REPRODUCTIVE HEALTH�

REPRODUCTIVE HEALTH – PROBLEM AND STRATERIES:�

• The programme “family planning” initiated in 1951.
• Reproductive and child health care (ACH)

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• Sexually transmitted diseases (STD).

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• Amniocentesis: A fetal sex determination test based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo.

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• ‘Saheli’ an oral contraceptive for female, developed by CDRI.

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POPULATION EXPLOSION AND BIRTH CONTROL

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• Increased health facilities, better living conditions are the cause of population explosion.

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• Out of 6 billion world population 1 billion are Indians.

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• Rapid decline in death rate, maternal mortalility rate (MMR) and infant mortality rate (IMR) are major cause of population growth.

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• Indian population growth rate is around 1.7 percent.

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Characteristics of ideal contraceptive

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• User friendly.
• Easily available.
• Effective
• Nor or least side – effects.
• No way interferes with sexual drive

BIRTH CONTROL METHODS:�

• Natural methods:
• work on the principle of avoiding chances of ovum and sperms meeting.
• Periodic abstinence:
• Avoid or abstain from coitus form day 10 to 17 of the menstrual cycle when ovulation could be expected.
• Chance of fertilization is very high in this period.
• It is called fertile period.
• Withdrawal or coitus interruption:
• The male partner withdraws his penis from the vagina just before ejaculation, so as to avoid insemination into the vagina.
• Lactational amenorrhea:
• No menstruation during lactation period.
• Chance of fertilization is nil.
• It is effective upto six month.

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Barrier methods:

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• Principle of working: prevents physical meeting of sperm and ovum.
• Such methods available both for male and female.
• Condoms:
• Barriers made of thin rubber/latex sheath.
• Used to cover the penis in male or vagina and cervix in the female.
• Used just before coitus so that semen not entered into the female reproductive tract.
• Male and female condoms are disposable.
• Prevents AIDS and STDs.
• Diaphragm, cervical caps and vaults:
• Barriers made of rubber.
• Inserted into the female reproductive tract to cover the cervix.
• Prevents conception by blocking the entry of sperm through cervix.
• They are reusable.

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Intra Uterine Devices:�

• These devices are only used by female.
• Inserted by doctor or by expert nurses in the uterus through vagina.
• Non-medicated IUDs e.g. Lippes loop.
• Copper releasing IUDs (CuT, Cu7, Multiload 375)
• Hormone releasing IUDs (Progestasert, LNG-20)
•  Principle of working:
• Increase phagocytosis of sperm within the uterus.
• Cu ion released suppresses sperm motility and fertilizing capacity of sperm.
• Hormone releasing IUDs make the uterus unsuitable for implantation and the cervix hostile to the sperm.

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Oral contraceptives:�

• This methods used by female only.
• Used in the form of tablets hence popularly called pills.
• Pills contain progestogens or progestogen-estrogen combination.
• Pills have to be taken daily for a period of 21 days.
• Started within first five days of menstruation.
• Pills are very effective with lesser side effect.
• Saheli- a non steroidal preparation used as oral contraceptive pills.
• Principle of working:
• Inhibit ovulation.
• Inhibit implantation.
• Alter the quality of cervical mucus to prevent/retard entry of sperms.

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Injections or implants:�

• Progestogens alone or in combination with estrogen used as injections or implants under the skin by female.
• Mode of action is similar as in pills
• It is very effective for long periods.
• Emergency contraceptives:
• These methods are used within 72 hours of coitus, rape or casual unprotected intercourse.
• Administration of progestogens or progestogen-estrogen combination.
• Use of IUDs.

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Surgical methods:�

• It is also called as sterilization method.
• Advised to both male and female partner.
• Permanent or terminal method to prevent pregnancy.
• Sterilization process in male is called ‘vasectomy,
• Sterilization process in female is called ‘Tubectomy’
• In vasectomy, a small part of the vas deferens is removed or tied up.
• In Tubectomy a small part of the fallopian tube is removed.
• Reversibility is very poor.

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MEDICAL TERMINATION OF PREGNANCY:�

• Intentional or voluntary termination of pregnancy before full term is called medical termination of pregnancy (MTP) orinduced abortion.

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• MTP has significant role in decreasing population.

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• It accounts for 1/5th of the total number of conceived pregnancies.

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• Legal restriction only to reduce female foeticide.
• This method is safe within 1st trimester.

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SEXUALLY TRANSMITTED DISEASES:�

• Diseases or infections which are transmitted through sexual intercourse.
• Also known as Venereal diseases (VD) or reproductive tract infections (RTIs)
• Gonorrhea, Syphilis, Genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B andHIV are some common STDs.
• Except hepatitis-B, genital herpes and HIV infections, others are curable.
• Symptoms:
• Itching, fluid discharge, slight pain, swelling in the genital region.
• STDs remain asymptomatic in female and remain undetected for long.
• In the later stage it may leads to Pelvic inflammatory diseases (PID), abortion, still births, ectopic pregnancy, infertility or even cancer in RT.
• Preventions:
• Avoid sex with unknown partners/ multiple partners.
• Always use condoms during coitus.
• In case of doubt, consult with a qualified doctor for early detection.
• Get complete treatment if diagnosed with disease.

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INFERTILITY:�

• The couple unable to produce children inspite of unprotected sex.
• The reason of infertility may be:-
• physical,
• congenital,
• diseases,
• drugs,
• immunological or
• Even psychological.
• Problems of infertility may be in male or female.
• Infertility clinic can diagnose and correct the cause of infertility.
• In case there no corrections are possible, some special technologies used to have children called assisted reproductive technologies. (ART)

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Assisted reproductive technologies:

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• (a) In vitro fertilization:
• Fertilization outside the body in the laboratory.
• Condition created in laboratory similar to the body.
• (b) Embryo transfer:
• Popularly known as test tube baby programme.
• Ova from the wife/donor and sperm from the husband/donor are collected and induced to form zygote under simulated conditions in the laboratory.
• The zygote or early embryos (with upto 8 blastomeres) could be transferred into the fallopian tube.
• ZIFT- Zygote intra fallopian transfer.
• IUT- Intra Uterine transfer (embryo with more than 8 blastomeres).
• Further development taken place within the female body.
• Embryo formed by in-vivo fertilization can also be transfer to assist those female who cannot conceive.

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• (c) Gamete intra fallopian transfer- GIFT
• Transfer of ovum collected from the donor into the fallopian tube of another female who cannot produce it.
• Such female can provide suitable environment for fertilization and development.
• (d) Intra cytoplasmic sperm injection (ICSI):
• The sperm is directly injected into the ovum.
• After in vitro fertilization either ZIFT or embryo transfer technique is followed.
• (e) Artificial insemination (AI)
• Semen is collected either from the husband or donor is artificially introduced into vagina or into the uterus (IUI-intra uterine insemination) of the female.
• Such technology is useful in cases either the male partner unable to inseminate the female or very low sperm counts in the ejaculates.

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Abbreviation�

• IUCD:  Intra Uterine Contraceptive Device
• RCH:  Reproductive and Child Health care
• STD:  Sexually Transmitted Disease
• HIV: human Immuno deficiency virus.
• AIDS: Acquired immuno deficiency syndrome
• CDRI:  Central Drug Research Institute
• MMR:  Maternal Mortality Rate
• IMR: Infant mortality rate.
• MTP:  Medical Termination of Pregnancy
• VD:  Venereal Disease
• RTI:  Reproductive Tract Infection

• PID:  Pelvic Inflammatory Disease
• ART:  Assisted Reproductive Technologies
• IVF:  In Vitro Fertilisation
• ZIFT:  Zygote Intra Fallopian Transfer
• AI: Artificial insemination
• IUI: Interna uterine insemination.
• ET: Embryo transfer.
• IUT: intra uterine transfer.
• ICSI: Intra Cytoplasmic Sperm Injection.

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Thanking you

Thanking you