UNIT -7 TOPIC ON Demography and family wefare

3rd GNM PPT

1. Concept Demography is the branch of social size, structure, which deals with the study of size, structure and distribution of populations, along with the spatial and temporal changes in them in response to birth, migration and ageing death .

2. TRENDS IN THE WORLD AND IN INDIA 1800 : 1 st billion 1930: 2 nd billion - 130 years 1960 : 3 rd billion - 30 years 1974: 4 th billion - 15 years 1987: 5 th billion - 12 years 1999: 6 th billion - 12 years 2014 : 7 th billion - 15 years 2025 : 8 th billion - expected

3. 1. Birth and Death rates Birth rate : Decrease affected by: Changes in government attitudes towards growth. Awareness and Education Increased availability of contraception Extension of services through F.P. programme Marked change in marriage patterns

4. Birth rate of WORLD fell gradually from 32.9 per 1,000 people in1970 to 18.2 per 1,000 people in 2019 . Death rate : Decrease affected Better MCH services Successful EPI immunization Diarrheal Disease Control and Acute Respiratory Infection control programme Control of other infectious diseases The death rate for World in 2019 was 7.579 deaths per 1000 people, a 0.44% increase from 2018.

5. 2. Growth rate CBR-CDR= Current Annual Growth Rate GR like train Rating Ann u a l GR% Stationery No growth Slow <0.5 Moderate 0.5-1 Rapid 1-1.5 Very rapid 1.5-2 Explosive 2-2.5>

6. Factors affecting GR: Age distribution, marriage customs, cultural, social and economic factors. Peak around 1970 2.2% Africa, 1.5% Asia, 1.3% Latin America, 0.2% in Europe. 95% in developing countries 1/3 population < 15yrs age group Estimated 10 billion by 2020 Global total fertility rate 2.6% 176 people/ minute

7. DEMOGRAPHIC TRENDS IN INDIA DEMOGRAPHIC INDICATORS : Measurement of Mortality . Measurement of Morbidity. 3. Measurement of disability 4 . Measurement of natality. 5. Measurement of the presence, absence or distribution of the characteristics or attributes of the disease. 6 . Measurement of medical needs, health care facilities, utilization of health services and other health related events. 7 . Measurement of the presence, absence or distribution of the environmental and other factors suspected of causing the disease. 8. Measurement of demographic variables.

8. Demographic Trends in India Rates, Ratios and Proportions Epidemiologists express health events as Rates, Ratios and Proportions Rate : Measures the occurance of some particular event in a population during a given period of time period. It is the statement of the risk of of developing a condition. It indicates the change in some event that takes place in a population over a period of time i t comprises of: 1. numerator, 2 . denominator and 3 . multiplier.

9. Ratio : Expresses a relation in size between two random quantities. (E.g) x : y (or) x/y Proportion : Is a ratio which indicates the relation in magnitude of a part of the whole. Expressed in terms of Percentage. T h e n u m e r a to r i s a lw a y s i n c l u d e d i n th e d e no m i n a t o r . A Proportion is usually expressed as percentage. (Eg) The no. of children with scabies at a certain time. x 100 The total number of children in the village at the same time

10. Demographic Indicators The indicators are specified under 2 classifications Population Statistics: Population size, sex ratio, Density dependency ratio Vital Statistics: birth rate & death rate, natural growth rate, life expectancy at birth, mortality fertility rates .

11. India Land area : only 2.4% of world land area However support 17.5% of world’s population India is now the second most populated country of the world after China. Population of India is 1.37 billion or 1,369 millions in 2019 , compared to 1.354 billion in 2018. Population growth rate for 2019 is projected at 1.08%.

12. 1. a ge & sex composition of India 0-14 yrs : male population is 0.4% more than female 60+ : female population 0.7% more than male Proportion < 14 yrs is showing decline Proportion of elderly > : burden on health services in the country

13. 2. Age at marriage In India there has been a practice of early marriage . In 1955 under Hindu marriage Act, the minimum age at marriage for boys was 18 and for girls were 15years. Later in 1978 the child marriage restraint act was fixed the minimum marriage age for boys 21 and for girls at 18 years. Age at marriage determines the span of reproductive period of a women and ability to produce the number of child

14. 3. Sex ratio : No of females/1000 males Sex composition is affected by -mortality conditions of males and females -sex selective migration -sex ratio at birth -Female deficit syndrome is considered adverse because of social implications

15. Low sex ratio indicates strong male child preference Consequent gender inequities Neglect of girl child resulting in higher mortality at younger age Female infanticide Female feticide Higher MMR The easy availability and accessibility of sex determination may be a catalyst for the same

16. Sex Ratio in India: Females : 48.0% Males : 52.0% Sex Ratio: 1.08(Males to Females) Kerala is the only state with 1,058 females per 1000 males Sex ratio at birth: No.of females per 1000 males Affected by sex selectivity 2014 – 2016 : 898 There is urban - rural difference seen seen Tamilnadu sex ratio is 903: U = 915 and R = 926 Child sex ratio: 0 – 6 years Considerable fall has been seen 1961 = 927 & 2011 = 914

17. 4. Age Dependency Ratio: Total dependency ratio (TDR) = 0-14 years of age + pop. >65 years x 100 population on 15 to 64 years Also called Societal dependency ratio and can be divided as Young age D.R.(0-14), Old age D.R.(>65 years). 50.546 is the TDR (2016)

18. Demographic bonus : connotes the period when the DR in a population declines because of decline in fertility, until it starts to rise again because of increasing longevity. Demographic burden : connotes the increase in the TDR during any period of time , mostly caused by increased old age dependency ratio .

19. 5. Density of the population One of the important indices of population concentration is the density of population. It is defined as the number of persons living per sq km. The population density of India in 2016 was 401.4, 2011 was 382 per sq km as compared to 325 in 2001, 267 in 1991 and 77 in 1901.

20. 6. Urbanization No.of persons residing in urban localities In India urban areas means: towns, places more than 5000 inhabitants, density not less 1000 persons per square mile or 390 per Sq km and atleast 3/4 th of the adult male population are employed in pursuits other than agriculture. according to

21. 1901 census = was 11.4%. 2001 census = 28.53% 2011 census = crossed 30% as per In 2017, the numbers increased to 34%, according to The World Bank, by 2030, 40.76% of country's population is expected to reside in urban areas . Annual urbanization increase is 2.8%

22. Reasons for Urbanisation : Natural growth – through births Migration from villages for employment Attraction of better living conditions Availability of social services such as education, health, transport, entertainment. Continuous migration of people from rural to urban will constitute a social crisis in India, impacting quality of life.

23. 7. Family size The total number of children a woman has borne at a point in time Completed family size: Total number of children borne by a woman during her child bearing age between 15 – 45 years * Family size depends on: duration of marriage, education of couple, the number of live births and living children, preference of male child, desired family size, etc * Two child family norm → long term demographic goal of NRR=1

24. 7.L iteracy and Education 1948: Declaration of human rights stated that everyone has a right to education, yet not realised. Education is a crucial element in economic and social development 1991 census: literacy rate for the population relating to seven years age and above

25. Literate: read and write with understanding in any language Literacy is generally associated with Modernization Urbanization Industrialization Communication Commerce

26. 8. Life expectancy at birth 1 Life expectancy at a given age is the average no.of years which a person of that age may expect to live, according to the mortality pattern prevalent in that country.

27. Life expectancy at birth has been increasing globally. In India it was ……………. 1. 1901 : 23.63 & 23.96 2. 2001 : 63.9 & 66.9 3. 2011 : 64 & 67 4. 2017 : 67 males and 70 females.

28. Concept of fertility and infertility “ Infertility ” is a term used to describe the inability of a couple to get pregnant or the inability of a woman to carry a pregnancy to term. Infertility is defined clinically as not being able to achieve pregnancy after 1 year of having regular, unprotected intercourse, or after 6 months if the woman is older than 35 years of age . Fertility is refers the ability to produce viable offspring is the actual bearing of children.

29. Concept of fertility It helps to build their family Develop awareness about reproductive system and how conception occurs. Parent must show interest taking in time investigation They should involve in the treatment programme Pregnancy can be achieved by IVF.

30. FACTORS AFFECTING FERTILITY age at marriage Duration of married life Spacing of children Education Economic status Caste and religion Nutrition family planning Other

31. Infertility concept Determining the partners age trying to conceive and inappropriate timing of intercourse to ovulation No previous pregnancy should have smoking and BMI should be normal Both male and female are cause No intake of drugs and alcohol Avoid laptops on their lapse They must have health sexual intercourse Weight reduction They should have positive attitude

32. Small family norm The family plays a very important role in the health welfare of not only individual , family and community. Small family norm connotes control over the number of children

33. NATURE OF SMALL FAMILY NORMS The main motive behind small family norms is to control the population of the particular country.

34. ADVANTAGES OF SMALL FAMILY NORMS IN POPULATION CONTROL Advantages for Mother Small family norms help to maintain the health of the mother. It also helps to minimize the fear of unwanted pregnancy. Small family norms minimize the number of children and it helps to lessen strain and worry that arises from having many children . It helps the mother to give more time and energy to her children. It also helps the mother to spend more time on the education and vocation of her children. Small family norms provide better job opportunities to the mother as she is then free from family problems that exists in large families. Small family norms help the mothers to save the health of children.

35. 2) Advantages to Child: Child will have conducive atmosphere for his proper physical and psychological growth and development. Child gets proper nutrition, education, prenatal care and love . 3 ) Advantages to Father: Father can provide children with better education, comfort, food, clothing and recreation. He will be more relaxed and enjoy good health. He will improve living standards, better health and better quality of life.

36. 4) Advantages for Community: Small family leads to conservation of natural resources and savings. Small family norm helps the nation to have enough schools, hospitals and other basic services. Small family yields more employment. Small family norms provide happiness, peace, harmony and prosperity among the people of a nation

37. BARRIERS OF SMALL FAMILY NORMS Religious Barriers Preference for Son: In Indian society, desire or preference for a son is deeply rooted. The son is a religious necessity as he performs last rites of the parents believed to be necessary for the salvation of the soul. The son is also old age insurance to the parents. God Given Children : There is a religious belief among some sections of the society that it is the will of God that has bestowed children to them.

38. 2) Demographic Barriers: Early Marriage : Early marriage is prevalent in our society. Child marriage contributes to virtually every social problem that gives India a low ranking in women’s right. Lack of Adequate Knowledge of Family Planning Methods: Contraceptive use is very low among married couples in India. Main reason behind this is lack of proper knowledge about family planning methods. Large Family system: For a long time, large family system provided facilities for the care and bringing up of children. Couples saw safety in large families. This also hampers the norm of small family

39. 3 ) Economic Barriers: Low Standard of Living : This is another barrier of small family norms. Low standard of living encourages particular section of people to indulge in sex play as entertainment. Backward Agricultural Economy : In India, which practiced agriculture of the traditional type for a number of decades, a large number of children were considered as an advantage. Even if a few of them did not survive beyond ten to fifteen years, certain functions of economic nature like tending cattle or carrying out simple tasks in the fields could be fulfilled by the younger ones.

40. 4) Educational Barriers: literacy of Masses: Lack of mass literacy has been undoubtedly an important factor in having large families. Without adequate literacy and education, people remain unacquainted with the benefits of increased knowledge. They believe in superstitions and sometimes think that large families are the gift of God. They become fatalists. Neglect of Girls’ Education : Lack of girls’ education create different problems while adopting small family norms. As most women have no knowledge about family planning due to lack of education, they pose an obstacle in the fulfilment of the dream of small family norms.

41. 5) Recreational Barriers: Lack of Means of Entertainment: A substantial section of people for years have remained without adequate recreational facilities. More Leisure Time: Main occupation of nearly 70% of Indian population is subsistence agriculture. Agriculture is unable to provide employment throughout the year. Thus there is lot of leisure time at their disposal. The easiest time pass for them has been to occupy themselves in sexual activities, resulting in large families .

42. Family welfare

43. Definition Family welfare including not only planning of births but the welfare of whole family by means of total family health care.

44. National family welfare programme Launched officially in 1952, by the Union Ministry of Health & Family Welfare, Govt. Of India.

45. H i s t o r y Started in year- 1951 In 1977 the government of India redesigned the “National Family Planning Programme” as the “National Family Welfare Programme” India is the first country in the world that implemented the family welfare programme at government level

46. Concept of family welfare Related to quality of life As such it includes Education, Nutrition, Health ,

47. C o n t . . Employment, Women’s welfare and Rights, Safe Drinking Water All Vital Factors Associated With Concept Of Welfare

48. Aims and Objectives To promote the adoption of small family norms To promote the use of spacing methods To supply of contraceptives To arrange for clinical & surgical services Participation of voluntary organization/local leaders/ local self government

49. G o als Reduction of birth rate Reduction of death rate Raising couple protection rate Reduction in average family size Decrease in infant mortality rate

50. Importance

51. importance Family welfare reduces maternal, perinatal and infant mortality and morbidity. It enables the parents to do their best for their children’s welfare. It leads to socioeconomic progress of the country.

52. Family welfare method

53. M e t h o d T e m p o r a r y P e r ma n e n t

54. Barrier method Female- Tubectomy Natural contraception Male- Vasectomy Temporary Permanent Intrauterine contraceptive device (IUCD) Steroidal contraception

55. Temporary method Barrier method Mechanical Use of mechanical Male – condom Female- condom D ia p h r a g m, cervical cap C h e mi c al method Creams Jelly Foams tables and chemical both

56. Male Condom - Most common and effective barrier method. made of Latex and Polyurethane used in the prevention of pregnancy and spread of STI’s (including HIV) Mechanical method

57. Advantages: easily available Safe and inexpensive Do not require medical supervision No side effect Disadvantages : Failure rate due to incorrect uses

58. Female Condom: The pouch made up of Polyurethane, which lines the vagina. It is 17 c.m in length with one flexible polyurethane ring at each end .

59. Diaphragm: the diaphragm is a vaginal barrier. It was invented by the German physician in 1882. Also known as “DUTCH CAP” . Made up of synthetic rubber or plastic material. It range in diameter from 5 -10 cm . A spermicidal jelly is always used along with the diaphragm. The diaphragm is inserted 3 hours before sexual intercourse and must remain in place for not less than 6 hours.

60. C h e m i c al Spermicidal – Available as vaginal foams gels, creams, tablets & suppositories usually they contain surfactant like- nonoxynol-9, octoxynol or benzalkonium May cause sperm immobilisation

61. Vaginal Sponge : it is a small polyurethane foam sponge measuring 5 cm ×2.5 cm, with the spermicide. The sponge is far less effective than the diaphragm.

62. Natural method 1. Rhythm method Recording of previous menstrual cycle Noting the basal body temperature chart Noting excessive mucous vaginal discharge Breastfeeding ,lactation amenorrhea Coitus interruptus

63. Intrauterine contraceptive devices There are two basis types of IUD : Non medicated and Medicated.

64. First Generation IUDs: The non medicated devices. They appeared in different shapes and size : loop, spirals, coils, rings. i.e. Lippes Loop : is double –S shaped device made up of polyethylene, a plastic material that is non toxic , non tissue reactive and extremely durable.

65. Second Generation IUDs: tried in 1970’s by adding to the IUDs. It was found that metallic copper had a strong anti- fertility Earlier devices: Copper -7 Copper T- 200 (4 year) Newer devices: T devices i)Cu -T 220 ii)Cu -T 380 (10 year ) Nova T Multiload devices i)ML- Cu- 250 (3year)

66. Third Generation IUDs: hormonal device LNG- 20 is a T shaped IUD releasing 20 mcg of Levonorgestrel (LNG)(a potent synthetic steroid)

67. Mechanism of Action: IUD causes a foreign- body reaction in the uterus causing cellular and biochemical changes in the endometrium and uterine fluids, and it is believed that these changes impair the viability of the gamete and thus reduces its chances of fertilization. Copper has got additional local ant fertility effect

68. Time of insertion Interval Postabortal Postpartum Post placental delivery

69. Method of insertion 2 steps Preliminaries Actual steps Technique – “No- touch” method

70. Advantages : Simplicity Insertion takes only few minutes Inexpensive Once inserted IUD stay in place as long as required Contraindications: Risk of Ectopic pregnancy Require motivation Vaginal bleeding of undiagnosed etiology Ca cervix, pelvic tumors

71. Steroidal contraception O r a l P a r e nt e r a l D ev i ce Combined p r e p a r a t i o n Single p r e p a r a t i o n Injectables I m p la n t IUD Vaginal ring T r a n s d e r m al patches

72. Combined oral contraceptive pills . Combined pill : Combined pill contain no more than 30-35 mcg of a synthetic estrogen, and 0.5 to 1 mg of a progestogen. MALA- N and MALA- D (Levonorgestrel 0.15 mg and Ethinil oestradiol 0.03 mg)

73. Progestgen – only pill (POP) : This pill is commonly referred to as “minipill” or “micropill”. It contain only progestogen.

74. Injectable DMPA- Depomedroxy Progesterone acetate Route- Intramuscular with in 5 days of the cycle Dose- 150 mg every 3 month 300 mg every 6 month NET-EN (Norethisterone enantate) : IM dose of 200 mg every 60 days. DMPA – SC 104 mg : 3 month interval Once -a- month combined injectables

75. Implant Subdermal implant : Implants are placed in the body, filled with hormone that prevents pregnancy plastic capsules the size of paper matchsticks inserted under the skin in the arm 99.95% effectiveness rate Norplant I vs. Norplant (R)II Six capsules (35 mg ) each Three years Two capsules Five years

76. Emergency contraception Post- coital contraception : recommended within 72 hours of an unprotected intercourse. Two methods are available: IUD: insertion of copper device within 5 days. Hormonal : levonorgestrel 0.75 mg tablet is approved for the emergency contraception. (1st tab. Within 72 hours and 2nd tab. After 12 hour of first dose.)

77. Permanent method Male – Vasectomy Female- Tubectomy

78. V a s e c t o m y Methods – No-scalpel vasectomy Percutaneous vasectomy Open ended vasectomy

79. T ub e c t o m y There are 2 method Abdominal Vaginal Abdominal – Conventional Minilaparotomy

80. A. Conventional (laparatomy) steps Using a lapraoscope through the abdomen, fallopian tubes are located and are blocked by a fallop ring or a rubber ring, so that ovum can not reach the uterus.

81. Technique- Pomeroy’s method Uchida technique Irving method Madlener method Kroener method

82. Pomeroy’s method

83. U c h i d a

84. B. Minilaparotomy an incision of 2.5 to 3 cm is performed in lower abdomen and a part of fallopian tubes is cut and tied .

85. 2. Vaginal ligation

86. Concepts of counseling counseling is a face-to-face communication with the client or couple in order to help them arrive at voluntary and informed decisions.

87. D e f i n i t i o n Family planning counseling is defined as a continuous process that the counselor provide to help clients and people to make and arrive at informed choices about the size of their family (i.e. the number of children they wish to have).

88. Types of Family Planning Counseling Individual counseling : 7/31/2020

89. Couple counseling :

90. Group information sharing :

91. General principles of counseling Privacy — find a quiet place to talk. Take sufficient time. Maintain confidentiality. Keep it simple. Say it again .

92. Stages of counseling for family planning General counseling Method-specific counseling Return/follow-up counseling

93. Steps in family planning counseling GATHER approach G — Greet the client A — Ask the clients about themselves T — Tell them all about family planning methods H — Help them to choose a method E — Explain how to use a method R — Appoint a return visit for follow-up

94. Factors influencing family planning counseling outcomes Factors related to counselor Factors related to the client External/programmatic factors 7/31/2020

95. FAMILY WEFARE POLICY

96. NATIONAL WELFARE PROGRAMME

97. ROLE OF NURSE IN FAMILY PLANING PROGRAMME