Reproductive health refers to reproductive organs that are healthy and function normally. According to the World Health Organisation (WHO), reproductive health is defined as comprehensive well-being in all areas of reproduction, including physical, mental, behavioural, and social well-being.
India was one of the first countries to implement reproductive health initiatives. In 1951, family planning measures were created to attain overall reproductive health, and these tactics were examined regularly. RCH (reproductive and child health care) programmes are designed to raise public knowledge about various reproductive issues and assist in developing a reproductively healthy society by offering resources and support.
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Reproductive and Child Health- Phase I Program
The abbreviation RCH stands for Reproductive and Child Health. It is a programme initiated in October 1997 to reduce maternal, newborn, and child mortality rates. There was a list of objectives that were aimed at achieving during the first stage of the programme, and they were as follows:
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- To improve policy administration by implementing a participatory design that empowers organisations to make the best use of project resources.
- To improve the current family wellness services’ quality, coverage, and effectiveness.
- To gradually broaden the scope and coverage of services related to family welfare to provide a comprehensive package of RCH help.
- Increase the range of the existing family welfare (FW) wellness programmes to accommodate new components.
- To improve the quality and infrastructure of FW services, preference should be given to rural parts of cities or districts.
The four components included in the RCH phase I program are:
- Family planning.
- Reducing child mortality and safe motherhood.
- Health-care delivery with a client-centred approach.
- RTI, STD, and AIDS prevention and management.
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RCH Phase I Interventions in all Districts
- Immunisation, Vitamin A, and pneumonia prophylaxis are examples of child survival interventions. Vitamin A is provided to all children under the age of five. The first dosage (1 lakh units) is given along with measles vaccination at nine months. The second dose is administered along with DPT OPV booster doses. There is a six-month interval between subsequent dosages (2 lakh units each).
- Antenatal checkups, tetanus immunisation, safe delivery, and anaemia management programmes are examples of safe motherhood interventions.
- Implementation of the target-free strategy.
- At all levels, high-quality training is provided.
- Slums and tribal communities have their RCH package.
- District hospitals have RTI/STD clinics.
- PHC provides a safe abortion facility by providing equipment and contract doctors.
- Panchayats, women’s groups, and non-governmental organisations (NGOs) have increased community participation.
- Adolescent reproductive health and hygiene
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Reproductive and Child Health- Phase II Program
Beginning on April 1, 2005, RCH –Phase II focused on lowering mother and child mortality and morbidity, concentrating on rural health care. Institutional delivery: to promote institutional delivery, the primary initiatives are:
1. Essential Obstetric Care
- Institutional Delivery: Half of the PHC and CHC would be converted into 24-hour delivery centres.
- Skilled attendance at delivery: Guidelines for conducting regular deliveries and managing obstetric difficulties for Auxiliary Nurse Midwife (ANM) and Lady Health Assistant (LHV) in attendance at delivery.
- Policy decisions: ANMs and LHVs can use medications in certain emergency cases to reduce maternal mortality.
- Emergency Obstetric Care
The minimum services provided by fully functional first referral units (FRUs):
- Normal and assisted deliveries are available 24 hours a day.
- Surgical operations, including caesarean sections, are included in Emergency Obstetric Care (EmOC).
- Care for newborns
- Emergency care of sick children.
- Laparoscopic services are available as part of the full range of family planning options.
- Safe abortion services
- RTIs and STIs are treated.
- Storage facility for blood
- Essential lab services
- Transportation (referral) services
New Initiatives under RCH Phase II Program
- Life-saving anaesthetic skills training for MBBS doctors in emergency obstetric care. The Government of India is also implementing obstetric management skills training for MBBS doctors, with a 16-week training schedule in all obstetric management abilities, including caesarean section surgery.
- Establishment of blood storage centres at FRUs in accordance with Indian government norms
- Safe abortion services
- Village health and nutrition day should be conducted once a month to give prenatal and postpartum care and promote institutional delivery, health education, immunisation, family planning, and nutrition programmes.
- Maternal death reviews are conducted to improve the quality of obstetric treatment and reduce maternal morbidity and mortality.
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Other Initiatives Taken by the Government For Reproductive Health Awareness
- Introducing sex education in schools is a helpful step in providing accurate information to teenagers and discouraging them from believing in sex-related myths and misconceptions. Adolescents should be educated on reproductive organs, adolescence and its changes, safe and sanitary sexual behaviours, Sexually Transmitted Diseases (STDs), AIDS, and other topics.
- Married couples or those of marriageable age should be taught about birth control methods, prenatal care, postnatal care of the mother and child, the value of breastfeeding, and equal opportunity for male and female children, among other topics. As a result, healthy families of the desired size will be formed.
- Strong support and infrastructure are required to implement action plans such as providing medical help and care for reproduction-related disorders, pregnancy, delivery, STDs, abortions, contraception, menstruation problems, infertility, and so on.
- Statutory ban on amniocentesis: Amniocentesis is useful for detecting chromosomal abnormalities and developmental issues in the foetus. However, it is being abused to determine the gender of a foetus, resulting in female foeticides. As a result, the statutory ban on amniocentesis for sex determination keeps female foeticides in check.
Birth Control Strategies
Some methods of contraception are:
- Natural or Traditional
- Barrier Methods
- Intrauterine devices (IUDs)
- Oral contraceptives
- Injectable and implants
- Surgical Methods
- Natural Methods:
It is based on principles that prevent sperm and egg from fusing. Natural barriers do not employ chemicals. Thus, there are no adverse effects, yet their success rate is limited, and the chance of failure is high. They aren’t entirely risk-free. Here are some examples:
- Periodic Abstinence
- Withdrawal or Coitus interruptus
- Lactational amenorrhea
- Barrier Methods:
In this procedure, various physical barriers inhibit sperm and ovum fusion.
- Condoms are the physical barriers made up of thin rubber or latex sheath that cover the penis in males, while in the case of females, they cover the cervix. They can also help prevent STDs.
- Females can also utilise additional barriers to protect the cervix, such as cervical caps, diaphragms, and vaults.
- Intrauterine Devices (IUDs):
Intrauterine Devices (IUDs) are medical devices that are put into a woman’s uterus through the vaginal canal with the assistance of a doctor or a nurse. There are several types of IUDs:
- IUDs that are not medicated, such as Lippes Loop.
- Copper-releasing IUDs like Copper-T, Copper-7, and Multiload 375.
- Hormone releasing IUDs such as LNG-20 IUDs emit a hormone similar to Progestasert.
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- Oral Contraceptives:
This procedure involves taking pills that contain a mixture of oral progestogens or progesterone and oestrogen. They are taken for 21 days and are not taken during the menstrual cycle’s first 7 days. They are taken again after 7 days of the menstrual cycle and should only be stopped when the woman seeks to conceive. A new generation of non-steroidal medications called Saheli is used once a week and has minimal side effects.
- Injectable and Implants:
Females can use specific implants or injections that are administered under the skin. These are either progesterone-only or progesterone-and-estrogens combinations. They act similarly to tablets, but for a longer period.
- Surgical Methods:
This method involves surgery interfering with the migration of gametes, failing conception. They are the terminal methods of contraception and are therefore also called sterilisation. In the case of males, sterilisation is known as vasectomy, whereas in the case of females, it is known as tubectomy.
(i) Vasectomy: A small incision in the scrotum is used to sever the Vas deferens of the male reproductive system, which is subsequently tied up.
(ii) Tubectomy: In this procedure, the female reproductive system’s fallopian tubes are cut and knotted using a tiny incision in the abdomen or vagina.
These are very effective contraception methods, but the chances of their being reversed are slim.
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The quality of family planning services must be improved, particularly in imparting information and method selection to prevent an undesired pregnancy. Maternity care should be extended, while preventative services (such as health and sex education for men and women, family planning, and STI prevention) should be expanded. At a social level, measures to improve reproductive health status through education, legislative changes, and cultural changes must be encouraged.