Reproductive Health: Problems and Strategies

Overview

• Reproductive Health: A state of complete physical, mental, and social well-being in all matters relating to the reproductive system.
• Importance: Essential for the overall health of individuals and communities, influencing population dynamics and social structures.

Problems

• Lack of Awareness: Insufficient knowledge about reproductive health issues, leading to misconceptions and unhealthy practices.
• Access to Services: Limited access to healthcare services, especially in rural areas.
• Cultural Barriers: Societal norms and taboos surrounding discussions of reproductive health.
• High Maternal and Infant Mortality Rates: Due to inadequate healthcare facilities and lack of prenatal and postnatal care.

Strategies

• Education and Awareness: Implementing comprehensive sex education in schools and communities.
• Healthcare Infrastructure: Strengthening healthcare facilities to provide reproductive health services.
• Community Involvement: Engaging local leaders and organizations to promote reproductive health awareness.
• Policy Implementation: Enforcing laws and regulations to protect reproductive rights and ensure access to services.

Population Stabilization and Birth Control

Importance of Population Stabilization

• Overpopulation Issues: Strain on resources, environmental degradation, and social challenges.
• Sustainable Development: Essential for achieving economic growth and improving quality of life.

Contraceptive Methods

Natural Methods

Natural methods work on the principle of avoiding the meeting of ovum and sperm. Key methods include:

1. Periodic Abstinence:

   • Couples abstain from coitus from day 10 to 17 of the menstrual cycle (fertile period) to prevent conception.

2. Withdrawal (Coitus Interruptus):

   • The male partner withdraws his penis from the vagina just before ejaculation to avoid insemination.

3. Lactational Amenorrhea Method:

   • Based on the absence of menstruation during intense lactation post-parturition.
   • Effective for up to six months following childbirth, as long as the mother breastfeeds fully.

Advantages and Disadvantages

• Advantages: No medicines or devices used, resulting in minimal side effects.
• Disadvantages: Higher chances of failure compared to other methods.

Barrier Methods

Barrier methods prevent the physical meeting of ovum and sperm using various devices:

1. Condoms:

   • Thin rubber/latex sheaths used by males (or females) to cover the penis or vagina and cervix.
   • Prevents the entry of semen into the female reproductive tract.
   • Popular brands include ‘Nirodh’.
   • Also protect against STIs and AIDS.

2. Diaphragms and Cervical Caps:

   • Rubber barriers inserted into the female reproductive tract to cover the cervix.
   • Often used with spermicidal creams, jellies, or foams to enhance effectiveness.

Intrauterine Devices (IUDs)

IUDs are inserted into the uterus by healthcare professionals:

1. Types of IUDs:

   • Non-Medicated IUDs: e.g., Lippes loop.
   • Copper-Releasing IUDs: e.g., CuT, Cu7, Multiload 375.
   • Hormone-Releasing IUDs: e.g., Progestasert, LNG-20.

2. Mechanism of Action:

   • Increase phagocytosis of sperm and suppress sperm motility.
   • Hormone-releasing IUDs make the uterus unsuitable for implantation and the cervix hostile to sperm.

3. Usage:

   • Ideal for women wanting to delay pregnancy or space children.

Oral Contraceptives

Oral contraceptives are taken in the form of pills:

1. Types:

   • Progestogens or progestogen-estrogen combinations.
   • Pills are taken daily for 21 days, starting within the first five days of the menstrual cycle.

2. Mechanism of Action:

   • Inhibit ovulation and implantation, alter cervical mucus to prevent sperm entry.

3. Examples:

   • Saheli: A non-steroidal, once-a-week pill with few side effects.

Emergency Contraceptives

• Progestogens or progestogen-estrogen combinations can be administered within 72 hours of coitus to prevent possible pregnancy.

Surgical Methods (Sterilization)

Surgical methods are considered terminal methods to prevent further pregnancies:

1. Vasectomy (Male):

   • A small part of the vas deferens is removed or tied through a small incision on the scrotum.

2. Tubectomy (Female):

   • A small part of the fallopian tube is removed or tied through a small incision in the abdomen or vagina.

Effectiveness and Reversibility

• These techniques are highly effective but have poor reversibility.

Definition

• MTP: The process of ending a pregnancy through medical or surgical means.

Legal Framework

• Laws and Regulations: In many countries, MTP is regulated by law, allowing it under specific circumstances (e.g., health risks, fetal abnormalities).

Reasons for MTP

• Health Risks: Protecting the health of the mother.
• Fetal Abnormalities: Cases where severe genetic disorders are detected.
• Unplanned Pregnancies: Addressing situations of unwanted pregnancies.

Procedures

• Medical Methods: Use of medications to induce abortion.
• Surgical Methods: Procedures like suction aspiration or dilation and curettage (D&C).

Importance of Safe MTP

• Reducing Maternal Mortality: Ensuring safe procedures to prevent complications.
• Access to Services: Providing safe and legal options for women.

Sexually Transmitted Infections (STIs)

Overview

• STIs: Infections transmitted through sexual contact, affecting reproductive health.

Common STIs

• Chlamydia: Often asymptomatic; can lead to infertility if untreated.
• Gonorrhea: Similar to chlamydia; can cause pelvic inflammatory disease (PID).
• Syphilis: Can cause serious health issues if not treated; characterized by stages.
• HIV/AIDS: Affects the immune system; requires lifelong management.

Prevention Strategies

• Safe Sex Practices: Use of condoms and regular STI screenings.
• Education: Raising awareness about STIs and their transmission.
• Vaccination: Vaccines available for certain STIs (e.g., HPV).

Infertility

Infertility

Overview

• Definition: Infertility refers to the inability of couples to conceive despite unprotected sexual cohabitation.
• Global Issue: A significant number of couples worldwide, including in India, face infertility challenges.

Causes of Infertility

• Physical Factors: Anatomical or physiological issues.
• Congenital Factors: Genetic abnormalities present from birth.
• Diseases: Health conditions affecting reproductive capabilities.
• Drugs: Certain medications may impact fertility.
• Immunological Factors: Immune system responses affecting reproduction.
• Psychological Factors: Stress and mental health issues can contribute to infertility.

Gender Dynamics

• Common Misconception: In India, the female partner is often blamed for childlessness.
• Reality: Many infertility issues stem from the male partner.

Diagnosis and Treatment

• Specialized Healthcare Units: Infertility clinics can provide diagnosis and corrective treatments.
• Assisted Reproductive Technologies (ART): Techniques to assist couples in conceiving when natural methods fail.

Assisted Reproductive Technologies (ART)

1. In Vitro Fertilization (IVF):

   • Fertilization occurs outside the body under laboratory conditions.
   • Ova and sperm are collected and induced to form a zygote.
   • Embryo Transfer (ET):
     • Zygotes or early embryos (up to 8 blastomeres) can be transferred to the fallopian tube (ZIFT).
     • Embryos with more than 8 blastomeres are transferred to the uterus (IUT).

2. Gamete Intra Fallopian Transfer (GIFT):

   • Transfer of an ovum from a donor into the fallopian tube of a female who cannot produce one but can support fertilization.

3. Intra Cytoplasmic Sperm Injection (ICSI):

   • A sperm is directly injected into the ovum to form an embryo in the laboratory.

4. Artificial Insemination (AI):

   • Semen from the husband or a healthy donor is artificially introduced into the female’s reproductive tract.
   • Intra-Uterine Insemination (IUI): A specific type of AI where semen is introduced directly into the uterus.

Challenges and Considerations

• Precision and Expertise: These techniques require high precision and specialized handling by trained professionals.
• Cost: ART facilities are often expensive and available only in a limited number of centers.
• Emotional, Religious, and Social Factors: These can deter couples from pursuing ART methods.

Alternative Options

• Adoption: Legal adoption is a viable option for couples seeking parenthood, especially given the number of orphaned and destitute children in India.