Reproductive Health

2.1 Core concepts

• Reproductive health (WHO definition): total well-being in all aspects of reproduction — physical, emotional, behavioural and social; a reproductively healthy society has physically and functionally normal reproductive organs plus normal emotional and behavioural interactions in all sex-related aspects (NCERT §3, p. 41).
• India's family planning history: India was amongst the first countries to launch national action plans; programmes called 'family planning' were initiated in 1951 and were periodically assessed; the improved version is now called Reproductive and Child Health Care (RCH) programmes (NCERT §3.1, p. 41–42).
• RCH tasks: create awareness about reproduction-related aspects via audio-visual/print media; introduce sex education in schools; educate fertile couples on birth control, pregnancy/post-natal care, breast feeding, equal opportunities for male and female child (NCERT §3.1, p. 42).
• Statutory ban on amniocentesis for sex-determination is used to legally check the menace of female foeticides; amniocentesis itself samples amniotic fluid of the foetus to test for genetic disorders such as Down syndrome, haemophilia, sickle-cell anaemia (NCERT §3.1, p. 42).
• Saheli: a non-steroidal "once a week" oral contraceptive for females, developed by scientists at the Central Drug Research Institute (CDRI), Lucknow; has very few side-effects and high contraceptive value (NCERT §3.1, p. 42–43; §3.2, p. 45).
• Population growth: world population — 2 billion (1900) → 6 billion (2000) → 7.2 billion (2011); India — ~350 million at independence → ~1 billion (2000) → 1.2 billion (May 2011); 2011 census population growth rate <2% (20/1000/year) (NCERT §3.2, p. 43).
• Drivers of growth: rapid decline in death rate, maternal mortality rate (MMR) and infant mortality rate (IMR), plus increase in number of people in reproducible age (NCERT §3.2, p. 43).
• Statutory measures to check growth: marriageable age — female 18 years, male 21 years; incentives for small families; Hum Do Hamare Do slogan (NCERT §3.2, p. 43).
• Ideal contraceptive properties: user-friendly, easily available, effective, reversible, with no/least side-effects, and must not interfere with sexual drive/desire/act (NCERT §3.2, p. 43).
• Categories of contraceptives: Natural/Traditional, Barrier, IUDs, Oral contraceptives, Injectables, Implants and Surgical methods (NCERT §3.2, p. 43).
• Natural methods: (i) Periodic abstinence — avoid coitus from day 10 to 17 of menstrual cycle (the fertile period); (ii) Withdrawal / coitus interruptus — male withdraws penis before ejaculation; (iii) Lactational amenorrhea — ovulation suppressed during intense lactation after parturition; effective only up to 6 months post-parturition; failure rates are high but side-effects nil (NCERT §3.2, p. 44).
• Barrier methods: Condoms (male and female) made of thin rubber/latex sheath ('Nirodh' is a popular male brand); disposable; also protect against STIs/AIDS. Diaphragms, cervical caps and vaults are reusable rubber barriers inserted in the female tract covering the cervix; spermicidal creams/jellies/foams used alongside (NCERT §3.2, p. 44).
• IUDs (inserted by doctors/nurses via vagina): (a) Non-medicated — Lippes loop; (b) Copper-releasing — CuT, Cu7, Multiload 375; (c) Hormone-releasing — Progestasert, LNG-20. Mechanism: increase phagocytosis of sperms in uterus; Cu ions suppress sperm motility and fertilising capacity; hormonal IUDs additionally make uterus unsuitable for implantation and cervix hostile to sperms. Ideal for delaying/spacing pregnancies; one of the most widely accepted methods in India (NCERT §3.2, p. 44–45).
• Oral pills: small doses of progestogens or progestogen–estrogen combinations; taken daily for 21 days starting within first 5 days of cycle, gap of 7 days, then repeat. Mechanism — inhibit ovulation and implantation; alter cervical mucus to retard sperm entry. Saheli is a non-steroidal once-a-week pill (NCERT §3.2, p. 45).
• Injectables / Implants: progestogens (alone or with estrogen) administered as injections or sub-dermal implants; mode of action similar to pills but effective period much longer (NCERT §3.2, p. 45).
• Emergency contraception: progestogens / progestogen-estrogen combinations / IUDs administered within 72 hours of coitus; used after rape or casual unprotected intercourse (NCERT §3.2, p. 45).
• Surgical methods (sterilisation): terminal methods that block gamete transport. Vasectomy — a small part of vas deferens is cut/tied through a small scrotal incision. Tubectomy — a small part of fallopian tube is cut/tied through abdominal or vaginal incision. Highly effective but reversibility is very poor (NCERT §3.2, p. 45–46).
• Side-effects of contraceptives: nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding, even breast cancer (not very significant but should not be ignored) (NCERT §3.2, p. 46).
• Medical Termination of Pregnancy (MTP): intentional/voluntary termination of pregnancy before full term, also called induced abortion; ~45–50 million MTPs/year worldwide = 1/5 of conceived pregnancies. Legalised in India in 1971 with strict conditions to curb misuse (NCERT §3.3, p. 46).
• MTP safety window: relatively safe in the first trimester (up to 12 weeks); second-trimester MTPs are much riskier. Misuse of amniocentesis for sex-determination followed by MTP of female foetus is illegal (NCERT §3.3, p. 46).
• MTP Amendment Act, 2017: ≤12 weeks — opinion of one registered medical practitioner; 12–24 weeks — opinion of two RMPs in good faith. Grounds: (i) risk to life or grave injury (physical/mental) to woman; (ii) substantial risk of serious handicap in the child (NCERT §3.3 sidebar, p. 46).
• STIs / VD / RTI — common diseases: Gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B, and HIV (leading to AIDS — most dangerous, detailed in Chapter 7) (NCERT §3.4, p. 47).
• Non-coital transmission (hepatitis-B and HIV): sharing injection needles, surgical instruments, blood transfusion, infected mother to foetus (NCERT §3.4, p. 47).
• Curability: all listed STIs are completely curable if detected early, except hepatitis-B, genital herpes and HIV (NCERT §3.4, p. 47).
• Early STI symptoms: itching, fluid discharge, slight pain, swellings in genital region; infected females are often asymptomatic. Complications — PID (pelvic inflammatory disease), abortions, still births, ectopic pregnancies, infertility, cancer of reproductive tract. High incidence in 15–24 year age group (NCERT §3.4, p. 47).
• STI prevention: (i) avoid sex with unknown/multiple partners; (ii) use condoms during coitus; (iii) consult qualified doctor for early detection and complete treatment (NCERT §3.4, p. 47).
• Infertility: inability to produce children despite unprotected sexual co-habitation; causes — physical, congenital, diseases, drugs, immunological or psychological. In India the female is often blamed but the problem frequently lies with the male partner (NCERT §3.5, p. 47–48).
• Assisted Reproductive Technologies (ART):
• IVF (in vitro fertilisation) + ET (embryo transfer) = "test-tube baby" programme; ova and sperms induced to form zygote in lab.
• ZIFT (Zygote Intra Fallopian Transfer): zygote or early embryos up to 8 blastomeres transferred into fallopian tube.
• IUT (Intra Uterine Transfer): embryos with more than 8 blastomeres transferred into uterus.
• GIFT (Gamete Intra Fallopian Transfer): ovum from a donor transferred into fallopian tube of a female who cannot produce one but can support fertilisation and development.
• ICSI (Intra Cytoplasmic Sperm Injection): sperm directly injected into ovum in the lab.
• AI (Artificial Insemination) / IUI (Intra-Uterine Insemination): semen from husband/donor introduced into vagina or uterus — used when male cannot inseminate or has low sperm count (NCERT §3.5, p. 48).
• Legal adoption is mentioned as one of the best methods for couples seeking parenthood (NCERT §3.5, p. 48).

2.2 Definitions to memorise

2.3 Diagrams / processes to remember

• Figure 3.1(a) Condom for male and Figure 3.1(b) Condom for female (p. 44) — barrier devices made of thin rubber/latex; disposable; self-insertable.
• Figure 3.2 Copper T (CuT) (p. 44) — T-shaped copper-releasing IUD inserted into uterus through vagina; the released Cu ions suppress sperm motility.
• Figure 3.3 Implants (p. 45) — rod-shaped sub-dermal progestogen/progestogen-estrogen implants.
• Figure 3.4(a) Vasectomy (p. 45) — vas deferens tied and cut on each side; Figure 3.4(b) Tubectomy — fallopian tubes tied and cut.
• Sequence to remember (ART): ova + sperm → zygote in lab (IVF) → if ≤ 8 blastomeres → ZIFT (fallopian tube); if > 8 blastomeres → IUT (uterus) (NCERT §3.5, p. 48).

2.4 Common confusions / NTA trap points

• Day window for fertile period: NCERT says day 10 to 17 of menstrual cycle — not 8–18 or 12–16; this exact range is a favourite distractor swap.
• Blastomere cut-off for ZIFT vs IUT: ZIFT is up to 8 blastomeres (fallopian tube), IUT is more than 8 blastomeres (uterus). NCERT also calls embryos up to 8 cells "early embryos."
• Curable vs incurable STIs: the only three NCERT lists as not completely curable are hepatitis-B, genital herpes and HIV — students often add gonorrhoea or syphilis to that list, which is wrong.
• MTP windows (MTP Amendment Act 2017): ≤12 weeks → one RMP; 12–24 weeks → two RMPs. Many students remember the old 20-week ceiling — NCERT now uses 24 weeks.
• Saheli specifics: non-steroidal, once-a-week, developed at CDRI Lucknow — confused with daily pills or with combined OC pills.
• Hormone-releasing vs copper-releasing IUDs: Lippes loop = non-medicated; CuT, Cu7, Multiload 375 = copper-releasing; Progestasert, LNG-20 = hormone-releasing. Mixing these is a classic trap.
• Emergency contraception window: within 72 hours of coitus — not 24 or 48 hours.
• Statutory marriageable age: female 18, male 21 — not the other way round.
• Amniocentesis misuse — NCERT highlights its misuse for sex-determination and the legal ban; it was originally for genetic disorders.
• Tubectomy vs vasectomy — Tubectomy = female (fallopian tube cut); Vasectomy = male (vas deferens cut); both >99% effective and largely irreversible.

2.5 Quick comparison table — contraceptives & RCH at a glance