Reproductive Health

Reproductive Health and RCH Programmes

Reproductive Health (WHO Definition): Total well-being in all aspects of reproduction (physical, emotional, behavioural, and social)

• India was among first countries to initiate 'family planning' programmes in 1951
• Current programmes: Reproductive and Child Health Care (RCH) programmes

Saheli

New oral contraceptive for females developed by scientists at Central Drug Research Institute (CDRI) in Lucknow, India 1994, 2008, 2018

Amniocentesis

Key Term: A foetal sex determination and diagnostic test based on chromosomal pattern in cells of amniotic fluid surrounding developing embryo

Diagnostic Uses

• Used to test for genetic abnormalities like Down's syndrome, haemophilia, sickle-cell anemia, cleft palate, and identifying Barr bodies or autosomes 1997, 2010, NEET-I 2016
• Usually performed when woman is between 14-16 weeks pregnant NEET-I 2016

Exception/Crucial detail: Amniocentesis CANNOT be used to detect metabolic disorders like Jaundice NEET 2013

Statutory Ban: Statutory ban on amniocentesis for sex-determination to legally check increasing menace of female foeticide NEET 2023

Population Explosion and Birth Control

Causes of Population Growth

• Rapid decline in Death rate, Maternal Mortality Rate (MMR), and Infant Mortality Rate (IMR)
• Increase in number of people in reproducible age

Ideal Contraceptive Characteristics

• User-friendly, easily available, effective, reversible
• No or least side-effects
• Should not interfere with sexual drive

Natural Methods

Based on principle of avoiding chances of ovum and sperms meeting

• Periodic Abstinence: Couples avoid coitus from day 10 to 17 of menstrual cycle when ovulation is expected (fertile period)
• Withdrawal (Coitus Interruptus): Male partner withdraws penis from vagina just before ejaculation
• Lactational Amenorrhea: Absence of menstruation due to intense lactation following parturition. Chances of conception almost nil

Crucial limit: Effective only up to maximum period of six months following parturition NEET 2022

Barrier Methods

• Condoms: Thin rubber/latex sheath used to cover penis or vagina/cervix. Protects user from contracting STIs and AIDS. E.g., 'Nirodh' for males
• Diaphragms, Cervical Caps, and Vaults: Reusable barriers made of rubber inserted into female reproductive tract to cover cervix during coitus 2011, 2022. Spermicidal creams, jellies, and foams increase efficiency

Intra Uterine Devices (IUDs)

Inserted by doctors or expert nurses in uterus through vagina. Generally increase phagocytosis of sperms within uterus NEET 2017

IUD Type	Examples	Core Mechanism
Non-medicated IUDs	Lippes loop 2004	Increase phagocytosis of sperms
Copper releasing IUDs	CuT, Cu7, Multiload 375 2010, 2014, NEET 2023	Cu²⁺ ions suppress sperm motility and fertilising capacity
Hormone releasing IUDs	Progestasert, LNG-20 2014, 2021	Make uterus unsuitable for implantation and cervix hostile to sperms 2001, 2010, 2014, NEET-I 2016, 2019

Oral Contraceptives and Injectables

• Pills: Small doses of progestogens or progestogen-estrogen combinations 1998, 2008. Taken daily for 21 days starting within first 5 days of menstrual cycle
• Mechanism: Inhibit ovulation and implantation and alter quality of cervical mucus to retard sperm entry 1989, 1992, 2012

Saheli (Special Features)

• Non-steroidal preparation
• 'Once a week' pill with very few side effects and high contraceptive value 1994, 2008, 2018

• Injectables/Implants: Progestogens alone or with estrogen used as injections or implants under skin. Effective periods much longer
• Emergency Contraceptives: Progestogens/progestogen-estrogen combinations or IUDs administered within 72 hours of coitus to avoid possible pregnancy due to rape or casual unprotected intercourse

Surgical Methods (Sterilization)

Terminal methods to prevent any more pregnancies. Highly effective, but reversibility is very poor

• Vasectomy (Males): Small part of vas deferens is removed or tied up through small incision on scrotum 2014, NEET-II 2016
• Tubectomy (Females): Small part of fallopian tube is removed or tied up through small incision in abdomen or through vagina 2014

Medical Termination of Pregnancy (MTP)

Legal and Safety Aspects

• MTP Definition: Intentional or voluntary termination of pregnancy before full term (Induced abortion)
• Legalization: Government of India legalized MTP in 1971 with strict conditions to avoid misuse, specifically to check illegal female foeticides NEET 2017

Safety Period: MTPs considered relatively safe only during first trimester (up to 12 weeks of pregnancy). Second-trimester abortions are much riskier

Sexually Transmitted Infections (STIs)

Types and Curability

Also known as Venereal Diseases (VD) or Reproductive Tract Infections (RTI)

• Includes: Gonorrhoea, Syphilis, Genital herpes, Chlamydiasis, Genital warts, Trichomoniasis, Hepatitis-B, and HIV (leading to AIDS)
• Note: Malaria is NOT an STD 1996

Crucial Exception (High-Yield): Except for Hepatitis-B, Genital herpes, and HIV infections, all other STIs are completely curable if detected early and treated properly 2015, NEET 2017, NEET 2023

Transmission and Symptoms

• Alternative Transmission (Hep-B & HIV): Can also be transmitted by sharing injection needles, surgical instruments, via blood transfusion, or from infected mother to foetus
• Early Symptoms: Itching, fluid discharge, slight pain, and swellings in genital region
• Complications (if untreated): Pelvic Inflammatory Diseases (PID), abortions, stillbirths, ectopic pregnancies, infertility, or cancer of reproductive tract

Infertility and Assisted Reproductive Technologies (ART)

Infertility Definition

Inability to produce children despite two years of unprotected sexual cohabitation

Test Tube Baby Programme (IVF)

Involves In Vitro Fertilisation (IVF) (fertilisation of egg outside body in almost similar conditions as in body) followed by Embryo Transfer (ET) into mother's womb 1994, 2003, 2014

ART Techniques

ART Technique	Full Form & Mechanism	Target Transfer Site
ZIFT	Zygote Intra Fallopian Transfer: Transfer of zygote or early embryo (up to 8 blastomeres) 2010, 2014, 2015	Fallopian Tube
IUT	Intra Uterine Transfer: Transfer of embryos with more than 8 blastomeres to complete further development 2014, 2015	Uterus
GIFT	Gamete Intra Fallopian Transfer: Transfer of ovum collected from donor into another female who cannot produce one, but can provide suitable environment for fertilisation 1996, 2011, 2014, 2015	Fallopian Tube
ICSI	Intra Cytoplasmic Sperm Injection: Specialized procedure to form embryo in laboratory where sperm is directly injected into ovum 2010	In Vitro (Lab)
AI / IUI	Artificial Insemination / Intra Uterine Insemination: Semen collected from husband or healthy donor is artificially introduced into vagina or uterus NEET 2013	Vagina / Uterus