Reproductive Health – Problems And Strategies

Reproductive health signifies a state of complete physical, emotional, behavioural, and social well-being concerning all aspects of reproduction. India was a pioneer in establishing national programs to achieve reproductive health, initially known as ‘family planning’ and later evolving into comprehensive Reproductive and Child Health Care (RCH) programmes. These initiatives aim to create awareness, provide facilities, and offer support for building a reproductively healthy society.

Key strategies include:

• Public Awareness: Utilizing audio-visual and print media to educate people about reproductive organs, adolescence, safe sexual practices, STIs, AIDS, and family planning methods.
• Sex Education: Encouraging the inclusion of sex education in schools to provide accurate information and dispel myths.
• Healthcare Infrastructure: Establishing robust infrastructure and professional expertise to provide medical assistance for various reproductive issues like pregnancy, delivery, STDs, abortions, contraception, and infertility.
• Technological Advancements: Implementing improved techniques and strategies for efficient care.
• Legal Measures: Enacting laws such as the statutory ban on amniocentesis for sex determination to curb female foeticide and promoting child immunization.
• Research and Development: Supporting research to find new and improve existing reproductive health methods, exemplified by the development of ‘Saheli’, an oral contraceptive for females.

These efforts have led to improvements such as reduced maternal and infant mortality rates, better detection and treatment of STIs, and increased access to medical facilities.

Population Stabilisation And Birth Control

Despite advancements in living conditions and healthcare, the global population has seen an explosive growth, increasing from approximately 2 billion in 1900 to over 7.2 billion by 2011. India's population also rose dramatically. This rapid growth is attributed to a decline in death rates (including maternal and infant mortality) and an increase in the proportion of people in reproductive age groups. While RCH programs have helped reduce the growth rate, it remains a significant concern, potentially leading to scarcity of basic resources.

To address this, promoting smaller families through various contraceptive methods is crucial. Societal measures include statutory raising of the marriageable age for females to 18 and males to 21, and incentives for couples with small families.

Contraceptive Methods: An ideal contraceptive is user-friendly, available, effective, reversible, and has minimal side effects, without interfering with sexual drive. Contraceptives are broadly categorized as:

• Natural/Traditional Methods: These aim to avoid the meeting of ovum and sperm.
  • Periodic Abstinence: Abstaining from coitus between days 10-17 of the menstrual cycle when ovulation is likely.
  • Withdrawal (Coitus Interruptus): The male withdraws his penis from the vagina before ejaculation to avoid insemination.
  • Lactational Amenorrhea: Absence of menstruation due to intense lactation following childbirth can suppress ovulation for up to six months, though its effectiveness can be high if consistently practiced.
  These methods have almost no side effects but a higher failure rate.
• Barrier Methods: These physically prevent the meeting of ovum and sperm.
  • Condoms: Latex or rubber sheaths for the penis (male) or vagina/cervix (female) to prevent semen entry into the female reproductive tract. ‘Nirodh’ is a popular male condom brand. They also offer protection against STIs and AIDS.
  • Diaphragms, Cervical Caps, Vaults: Rubber barriers inserted into the female reproductive tract to cover the cervix. They are used with spermicidal creams, jellies, or foams to increase effectiveness.
  These are reusable and can be self-inserted, offering privacy.
• Intra-Uterine Devices (IUDs): Devices inserted into the uterus by trained professionals. They include non-medicated IUDs (e.g., Lippes loop), copper-releasing IUDs (e.g., CuT, Cu7), and hormone-releasing IUDs. IUDs work by increasing sperm phagocytosis and suppressing sperm motility and fertilizing capacity. Hormone-releasing IUDs also alter cervical mucus and make the uterus unsuitable for implantation. They are highly effective and widely accepted for spacing pregnancies.
• Oral Contraceptives (Pills): Daily oral administration of small doses of progestogens or progestogen-estrogen combinations. They inhibit ovulation, implantation, and alter cervical mucus quality. ‘Saheli’ is a notable ‘once-a-week’ pill with few side effects.
• Injectables and Implants: Progestogens or progestogen-estrogen combinations can be administered as injections or subcutaneous implants, offering longer-term contraception.
• Emergency Contraceptives: Progestogen-estrogen combinations or IUDs used within 72 hours of coitus can prevent pregnancy in cases of unprotected intercourse or rape.
• Surgical Methods (Sterilization): Terminal methods to prevent further pregnancies by blocking gamete transport.
  • Vasectomy (Male): A small part of the vas deferens is removed or tied.
  • Tubectomy (Female): A small part of the fallopian tube is removed or tied.
  These are highly effective but have poor reversibility.

It is crucial to consult qualified medical professionals for selecting and using contraceptive methods. While widespread use helps control population growth, potential side effects should not be ignored.

Medical Termination Of Pregnancy (MTP)

Medical Termination of Pregnancy (MTP), or induced abortion, is the intentional termination of pregnancy before its full term. Globally, a significant number of MTPs are performed annually, accounting for about one-fifth of all conceived pregnancies. While legal in many countries under specific conditions, MTPs are debated due to ethical, religious, and emotional considerations. India legalized MTP in 1971 with strict conditions to prevent misuse, particularly to curb illegal female foeticides.

Reasons for MTP:

• To manage unwanted pregnancies resulting from casual unprotected intercourse, contraceptive failure, or rape.
• When continuation of pregnancy poses a risk to the mother's physical or mental health, or the fetus's life, or if there's a substantial risk of the child being born with severe physical or mental abnormalities.

Safety and Risks:

• MTPs are relatively safe during the first trimester (up to 12 weeks of pregnancy).
• Second-trimester abortions are significantly riskier.
• A concerning trend is the prevalence of illegal and unsafe abortions performed by unqualified practitioners, which can be fatal.
• The misuse of amniocentesis for sex determination, often leading to female foeticide, is another dangerous practice. The Medical Termination of Pregnancy (Amendment) Act, 2017, was enacted to reduce illegal abortions and associated maternal mortality and morbidity.

Preventative measures like counseling on avoiding unprotected coitus, understanding risk factors, and improving access to healthcare facilities are essential to address these issues.

Sexually Transmitted Infections (STIs)

Sexually Transmitted Infections (STIs), also known as venereal diseases (VD) or reproductive tract infections (RTI), are infections or diseases transmitted through sexual intercourse. Common STIs include Gonorrhoea, Syphilis, Genital Herpes, Chlamydiasis, Genital Warts, Trichomoniasis, Hepatitis-B, and HIV/AIDS.

Transmission: Beyond sexual contact, Hepatitis-B and HIV can also be transmitted through shared needles, infected blood transfusions, or from an infected mother to her fetus.

Curability: Most STIs, except Hepatitis-B, Genital Herpes, and HIV, are completely curable if detected and treated early.

Symptoms and Risks: Early symptoms are often mild (itching, discharge, slight pain, swelling in the genital region) and may be asymptomatic in females, leading to undetected infections. The social stigma attached to STIs further deters timely diagnosis and treatment. Untreated STIs can lead to serious complications like pelvic inflammatory diseases (PID), abortions, stillbirths, ectopic pregnancies, infertility, and reproductive tract cancers.

Prevention:

• Avoid sex with unknown or multiple partners.
• Always use condoms during coitus.
• Seek early detection and complete treatment from a qualified doctor if any doubt or symptoms arise.

STIs pose a significant threat to societal health, with a high incidence reported among individuals aged 15-24 years.

Infertility

Infertility is the inability of a couple to produce children through unprotected sexual cohabitation for a significant period (typically two years). Various factors can contribute to infertility, including physical, congenital, disease-related, drug-induced, immunological, or psychological causes. While societal blame often falls on the female partner, infertility issues can equally originate from the male partner.

Assisted Reproductive Technologies (ART): For couples unable to conceive naturally or where corrective treatments are not possible, ART offers solutions:

• In Vitro Fertilization (IVF) and Embryo Transfer (ET): Commonly known as the "test-tube baby" program, this involves fertilizing ova and sperms outside the body under laboratory conditions. The resulting zygote or early embryo (up to 8 blastomeres) can be transferred into the fallopian tube (ZIFT - Zygote Intra Fallopian Transfer), while embryos with more than 8 blastomeres are transferred into the uterus (IUT - Intra Uterine Transfer) to complete development. Embryos formed via in vivo fertilization can also be transferred.
• Gamete Intra Fallopian Transfer (GIFT): An ovum from a donor is transferred into the fallopian tube of another female who cannot produce ova but can provide a suitable environment for fertilization and development.
• Intra Cytoplasmic Sperm Injection (ICSI): A specialized procedure where a sperm is directly injected into the ovum to facilitate fertilization.
• Artificial Insemination (AI): Used for infertility cases arising from the male partner's inability to inseminate or low sperm count. Semen is collected from the husband or a donor and artificially introduced into the female's vagina or uterus (IUI - Intra Uterine Insemination).

These ART procedures require high precision, specialized professionals, and expensive instrumentation, limiting their availability and affordability. Emotional, religious, and social factors can also be deterrents. In situations where these options are not feasible, legal adoption is a well-regarded alternative for couples seeking parenthood.

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