NEET Biology Reproductive Health Notes

NEET Biology notes on Chapter 4 Reproductive Health, covering reproductive health and the Reproductive and Child Health (RCH) programme, the population explosion and its causes, contraceptives (natural, barrier, IUDs, oral, injectables and implants, and surgical methods), medical termination of pregnancy (MTP), infertility and the assisted reproductive technologies (IVF-ET, ZIFT, IUT, GIFT, ICSI and AI), and adoption.

AT A GLANCE

Terms and Definitions: Reproductive and Child Health Care; Population Explosion; Contraceptive; Contraceptives; Traditional; Barriers; IUDs; Oral; Implants; Surgicals; Medical Termination of Pregnancy; Infertility; IVF-ET; ZIFT; IUT; GIFT; ICSI; AI; Adoption.

Terms and definitions to learn:
1. Amniocentesis
2. Reproductive health
3. Contraceptive
4. Amenorrhoea
5. Infertility

Acronyms to learn:
1. MTP
2. IUD
3. ART
4. GIFT
5. IVF-ET
6. IMR
7. STD
8. PID

Differences to learn:
1. Vasectomy and tubectomy
2. Infertility and sterility
3. Artificial insemination and intra-uterine insemination
4. Periodic abstinence and coitus interruptus

Contraceptives to learn: Pills, Implants, Natural, Cu-T, Condoms.

REPRODUCTIVE HEALTH

According to the World Health Organization (WHO), reproductive health means total well-being in all aspects of reproduction, i.e., physical, emotional, social and behavioural.

India was amongst the first countries in the world to initiate a 'family planning' programme at a national level. This was initiated in 1951 for attaining total reproductive health as a social goal.

Improved programmes covering wider areas related to reproduction are currently in operation under the 'Reproductive and Child Health Care (RCH)' programmes. The major tasks under this programme are to create awareness among people about various reproductive aspects, and to provide facilities and support for building up a reproductively healthy society.

With the help of audio-visual and print media, governmental and non-governmental organisations (NGOs) have taken various steps to create awareness among people about reproductive aspects. These steps include:
1. Introduction of sex education in schools to provide right information to the younger generation, so that they do not believe in myths and misconceptions about sex-related aspects.
2. Proper information about reproductive organs, adolescence, safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS, etc., to lead a reproductively healthy life.
3. Educating people, especially fertile couples and those in the marriageable age group, about available birth control options, care of pregnant mothers, post-natal care of the mother and child, importance of breast feeding, equal opportunities for the male and the female child, etc., to give rise to a reproductively healthy society.
4. Awareness of problems due to uncontrolled population growth, social evils like sex-abuse and sex-related crimes, etc.
5. Strong infrastructural facilities, professional expertise and material support to provide medical assistance and care to people in reproduction-related problems like pregnancy, delivery, STDs, abortions, contraception, menstrual problems, infertility, etc.
6. Implementation of better techniques and new strategies from time to time to provide more efficient care and assistance to people.
7. Statutory ban on amniocentesis for sex-determination, to legally check increasing female foeticides.
8. Immunisation of infants and mothers.
9. Better awareness about sex-related matters, increased number of medically assisted deliveries and better post-natal care, leading to decreased maternal and infant mortality rates, small families, better detection and cure of STDs, and overall increased medical facilities for all sex-related problems, etc.

POPULATION EXPLOSION

The increased health facilities, along with better living conditions, had an explosive impact on the growth of population. The world population, which was around 2 billion in 1900, increased three-fold, i.e., to about 6 billion in just 100 years. A similar trend was observed in India too. Our population, which was approximately 350 million at the time of our independence, reached close to a billion by 2000 and crossed 1 billion in May 2000. This means that every sixth person in the world is an Indian.

The major reasons for this growth are:
1. A rapid decline in death rate.
2. A decline in maternal mortality rate (MMR).
3. A decline in infant mortality rate (IMR).
4. Increase in the number of people reaching reproductive age.

According to the 2001 census report, the population growth rate was around 1.7 per cent. This is the rate at which our population could double in 33 years. Such an alarming growth rate could lead to scarcity of even the basic requirements, i.e., food, shelter and clothing. Therefore, the government took the following measures to check such a population growth:
1. Motivation to people for smaller families.
2. Popularisation of 'A small family is a happy family'.
3. Introduction of the slogan 'Hum Do Hamare Do' (we two, our two), or 'one child norm'.
4. The marriageable age of female and male was raised to 18 and 21 years respectively.
5. Incentives were given to couples with small families.

Check Point
1. Fill in the blanks with suitable words / statements.
(i) Fertile period in menstrual cycle is from ............. to ............ days.
(ii) In India 'Family planning' programme was initiated in year .......................................
(iii) According to 2001 census our population growth rate was ...................... per thousand per year.
(iv) ... ... ... ... ... ... ... method is used to prevent unwanted pregnancies.
(v) RCH stands for ......................

CONTRACEPTIVES

The method used for birth control, or for preventing unwanted pregnancies, is called a contraceptive method. Contraceptives either prevent gamete formation, fertilisation or implantation. An ideal contraceptive is one which is user-friendly, easily available, effective and reversible with no or least side-effects. It also does not interfere with the sexual drive, sexual desire and/or the sexual act of the user.

The available contraceptives fall into the following categories:
1. Natural / traditional contraceptives
2. Barrier contraceptives
3. IUDs
4. Oral contraceptives
5. Injectables and implants
6. Surgical methods

1. Natural or traditional contraceptives

Natural methods work on the principle of avoiding the chances of ovum and sperms meeting. There are three such methods for contraception:
(a) Periodic abstinence: In this the couples avoid or abstain from coitus from day 10 to 17 of the menstrual cycle. Ovulation normally occurs on the 14th day, and the chances of fertilisation are very high during this period. This period is also known as the fertile period. Thus, by abstaining from coitus during this period, one can prevent conception.
(b) Withdrawal or coitus interruptus: This is the method in which the male partner withdraws his penis from the vagina just before ejaculation, so as to avoid insemination.
(c) Lactational amenorrhoea (absence of menstruation during lactation): It is based on the fact that menstrual cycle and ovulation do not occur during the period of intense lactation following parturition. Therefore, as long as the mother breast-feeds the child fully, the chances of conception are very few. However, this method is effective only up to a maximum period of six months following parturition.

As no medicines or devices are used in these methods, side effects are almost nil, though the chances of failure are high.

2. Barrier contraceptives

In such methods, the ovum and sperms are prevented from meeting with the help of barriers. Such methods are available for both males and females.
(a) Condoms: These are barriers made of thin rubber or latex sheath, used to cover the penis in the male, or the vagina and cervix in the female, just before coitus, so that the ejaculated semen does not enter the female reproductive tract. 'Nirodh' is a popular brand of condom for the male. Use of condoms has increased in recent years due to their additional benefit of protecting the user from contracting STDs and AIDS. Both male and female condoms are disposable (not reusable), can be self-inserted, and thereby give privacy to the user.
(b) Diaphragms, cervical caps and vaults: These are also barriers made of rubber, and are inserted into the female reproductive tract to cover the cervix during coitus. They prevent conception by blocking the entry of sperms through the cervix. They are reusable.
(c) Spermicidal creams, jellies and foams are used to kill sperms. They can also be used along with barriers to increase their contraceptive efficiency.

[Figure: Fig. 4.1 Male condom]
[Figure: Fig. 4.2 Female condom]

3. Intra uterine devices (IUDs)

These devices are inserted by doctors or expert nurses into the uterus through the vagina. IUDs increase phagocytosis of sperms within the uterus. These IUDs can be:
(a) Non-medicated (e.g., Lippes loop).
(b) Copper releasing (e.g., CuT, Cu7, Multiload 375). The copper ions suppress the motility and fertilisation capacity of sperms.
(c) Hormone releasing (e.g., Progestasert, LNG-20). Hormone releasing IUDs, in addition, make the uterus unsuitable for implantation and the cervix hostile to sperms.

[Figure: Fig. 4.3 Copper-T]

IUDs are ideal contraceptives for females who want to delay pregnancy and/or space children. It is one of the most widely accepted methods of contraception in India.

4. Oral contraceptives

Such contraceptives are small oral doses of either progestogens or progestogen-oestrogen combinations, used by females. They are used in the form of tablets, and hence are popularly called 'pills'.

The common pills are taken daily for a period of 21 days, starting preferably within the first five days of the menstrual cycle. After a gap of 7 days (during which menstruation occurs), the course has to be repeated in the same pattern till the female desires to prevent conception.

The pills inhibit ovulation and implantation, as well as alter the quality of cervical mucus to prevent or retard the entry of sperms. Pills are very effective, with fewer side effects, and are well accepted by females.

Saheli: The new oral contraceptive for females contains a non-steroidal preparation. It was developed by scientists at the Central Drug Research Institute (CDRI), Lucknow, India. It is a 'once a week' pill with very few side effects and high contraceptive value.

Morning after pills and 72-hour pills are also available for emergency use, to avoid possible pregnancy due to rape or casual unprotected coitus or intercourse.

5. Injectables / Implants

Progestogens alone, or in combination with oestrogen, can also be used by females as injections or implants under the skin. Their mode of action is similar to that of pills, and their effective periods are much longer. Norplant is a set of six small plastic capsules which are placed under the skin of a woman's upper arm. It contains no oestrogen.

[Figure: Fig. 4.4 Norplant]

6. Surgical methods

Surgical methods, also called sterilisation, are generally advised for the male or female partner as a terminal method to prevent any more pregnancies. Surgical intervention blocks gamete transport and thereby prevents conception. The sterilisation procedure in the male is called 'vasectomy', and that in the female is called 'tubectomy'. In vasectomy, a small part of the vas deferens is removed or tied up through a small incision on the scrotum. In tubectomy, a small part of the fallopian tube is removed or tied up through a small incision in the abdomen or through the vagina. These techniques are highly effective, but their reversibility is very poor.

[Figure: Fig. 4.5 Vasectomy - the male reproductive system showing the testis, the vas deferens tied and cut, and the penis]
[Figure: Fig. 4.6 Tubectomy - the female reproductive system showing the ovary, the uterus, the vagina, and the fallopian tubes tied and cut]

Check Point
1. Mark True or False in the following statements:
(i) The diaphragm in females is a reusable contraceptive device.
(ii) Ovulation does not occur during intense lactation.
(iii) Copper-T is an IUD.
(iv) 'Saheli' is a common pill, taken daily, for 21 days.
(v) The implant 'Norplant' contains oestrogen.

It needs to be emphasised that the selection of a suitable contraceptive method and its use should always be undertaken in consultation with qualified medical professionals. Contraceptives are not regular requirements for the maintenance of reproductive health. In fact, they are practised against a natural reproductive event, i.e., conception or pregnancy. One is forced to use these methods either to prevent pregnancy, or to delay or space pregnancy due to personal reasons. The widespread use of these methods has a significant role in checking the uncontrolled growth of population. However, their possible ill-effects, like nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding or even breast cancer, though not very significant, should not be totally ignored.

MEDICAL TERMINATION OF PREGNANCY (MTP)

Intentional or voluntary termination of pregnancy before full term is called medical termination of pregnancy (MTP), or induced abortion. Nearly 45 to 50 million MTPs are performed in a year all over the world, which accounts for about one-fifth of the total number of conceived pregnancies in a year. Obviously, MTP has a significant role in decreasing the population, though it is not meant for that purpose. Whether to accept or legalise MTP is debatable in many countries, due to emotional, ethical, religious and social issues involved in it.

In India, MTP was legalised in 1971 with some strict conditions to avoid its misuse. Such restrictions are all the more important to check indiscriminate and illegal female foeticides.

MTP is done to get rid of unwanted pregnancies due to:
1. Casual unprotected intercourse.
2. Failure of the contraceptive used during coitus.
3. Rapes.

MTPs are also essential in certain cases where continuation of the pregnancy could be harmful or even fatal, either to the mother or to the foetus, or both.

MTPs are considered relatively safe during the first trimester, i.e., up to 12 weeks of pregnancy. In the second trimester they are risky. MTPs should be performed legally by qualified doctors. Nowadays MTPs are being practised for killing female foetuses by determining the sex of the unborn child, due to the misuse of amniocentesis. Such practices should be avoided, because they are dangerous both for the young mother and the foetus, and they also alter the sex ratio. Effective counselling on the need to avoid unprotected coitus, and on the risk factors involved in illegal abortions, can check this unhealthy trend.

(For STDs please refer Chapter 8, 'Human Health and Diseases'.)

Check Point
1. Fill in the blanks with suitable word or statement:
(i) In India the MTP was legalised in year .....................
(ii) ............. has been legally banned to check female foeticides.
(iii) ART stands for ..........................
(iv) ....................... is also known as 'Test tube baby' method.
(v) ....................... is the technique of injecting sperm into ovum.

INFERTILITY

The inability to conceive or produce children even after two years of unprotected cohabitation is called infertility. A large number of couples all over the world, including India, are infertile. The reasons for this could be many, such as physical, congenital, diseases, drugs, physiological (immunological), psychological, etc.

In India, often the female is blamed for the couple being childless, but more often the problem lies in the male partner. Specialised health care units (infertility clinics, etc.) can help in the diagnosis and corrective treatment of some of these disorders, and enable these couples to have children. However, where such corrections are not possible, the couples could be assisted to have children through certain special techniques, commonly known as assisted reproductive technologies (ART).

ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

Following is the list of important techniques which could benefit such infertile couples.

1. IVF and ET

In vitro fertilisation (IVF) is the fertilisation outside the body, in almost similar conditions as that in the body, which is followed by embryo transfer (ET). In this method, popularly known as the 'test-tube baby' method, the ova from the wife or donor (female) and sperms from the husband or donor (male) are collected and induced to form a zygote under simulated conditions in the laboratory. The zygote or early embryos are then transferred into the fallopian tube or uterus to complete their further development.

2. ZIFT

In ZIFT (Zygote Intra Fallopian Transfer), the zygote formed in vitro, or early embryo up to 8-blastomere, is transferred into the fallopian tube.

3. IUT

In IUT (Intra Uterine Transfer), the embryos with more than 8 blastomeres are transferred into the uterus for further development. Embryos formed by in vivo fertilisation can also be used for transfer to assist those females who cannot conceive.

4. GIFT

GIFT (Gamete Intra Fallopian Transfer) is the transfer of an ovum collected from a donor into the fallopian tube of the recipient, who can provide a suitable environment for fertilisation and further development.

5. ICSI

ICSI (Intra Cytoplasmic Sperm Injection) is another specialised procedure to form an embryo in the laboratory, in which a sperm is directly injected into the ovum.

6. AI

AI (Artificial Insemination) is used for cases of infertility which are either due to the inability of the male partner to inseminate the female (impotency or erectile dysfunction), or due to very low sperm counts in the ejaculate. In this technique, the semen collected either from the husband or a healthy donor is artificially introduced either into the vagina or into the uterus (IUI, intra-uterine insemination) of the female.

ART requires extremely high precision handling by specialised professionals and expensive instrumentation. Infertility facilities are presently available only in very few centres in the country, so their benefits are affordable to only a limited number of people. Emotional, religious and social factors are also involved in the adoption of these methods.

Check Point
1. Differentiate between:
(i) Injectable and implantable contraceptives
(ii) Disposable and reusable contraceptives
(iii) Natural and artificial contraceptives
(iv) GIFT and ZIFT
(v) Vasectomy and tubectomy

ADOPTION

Our law also permits legal adoption. Adoption can benefit not only the people who are looking for parenthood, but also many orphaned and destitute children in India, who would probably not survive till maturity unless taken care of.