CBSE CHAPTER- 4

REPRODUCTIVE HEALTH

INTRODUCTION

Reproductive health refers to a state of complete physical, mental, and social well-being in all matters relating to the reproductive system, including the ability to have a satisfying and safe sex life and the capability to reproduce. It implies that people have access to information, education, and services to support their reproductive choices and the freedom to decide if, when, and how often to have children. Reproductive health also encompasses the prevention and treatment of sexually transmitted infections (STIs), including HIV, and the prevention of unsafe abortions. It is a fundamental aspect of overall health and an essential human right.

Reproductive health is an integral component of overall health in a society. India pioneered family planning programs in 1951, which have been evaluated periodically over the past few decades. However, there are still several crucial reproductive health concerns that need to be addressed, including:

  • Pregnancy complications, childbirth issues, and unsafe abortions
  • High rates of sexually transmitted infections (including HIV/AIDS) among young people aged 15 to 24
  • Limited education and reduced future income for young mothers due to early pregnancy and childbearing

To address these challenges, improved reproductive health programs have been implemented under the name of Reproductive and Child Health Care (RCH) programs. The following strategies are essential components of reproductive health programs:

Reproductive health programs aim to create awareness in both males and females about various reproductive aspects through audio-visual and print media, provide sex education in schools to dispel myths and misconceptions about sex-related issues, offer proper information about reproductive organs, adolescence, and safe hygienic sexual practices, and educate fertile couples and those of marriageable age about birth control measures, prenatal and postnatal care for mothers and children, and more.

POPULATION EXPLOSION AND BIRTH CONTROL

Human population explosion refers to the rapid increase in human population size over a relatively short period. The growth rate of the population depends on various factors, including fertility, natality, mortality, migration, age, and sex structure. Birth control is the regulation of conception by preventive methods or devices to limit the number of offspring. Contraception is a birth control method that deliberately prevents fertilization. There are two types of contraceptive methods – temporary and permanent. Natural methods, chemical methods, mechanical means, physiological devices, or hormonal methods are temporary methods, while sterilization is a permanent method.

Natural methods work on the principle of avoiding the chance of ovum and sperm meeting, and they include safe periods, abstinence, coitus interruptus, and lactational amenorrhea. Safe period, also known as the rhythm method, refers to a week before and a week after menses, which is considered a safe period for sexual intercourse. Periodic abstinence is a method in which couples avoid coitus from day 10 to 17 of the menstrual cycle when ovulation is expected. Withdrawal or coitus interruptus is another method in which the male partner withdraws his penis from the vagina before ejaculation. Lactational amenorrhea method is based on the fact that ovulation and therefore the cycle do not occur during the period of intense lactation following parturition.

Chemical methods involve the use of spermicides, such as lactic acid, citric acid, boric acid, potassium permanganate, and zinc sulfate. Foams, jellies, pastes, and creams are introduced into the vagina before sexual intercourse to immobilize and kill the sperm. Mechanical methods prevent the ovum and sperm from physically meeting with the help of barriers. Such methods are available for both males and females and include condoms, diaphragms, cervical caps, vaults, and intrauterine devices (IUDs).

Condoms are thin rubber or latex sheaths that cover the penis before coitus. Diaphragms, cervical caps, and vaults are rubber barriers inserted into the female reproductive tract to cover the cervix during coitus.

IntraUterine Devices (IUDs) are inserted by doctors in the uterus through vagina. These Intra Uterine Devices are presently available as the non-medicated IUDs (e.g., Lippes loop), copper releasing IUDs (CuT, Cu7, Multiload 375) and the hormone releasing IUDs (Progestasert, LNG-20).

Hormonal methods include birth control pills, which check ovulation by inhibiting the secretion of FSH and LH that are necessary for ovulation.

Saheli –the new oral contraceptive for the females contains a non-steroidal preparation. It was developed by scientists at Central Drug Research Institute (CDRI) in Lucknow, India.

Pill Mala D is taken daily, and the pill Saheli is taken weekly.

Progestogens alone or in combination with estrogen can also be used by females as injections or implants under the skin.

Surgical methods, also called sterilization, are generally advised for male or female partners as a terminal method to prevent further pregnancies. Sterilization procedures in the male are called vasectomy, and in the female, they are called tubectomy.

Vasectomy involves removing or tying up a small part of the vas deferens through a small incision on the scrotum, while tubectomy involves removing or tying up a small part of the fallopian tube through a small incision in the abdomen or vagina.

Aminocentesis

Aminocentesis is a medical procedure used for prenatal diagnosis of genetic disorders in the developing fetus. It involves the removal of a small amount of amniotic fluid that surrounds the fetus in the uterus. This procedure is typically done between the 15th and 20th week of pregnancy.

Advantages of aminocentesis include early detection of genetic disorders, allowing parents to prepare emotionally and medically for the birth of a child with a genetic disorder. It also provides information to make informed decisions regarding pregnancy termination. Additionally, it can provide information about the sex of the fetus, which may be helpful in cases where certain genetic disorders are sex-linked.

However, there are also some disadvantages of aminocentesis. The procedure is invasive and carries a risk of miscarriage or injury to the fetus. In rare cases, infection or bleeding may occur. Additionally, the results of the test may cause emotional distress for the parents, particularly if the results indicate the presence of a genetic disorder.

Medical Termination Of Pregnancy MTP

MEDICAL ABORTION

Intentional or voluntary termination of pregnancy before full term is referred to as medical abortion or induced abortion. Around 45 to 50 million medical abortions are performed globally each year, which accounts for 1/5th of the total number of conceived pregnancies in a year. In 1971, the Government of India legalized medical abortion under certain strict conditions to prevent its misuse. Medical abortion is considered relatively safe during the first trimester, i.e., up to 12 weeks of pregnancy. The combination of misoprostol (a prostaglandin) and mifepristone (an anti-progesterone) is an effective method. Vacuum aspiration and surgical procedures are used thereafter. Medical abortion is used to terminate unwanted pregnancies or when the continuation of the pregnancy could be harmful or even fatal to either the mother or the fetus or both.

NOTE :

The Medical Termination of Pregnancy (Amendment) Act, 2017 was enacted by the government of India with the intention of reducing the incidence of illegal abortion and consequent maternal mortality and morbidity. According to this Act, termination of pregnancy may be allowed on certain grounds within the first 12 weeks of pregnancy on the opinion of one registered medical practitioner. If the pregnancy has lasted more than 12 weeks, but fewer than 24 weeks, two registered medical practitioners must be of the opinion, formed in good faith, that the required ground exists. The grounds for such termination of pregnancies include:

(i) The continuation of the pregnancy would involve a risk to the life of the pregnant woman or cause grave injury to her physical or mental health; or

(ii) There is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.

SEXUALLY TRANSMITTED DISEASES (STDs)

 

Sexually transmitted infections (STIs) or reproductive tract infections (RTIs) are diseases or infections that are spread through sexual contact. These infections are a major public health concern and can cause serious health problems if left untreated. STIs include gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis B, and HIV leading to AIDS. While all STIs are serious, HIV is the most dangerous and is discussed in detail in Chapter 8.

Apart from sexual contact, STIs can also be transmitted through sharing injection needles, surgical instruments, transfusion of blood, or from an infected mother to the foetus. Except for hepatitis B, genital herpes, and HIV infections, other STIs are completely curable if detected early and treated properly. However, early symptoms of most STIs are minor and include itching, fluid discharge, slight pain, swellings, etc., in the genital region. Infected females may often be asymptomatic and hence, may remain undetected for long. This is why it is important to get tested regularly, even if you feel fine.

Delay in diagnosis and treatment can lead to complications such as pelvic inflammatory diseases (PID), abortions, still births, ectopic pregnancies, infertility, or even cancer of the reproductive tract. STIs are a major threat to a healthy society, and prevention or early detection and cure of these diseases are given prime consideration under the reproductive health-care programmes.

While all persons are vulnerable to STIs, their incidence is reported to be very high among persons in the age group of 15-24 years. Therefore, it is important for individuals in this age group to take preventive measures to protect themselves from these infections.

The following are some simple principles to follow to be free of these infections:

(i) Avoid sex with unknown partners or multiple partners.

(ii) Always use condoms during coitus.

(iii) In case of doubt, one should go to a qualified doctor for early detection and get complete treatment if diagnosed with infection.

STIs are preventable, and everyone has the right to access information and services to prevent and treat STIs. By taking preventive measures and getting tested regularly, we can protect ourselves and contribute to a healthier society.

Infertility

Infertility is a medical condition characterized by the inability to conceive or bear children after at least two years of attempting to do so through unprotected sexual intercourse.

Couples who struggle with infertility have access to a range of treatment options. Assisted reproductive technology (ART) is a type of fertility treatment that involves the manipulation of both eggs and sperm. The process typically involves surgically removing eggs from a woman’s ovaries, fertilizing them with sperm in a laboratory setting, and then returning the fertilized eggs to the woman’s body or donating them to another woman. There are several common techniques used in ART, including in vitro fertilization (IVF), zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), and gamete intrafallopian transfer (GIFT). In some cases, surrogacy or surrogate motherhood may also be an option.

One method of treating infertility is in vitro fertilization (IVF), which involves fertilizing an egg with sperm in a laboratory and then transferring the resulting embryo into the female reproductive system. This process is often referred to as the “test tube baby” program. The first attempt at creating a test tube baby was made by Italian scientist Dr. Petrucci in 1959, but the human embryo only survived for 29 days. However, the experiment paved the way for further research in the field of reproductive science. The first successful test tube baby was born on July 25, 1978, to Lesley and Gilbert Brown in Oldham, England. Mrs. Brown had obstructed fallopian tubes, and the procedure was carried out by Drs. Patrick Steptoe and Robert Edwards of England. The baby girl was named Louise Joy Brown. Since then, test tube babies have been born in several countries, including Australia and the United States. India’s first test tube baby, Durga, was born on October 3, 1978, in Kolkata to Kanupriya Aggarwal and was created by Dr. Subash Mukherjee.

In the process of creating a test-tube baby, eggs from the female partner or a donor and sperm from the male partner or a donor are collected and then combined in a laboratory setting to form a zygote. The zygote may contain up to 8 blastomeres, which are early-stage cells. The zygote or early-stage embryos can then be transferred into the fallopian tube using a method called zygote intrafallopian transfer (ZIFT), or into the uterus using a method called intrauterine transfer (IUT), where they can continue to develop. Embryos formed through natural fertilization within the female can also be used for such transfers to help those who cannot conceive.

Another specialized procedure used to form an embryo in a laboratory setting is intracytoplasmic sperm injection (ICSI), which involves directly injecting a sperm into an egg. For cases of infertility caused by male partners’ inability to inseminate the female or due to very low sperm counts in the ejaculate, artificial insemination (AI) can be used to correct the issue. In AI, semen collected from either the male partner or a healthy donor is introduced artificially into either the vagina or the uterus (intrauterine insemination or IUI) of the female.

Gametic Intra-Fallopian Transfer (GIFT) is an assisted reproductive technology that involves injecting both sperm and eggs into the fallopian tube of a woman. This technique is typically used for couples with unexplained infertility, mild male infertility, or cervical infertility. The sperm is collected through methods like masturbation or electro ejaculation, while the eggs are obtained through laparoscopy. GIFT is usually performed on a woman in the proliferative stage of her menstrual cycle, and the procedure involves using a separate catheter to inject the sperm and eggs into the middle portion of the fallopian tube. It is worth noting, however, that GIFT is not a commonly used technique in modern assisted reproductive technologies.

Surrogacy is a form of assisted reproductive technology in which a woman agrees to carry a pregnancy for another person or couple. This can involve using the intended parents’ sperm and egg or donor sperm and/or egg. The surrogate mother carries the pregnancy to term and gives birth to a baby that will be raised by the intended parents. Surrogacy is a complex process that requires careful legal, medical, and emotional considerations for all parties involved. It is important to approach the topic of surrogacy with sensitivity and respect.

NCERT SOLUTION FOR REPRODUCTIVE HEALTH CHAPTER

 

For Other Biology Chapters

Reproduction in organism

Chapter 1 Reproduction in organism Part-1

Sexual Reproduction in flowering plants

Click here for Part- 1 Introduction and Male Reproductive organ

Click here for Part-2 Female reproductive whorl

Click here for Part-4 Fertilization Endospem and Embryo Development

Click here for Part-3 Pollination and Fertilization

Human Reproduction

Click here Female Reproductive system (Part-2)

Click here for Male Reproductive System (Part-1)

Click here for Gametogenesis (Part-3)

Click here for pregnancy & Embryonic Development (Part-4)

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