Reproductive Health, NEET Level, Class XII

1. REPRODUCTIVE
HEALTH
BY: DR. PRITIMA GUPTA

2. INTRODUCTION
 According to WHO (1948), health is defined as “HEALTH IS A STATE OF
COMPLETE PHYSICAL, MENTALAND SOCIAL WELL BEING AND
NOT MERELYAN ABSENCE OF A DISEASE OR INFIRMITY.”
 Any condition which interferes with the normal functioning of the body/ body
organs & impairs the health is called DISEASE.
 Three main causes of disease –
1. GENETIC DISORDERS – Eg: Haemophilia, sickle cell anaemia, colour
blindness, Down’s syndrome etc.
2. INFECTIOUS DISEASES – Eg: Bacterial, viral, fungal etc.
3. LIFE STYLE DISEASES – Eg: Obesity, blood pressure etc.

3. REPRODUCTIVE HEALTH –
PROBLEMS AND STRATEGIES
• DEFINITION – According to WHO, reproductive health means a total well
being in all aspects of reproduction i.e., physical, emotional, behavioural and
social.
#PROGRAMMES INVOLVED IN MAINTAINING REPRODUCTIVE
HEALTH –
1. Family Planning Programme
2. Reproductive and Child Health Care (RCH) Programme

4. FAMILY PLANNING PROGRAMME
• India was the first country in the world to have launched a National Programme for
Family Planning in 1952.
• Being repositioned to not only achieve population stabilization goals but also
promote reproductive health and reduce maternal, infant & child mortality and
morbidity.
• “MISSION PARIWAR VIKAS” :For improved access to contraceptives and family
planning services in high fertility districts spreading over seven high focus states, the
Ministry of Health and Family Welfare launched “Mission Pariwar Vikas” in 2016.
Special focus has been given to 146 high fertility Districts of Bihar, Uttar Pradesh,
Assam, Chhattisgarh, Madhya Pradesh, Rajasthan & Jharkhand, with an aim to
ensure availability of contraceptive methods at all the levels of Health Systems.

5. REPRODUCTIVE AND CHILD
HEALTH CARE PROGRAMME
• It was launched in October 1977.
• AIM – Promote health of mother and children and reduce infant, child and maternal
mortality rates, for population stabilization.
• STRATEGIES –
1. To improve quality, coverage and effectiveness of existing family welfare services.
2. To gradually expand the scope and coverage of family welfare services.
3. Progressively expand and include more elements of a defined package of essential.
4. To give importance to disadvantaged areas by increasing the quality and
infrastructure of family welfare services.

6. PROBLEMS
ASSOCIATED
WITH
REPRODUCTIVE
HEALTH
Lack of
awareness in
people
Myths and
misconceptions
about sex
related aspects
Congenital
or acquired
infertility
Illegal
abortion of
female
foetuses
POPULATION
EXPLOSION
Common
occurrence
of STDs

7. AIMS OF REPRODUCTIVE
HEALTH PROGRAMMES
1. To ensure responsible, safe and
satisfying reproductive life.
2. To create awareness.
3. To provide sex education.
4. To prevent and control STDs.
5. To educate the fertile couples.
6. To provide medical facilities.
7. To improve existing techniques & to
develop new techniques.
8. To raise the marriageable age.
9. To impose statutory ban on
amniocentesis, to check increasing
female foeticide.
10. To manage disorders related to
reproductive system.
11. To lessen the problem of infertility by
promoting assisted reproductive
activities. (ARTs)

8. STEPS TAKEN TO
MAINTAIN A
REPRODUCTIVELY
HEALTHY SOCIETY
Imposing a statutory
ban on amniocentesis
Massive child
immunization
programmes
being followed
Creation of specialised health
centres like infertility clinics
for the diagnosis & corrective
treatment of some infertility
disorders
MTP was legalised
in 1971 to decrease
the population size

9. INDICATORS OF
IMPROVED
REPRODUCTIVE
HEALTH
Better
awareness
about sex
related
matters Better post
natal care
thereby
decreasing
MMR &
IMR
More
couples
opting
family
planning
measures
Better
techniques
of early
diagnosis &
cure of
STDs
Improved &
new medical
facilities for
sex related
problems
More no. of
ARTs so
decreasing
the
problems of
infertility

10. DEMOGRAPHY: IN INDIA
• DEFINITION – The
scientific study of human
population is called
DEMOGRAPHY while
the persons involved in
the scientific studies of
human population are
called
DEMOGRAPHERS.
Consequences of
uncontrolled
population growth
The advantages
of a small family
norm
The growth,
distribution &
density of
population
The relationship b/w
the population to the
standard of life
Methods of control
of human
population growth
SIGNIFICANCEOFSTUDYINGHUMAN
POPULATION

11. POPULATION TRENDS IN INDIA
• India is second most populous country in the world, next to China.
• According to 2001 census – 1027 million.
• 2011 census – 1210.2 million.
• India has 17.2% of the total world population.
• Land area – 2.42% of total land area of the world.
• India’s population is currently growing at the rate of 1.2 million per month
and there is a net annual increase of 16 million.
• India’s population has reached 1.26 billion.
11th May, 2000.
India’s
population
reached ONE
BILLION.

12. CAUSES OF INCREASE IN HUMAN POPULATION
DECLINE IN
DEATH RATE
BETTER SANITATION & COMMUNITY
HEALTH
IMPROVEMENT IN AGRICULTURE
CONTROL OF DISEASES
BETTER MEANS OF
TRANSPORT
BETTER STORAGE
CONDITIONS
DECREASE IN
INFANT
MORTALITY
• The excess of births over deaths in a year
per 1000 in the population is called
GROWTH RATE.
• The birth rate, death rate and growth rate
are all VITAL RATES.
• It is decrease in death rate, maternal
mortality rate (MMR) and infant mortality
rate (IMR) as well as increase in longevity
which are two primary factors for the
increase in human population.
• According to 2001 census –
• BIRTH RATE in India has declined
from 36 per 1000 in 1981
to 30.5 in 1991 and
then 26 in 2001 and
finally to 22.22 in 2011 while
• DEATH RATE declined
from 13.8 per 1000 in 1981
to 9.4 in 1991 and
then to 8 in 2001 and
finally to 6.4 in 2011.

13. CONSEQUENCES OF OVER POPULATION
1. SPACE
2.FOOD SUPPLY 3.PRICE-RISE
4. UNEMPLOYMENT
5. EDUCATION 6. ENERGY CRISIS
7. HYGIENIC CONDITION
8. POLLUTION 9.ECO-DEGRADATION
METHODSTOCONTROL
OVERPOPULATION
1. EDUCATION
2. AGE OF
MARRIAGE
3. FAMILY
PLANNING
METHODS

14. SUGGESTED MEASURES
1. Literacy rate should be increased.
2. Involving social organizations.
3. Providing more job facilities to
women and taking steps against
gender discrimination for women
folks.
4. Proper implementation of
community health programme and
providing optimum medical
facilities.
5. Incentives to the people for
sterilization.
6. Providing facilities like
contraceptives, IUD, birth control
pills, sterilization etc.
7. Strict legal actions against child
marriage.
8. Spreading awareness.

15. BIRTH CONTROL MEASURES
• An ideal contraceptive should be –
1. User friendly.
2. Easily available and cheaper.
3. Effective but also reversible.
4. With no or the least side effects.
5. Should not interfere with the sexual desire and/ or sexual act of the user.

16. BIRTH
CONTROL
MEASURES
MECHANICAL
OR BARRIER
METHODS
CONDOMS
IUDs
DIAPHRAGMS, CERVICAL CAPS & VAULTS
CHEMICAL
METHODS
SPERMICIDAL TABLETS
PHYSIOLOGICAL (ORAL) DEVICES
IMPLANTS
SURGICAL
METHODS
NATURAL OR
TRADITIONAL
METHODS
MALE STERILIZATION (VASECTOMY)
FEMALE STERILIZATION (TUBECTOMY)
TO ABSTAIN
COITUS INTERRUPTS
PERIODIC ABSITENCE OR RHYTHM PERIOD
LACTATIONALAMENORRHOEA

17. MECHANICAL/ BARRIER METHODS
• These prevent physically meeting of ovum and sperm and are of following types –
CONDOMS
Disposable rubber or latex
sheaths.
Popularly called “NIRODH”.
Prevent deposition of sperm in
vagina.
Easily available, low cost,
reliable, effective & with no
side effects, user privacy
maintained.
DIAPHRAGMS,
CERVICAL CAPS &
VAULTS
Made up of rubber & are
fitted in vagina to cover
the cervix.
These are reusable.
INTRA UTERINE DEVICES
These include copper-T & loops
which are fitted in the uterus &
prevent the fertilization.
These increases phagocytosis of
sperms in the uterus.

18. • FEMALE CONDOMS –
They are made up of skin
friendly polyurethane. Act as
clip on the vagina wall
blocking the passage to the
womb.
• It is thin, soft, loose-fitting
sheath with a flexible ring at
each end.
The cervical cap is
smaller than the
diaphragm and can
be left in place
longer. The cervical
cap can be worn up
to 72 hours, and the
diaphragm can be
used up to 30 hours.

19. • INTRAUTERINE DIVICES (IUDs) –
• Several types of IUDs are available –
1. NON-MEDICATED IUDs – Lippe’s loop.
2. COPPER RELEASING IUDs – Cu-T,
Cu-7 and Multiload-375.
3. HORMONE RELEASING IUDs –
Progestasert and LNG-20
#MULTILOAD-375 – Plastic IUD. Can
prevent pregnancy for up to 5 years.
 It consists of small plastic rod wound with
copper wire and provided with two flexible
plastic arms and a nylon thread.
#HORMONE RELEASING IUDs –
Hormones make the uterus unsuitable for
implantation and the cervix hostile for sperms.

20. CHEMICAL METHODS
1. SPERMICIDAL – Tablets, jellies, paste and creams are introduced in the
vagina about 5-15 minutes before coital activity. Common spermicidal
creams used are – lactic acid, citric acid, potassium permanganate, zinc
sulphate etc.
2. PHYSIOLOGICAL (ORAL) DEVICES – Birth control pills are taken
through mouth. These contain a combination of synthetic progestins and
estrogen, so called “COMBINATION PILLS”. They change the quality of
cervical mucus thereby preventing entry of sperms.
#Mala-D – Taken daily for 21 days starting preferably within first 5 days of MC
and repeated after a gap of 7 days.
#Saheli – Weekly. Developed at CENTRAL DRUG RESEARCH INSTITUTE
(CDRI). It contains a non-steroidal preparation CENTCHROMAN.
#DRAWBACKS –
Nausea, breast-
tenderness, weight
gain, break through
bleeding (bleeding
between menstrual
perilous) and breast
cancer.

21. 3. IMPLANTS – Contains either only progesterone or progesterone-
estrogens combinations. Placed under the skin and has longer effective
period.
• They are found to be very effective even within 72 hours of coitus.
• NORPLANT is the most commonly used implant in India.
• It prevents ovulation and thickens the cervical
mucus which makes the sperm entry into uterus
difficult.
• It is get-in and forget it birth control measure and
it checks pregnancy for up to 4 years.
• #DRAWBACKS – 1. Irregular bleeding
• 2. Long term spotting.

22. NATURAL/ TRADITIONAL METHOD
1. TO ABSTAIN – Refraining from coitus.
2. COITUS INTERRUPTS – Withdrawing penis before ejaculation. It is the oldest
method.
LIMITATIONS – Some sperms may get deposited due to Cowper’s gland secretion.
1. PERIODIC ABSITENCE OR RHYTHM PERIOD – A week prior to menstrual
phase and a week later the same are supposed to be SAFE PERIOD.
2. LACTATIONALAMENORRHOEA (LAM) – During intense lactation after the
parturition, the mother does not undergo menstruation max upto 6 months.

23. SURGICAL METHODS
• These block the gamete transport and so prevent conception.
• High success rate but low reversibility rate.
1. MALE STERILIZATION – Permanent method.
 Either testes are removed – CASTRATION.
 Or cutting or tying of the vas deferens, called VASECTOMY.
2. FEMALE STERILIZATION –
 OVARIECTOMY – Surgical removal of ovaries.
 TUBECTOMY – Cutting or tying of fallopian tubes.
 TUBAL LIGATION – Blocking of fallopian tubes by an instrument c/as LAPROSCOPE.

24. AMNIOCENTESIS
• It is a pre-natal diagnostic technique done
during second trimester. (After 15 weeks)
• AIM –
1. Sex of the developing baby.
2. Genetically controlled congenital diseases.
3. Metabolic disorders in the foetus.
#DRAWBACKS –
1. Killing of female foeticide.
#Pre-Natal Diagnostic Techniques Act, 1994.

25. MEDICAL TERMINATION OF PREGNANCY (MTP)/
INDUCED ABORTION
• DEFINITION – It is intentional or
voluntary termination of pregnancy
before the foetus becomes viable.
• PERIOD – Can be done safely during the
first trimester of pregnancy i.e. upto 12
weeks.
#METHODS OF MTP -
1. Dilatation and curettage.
2. Vacuum Aspiration.
3. Administration of prostaglandins.
#SIGNIFICANCE -
1. Decreasing human populations.
2. Getting rid of unwanted pregnancies.
#DRAWBACKS –
1. It has raised many emotional, ethical,
religious & social issues.
2. Majority of MTPs are illegally by
unqualified quacks.
3. Misused for killing female foeticide.
Govt of India legalised
MTP in 1971.

27. SEXUALLY TRANSMITTED DISEASES
• DEFINITION – Diseases or infection which are transmitted
through sexual intercourse with infected persons are
collectively called STDs/ VENERAL DISEASES/
REPRODUCTIVE TRACT INFECTIONS (RTI).
1. SYPHILLIS – Causative organism – Bacterium Treponema
pallidum. Symptoms – Painless ulcer or chancre on the
genitals, swelling of local lymph glands, skin lesions, rashes,
hair loss, swollen joints.
2. GONORRHOEA - Causative organism – Bacterium
Neisseria gonorrhoeae. The bacterium lives in genital tubes,
produces pus containing discharge, pain around genitalia and
burning sensation during urination.

28. 3. AIDS – Caused by Human Immunodeficiency Virus (HIV). The symptoms include fever,
lethargy, pharyngitis, weight loss, nausea, headache etc. transmitted through semen and
blood.
4. HEPATITIS B – Caused by Hepatitis B Virus (HBV). The symptoms include fever, loss
of appetite, abdominal discomfort, nausea, fatigue followed by jaundice.
5. GENITAL HERPES – Caused by Herpes Simplex Virus (HSV). Vesiculopustular
lesions followed by clusters of painful erythematous ulcers over external genitalia and
perianal regions, vaginal and urethral discharge and swelling of lymph nodes are some
common symptoms.
6. GENITAL WARTS – Caused by Human Papilloma Virus (HPV). Symptoms include
benign, hard outgrowths with horny surface (warts) over the skin and mucosal surface of
external genitalia and perianal area.
7. CHLAMYDIASIS – Caused by Chlamydia trachomatis. Chlamydia is an obligate
intracellular pathogen. It causes trachoma, nongonococcal urethritis and other diseases.
8. TRICHOMONIASIS – Caused by Trichomonas vaginalis. Affects both male and
female. In females, it causes vaginitis with yellow vaginal discharge and burning
sensation characterized by a foul odour. Males are generally asymptomatic, however at
times a burning sensation occurs during urination.

29. MEASURES
TO
PREVENT
STDs
Avoiding
prostitution
or multiple
coitus
Use of
condoms
Consult
doctor if
required
Health
education
INFERTILITY
• DEFINITION – Inability to conceive or produce children even after
two years of unprotected sexual co-habitation.
• CAUSES – Physical, congenital diseases, drugs, immunological or
even psychological.

30. ASSISTED REPRODUCTIVE TECHNOLOGYIES
(ARTs)
• Infertile couples are assisted to have children by certain special techniques
collectively called ARTs. This includes the following –
1. Test-tube baby/ In vitro fertilization
2. GIFT – Gamete Intra Fallopian Transfer
3. ICSI – Intra Cytoplasmic Sperm Injection
4. AI/ AIT – Artificial Insemination/ Artificial Insemination Technique.

31. 1. TEST – TUBE BABY
• DEFINITION – The technique of in-vitro fertilization (IVF) and in-vitro
development followed by the embryo-transfer (ET) in the uterus of the normal
female to start the development and finally leading to normal birth, is called
TTB.
• First attempt – Italian scientist – DR. PETRUCCI. Embryo survived – 29
DAYS.
• First test tube baby was born to LESLEY & GILBERT BROWN on July 25,
1978, Oldham, England.
• The world’s 1st test tube baby (a girl) was named LOUISE JOY BROWN.

32. • India’s first test tube & world’s second test
tube baby was born on 3rd Oct, 1978 in
Kolkata. The girl was named KANUPRIYA
AGGARWAL & was created by Dr.
Subhash Mukherjee.
• First officially accepted India’s test tube baby
was HARSHA CHAWDA born on 6th Aug,
1986. she was produced by Dr. Indira
Hinduja of KEM hospital in Mumbai.
#PROCEDURE –
1. Removal of unfertilized ovum
2. Ovum is kept under aseptic conditions.
3. Fusion of sperm and ovum.
4. Zygote is stimulated to develop in-vitro
upto 32-celled stage.
5. Developing embryo is implanted on the
endometrium at 16-32 celled stage.
#SIGNIFICANCE:
1. Boon to infertile mothers.
2. Can be used fro men in oligospermia.
3. Oocytes can be donated.
4. Embryos can be frozen & preserved for 10
years for future use.
*SURROGATE MOTHER.
#IVF –ET TYPES – ZIFT; IUT

34. • Technique employed for females with
prolonged sterility.
• Useful when fimbriae fail to capture
the ovum or females having sperms
antibodies in their cervical secretion.
• This includes transfer of washed
sperms and harvested ova to the
ampulla of the oviduct with the help of
laparoscope.
2. GAMETE INTRA-FALLOPIAN
TRANSFER (GIFT)
3. INTRA-CYTOPLASMIC
SPERM INJECTION (ICSI)
• Sperm is injected into the cytoplasm
of the ovum in culture medium &
then zygote or embryo is transferred
in the fallopian tube or uterus of the
female.
• It is mainly employed when male
suffers from oligospermia or
azoospermia.

35. • Technique followed when either male
partner fails to inseminate or suffers from
oligospermia.
• Semen of the male partner is collected,
concentrated and introduced in the vagina
of the female.
• If the collected semen – uterus – INTRA –
UTERINE INSEMINATION (IUI).
• If the donor of the semen is husband, then
it is called ARTIFICIAL
INSEMINATION HUSBAND (AIH).
4. ARTIFICIAL
INSEMINATION (AI) #DRAWBACKS
• TTB technique is not possible in women
with damaged uterine wall.
• Extremely high precision, specialised
professionals are required along with
expensive instrumentation, so available in
only few centres of the country.
• Have raised several ethical and legal
problems, emotional, religious and moral
issues in the society.
• Disadvantage – low success rate of IVF-
ET.

36. THANK
YOU