According to the World Health Organisation (WHO), reproductive health means a total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural, and social. India was amongst the first countries in the world to initiate action plans and programmes at a national level to attain total reproductive health as a social goal. These programmes called Family Planning were initiated in 1951. Improved programmes currently in operation are popularly known as Reproductive and Child Health (RCH) programmes. A major task is to prevent the misuse of Amniocentesis (fetal sex determination based on the chromosomal pattern in the amniotic fluid), which is legally banned to check female foeticide. Research on various reproduction-related areas is encouraged; for instance, ‘Saheli’, a new oral contraceptive for females, was developed by scientists at Central Drug Research Institute (CDRI) in Lucknow.

Population Explosion and Birth Control: The world population which was around 2 billion in 1900 rocketed to about 6 billion by 2000. A similar trend was observed in India. The reasons for this explosion include a rapid decline in death rate, Maternal Mortality Rate (MMR), and Infant Mortality Rate (IMR), as well as an increase in the number of people in reproducible age. To check this, the most important step is to motivate smaller families by using contraceptive methods. An ideal contraceptive should be user-friendly, easily available, effective, and reversible with no or least side effects. Contraceptive Methods are grouped into:

• • Natural/Traditional Methods: Work on the principle of avoiding chances of ovum and sperms meeting. Includes Periodic Abstinence (avoiding coitus from day 10 to 17 of the menstrual cycle), Coitus Interruptus (withdrawal), and Lactational Amenorrhea (absence of menstruation during intense lactation, effective up to 6 months following parturition).

  • Barrier Methods: Ovum and sperm are prevented from physically meeting. Condoms (e.g., Nirodh) are barriers for males (penis) and females (cervix/vagina) that also protect against STIs and AIDS. Diaphragms, cervical caps, and vaults are rubber barriers for females. Spermicidal creams/jellies are often used with them.

  • Intra Uterine Devices (IUDs): Inserted by doctors into the uterus. They increase phagocytosis of sperms. Types include Non-medicated IUDs (e.g., Lippes loop), Copper releasing IUDs (e.g., CuT, Cu7, Multiload 375) where copper ions suppress sperm motility and fertilising capacity, and Hormone releasing IUDs (e.g., Progestasert, LNG-20) which make the uterus unsuitable for implantation and the cervix hostile to sperms. IUDs are ideal for females who want to delay pregnancy or space children.

  • Oral Contraceptives: “Pills” are small doses of either progestogens or progestogen-estrogen combinations. They inhibit ovulation and implantation. Saheli is a non-steroidal preparation, taken once a week, with very few side effects and high contraceptive value.

  • Injectables and Implants: Progestogens used alone or in combination with estrogen under the skin.

  • Surgical Methods (Sterilization): Terminal methods to prevent any more pregnancies. Vasectomy is the sterilization procedure in males (a small part of the vas deferens is removed or tied up).

Tubectomy is the sterilization procedure in females (a small part of the fallopian tube is removed or tied up).

Medical Termination of Pregnancy (MTP): Intentional or voluntary termination of pregnancy before full term (induced abortion). Government of India legalized MTP in 1971 with some strict conditions to avoid its misuse. MTPs are considered relatively safe during the first trimester (up to 12 weeks). Second-trimester abortions are much riskier.

Sexually Transmitted Infections (STIs): Diseases transmitted through sexual intercourse (also called Venereal Diseases or VD). Common STIs include Gonorrhoea, Syphilis, Genital herpes, Chlamydiasis, Genital warts, Trichomoniasis, Hepatitis-B, and HIV. Among these, HIV infection is most dangerous. Except for Hepatitis-B, Genital herpes, and HIV infections, other diseases are completely curable if detected early and treated properly. Early symptoms are minor (itching, fluid discharge, slight pain, swelling). Absence of symptoms often leads to complications like Pelvic Inflammatory Diseases (PID), abortions, stillbirths, ectopic pregnancies, infertility, or cancer.

Infertility: The inability to produce children despite unprotected sexual co-habitation. Assisted Reproductive Technologies (ART) include:

• IVF (In Vitro Fertilization): Fertilization outside the body (test-tube baby programme). The zygote or early embryo (up to 8 blastomeres) is transferred into the fallopian tube (ZIFT – Zygote Intra Fallopian Transfer). Embryos with more than 8 blastomeres are transferred into the uterus (IUT – Intra Uterine Transfer).

• GIFT (Gamete Intra Fallopian Transfer): Transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce one but can provide a suitable environment for fertilization.

• ICSI (Intra Cytoplasmic Sperm Injection): A specialized procedure where a sperm is directly injected into the ovum.

• Artificial Insemination (AI): Semen collected from the husband or a healthy donor is artificially introduced into the vagina or uterus (IUI – Intra Uterine Insemination) of the female.