is permissible to detect any genetic
abnormality in the foetus (AIPMT 2010).
Procedure is used to test for presence of certain genetic
disorder like Down’s syndrome, hemophilia, sickle cell
anaemia, etc., determine the survivability of the foetus.
Chorionic villus sampling (CVS) is a genetic test that may
be offered during pregnancy to determine if the foetus has
any genetic or chromosomal abnormalities, such as
Down’s syndrome, Edwards’ syndrome, or Patau’s
 syndrome.
The test involves collecting a tiny sample of cells from the
placenta, which is the structure connecting the blood
supply of the mother to the unborn child.

MISUSE OF AMNIOCENTESIS
The procedure is often used to abort female foetus, leading
to the illegal practice of female foeticide.
It is prohibited by law to use amniocentesis for the sole
purpose of determining the sex of the foetus and also to
prevent female foeticide.
4.2 Population Stabilisation and Birth
Control
The term population refers to the total number of
individuals belonging to a specific species within a
specified geographical location at a specific point in time.
The world population was estimated to be around 2 billion
in 1900 and rapidly increased to approximately 6 billion by
the year 2000 and 7.2 billion in 2011.
Meanwhile, India’s population surpassed 1.2 billion in May
2011, compared to just 350 million at the time of
independence, indicating that roughly one out of every six
people in the world is Indian.
The 2011 census report showed a population growth rate of
less than 2%, (i.e., 20/1000/year), a rate at which Indian
population could increase rapidly.
Population surge at such an alarming rate will result in a
scarcity of basic necessities such as food, shelter and
clothing.

To control the population surge, various measures have

been adopted:
1. Creating awareness among people about (We two, ours
two) ‘Hum Do Hamare Do’ and many couples have
adopted slogan ‘One Child Norm’.
2. Making the legal age of marriage
18 years for females and 21 years for males.
3. Motivating the use of contraceptives for smaller families to
 avoid unwanted pregnancies.
4. Incentives given to couples with small families.
4.2.1 BIRTH CONTROL
Birth control methods work by interrupting one or more of
the three crucial stages in the reproductive cycle: (a)
Blocking the movement of sperm to the egg.
(b) Inhibiting ovulation.
(c) Hindering the implantation of the fertilized egg in the
uterus.

I. NATURAL/TRADITIONAL METHODS
It works on principle of avoiding chances of ovum and
sperm meeting.
1. Periodic Abstinence:

In this method, conception or coitus is abstained by

keeping track of the fertile period from day 10
to 17 of the menstrual cycle when ovaluation is expected.
As chances of fertilisation are very high during this period it
is referred as fertile period. Therefore abstaining from
coitus during this period can prevent conception.

It is based on the following factual information: (i) ovulation

takes place around the 14th day of the menstrual cycle.
(ii) the egg has a lifespan of approximately 1-2 days.
(iii) sperm can survive for up to 3 days.

The reliability of this method is limited due to the fact that

only a small percentage of women have regular menstrual
cycles, and the precise timing of ovulation is uncertain, as
it occurs approximately 14 days prior to the start of the next
menstrual period.

2. Coitus Interruptus (Withdrawal Method):

Method of withdrawing penis from the vagina just before

ejaculation to avoid insemination.
This method is only moderately effective as the timing of
ejaculation can be difficult to control, especially for men,
as some sperm may be released into the vagina before
ejaculation (NEET 2023).

3. Lactational Amenorrhea (Absence of Menstruation):

Ovulation and menstrual cycle do not occur during the

lactation period, and thus the chances of conception are
almost none (NEET 2019, 2022).
 However, this approach is only effective for a maximum
period of six months following the birth of the child. No
medicine or devices are required.

II. BARRIER METHODS

In these methods, egg and sperm are prevented from
meeting physically and fertilising due to presence of the
barriers.
These methods are available for both male and female
individuals.

Some of the barriers used in contraception are:

Spermicidal creams, jellies and foams are used along

with the other barriers such as condoms, diaphragms,
cervical caps and vaults to increase the contraceptive
 efficiency.

III. INTRA UTERINE DEVICES (IUDS)

These are inserted by medical experts in the uterus
through the vagina. They increase the phagocytosis of
sperms (Odisha NEET 2019, 2021, 2022).

These are also known as intrauterine contraceptive

device (IUCD or ICD).
IUDs can also create an inhospitable environment in the
uterus for implantation and the cervix for sperm, making
them an ideal contraceptive method for women.
In India, it is one of the most widely accepted forms of
contraception.

Following are the types of IUDs:

Advantages:
1. High Effectiveness: IUDs are among the most reliable
forms of birth control.
2. Long-Lasting: The duration of the device can vary from 3
 to 12 years, depending on the type.
3. Convenient: There is no need for pre-sex preparation or
daily reminders.
4. Cost-Effective: Although IUDs may have a higher initial
cost, they do not require any additional expenses for
several years.
Drawbacks of IUCDs: 1. The presence of barriers may act as
a mild irritant, causing the egg to move down the fallopian
tubes and uterus before fertilisation or implantation occurs.
2. There is a possibility of spontaneous expulsion of the
barrier without the woman’s knowledge.
3 The use of barriers can result in increased menstrual
bleeding and pain.
4. There is a risk of perforation of the uterus.
IV. ORAL CONTRACEPTIVES
Oral contraceptives is the method of oral administration of
progestogens or progestogen - estrogen combinations in
the form of pills or tablets (NEET 2019).

Contraceptive pills

Pills are consumed by females daily for 21 days beginning

within the first five days of the menstrual cycle.
After the gap of 7 days of the menstruation period, the
consumption of pills should be repeated in the same
pattern till the female wishes to avoid conception.
‘Saheli’–a new oral contraceptive for the females–was
developed by scientists at Central Drug Research Institute

( )
 (CDRI) in Lucknow. It is ‘once a week’ pill with few side
effects and high contraceptive value.
They inhibit ovulation and implantation, also alter the
quality of cervical mucus to prevent/retard the entry of
sperms.

Morning After Pills:

The term “morning after pill”, also referred to as

emergency contraception.
Although the term “morning after” is misleading, as these
pills can be taken within 72 hours of sexual intercourse to
prevent pregnancy, not just the morning after.
This pill also include progestogens or progestogen-
estrogen combinations.
It helps to avoid unwanted pregnancy due to rape, casual
unprotected intercourse.
It contains non-steroidal preparation, which blocks
estrogen receptors and prevents eggs from implantation
(NEET 2018).
It is once a week pill with very few side effects and a high
contraceptive value.
Oral contraceptive pills come in two forms: Mini pills and
combined pills.

V. SUBCUTANEOUS IMPLANTS AND

HORMONE (INJECTABLES AND IMPLANTS)
INJECTIONS
A new form of contraception involves the placement of
 synthetic progesterone under the skin, known as
subcutaneous implantation. This method works similarly
to oral contraceptives by stopping ovulation and
increasing the thickness of cervical mucus to hinder sperm
transport.
Progestogens or Progestogen-estrogen hormone
combinations are used by females as injections or
implants under the skin (NEET 2019). Their mode of action is
similar to those of contraceptive pills, and they are
effective for longer periods.

VI. SURGICAL METHODS

Surgical methods, also called sterilisation, are generally
advised for the male/female partner as a terminal method
to prevent any more pregnancies. Surgical intervention
blocks gamete transport and thereby prevent conception.

(a) (b) Fig. 4.2.1 Surgical Methods (a) Vasectomy (b)

Tubectomy
Surgical methods are highly effective but reversibility is
poor.
It needs to be emphasised that the selection of a suitable
contraceptive method and its use should always be
undertaken in consultation with qualified medical
professionals.
One must also remember that contraceptives are not
regular requirements for the maintenance of reproductive
health. In fact, they are practiced against a natural
reproductive event,
i.e., conception/pregnancy.
One is forced to use these methods either to prevent
pregnancy or to delay or space pregnancy due to personal
reasons.
Side effects of anti-natural contraceptives, including
nausea, abdominal pain, breakthrough bleeding, irregular
menstrual bleeding, breast cancer etc. should not be
ignored.
4.3 Medical Termination of Pregnancy
Deliberate and voluntary termination of pregnancy
before its complete term is called Medical Termination of
Pregnancy (MTP) or induced abortion.
Nearly 45 to 50 million MTPs are performed in a year all
over the world (i.e., 1/5th of the total number of conceived
pregnancies in a year).
MTP helps to decrease the population.
Many countries have not legalised MTP due to emotional,
ethical, religious and social issues involved in it.
Government of India legalised MTP in 1971 with some strict
conditions to check illegal female foeticide.
MTPs are safe during the first trimester (up to 12 weeks of
pregnancy) (AIPMT 2011). Second-trimester abortions are
very risky.

4.3.1 ROLE OF MTPS

Medical Termination of Pregnancy (MTP) is performed for

various reasons, including unwanted pregnancy due to
unprotected or contraceptive-less intercoursem, failure of
contraceptive used during coitus or in case of rapes and
situations where pregnancy could be harmful or fatal to
either the mother or foetus.

The amniocentesis is misused to determine sex of unborn

child. If foetus is found to be a female then it is followed by
MTP, which is completely illegal.
4.4 SEXUALLY TRANSMITTED
INFECTIONS (STIs)
Collectively, illnesses or infections that are spread through
sexual intercourse with infected individuals are referred to
as sexually transmitted diseases (STDs), venereal
diseases (VD), or reproductive tract infections (RTI).
E.g., Gonorrhoea (NEET 2023), syphilis, genital herpes,
chlamydiasis, genital warts, trichomoniasis, hepatitis-B
and HIV leading to AIDS (NEET 2020).

Hepatitis-B and HIV are also transmitted through the

following ways: (i) By sharing of needles, surgical
instruments etc. with an infected person (ii) By transfusion of
blood (iii) From infected mother to foetus

Other than hepatitis-B, genital herpes and HIV, other STDs

are completely curable if detected early and treated
properly (NEET 2019).
Early symptoms of STDs are mild and include itching, fluid
discharge, slight pain, swellings, etc., in the genital region.
Absence or less significant early symptoms, as well as the
social stigma, deter the infected persons from consulting a
doctor. This leads to pelvic inflammatory diseases (PID),
infertility, ectopic pregnancies, abortions, still births or
cancer of the reproductive tract in an infected person.
Every person is vulnerable to STDs, and the chances of STDs
are very high among persons in the age group of 15-24
years.

Preventive measures in form of following simple principles

should be followed:

/
Avoid sex with unknown partner/multiple partners.
Make sure to consistently use condoms during sexual
intercourse.
If unsure, it is important to seek advice from a reputable
healthcare professional. In the event of STD diagnosis,
ensure to undergo full treatment.
4.5 INFERTILITY
Infertility is the inability to conceive or produce children
even after unprotected sexual cohabitation or
arrangement.
The reasons for infertility could be physical, congenital,
diseases, drugs, immunological or even psychological.
There are some corrective methods that cure infertility
problems and assist childless couples in having children
through special techniques referred as Assisted
Reproductive Technologies (ART).

Some of these techniques are:

IN VITRO FERTILISATION (IVF)

Here the fertilisation takes place outside the body in almost
similar condition (as inside body).
This method is commonly known as a test-tube baby
programme.
In this approach, eggs from the wife or a donor and sperm
from the husband or a donor are harvested and combined
( )
in a laboratory (under simulated conditions) setting to
create a zygote.

Fig. 4.5.1 Diagrammatic representation of in vitro fertilisation (IVF) process

Embryo transfer (ET) is a procedure in which an embryo,

either formed through in vitro fertilisation (IVF) or in vivo
fertilisation (natural conception), is transferred to a
woman’s uterus to establish a pregnancy. IVF followed by
ET is a common fertility treatment used to help couples
who are struggling to conceive.
During IVF, eggs are collected from the woman’s ovaries
and fertilized with sperm in a laboratory. The resulting
embryos are cultured for a few days before being
transferred to the woman’s uterus. In some cases, extra
embryos can be frozen and stored for future use.
In contrast, in vivo fertilisation occurs naturally inside the
woman’s body when sperm from a man fertilizes an egg
released from a woman’s ovary during ovulation. If there
 are any issues with fertility, the couple may choose to
undergo IVF followed by ET using either their own embryos
or donated embryos from a donor.
Embryo transfer techniques that transfer embryos to assist
females who cannot conceive are: Zygote Intra Fallopian
Transfer (ZIFT) and Intra Uterine Transfer (IUT) (NEET
2020).

ARTIFICIAL INSEMINATION (AI) TECHNIQUE

Artificial insemination (AI) is a technique used in infertility
cases where the semen collected either from the husband
or a healthy donor is artificially introduced into the vagina
or uterus of the female through intra-uterine
insemination (IUI) (NEET 2013).
This is done when the male partner is unable to inseminate
the female or has a very low sperm count in ejaculation
(NEET 2017).

Fig. 4.5.2 Diagrammatic representation of artificial insemination process Gamete

Intra Fallopian Transfer (GIFT)
 GIFT is a more costly and invasive process compared to in
vitro fertilisation (IVF), it has better success rates than IVF.
It is a method of transfer of an ovum from a donor into the
fallopian tube of another female who cannot produce an
ovum but can provide a suitable environment for
fertilisation and development.
The GIFT technique requires functional fallopian tubes. The
criteria for its use are the same as in vitro fertilisation (IVF),
except the tubal factor.

INTRA CYTOPLASMIC SPERM INJECTION

(ICSI)
ICSI method involves the injection of a single
spermatozoon or spermatozoid directly into the cytoplasm
of an oocyte by piercing the zona pellucida with a
micropuncture.
This procedure is carried out using a high-quality inverted
operating microscope.
After fertilisation, the embryo is implanted into the
woman’s uterus.

SURROGACY
Here, a woman (surrogate mother) bears a child for a
couple unable to produce children because the wife is
infertile or unable to carry.
The surrogate is impregnated through artificial
insemination or the implantation of an embryo produced
by IVF.

PROBLEMS OF ART
ART requires specialized professionals and expensive
instrumentation. Therefore, these facilities are available
only in very few centres and to limited people.
Emotional, religious and social problems are also some
factors that deter couples from adopting these methods.