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CHAPTER 4

REPRODUCTIVE HEALTH

4
...
2

Population Explosion
and Birth Control

4
...
4

Sexually Transmitted
Diseases

4
...
Now, let’s discuss a closely related
topic – reproductive health
...
However, it has a broader
perspective and includes the emotional and social aspects
of reproduction also
...
e
...
Therefore, 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
...


4
...

These programmes called ‘family planning’ were
initiated in 1951 and were periodically assessed over
the past decades
...

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
...
Parents, other
close relatives, teachers and friends, also have a major role in the
dissemination of the above information
...
Proper information
about reproductive organs, adolescence and related changes, safe and
hygienic sexual practices, sexually transmitted diseases (STD), AIDS,
etc
...
Educating people, especially fertile
couples and those in marriageable age group, about available birth
control options, care of pregnant mothers, post-natal care of the mother
and child, importance of breast feeding, equal opportunities for the male
and the female child, etc
...
Awareness of problems
due to uncontrolled population growth, social evils like sex-abuse and
sex-related crimes, etc
...

Successful implementation of various action plans to attain
reproductive health requires strong infrastructural facilities, professional
expertise and material support
...
Implementation of better techniques and new strategies
from time to time are also required to provide more efficient care and
assistance to people
...
, are
some programmes that merit mention in this connection
...
Do you know
that ‘Saheli’–a new oral contraceptive for the females–was developed
by scientists at Central Drug Research Institute (CDRI) in Lucknow, India?
Better awareness about sex related matters, increased number of medically
assisted deliveries and better post-natal care leading to decreased maternal

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REPRODUCTIVE HEALTH

and infant mortality rates, increased number of couples with small
families, better detection and cure of STDs and overall increased medical
facilities for all sex-related problems, etc
...


4
...
However, increased health facilities
along with better living conditions had an explosive impact on the growth
of population
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A similar
trend was observed in India too
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That means, every
sixth person in the world is an Indian
...
Through our RCH programmes, though we could bring
down the population growth rate, it was only marginal
...
7 per
cent, i
...
, 17/1000/year, a rate at which our population could double in
33 years
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e
...
Therefore, the government was
forced to take up serious measures to check this population growth rate
...
You might have seen
advertisements in the media as well as posters/bills, etc
...
Many couples, mostly the young, urban, working ones have even
adopted an ‘one child norm’
...
Let us describe some of the commonly used contraceptive
methods, which help prevent unwanted pregnancies
...
It also should in no
way interfere with the sexual drive, desire and/or the sexual act of the
user
...

Natural methods work on the principle of avoiding chances of ovum
and sperms meeting
...
As chances of fertilisation are

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BIOLOGY

very high during this period, it is called the fertile period
...

Withdrawal or coitus interruptus is another method in which the male
partner withdraws his penis from the vagina just before ejaculation so as
to avoid insemination
...
Therefore, as long
as the mother breast-feeds the child fully, chances of
conception are almost nil
...
1(a) Condom for male
reported to be effective only upto a maximum period of six
months following parturition
...

Chances of failure, though, of this method are also high
...
Such
methods are available for both males and females
...
1 a, b) are barriers made of thin rubber/
latex sheath that are used to cover the penis in the male or
vagina and cervix in the female, just before coitus so that
Figure 4
...
This can prevent conception
...
Use of condoms
has increased in recent years due to its additional benefit of
protecting the user from contracting STDs and AIDS
...

Diaphragms, cervical caps and vaults are also barriers
made of rubber that are inserted into the female reproductive
tract to cover the cervix during coitus
...
They are reusable
...

Another effective and popular method is the use of Intra
Uterine Devices (IUDs)
...

These Intra Uterine Devices are presently available as the
Figure 4
...
Copper T (CuT)
non-medicated IUDs (e
...
, Lippes loop), copper releasing
IUDs (CuT, Cu7, Multiload 375) and the hormone releasing IUDs
(Progestasert, LNG-20) (Figure 4
...
IUDs increase phagocytosis of sperms
60
within the uterus and the Cu ions released suppress sperm motility
and the fertilising capacity of sperms
...
IUDs are ideal contraceptives for the females

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REPRODUCTIVE HEALTH

who want to delay pregnancy and/or space children
...

Oral administration of small doses of either progestogens
or progestogen –estrogen combinations is another
contraceptive method used by the females
...
Pills have to be taken daily for a period of 21 days
starting preferably within the first five days of menstrual
cycle
...
3 Implants
occurs) it has to be repeated in the same pattern till the
female desires to prevent conception
...
Pills are very effective with lesser side effects and
are well accepted by the females
...
It is a ‘once a week’ pill
with very few side effects and high contraceptive value
...
3)
...
Administration of progestogens or progestogen-estrogen
combinations or IUDs within 72 hours of coitus have been found to be
very effective as emergency contraceptives as they could be used to avoid
possible pregnancy due to rape or casual unprotected intercourse
...
Surgical intervention blocks gamete transport and thereby
prevent conception
...
4a Vasectomy

Figure 4
...
In vasectomy, a small part of the vas
deferens is removed or tied up through a small incision on the scrotum
(Figure 4
...
4b) or tied up through a small incision in the abdomen
or through vagina
...

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
...
In fact, they are practiced against a natural
reproductive event, i
...
, conception/pregnancy
...
No doubt, the widespread use of these methods have
a significant role in checking uncontrolled growth of population
...


4
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Nearly
45 to 50 million MTPs are performed in a year all over the world which
accounts to 1/5th of the total number of conceived pregnancies in a year
...
Whether to accept / legalise MTP or not is
being debated upon in many countries due to emotional, ethical, religious
and social issues involved in it
...
Such restrictions
are all the more important to check indiscriminate and illegal female
foeticides which are reported to be high in India
...
MTPs are also essential in
certain cases where continuation of the pregnancy could be harmful or
even fatal either to the mother or to the foetus or both
...
e
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Second trimester abortions are much more riskier
...
Another dangerous trend is the misuse of amniocentesis to
determine the sex of the unborn child
...

Such practices should be avoided because these are dangerous both for
the young mother and the foetus
...


4
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Gonorrhoea, syphilis,
genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B
and of course, the most discussed infection in the recent years, HIV leading
to AIDS are some of the common STDs
...

Some of these infections like hepatitis–B and HIV can also be
transmitted by sharing of injection needles, surgical instruments, etc
...
Except for hepatitis-B, genital herpes and HIV infections,
other diseases are completely curable if detected early and treated
properly
...
, in the genital region
...
Absence or less significant symptoms in the early stages of
infection and the social stigma attached to the STDs, deter the infected
persons from going for timely detection and proper treatment
...
STDs are a major threat to a healthy society
...
Though all persons are vulnerable to these infections, their
incidences are reported to be very high among persons in the age group
of 15-24 years – the age group to which you also belong
...
One could be free of these
infections by following the simple principles given below:
(i) Avoid sex with unknown partners/multiple partners
...

(iii) In case of doubt, one should go to a qualified doctor for early
detection and get complete treatment if diagnosed with disease
...
5 INFERTILITY

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A discussion on reproductive health is incomplete without a mention of
infertility
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e
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The reasons for this could be many–physical,
congenital, diseases, drugs, immunological or even psychological
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Specialised
health care units (infertility clinics, etc
...
However, where such corrections are not possible, the couples
could be assisted to have children through certain special techniques
commonly known as assisted reproductive technologies (ART)
...
In this method, popularly known as test tube
baby programme, ova from the wife/donor (female) and sperms from the
husband/donor (male) are collected and are induced to form zygote under
simulated conditions in the laboratory
...
Embryos formed by in-vivo fertilisation (fusion
of gametes within the female) also could be used for such transfer to assist
those females who cannot conceive
...
Intra cytoplasmic
sperm injection (ICSI) is another specialised procedure to form an embryo
in the laboratory in which a sperm is directly injected into the ovum
...
In this technique,
the semen collected either from the husband or a healthy donor is artificially
introduced either into the vagina or into the uterus (IUI – intra-uterine
insemination) of the female
...
Therefore, these facilities are presently available only
in very few centres in the country
...
Emotional, religious and social
factors are also deterrents in the adoption of these methods
...
Our laws permit legal adoption
and it is as yet, one of the best methods for couples looking for
parenthood
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e
...
Our
nation was the first nation in the world to initiate various action plans
at national level towards attaining a reproductively healthy society
...
, is the primary step towards reproductive health
...

An overall improvement in reproductive health has taken place in
our country as indicated by reduced maternal and infant mortality
rates, early detection and cure of STDs, assistance to infertile couples,
etc
...
Such a growth necessitated intense
propagation of contraceptive methods
...
Though contraceptives are
not regular requirements for reproductive health, one is forced to use
them to avoid pregnancy or to delay or space pregnancy
...
MTP is
generally performed to get rid of unwanted pregnancy due to rapes, casual
relationship, etc
...

Diseases or infections transmitted through sexual intercourse are
called Sexually Transmitted Diseases (STDs)
...
Early detection facilitate better cure of these diseases
...

Inability to conceive or produce children even after 2 years of
unprotected sexual cohabitation is called infertility
...
In Vitro fertilisation followed by
transfer of embryo into the female genital tract is one such method and
is commonly known as the ‘Test Tube Baby’ Programme
...


What do you think is the significance of reproductive health in a society?

2
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3
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Do you think that reproductive health in our country has improved in
the past 50 years? If yes, mention some such areas of improvement
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What are the suggested reasons for population explosion?

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7
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Why?

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Is this
ban necessary? Comment
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Suggest some methods to assist infertile couples to have children
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What are the measures one has to take to prevent from contracting STDs?
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(True/False)
(b) Infertility is defined as the inability to produce a viable offspring
and is always due to abnormalities/defects in the female partner
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(True/False)
(d) Creating awareness about sex related aspects is an effective
method to improve reproductive health of the people
...
Correct the following statements :
(a) Surgical methods of contraception prevent gamete formation
...

(c) Oral pills are very popular contraceptives among the rural women
...
T
...


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