Reproductive health; problems and strategies| Population explosion| Birth control methods|

  Reproductive Health: Problems and Strategies 

Reproductive Health simply refers to healthy reproductive organs with normal functions. According to the World Health Organization (WHO), reproductive health means a total well-being in all aspects of reproduction, i.e., physical, emotional, behavioral and social. The improved reproductive health of society requires following factors. 

✔ Better awareness about sex-related matters. 

✔ Increased number of medically assisted deliveries and better postnatal care so, as to decrease maternal and infant mortality rates. 

✔ Increased number of couples with small families. 

✔ Better detection and cure of STDs (Sexually Transmitted Diseases). 

✔ Overall increased medical facilities for all sex-related problems. 

✒Awareness of Reproductive Health: -

Some of the measures taken for the awareness of reproductive health are as follows: -

(i) The family planning programmes were initiated in India in 1951 and were periodically assessed over the past decades. The programmes were improved and covered reproduction-related areas under the popular name Reproductive and Child Healthcare (RCH) programmes. It was launched in 1997. Major tasks of RCH programme are: -

✅Creating awareness among the people about reproduction related aspects. 

✅ Providing facilities and support for building up a reproductively healthy society. Governmental and non-governmental agencies have taken various important steps to create awareness among people about reproduction-related aspects. 

(ii) In schools, introducing sex education is a good step to provide right information to adolescents to discourage them from believing in myths and misconceptions about sex-related issues. Adolescents should be informed about reproductive organs, adolescence and related changes, safe and hygienic sexual practices, sex abuse, STDs, AIDS, etc.

 (iii) Married couple or those in marriageable age group should be educated about available birth control options, care of pregnant mothers, postnatal care of the mother and child, importance of breast feeding, equal opportunities for the male and female child, etc. This will lead to the formation of socially conscious healthy families of desired size. 

(iv) Successful implementation of action plans like providing medical assistance and care to reproduction-related problems, pregnancy, delivery, STDs, abortions, contraception, menstrual problems, infertility, etc. need strong support and infrastructural facilities.

(v) Statutory ban on amniocentesis It is a prenatal diagnostic technique based on chromosomal pattern in which a sample of amniotic fluid is taken from the uterus of a pregnant woman to detect the early development of foetus. The benefits of amniocentesis include the diagnosis of chromosomal abnormalities and developmental disorders of it foetus. However, is being misused for sex-determination of foetus that leads to female foeticides. Therefore, statutory ban on for amniocentesis sex-determination keeps check on female foeticides. 

Population Explosion: -

The tremendous increase in the size and growth rate of population is called population explosion. It occurs due to increased health better living conditions.

(i) Reasons of population explosion include 

✅ Decreased death rate. 

✅ Declined Maternal Mortality Ratee (MMR). 

✅ Decreased Infant Mortality Rate (IMR). 

✅Increase in the number of people in reproductive age. 

(ii) According to the 2001 census report, the population growth rate was around 1.7%, i.e. 17/1000/year. By this rate, our population could double in 33 years. 

Methods to prevent population explosion include 

✔ Raising the marriageable age now, it is 18 years for females and 21 years for males. 

✔ Couples with small families should be given some incentives. 

✔ Birth control is an important step to control the population growth by motivating smaller families by using contraceptive methods. 

Birth Control (Contraception) Methods: - 

Contraceptive methods are ideal if they are user friendly, easily available, effective, reversible with no side effects and non-interferring with the sexual drive, desire and the sexual act. There are several methods of birth control that can be categorised as follows: - 

Natural Methods: -

Natural method of birth control involves avoiding ances of sperm and ovum meeting. It can be achieved by 

•  Periodic abstinence in which couples avoid coitus from day 10-17 (fertile period) of the menstrual cycle. In this period, ovulation 1s expected to occur and chances of fertilization are very high. This method is also called rhythm method. 
•  Coitus interruptus is also called 'rejected Sexual intercourse' or 'pull-out'/withdrawl method. In this method, the penis is withdrawn from the vagina just before ejaculation, so that semen is not deposited in the vagina.

• Lactational amenorrhea is the absence of menstruation during the period of intense lactation following parturition. As ovulation does not occur in this period, the chances of conception are nil. This method is reliable for a maximum period of 6 months after delivery. Main advantage of these methods is that, they do not cause any type of side effect. The main disadvantage is that, these methods are not 100% reliable, as these depend on chance. 

Barrier Methods: -

These methods are based on the prevention of ovum and sperm from physically meeting with the help of barriers. Barriers may be mechanical or chemical and uscd by both males and females 

(i) Mechanical Barriers: -

✅Condoms:-

 They are made of thin rubber or latex sheath to cover the penis in male or vagina and cervix in females (femidom) They prevent meeting of sperm and ova. Condoms provide protection from sexually transmitted discases. They are disposable and can be self-inserted and thereby gives privacy to the user. 

✅Diaphragms, Cervical Caps and Vaults: - They are made up of rubber that are inserted into the female reproductive tract to cover the cervix during coitus. They are reusable. 

(ii) Chemical Barriers: -

They include spermicidal creams, jellies and foams. They are usually used along with the barriers to increase their contraceptive efficiency.

Intra Uterine Devices (IUDS): - 

These devices are introduced in the uterus through vagina by doctors or expert nurses. These are of following types: -

✅Non-medicated IUDs, e.g. Lippes loop. 

✅ Copper-releasing IUDs, e g. Cu-T, Cu-7 and multiload 375. 

✅ Hormone-releasing IUDs, e.g. progestasert, LNG-20.

IUDs prevent contraception in the following ways: -

✅ Increase phagocytosis of sperms within the uterus. 

✅ Some IUDs suppress sperm motility and fertilizing ability of sperm by releasing copper ions. 

✅The hormone releasing IUDs make uterus unsuitable for implantation and make the cervix hostile to sperms. IUDs are ideal Contraceptives for females who want to delay pregnancy. It is one of the most widely accepted contraception method in India.

Oral Contraceptives: -

These are hormonal preparations in the form of pills. Their major fecatures include 

(i) Pills are of two types-combined pills and mini pills. Combined pills (Mala-D and Mala-N) contain synthetic progesterone and oestrogen whereas mini pills contain progestin (progesterone like synthetic hormone) only. 

(ii) Oral pills inhibit ovulation and modify the quality of cervical mucus to prevent/retard the entry of sperms. They also modify uterine endometrium by making it unsuitable for implantation. 

(iii) Oral pills have to be taken daily for a period of 21 days starting within the first five days of menstrual cycle. 

(iv) Saheli an oral contraceptive pill developed by scientists at Central Drug Research Institute (CDRI), Lucknow, contains a non-steroid called centchroman. It is a once-a-week pill, with very few side effects and high contraceptive value. 

Implants or injections: -

These are effective for longer period, although their mode of action is similar to thal of oral contraceptives. Progesterone alone or in combination with oestrogen are used by females as injections (Depo Provera) or implants under the skin. 

Emergency Contraceptives: -

It includes administration of high dose of progesterone or progestogen-Oestrogen Combinations within 72 hours of coitus. It has been found to be very effective to avoid possible pregnancy due to unprotected intercourse.

Sterilisation or Surgical Methods: -

Sterilisation methods are used by male/female partner as a terminal/ permanent/stable method to prevent any more pregnancies. These methods block the transport of gametes and prevent Contraception. There are of following two types 

(i) Vasectomy is applied in case of males. In this method, a small portion of vas deferens is removed or tied up through an incision on the scrotum to prevent the passage of sperms.

 

(ii) Tubectomy is applied in case of females, where a small part of Fallopian tube is removed or tied up through a small incision in the abdomen or through vagina to prevent the passage of ova. Both of these methods are highly effective. but poorly reversible.