REPRODUCTIVE
HEALTH
REPRODUCTIVE
HEALTH – PROBLEM AND STRATERIES:
·
The
programme “family planning” initiated in 1951.
·
Reproductive
and child health care (ACH)
·
Sexually
transmitted diseases (STD).
·
Amniocentesis: A fetal sex determination test
based on the chromosomal pattern in the amniotic fluid surrounding the
developing embryo.
·
‘Saheli’
an oral contraceptive for female, developed by CDRI.
POPULATION
EXPLOSION AND BIRTH CONTROL:
·
Increased
health facilities, better living conditions are the cause of population
explosion.
·
Out
of 6 billion world population 1 billion are Indians.
·
Rapid
decline in death rate, maternal mortalility rate (MMR) and infant
mortality rate (IMR) are major cause of population growth.
·
Indian
population growth rate is around 1.7 percent.
Characteristics
of ideal contraceptive.
·
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.
Barrier
methods:
·
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.
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.
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.
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.
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.
MEDICAL
TERMINATION OF PREGNANCY:
- Intentional or voluntary
termination of pregnancy before full term is called medical termination
of pregnancy (MTP) or induced abortion.
- MTP has significant role in
decreasing population.
- It accounts for 1/5th of the
total number of conceived pregnancies.
- Legal restriction only to
reduce female foeticide.
- This method is safe within 1st
trimester.
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 and HIV 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.
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)
Assisted
reproductive technologies:
(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.
(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.
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 Fertilization
ZIFT: Zygote Intra Fallopian
Transfer
AI: Artificial insemination
IUI: Interna uterine insemination.
ET: Embryo transfer.
IUT: intra uterine transfer.
ICSI: Intra Cytoplasmic Sperm
Injection.
