Reproductive Health

Significance of reproductive health in society: 1. Population control: • Knowledge of contraception helps in planned families and managing population growth • Prevents over-population which leads to resource depletion and poverty 2. Prevention of sexually transmitted infections (STIs): • Awareness of STIs (HIV, syphilis, gonorrhoea) helps in prevention and early treatment • Reduces spread of infections through safe practices 3. Reduction of maternal mortality: • Proper prenatal and postnatal care reduces deaths during childbirth • Trained healthcare during delivery prevents complications 4. Infant health: • Reduces infant mortality rates • Ensures healthy birth outcomes and proper nutrition for newborns 5. Reduction of gender inequality: • Women's reproductive rights empower women in society • Access to reproductive healthcare reduces discrimination 6. Reduction of unsafe abortions: • Access to legal, safe medical termination of pregnancy (MTP) prevents deaths from unsafe procedures 7. Social and economic benefits: • Healthy families contribute productively to society • Reduces burden on healthcare systems 8. Eradication of sex-selective practices: • Awareness programs reduce female foeticide and infanticide As per WHO: Reproductive health means a complete state of physical, mental, and social well-being in all matters related to reproductive system — not merely absence of disease.

Important steps to achieve reproductive health: 1. Awareness and education: • Sex education in schools — accurate information about reproductive anatomy, puberty, contraception, and STIs • Removal of myths, taboos, and misconceptions about sex and reproduction 2. Reproductive healthcare services: • Accessible family planning clinics and contraceptive services • Prenatal care for pregnant women; safe delivery services • Postnatal care for mother and child 3. Contraceptive methods: • Promote use of safe, effective contraception to prevent unwanted pregnancies • Information on barrier methods, hormonal methods, IUDs, and sterilisation 4. Prevention and treatment of STIs: • Awareness about HIV/AIDS and other STIs • Promote condom use; provide testing and treatment 5. Maternal and child health programs: • Immunisation, nutritional support, and regular check-ups • Training skilled birth attendants and midwives 6. Legal and policy framework: • Medical Termination of Pregnancy (MTP) Act — provides safe, legal abortion services • Prohibition of sex-determination tests (PNDT Act in India) to prevent female foeticide 7. Amniocentesis regulation: • Ban misuse of amniocentesis and ultrasonography for sex determination 8. Research and development: • Development of new contraceptives and reproductive technologies • Assisted Reproductive Technologies (ART) for infertile couples 9. Government programs: • Family welfare programs, RNTCP, NACP (National AIDS Control Programme)

Tubectomy and Vasectomy are permanent surgical contraceptive methods (sterilisation). Vasectomy (male sterilisation): • A small portion of the vas deferens (sperm duct) is surgically removed or blocked • Procedure: Under local anaesthesia, a small incision is made in the scrotum • A segment of vas deferens is cut, ligated (tied), cauterised, or blocked with clips • Result: Sperm cannot pass from testes to urethra → semen has no sperm • Very effective (>99%) • Simple, outpatient procedure; quick recovery • Sexual function and testosterone production unaffected • Reversal (vasovasostomy) possible but success varies Tubectomy (female sterilisation — tubal ligation): • A small portion of the fallopian tube (oviduct) is surgically removed or blocked • Procedure: Laparoscopy (keyhole surgery) or minilaparotomy • Tubes are cut, tied (ligated), cauterised, or blocked with clips/rings • Result: Egg cannot travel from ovary to uterus → fertilisation prevented • Very effective (>99%) • Slightly more invasive than vasectomy (requires anaesthesia) • Ovarian function and menstrual cycle continue normally • Reversal (tubal reversal) possible but less successful than vasectomy reversal Both methods are considered permanent and should be chosen only when no more children are desired.

Amniocentesis: • A prenatal diagnostic procedure in which a small sample of amniotic fluid (15–20 mL) is withdrawn from the amniotic sac surrounding the foetus using a needle inserted through the mother's abdomen (guided by ultrasound) • Performed around 14–18 weeks of pregnancy • The amniotic fluid contains foetal cells (shed from foetal skin) which can be cultured and analysed Purpose (legitimate medical uses): 1. Detection of chromosomal abnormalities: • Down syndrome (trisomy 21), Turner syndrome (45, X), Klinefelter syndrome (47, XXY) 2. Detection of genetic disorders: • Sickle cell anaemia, cystic fibrosis, haemophilia, Tay-Sachs disease, PKU 3. Detection of neural tube defects: • Elevated alpha-fetoprotein (AFP) levels indicate spina bifida or anencephaly 4. Assessing foetal lung maturity Threat of misuse: • YES — serious threat of misuse for sex determination • The technique can reveal the chromosomal sex of the foetus (XX or XY) • In societies with strong son preference (e.g., parts of India), this has been misused to detect female foetuses and carry out sex-selective abortions → female foeticide • India enacted the PNDT Act 1994 (Pre-natal Diagnostic Techniques Act, now PCPNDT Act) to prohibit use of any prenatal technique for sex determination • Violation is punishable by law (imprisonment and fine) • Despite legal prohibition, misuse continues in some areas

Contraceptive methods comparison: Barrier Methods: • Purpose: Physically prevent sperm from reaching the egg • Male condom: Latex sheath covering penis; also prevents STIs (only method that does both) • Female condom: Polyurethane pouch inserted in vagina • Diaphragm: Cup-shaped device covering cervix (used with spermicide) • Cervical cap: Smaller rubber cap over cervix • Spermicides: Chemical agents that kill sperm (gels, foams, creams) • Effectiveness: Moderate (85–98% with perfect use) • Reversibility: Fully reversible; temporary; no hormonal effects • Advantage: Condoms provide STI protection Intra-Uterine Devices (IUDs): • Small devices inserted into the uterus by a healthcare provider • Types: – Non-medicated (inert): Lippes loop — rarely used now – Copper-releasing: Cu-T, Cu 7, Multiload 375 — copper ions are spermicidal; prevent fertilisation and implantation – Hormone-releasing: LNG-20 — releases progestin; thickens cervical mucus, suppresses ovulation • Effectiveness: Very high (>99%) • Reversibility: Reversible — removed when pregnancy desired • Duration: 3–10 years depending on type • Advantage: Long-acting, no daily maintenance Surgical Methods (Sterilisation): • Permanent, highly effective methods • Vasectomy (male): Cutting/blocking vas deferens • Tubectomy (female): Cutting/blocking fallopian tubes • Effectiveness: >99% • Reversibility: Considered permanent (reversal possible but not reliable) • Suitable for those who do not want more children • No effect on hormones or sexual function

MTP (Medical Termination of Pregnancy): • Intentional termination of a pregnancy before the foetus is viable (before it can survive outside the womb) • Commonly called induced abortion • Can be done by medication (medical MTP) or surgical procedures Conditions under which MTP is advised: 1. Contraceptive failure: • Unwanted pregnancy due to failure of contraceptive method 2. Rape or sexual assault: • Pregnancy resulting from rape or incest 3. Risk to mother's health: • Continuation of pregnancy poses serious risk to physical or mental health of the mother 4. Foetal abnormalities: • Prenatal diagnosis reveals serious foetal abnormalities (chromosomal defects, severe malformations) incompatible with normal life 5. Socioeconomic reasons: • Some countries/laws include socioeconomic hardship as a valid reason Legality in India: • YES — MTP is legal in India under the Medical Termination of Pregnancy Act, 1971 (amended in 2021) • Original Act (1971): Allowed MTP up to 20 weeks with opinion of one doctor; up to 20 weeks with two doctors for certain conditions • MTP Amendment Act 2021: Extended to 24 weeks for special categories (rape survivors, minors, foetal abnormalities); beyond 24 weeks only with Medical Board approval for foetal abnormalities • Must be performed by registered medical practitioners in approved facilities • WARNING: MTP must NOT be used for sex-selective abortion (female foeticide) — this is illegal