Reproductive Health Biology Notes - Population Control, Contraception, MTP, STDs and Assisted Reproductive Technologies

Reproductive Health: Problems & Strategies

• According to the World Health Organisation (WHO), reproductive health is a total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural, & social.
• India initiated reproductive health programmes (family planning) in 1951.
• Now wider reproduction-related areas are in operation under Reproductive & Child Health Care (RCH) programmes.
• Such programmes deal with the following:
  • Give awareness about reproduction-related aspects for creating a reproductively healthy society.
  • Educate people about birth control, care of pregnant mothers, post-natal care of mother and child, importance of breastfeeding, equal opportunities for male & female children, etc.
  • Awareness of problems due to population explosion, social evils like sex-abuse and sex-related crimes, etc.

Aims and Needs of Sex Education in Schools

• To provide right information about sex-related aspects. It helps to avoid sex-related myths and misconceptions.
• To give proper information about reproductive organs, adolescence and related changes, safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS, etc.

Population Stabilization & Birth Control

• In 1900, the world population was about 2 billion. By 2000, it rocketed to about 6 billion and reached 7.2 billion in 2011.
• In India, the population was nearly 350 million at the time of independence. It reached 1 billion by 2000 and crossed 1.2 billion in May 2011. This means every sixth person in the world is an Indian.
• According to the 2011 census report, our population growth rate was less than 2% (i.e., 20/1000/year), a rate at which our population could increase rapidly.

Reasons for Population Explosion

• Increased health facilities and better living conditions.
• Rapid decline in death rate, maternal mortality rate (MMR), and infant mortality rate (IMR).
• Increase in the number of people in reproducible age.

Impacts of Population Explosion

• Scarcity of basic requirements (e.g., food, shelter, & clothing).

Control Measures

• Motivate smaller families by using contraceptive methods.
• Aware people about the slogan Hum Do Hamare Do (we two, our two). Many couples have adopted a ‘one child norm’.
• Statutory raising of the marriageable age of females (18 years) and males (21 years).

Properties of an Ideal Contraceptive

• User-friendly, easily available, effective, and reversible.
• No or least side effects.
• It should not interfere with sexual drive, desire, & sexual act.

Contraceptive Methods

1. Natural/Traditional Methods

• Avoid chances of ovum and sperms meeting. It includes:
  • Periodic abstinence: Avoid coitus from day 10 to 17 (fertile period) of the menstrual cycle to prevent conception. The fertile period is the period with chances of fertilization.
  • Coitus interruptus (withdrawal): Withdraw the penis from the vagina just before ejaculation to avoid insemination.
  • Lactational amenorrhea: It is the absence of menstrual cycle & ovulation due to intense lactation after parturition. Fully breastfeeding increases lactation. This method helps to prevent conception and is effective up to 6 months following parturition.
• Natural methods have no side effects, but the chances of failure are high.

2. Barriers

• They prevent the physical meeting of sperm & ovum. Examples include:
• Condoms (e.g., Nirodh):
  • Made of rubber/latex sheath.
  • Condoms for males: Cover the penis.
  • Condoms for females: Cover the vagina & cervix.
  • Condoms are used just before coitus. They prevent the entry of semen into the female reproductive tract.
  • Condoms are very popular because:
    • They protect the user from STDs and AIDS.
    • Easily available and disposable.
    • They can be self-inserted, thereby giving privacy to the user.
• Diaphragms, cervical caps, and vaults:
  • Made of rubber and are inserted into the female reproductive tract to cover the cervix during coitus.
  • They block the entry of sperms through the cervix.
  • They are reusable.
• Spermicidal creams, jellies, & foams are used along with these barriers to increase contraceptive efficiency.

3. Intra Uterine Devices (IUDs)

• These are inserted by doctors or nurses in the uterus through the vagina. They increase phagocytosis of sperms.
• IUDs are an ideal method to delay pregnancy or space children.
• Types of IUDs:
  • Non-medicated IUDs: They retard sperm motility and have a spermicidal effect. E.g., Lippes loop.
  • Copper-releasing IUDs: Cu ions suppress motility and the fertilizing capacity of sperms. E.g., CuT, Cu7, Multiload 375.
  • Hormone-releasing IUDs: They make the uterus unsuitable for implantation and the cervix hostile to the sperms. E.g., Progestasert, LNG-20.

4. Oral Contraceptives

• Oral administration of progestogens or progestogen–oestrogen combinations in the form of tablets (pills).
• Pills are taken daily for 21 days, starting within the first five days of the menstrual cycle. After a gap of 7 days (menstruation period), they should be repeated in the same pattern until the female desires to prevent conception.
• They inhibit ovulation and implantation and thicken cervical mucus to prevent the entry of sperms.
• Pills are very effective with lesser side effects.
• Saheli: A new oral contraceptive for females, developed by the Central Drug Research Institute (CDRI) in Lucknow. It contains a non-steroidal preparation. It is a ‘once a week’ pill with very few side effects and high contraceptive value.

5. Injectables & Implants

• Progestogens or progestogen-oestrogen combinations are used by females as injections or implants under the skin.
• Their mode of action is like that of pills, and their effective periods are much longer.

• Progestogens or progestogen-oestrogen combinations & IUDs are used as emergency contraceptives within 72 hours of coitus. They avoid pregnancy due to rape or casual intercourse.

6. Surgical Methods (Sterilization)

• They help to block gamete transport and thereby prevent conception. They are very effective, but reversibility is very poor.
• Vasectomy: Sterilization procedure in males. In this, a small part of the vas deferens is removed or tied up through a small incision on the scrotum.
• Tubectomy: Sterilization procedure in females. In this, a small part of the fallopian tube is removed or tied up through a small incision in the abdomen or through the vagina.

Side Effects of Anti-Natural Contraceptives

• Nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding, breast cancer, etc.

Medical Termination of Pregnancy (MTP)

• Intentional or voluntary termination of pregnancy before full term is called MTP or induced abortion.
• 45 to 50 million MTPs are performed annually worldwide (i.e., 1/5th of the total number of conceived pregnancies).
• MTP helps to decrease the population.
• Many countries have not legalized MTP due to emotional, ethical, religious, and social issues.
• The Government of India legalized MTP in 1971 with strict conditions to prevent illegal female foeticides.

Importance of MTP

• To avoid unwanted pregnancies due to casual intercourse, failure of contraceptives used during coitus, or rapes.
• It is essential in cases where continuation of the pregnancy could be harmful to the mother, the fetus, or both.
• MTPs are safe during the first trimester (up to 12 weeks of pregnancy). Second-trimester abortions are very risky.

Problems Related to MTP

• The majority of MTPs are performed anonymously.
• Misuse of the amniocentesis test for female sex determination. If the fetus is female, it is often followed by MTP. Such practices are dangerous for the young mother and fetus.
• Amniocentesis: In this procedure, some amniotic fluid of the fetus is taken to analyze fetal cells and dissolved substances. It is used to test for the presence of genetic disorders, the survivability of the fetus, etc.

• The Government of India enacted The Medical Termination of Pregnancy (Amendment) Act, 2017 to reduce illegal abortions and consequent maternal mortality and morbidity.
• According to this Act, a pregnancy may be terminated within the first 12 weeks on the opinion of a registered medical practitioner. If the pregnancy is between 12–24 weeks, two registered medical practitioners must agree.

Sexually Transmitted Infections (STIs)

• Diseases or infections transmitted through sexual intercourse are called Sexually Transmitted Diseases/Infections (STDs or STIs), also known as Venereal Diseases (VD) or Reproductive Tract Infections (RTI).
• Examples include Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B, and HIV leading to AIDS.
• Hepatitis-B and HIV are also transmitted by:
  • Sharing of injection needles, surgical instruments, etc.
  • Transfusion of blood.
  • From an infected mother to the fetus.
• Except for hepatitis-B, genital herpes, and HIV, other diseases are completely curable if detected early and treated properly.
• Early symptoms: Itching, fluid discharge, slight pain, swellings, etc., in the genital region.
• Absence or less significant early symptoms and social stigma deter infected persons from consulting a doctor. This can lead to pelvic inflammatory diseases (PID), infertility, ectopic pregnancies, abortions, stillbirths, and cancers of the reproductive tract.
• All persons are vulnerable to STDs, with a very high prevalence among those in the age group of 15–24 years.

Prevention of STDs

• Avoid sex with unknown partners or multiple partners.
• Always use condoms during coitus.
• In case of doubt, consult a qualified doctor for early detection and complete treatment.

Infertility and Assisted Reproductive Technologies (ART)

• Infertility is the inability to conceive or produce children even after 2 years of unprotected sexual cohabitation.
• The reasons for this may be physical, congenital, diseases, drugs, immunological, or even psychological.

• The technologies used to correct the infertility problems are called Assisted Reproductive Technologies (ART). Some of them are given below:

1. In Vitro Fertilisation (IVF) or Test Tube Baby Programme

• In this method, ova from the wife/donor and sperms from the husband/donor are collected and induced to form a zygote under simulated conditions in the laboratory. This is followed by Embryo Transfer (ET).
• ET is of 2 types:
  • Zygote Intra Fallopian Transfer (ZIFT): Transfer of a zygote or early embryo (with up to 8 blastomeres) into the fallopian tube.
  • Intra Uterine Transfer (IUT): Transfer of an embryo with more than 8 blastomeres into the uterus.
• Embryos formed by in vivo fertilisation (fertilisation within the female) are also used for such transfers to assist females who cannot conceive.

2. Gamete Intra Fallopian Transfer (GIFT)

• Transfer of an ovum from a donor into the fallopian tube of another female who cannot produce an ovum but can provide a suitable environment for fertilisation and development.

3. Intra Cytoplasmic Sperm Injection (ICSI)

• It is a laboratory procedure in which a single sperm (from the male partner) is injected directly into an egg (from the female partner). After fertilisation, the embryo is implanted into the woman’s uterus.

4. Artificial Insemination (AI) Technique

• The semen collected from the husband or a donor is artificially introduced into the vagina or the uterus of the female.
• Artificial insemination into the uterus is known as Intra-Uterine Insemination (IUI).
• This technique is useful for male partners with an inability to inseminate the female or with low sperm counts, etc.

Problems of ART

• It requires specialized professionals and expensive instrumentation. Therefore, these facilities are available only in very few centres.
• Emotional, religious, and social problems.

Legal adoption is a good method for couples looking for parenthood.