This article examines the role of male responsibility and participation in the enhancement of reproductive health in India. Men are recognized to be responsible for the large proportion of reproductive ill health suffered by their female partners. Lack of knowledge, nonavailability of acceptable contraceptives and lack of services with quality of care deter men from sharing the responsibility in reproductive health matters. Misinformation regarding male sexuality and limited availability of scientific data contributed men's less involvement in reproductive health. Thus, various strategies are implemented to increase men's awareness of reproductive health and the accessibility of products and services. These strategies include: 1) increasing contraceptive options for men; 2) supporting women's contraceptive use; 3) improving sexual behavior and safe sex practices; and 4) narrowing the gender gap for better fertility control. Moreover, extensive research is required in order to understand men's perceptions and needs about fertility regulation and sexual behavior as well as services development.
India's population has crossed one billion mark and is continuing to grow by almost 20 million people every years. In view of the large diversity in the perceptions and needs of people in India, no single fertility regulation research strategy will probably be effective across the country. The fertility regulation research programmes should therefore be linked to the potential user's perceptions and needs. Increase in contraceptive options by introducing existing methods and developing newer more effective and safer methods backed by service delivery system with appropriate quality of care is essential to curtail the burden of reproductive ill health. Tailored information, education and communication programmes promoted through interpersonal and mass media communication can help dispel the myths and disbelieves about the available fertility regulating technologies and help increase awareness and eventually the acceptance of the available methods and services. A multidisciplinary comprehensive approach integrating various components of reproductive health might be a better option rather than an isolated focus on fertility regulation with an intention of improving the contraceptive prevalence rate. Various initiatives have, been taken by the Government as well as non-governmental agencies to confront the alarming rise in population growth. However, there is no time for complacency. Modern fertility regulating methods still remain unavailable to more than 35 million couples in India. Any further delay in controlling the high fertility rate and meeting the large unmet need for contraception may be too late to ensure better quality of life for the coming generations.
This paper examines the contributions of scientists in the field of contraceptive research and development during the 50 years of independence in India. The empowerment of couples in controlling their fertility by choice rather than by chance is the main goal of their contraceptive research and development. Their main contribution includes evaluation and amelioration regarding the safety, efficacy, and acceptability of contraceptive methods, and development of new methods for fertility regulation. The contraceptive methods being used include vasectomy, oral contraceptives, and long-acting methods. Moreover, they also proposed a hypothesis with regards to reproductive processes that lead to the development of newer technologies. Thus, their achievements over the past 50 years have enriched the field of contraceptive research and product development.
Oral contraceptive agents (OCs) have been a part of the family planning package in India for a number of years, but their acceptability, particularly in low income groups, is quite poor. Clinical trials show a continuation rate over 6 to 12 months of less than 25% to 50%. Recent studies suggest that poor motivation and the inconvenience of having to remember to take a pill daily, rather than biomedical and physiological factors, are the major factors responsible for the discontinuation from OC trials. The interactions between OCs and nutrition are broken down to: 1) the effects of OCs on nutrition status; 2) the effects of malnutrition on some of the well documented and other side effects of OCs; 3) the effects of malnutrition on metabolism of contraceptive steroids and contraceptive efficacy; and 4) a 3 way interaction between malnutrition, disease, and drugs used in the treatment of these diseases. Experiments with rats show that OCs alter the vitamin economy by increasing the cellular requirement for the vitamins by selective increments in specific binding proteins, or apoenzymes, rather than tissue depletion. In a recent special Programme for Research in Human Reproduction (WHO), nutritional status did not appear to have any significant effect on compliance, contination rates, pregnancy rates, prevalence of menstrual side effects, or prevalence of nonspecific symptoms in any of the 3 Indian centers. Overall, data suggest that use of low dose formulations of OCs over a period of 1 year does not significantly alter the existing state of malnutrition in women in developing countries. Although malnutrition does modify the pharmaco-dynamics of contraceptive steroids, the dose of hormones in the contraceptive preparations are adequate to maintain effective blood levels of the hormones. Therefore, OCs can be used by malnourished women for short-term spacing, provided there is adequate education and clinical support to ensure regular tablet taking and for screening women to whom OC use in contraindicated.
The role of population movement on the persistent transmission of malaria in Rameswaram Island was studied. Majority of the inhabitants of the island are fisherman, who engage in perennial fishing. They move from one to the other for fishing and stay in temporary camps depending on season and fish availability. Such seasonal fishing camps attract fisherman from the mainland coastal villages also. The parasitological and entomological studies carried out in these places reveal that some of the camps are highly vulnerable to the movement of individuals with malaria infection and highly receptive. Rameswaram being a holy place, receives pilgrims from all over India and Nepal. Plasmodium falciparum cases recorded from the pilgrims of North India indicate the danger of the possible introduction of chloroquine-resistant parasite in the island. Also, a large number of passengers in transit from various countries, many of which are at risk of malaria transmission, stay in the island before or after visiting Sri Lanka. Such population movements being a continuous and regular feature are significant and result in failures in the operational programmes.
Studies on the effects of vasectomy on hormone levels and accessory reproductive organ function in man have shown that there are no significant alterations in the levels of serum LH and FSH (Wieland, Hallberg, Zorn, Klein & Luria, 1972; Johnsonbaugh, O'Connell, Engel, Edson & Sode, 1975; Varma, Varma, Johanson, Kowarski & Migeon, 1975) or testosterone (Bunge, 1972; Wieland et al., 1972; Johnsonbaugh et al., 1975; Varma et al., 1975), although Smith, Tcholankian, Chowdary & Steinberger (1976) reported a significant increase in plasma testosterone and LH levels 1 year after vasectomy. Kobrinsky, Winter, Reyes & Faiman (1976) found an acute fall in FSH and testosterone concentrations: subsequently, FSH remained below while LH and testosterone returned to the prevasectomy level (Kobrinsky et al., 1976).
