Reproductive Health

• The term refers to the health of reproductive organs with regular functions. However, it encompasses a broader perspective, including reproduction's emotional and social aspects. 
• According to the World Health Organization (WHO), reproductive health means total well-being in all reproduction areas: physical, emotional, behavioral, and social. 
• A society where people have physically and functionally normal reproductive organs and healthy emotional and behavioral interactions in all sex-related aspects can be considered reproductively healthy.

1.0What is Meant by Reproductive Health ?

• India was among the first countries to implement national action plans and programs to achieve total reproductive health as a social goal. 
• These initiatives, known as 'family planning,' began in 1951 and have been periodically evaluated over the decades. Enhanced programs addressing a broader range of reproductive health issues are popularly known as 'Reproductive and Child Health Care (R.C.H.) programs.' 
• The primary objectives of these programs include raising awareness about various aspects of reproduction and providing the necessary facilities and support to build a reproductively healthy society. 
• Critical areas of emphasis encompass educating individuals about reproductive anatomy, adolescence and its associated transformations, practicing safe and hygienic sexual behaviors, sexually transmitted infections (S.T.I.s), and HIV/AIDS. This knowledge is particularly crucial for adolescents, empowering them to cultivate healthy reproductive behaviors.

2.0Components of Reproductive Health

Reproductive health encompasses various components that collectively contribute to the well-being of individuals and communities. These components include:

Population Explosion and Birth Control

• The world population, around 2 billion in 1900, surged to about 6 billion by 2000 and 7.2 billion by 2011. India experienced a similar trend. 
• Our population, approximately 350 million at independence, nearly reached 1 billion by 2000 and surpassed 1.2 billion in May 2011. 
• Factors contributing to this rapid growth include a significant decline in death rates, maternal mortality rates (M.M.R.), infant mortality rates (I.M.R.), and an increase in the number of people of reproductive age. 
• Despite efforts through our Reproductive and Child Health (R.C.H.) programs to reduce the population growth rate, the decrease was minimal. 
• According to the 2011 census, the population growth rate remained around 2 per cent, or 20 per 1,000 per year, indicating continued rapid population growth.

Family Planning

It  refers to practices that help individuals attain certain objectives 

(i) To avoid unwanted Births 

(ii) To bring about wanted birth 

(iii) To regulate the interval between pregnancies 

(iv) To determine the number of children in the family

3.0Reproductive Health Examples

Temporary or Spacing Methods

Natural Methods: Work on the principle of naturally avoiding chances of ovum and sperm meeting. Since these methods do not involve medicines or devices, they have minimal to no side effects. However, their effectiveness can be relatively low, leading to higher chances of failure. 

Types of Natural Methods

• Rhythm or Periodic abstinence method
• Withdrawal or Coitus Interruptus
• Lactational amenorrhea

Chemical Method: In this method, spermicidal or surface-active agents are used, which attach themselves to spermatozoa, inhibit O2 uptake, and kill sperm. Example: Vaginal Foam/tablets = 'Today'

Cream or Jelly = ''Nim-76''

Barrier Methods: In these methods, barriers prevent ovum (egg) and sperms from physically meeting. 

(i) Condoms 

(ii) Diaphragms, Cervical Caps & Vaults 

Intrauterine Devices (I.U.D.s): I.U.D.s are contraceptive devices that doctors or expert nurses insert into the uterus through the vagina. I.U.D.s are an ideal contraceptive for females who want to delay pregnancy or space between children. 

These I.U.D.s are of the following types-

(i) Non-medicated I.U.D.s 

(ii) Copper releasing I.U.D.s 

(iii) Hormone releasing I.U.D.s

Hormonal Methods are the most widely used and most effective (almost 100% effective). In this method, oral pills, injections, and implants are used. 

(i) Oral Pills 

(ii) Implants & Injections

(iii) Male Pill

(iv) Emergency Contraceptive Methods

Terminal Method: Surgical methods, known as sterilization, are typically recommended as a permanent solution to prevent further pregnancies. 

• For Males: Vasectomy involves removing or tying off a small segment of the vas deferens through a small incision in the scrotum.
• For Females: Tubectomy involves removing or tying off a small portion of the fallopian tube through a small incision in the abdomen or through the vagina.

Medical Termination of Pregnancy (M.T.P.)

• Medical termination of pregnancy (MTP), also known as induced abortion, refers to the deliberate termination of a pregnancy before full term. 
• This procedure is generally safer during the first trimester but carries increased risks in the second trimester. 
• Approximately 45 to 50 million MTPs are performed annually, accounting for about one-fifth of all pregnancies globally. While MTP plays a significant role in reproductive health, its primary aim is not population control.

Amniocentesis

In the 14th to 16th week of pregnancy, with the help of a long surgical needle, amniotic fluid is taken out from the uterus.  Few embryo cells (skin, liver and placenta) are present in this fluid. These cells are tested to know the – 

(i) Genetic disorder/chromosomal abnormalities like Down syndrome. 

(ii) Metabolic disorder (deficiency of protein, enzymes, hormones). 

(iii) Detection of Sex (Barr bodies).

Infertility

• If couples are unable to produce children in spite of unprotected sexual If couples are unable to produce children despite unprotected sexual cohabitation up to 2 years, this is called infertility.
• Causes of Infertility are physical conditions, congenital issues, diseases, drug use, immunological factors, or even psychological factors. Specialized healthcare units, such as infertility clinics, can help diagnose and treat some of these disorders, enabling couples to have children.
• However, if such corrections are not possible, couples may turn to assisted reproductive technologies (A.R.T.), which are categorized into two main types

1. In-Vitro Fertilization (Test Tube Baby)

Fertilization occurs outside a female's body in conditions similar to those inside. After that, the embryo is transferred into the fallopian tube or uterus of a surrogate mother or the same mother.  Sperms and eggs can be fertilized in an artificial medium similar to the medium in the fallopian tube, or ICSI can be used. 

• Intracytoplasmic Sperm Injection (ICSI)—This is a specialized procedure in which a sperm is directly injected into the cytoplasm of an ovum to form an embryo in the laboratory.

Embryo Transfer (E.T.) Methods: 

• Zygote Intrafallopian Transfer (ZIFT)—Zygotes or early embryos (with up to eight blastomeres) could be transferred into the fallopian tube of a surrogate or the same mother. 
• Intra Uterine Transfer (I.U.T.) – Embryos with more than eight blastomeres (commonly 32 cells stage) are transferred into the uterus.

2. In-Vivo Fertilization 

Fertilization occurs inside the body of females, either naturally or artificially. 

(a) Gamete Intra Fallopian Transfer (GIFT) - This is the Transfer of an ovum collected from an ovary into the fallopian tube of the same male or female who can't produce one but can provide a suitable environment for fertilization. 

(b) Artificial insemination – If a male is unable to inseminate the semen into the vagina or if there is a very low sperm count in the semen, then semen is artificially introduced either into the vagina or into the uterus of the female (intrauterine insemination) IUI. 

Sexually Transmitted Infections (S.T.I.s)

• These types of diseases are transmitted through sexual intercourse and are collectively known as sexually transmitted infections (S.T.I.s), venereal diseases (V.D.), or reproductive tract infections (R.T.I.s). 
• Common sexually transmitted infections (S.T.I.s) include gonorrhea, syphilis, genital herpes, chlamydia, genital warts, trichomoniasis, hepatitis B, and H.I.V., which can progress to AIDS. 
• Among these, H.I.V. is the most dangerous. Some infections, such as hepatitis B and H.I.V., can also be transmitted through shared injection needles, surgical instruments, blood transfusions, or from an infected mother to her fetus, except for hepatitis B, genital herpes, and H.I.V. infections, other S.T.D.s.

4.0Importance of Reproductive Health

• Proper reproductive health ensures the prevention and treatment of reproductive system diseases and infections, reducing the risk of complications like infertility, cancers, and sexually transmitted infections (S.T.I.s)
• Good reproductive health practices contribute to safer pregnancies and childbirth, reducing maternal mortality and morbidity rates. Ensuring the mother's health during pregnancy increases the likelihood of healthy births, decreasing infant mortality and the incidence of congenital disabilities.
• Economic Participation: Healthy reproductive practices enable women to participate more fully in education and the workforce, enhancing economic development and stability.
• Effective reproductive health programs help manage population growth, supporting sustainable development and resource management.
• Healthier populations contribute to economic growth by reducing healthcare costs and increasing productivity.
• Promoting awareness reduces the stigma and discrimination associated with reproductive health issues, encouraging more people to seek care and support.