Reproductive Health Health Article

Family planning

Couples trying to control the frequency and number of pregnancies can do so through family planning. Women may want to increase their chances of getting pregnant or determine the most infertile times to have intercourse so that they can prevent pregnancy. Women may choose to use barrier methods or oral contraceptives to prevent pregnancy, and men may use condoms.

In "natural family planning," women chart their menstruation and ovulation to determine fertile and infertile periods—but without actually having to use artificial contraception. Typically, women ovulate on the 14th day of their monthly cycle, which is the best time to become pregnant—although a woman is fertile over a range of days because sperm can remain viable inside the genital tract for up to 48 hours. Basal body temperatures and the texture of cervical mucus should be recorded. These data will aid in the determination of the woman's fertile days.

In 1970, President Richard Nixon signed into law Title X of the Public Health Service Act, referred to as "America's family planning program." The program provides funding for low-income women who need contraceptives to prevent pregnancy. The program set a minimum standard of care that requires women to have options among contraceptive methods, and prohibits coercion of women to choose one method over another. Individuals are charged fees for service based on their income and ability to pay. Title X monies do not fund abortions. The program provides for pelvic exams, Pap tests, breast examinations, safe-sex counseling, infertility screening, and referrals to specialized health care when needed.

Professional implications

There is a variety of health disciplines that serves the needs of individuals seeking reproductive health services. Gynecologists treat women seeking services that

include Pap exams, breast exams, and pelvic exams; obstetricians provide medical care for women who are pregnant and planning to carry their babies to term. These professionals can refer women to specialists for further care as necessary—such as radiologists (who perform mammograms and a variety of ultrasound procedures) and oncologists (in cases of possible or confirmed diagnoses of gynecological cancers). In lieu of an obstetrician, a pregnant woman may consult a midwife. Women may also consult their primary care doctors for basic reproductive health questions. Primary care physicians typically can perform routine Pap and pelvic exams and give advice on contraception.

Similarly, men can consult their primary care doctors for reproductive health care. For further problems and follow-up, however, urologists should be consulted.

For other issues related to reproductive health—particularly those of an emotional nature—licensed social workers, psychologists, psychiatrists, and sex therapists may be helpful.

KEY TERMS

Azoospermia—In infertile men, it refers to the lack of sperm being produced.

Cervix—The lowest part of the uterus that connects the vagina to the uterus.

Contraceptives—Devices or medications designed to prevent pregnancy by either suppressing ovulation, preventing sperm from passing through the cervix to fertilize an egg, or prevent implantation of a fertilized egg.

Diaphragm—A barrier form of contraception that is a flexible, dome-shaped device with a rim that blocks sperm from passing through the cervix.

Endometriosis—The presence and growth of functioning endometrial tissue in places other than the uterus that often results in severe pain and infertility.

Epididymis—Elongated cordlike structure along the posterior border of testes.

Fallopian tubes—Tubes that are part of a woman's reproductive system that extend from the uterus to the ovaries and carry a fertilized egg to the uterus for implantation.

Infertility—When a person is unable to perform the function of reproduction because of a physical, mental, or hormonal problem.

In vitro fertilization—When an egg is fertilized by sperm outside of the body.

Oligospermia—Low sperm count in men.

Ovulation—The discharge of a mature ovum, or egg, from the ovary.

Prostate—A gland made up of muscular and glandular tissue that surrounds the urethra at the bladder in men.

Testes—Male gonads; the paired egg-shaped glands normally located in the scrotum where sperm develop.

Urethra—Membranous canal through which urine is released from the bladder to the outside of the body.

Vas deferens—The tube cut in a vasectomy.

BOOKS

Knobil, Ernst, and Jimmy D. Neill, eds. Encyclopedia of Reproduction, Volumes 1-3. San Diego, CA: Academic Press, 1998.