In this chapter: reproductive health and national programmes; population growth; contraceptive methods; medical termination of pregnancy; sexually transmitted infections; infertility and assisted reproductive technologies.Reproductive health
According to the WHO, reproductive health means total well-being in all aspects of reproduction: physical, emotional, behavioural and social. India was among the first countries to start national action plans: family planning programmes in 1951, later expanded into Reproductive and Child Health Care (RCH) programmes.
- Amniocentesis is a foetal test based on the chromosomal pattern in amniotic fluid. Its use for sex determination is banned by law to check female foeticide.
- Population: about 2 billion in 1900 to about 6 billion in 2000. India's population, about 350 million at independence, crossed 1 billion in May 2000. The 2011 census reported a growth rate of less than 2% (20 per 1000 per year).
- Causes of rapid growth: decline in death rate, maternal mortality rate (MMR) and infant mortality rate (IMR), and an increase in people of reproductive age.
- The legal marriageable age is 18 for women and 21 for men.
Contraceptive methods
An ideal contraceptive should be user-friendly, easily available, effective and reversible, with no or least side effects, and it should not interfere with sexual drive or the sexual act.
| Method | Examples | How it works / notes |
|---|---|---|
| Natural | Periodic abstinence | Avoiding coitus on days 10 to 17 of the cycle (fertile period) |
| Withdrawal (coitus interruptus) | Male withdraws before ejaculation | |
| Lactational amenorrhoea | No menstruation (and no ovulation) during intense breastfeeding; effective only up to about six months after delivery | |
| Barrier | Condoms (male and female; "Nirodh" is a popular male brand) | Stop sperm from reaching the ovum; also protect against STIs |
| Diaphragms, cervical caps, vaults | Rubber devices covering the cervix; reusable. Often used with spermicidal creams, jellies or foams | |
| IUDs (intra-uterine devices) | Non-medicated: Lippes loop. Copper-releasing: CuT, Cu7, Multiload 375. Hormone-releasing: Progestasert, LNG-20 | Increase phagocytosis of sperms in the uterus; Cu ions suppress sperm motility and fertilising capacity; hormone IUDs make the uterus unsuitable for implantation and the cervix hostile to sperms. Ideal for spacing children; one of the most widely accepted methods in India |
| Oral pills | Progestogens alone or with oestrogen | Taken daily for 21 days, starting within the first five days of the cycle, then a 7-day gap (menstruation). They inhibit ovulation and implantation and alter cervical mucus |
| Saheli | Developed at CDRI, Lucknow; non-steroidal; a once-a-week pill with very few side effects and high contraceptive value | |
| Injections and implants | Progestogens alone or with oestrogen, under the skin | Same action as pills; effective for much longer |
| Emergency | Progestogens / combinations, or IUDs | Within 72 hours of coitus, to avoid possible pregnancy after rape or unprotected intercourse |
| Surgical (sterilisation) | Vasectomy (male): part of the vas deferens removed or tied through a small cut in the scrotum. Tubectomy (female): part of the fallopian tube removed or tied through a small cut in the abdomen or through the vagina | Very effective, but reversibility is very poor; terminal methods |
Medical termination of pregnancy (MTP)
- MTP is the intentional or voluntary termination of pregnancy before full term. About 45 to 50 million MTPs are performed every year worldwide (about one-fifth of all conceived pregnancies).
- India legalised MTP in 1971 with strict conditions. NCERT describes the MTP (Amendment) Act, 2017, meant to reduce illegal abortion and the resulting maternal deaths: termination within the first 12 weeks on the opinion of one registered medical practitioner, and between 12 and 24 weeks on the opinion of two. (The law was amended again in 2021; for the exam, follow the NCERT text.)
- MTP is relatively safe in the first trimester (up to 12 weeks). Many MTPs are still performed illegally by unqualified people, which is unsafe and can be fatal. Misuse of amniocentesis for sex determination is another concern.
Sexually transmitted infections (STIs)
- Examples: gonorrhoea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B and HIV (which leads to AIDS).
- Hepatitis-B and HIV also spread by sharing needles or surgical instruments, blood transfusion, and from an infected mother to the foetus.
- Except hepatitis-B, genital herpes and HIV, the others are completely curable if detected early and treated properly.
- Early symptoms are minor (itching, discharge, slight pain, swelling in the genital region). Untreated, they can cause pelvic inflammatory disease (PID), abortions, stillbirths, ectopic pregnancy, infertility and even cancer of the reproductive tract.
- STIs are most common in the 15 to 24 age group. To prevent them, avoid sex with unknown or multiple partners, always use condoms, and see a qualified doctor early if in doubt.
Infertility and assisted reproductive technologies (ART)
| Technique | What happens |
|---|---|
| IVF + ET ("test tube baby") | Ova (from wife or donor) and sperms (from husband or donor) are fertilised in the lab; the embryo is then transferred |
| ZIFT (zygote intra-fallopian transfer) | Zygote or early embryo (up to 8 blastomeres) transferred into the fallopian tube |
| IUT (intra-uterine transfer) | Embryo with more than 8 blastomeres transferred into the uterus |
| GIFT (gamete intra-fallopian transfer) | An ovum from a donor is transferred into the fallopian tube of a woman who cannot produce ova but can support fertilisation and development |
| ICSI (intra-cytoplasmic sperm injection) | A sperm is injected directly into the ovum in the lab |
| AI / IUI (artificial insemination / intra-uterine insemination) | For male inability to inseminate or very low sperm count: semen from the husband or a donor is introduced into the vagina or uterus |
Embryos formed by fertilisation inside a donor woman's body (in vivo) can also be transferred. These techniques are costly and need specialised centres; adoption is another option.
Common traps: (1) ZIFT = up to 8 blastomeres into the fallopian tube; IUT = more than 8 into the uterus. (2) GIFT transfers a gamete (ovum), not a zygote. (3) Lippes loop is non-medicated; CuT is copper-releasing; LNG-20 is hormone-releasing. (4) Saheli is once a week, non-steroidal, from CDRI Lucknow. (5) Hepatitis-B, genital herpes and HIV are not completely curable.NEET focus
- Types of IUDs with examples and mode of action.
- Pill schedule; Saheli; emergency contraception within 72 hours; lactational amenorrhoea up to 6 months.
- Vasectomy vs tubectomy; MTP rules and safety.
- STIs that are not curable; complications; age group.
- IVF, ZIFT, IUT, GIFT, ICSI, AI/IUI definitions.
Practice questions
Which of these is a hormone-releasing IUD?
- Lippes loop
- CuT
- Multiload 375
- LNG-20
Show answer
D. Progestasert is another.
Saheli, the oral contraceptive pill, is:
- Steroidal, taken daily
- Non-steroidal, taken once a week
- A copper IUD
- An injection
Show answer
B.
Transfer of an embryo with more than 8 blastomeres into the uterus is called:
- ZIFT
- GIFT
- IUT
- ICSI
Show answer
C.
Which STI is NOT completely curable?
- Gonorrhoea
- Syphilis
- Genital herpes
- Trichomoniasis
Show answer
C. Also hepatitis-B and HIV.
Lactational amenorrhoea is effective as a contraceptive only up to about how long after delivery?
- 1 month
- 6 months
- 1 year
- 2 years
Show answer
B. And only during intense breastfeeding.
Copper ions released by CuT:
- Inhibit ovulation
- Suppress sperm motility and fertilising capacity
- Block the fallopian tube
- Prevent menstruation
Show answer
B.
In GIFT, what is transferred into the fallopian tube?
- Zygote
- Embryo with 8 blastomeres
- Ovum from a donor
- Sperm
Show answer
C.