Reproductive health, according to the World Health Organization, is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes. It implies that people have the ability to reproduce, to regulate their fertility, and to practise safe sexual relationships free of disease, coercion and fear. The concept extends far beyond the biological aspects of reproduction to include social, emotional and educational dimensions, making reproductive health a crucial component of human development.
The chapter discusses the reproductive health problems and strategies that have been adopted in India under the Reproductive and Child Health Care (RCH) programme. It covers birth control measures, including the various contraceptive methods, medical termination of pregnancy, sexually transmitted diseases, and the assisted reproductive technologies that help infertile couples. A society that is reproductively healthy is one where couples enjoy good health, can plan their families, have healthy babies, and are free from reproductive disorders and infections. The chapter therefore emphasises awareness, education and access to reproductive health services for all sections of society.
India was among the first countries in the world to launch government-sponsored family planning programmes, in 1951. Since then, the country has implemented a series of national programmes to address reproductive health. The current approach is the Reproductive and Child Health Care (RCH) programme, which aims at improving the health of mothers and children, promoting family planning, and controlling sexually transmitted diseases and reproductive tract infections.
The key strategies adopted are: - Family planning and education: Creating awareness about reproductive health through formal school education and community programmes. - Contraception: Providing safe and reliable methods of birth control. - Maternal and child health: Ensuring safe pregnancy, delivery and care of the newborn. - Management of reproductive disorders: Treating infertility, sexually transmitted diseases and other reproductive tract problems. - Prevention of sex selection: Banning prenatal sex determination to prevent female foeticide and the alarming decline in the child sex ratio.
The main goal is to attain a reproductively healthy society where couples can plan their families, women have safe pregnancies, and every child is born healthy. Sex education and the use of audio-visual aids are emphasised to dispel myths and misconceptions about sex and reproduction among the young.
Although the world population has been rising rapidly, it has largely been brought under some control in developed countries. In India, the population has been growing at a rapid pace, which is referred to as population explosion. The high birth rate and decreasing death rate are the main causes. Population explosion leads to shortage of food, housing, employment and health care, and poses a serious threat to the environment.
A reproductively healthy society needs to control the population size. The methods of birth control are broadly classified as natural, barrier, IUDs, hormonal, surgical and emergency contraceptives. Contraceptives prevent the fertilisation of the ovum or implantation of the embryo.
Natural methods work on the principle of avoiding chances of ovum and sperm meeting: - Periodic abstinence (rhythm method): Avoiding coitus from day 10 to 17 of the menstrual cycle, when ovulation is most likely. - Withdrawal (coitus interruptus): Withdrawing the penis from the vagina before ejaculation. - Lactational amenorrhea: Absence of menstruation during prolonged lactation after childbirth, which reduces the chances of conception in the initial months.
Natural methods are not very reliable and have a high failure rate.
Barrier methods prevent the meeting of sperm and ovum physically: - Condoms: Thin rubber sheaths worn by the male (over the penis) or inserted by the female (in the vagina). Condoms protect against pregnancy as well as sexually transmitted diseases. - Diaphragms: Rubber barriers inserted into the female reproductive tract to cover the cervix. - Cervical caps and vaults: Similar devices covering the cervix.
IUDs are small devices inserted by doctors in the uterus. They are one of the most widely accepted and reliable methods. Types: - Non-medicated IUDs, e.g., Lippes loop. - Copper-releasing IUDs, e.g., CuT, Cu7, Multiload 375, which release copper ions that suppress sperm motility and fertilising capacity. - Hormone-releasing IUDs, e.g., Progestasert, LNG-20, which make the uterus unsuitable for implantation and the cervix hostile to sperms.
IUDs increase phagocytosis of sperms within the uterus and suppress sperm motility. They are ideal for spacing between children.
Oral contraceptive pills are hormonal preparations containing progestogen alone or a combination of progestogen and oestrogen. They inhibit ovulation and implantation, and also alter the quality of cervical mucus to impede the entry of sperms. Saheli, developed in India, is a non-steroidal oral contraceptive that inhibits ovulation, taken once a week. Progestogens alone can also be given as injections or implants under the skin.
Emergency contraceptives are used to avoid pregnancy after unprotected intercourse or rape. They include a high dose of progestogens or a combination of oestrogen and progestogen, taken within 72 hours of unprotected coitus, and an intrauterine device inserted within five days.
Surgical methods are terminal and highly effective, with a low failure rate: - Vasectomy: A small portion of the vas deferens is removed or tied in males, blocking the transport of sperms. - Tubectomy: A small portion of the fallopian tube is removed or tied in females, blocking the transport of the ovum.
Medical termination of pregnancy is the intentional or voluntary termination of pregnancy before full term. It is also called induced abortion. The MTP Act of 1971 was passed to legalise MTP in India with specific conditions.
MTPs are performed for several reasons: - To remove an unwanted pregnancy arising from rape or unprotected intercourse. - When the continuation of the pregnancy would pose a threat to the life or health of the mother. - When the foetus has serious congenital abnormalities.
About 45 to 50 million MTPs are performed worldwide every year, of which about 20 million are unsafe. Unsafe MTPs are a major cause of maternal mortality and morbidity. MTPs are most safe when done in the first trimester (first 12 weeks). Later terminations require more medical expertise and are more risky. MTP is legal in India but its misuse for sex-selective abortion is a serious concern, and prenatal sex determination is banned by law.
Sexually transmitted diseases are diseases that are transmitted through sexual contact. They are also called venereal diseases (VD) or reproductive tract infections (RTI). Important STDs include gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B and HIV-AIDS.
Most STDs are transmitted through sexual contact with an infected person, though some, like hepatitis-B and HIV, can also be transmitted by sharing injection needles, blood transfusion and from mother to child. Early symptoms include itching, fluid discharge, slight pain, swelling in the genital region, sores or warts. If untreated, they can lead to pelvic inflammatory disease (PID), stillbirths, ectopic pregnancy, abortion, infertility or even cancer of the reproductive tract. HIV-AIDS is the most dangerous STD.
The following measures help prevent STDs: - Avoid sex with multiple partners or unknown partners. - Always use condoms during sexual intercourse. - Consult a qualified doctor early if a partner shows any symptoms of an STD. - Avoid sharing needles and syringes. - All people, including adolescents, should be aware of the signs and symptoms, modes of transmission and consequences of STDs.
Infertility is the inability of a couple to produce a child in spite of unprotected sexual cohabitation for a period of two years. In India, about 15 to 20 million couples are known to be infertile. Infertility can be due to problems in either the male or the female partner, and sometimes in both.
The couples who are unable to conceive are advised to undergo specialised medical procedures known as assisted reproductive technologies (ART): - In vitro fertilisation (IVF): Fertilisation of the ovum with the sperm in a laboratory dish (in vitro) outside the body. The zygote formed is allowed to develop for about 8 to 32 cells and then transferred to the uterus. When it is transferred to the uterus it is called in utero transfer; when transferred to the fallopian tube, zygote intrafallopian transfer (ZIFT). - Gamete intrafallopian transfer (GIFT): Transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce one, but can provide the environment for fertilisation and development. - Intrauterine insemination (IUI): The husband's or donor's semen is artificially introduced into the uterus or oviduct of the female, used when the male partner has a low sperm count. - Intracytoplasmic sperm injection (ICSI): A sperm is injected directly into the ovum in the laboratory, used for severe male infertility. - Surrogacy: When a female who cannot conceive or carry a pregnancy to term, a donor (surrogate) mother is used to carry the embryo developed through IVF.
| Method | Mechanism | Examples |
|---|---|---|
| Natural | Avoid meeting of ovum and sperm | Rhythm, withdrawal, lactational amenorrhea |
| Barrier | Physical block to sperm | Condoms, diaphragm, cervical caps |
| IUDs | Suppress sperm motility, phagocytosis, prevent implantation | CuT, Cu7, Lippes loop, LNG-20 |
| Hormonal | Inhibit ovulation and implantation | Oral pills, Saheli, injections, implants |
| Surgical | Terminal sterilisation | Vasectomy, tubectomy |
| STD | Pathogen | Type | Curable |
|---|---|---|---|
| Gonorrhoea | Neisseria gonorrhoeae | Bacterial | Yes |
| Syphilis | Treponema pallidum | Bacterial | Yes |
| Genital herpes | Herpes simplex virus | Viral | No |
| Genital warts | Human papilloma virus | Viral | No |
| HIV-AIDS | Human Immunodeficiency Virus | Viral | No |
| ART | Procedure |
|---|---|
| IVF | Fertilisation outside the body in a dish |
| ZIFT | Zygote transferred to fallopian tube |
| GIFT | Donor ovum transferred to fallopian tube |
| IUI | Semen artificially introduced into uterus |
| ICSI | Sperm injected into ovum in laboratory |
| Surrogacy | Another woman carries the embryo |
Reproductive health is not merely the absence of disease but a comprehensive state of physical, mental and social well-being in all matters relating to the reproductive system. This chapter has outlined the national and international strategies to achieve reproductive health, from education and family planning to safe contraceptive technologies and maternal care. The array of contraceptive methods, ranging from natural rhythm and barriers to hormonal pills and surgical sterilisation, gives couples the freedom to plan their families responsibly. Medical termination of pregnancy provides a legal and safe option in specific circumstances, while awareness of sexually transmitted diseases, especially the distinction between curable and incurable infections, protects the community. Finally, assisted reproductive technologies offer hope to infertile couples, completing the chapter's message that reproductive health is achievable for everyone through awareness, access and responsible behaviour.