Demography and Family Planning

1. Demography and Family Planning Dr. Pracheth R, Assistant Professor, Community Medicine, Yenepoya Medical College

2. Outline • Demographic cycle • Birth and death rates • Growth rates • Sex ratio • Age pyramids • Dependency ratio • Urbanization • Fertility and related statistics • Population explosion

4. Maximum carrying capacity

5. Population explosion • India: 1,210,193,422 • Projected: 2025> China • Sudden, rapid increase : population size • Two main causes • Birth rate> death rate • Fertility rate falling but still higher> developed

6. Social factors: population explosion • Early marriage, universal marriage • Poverty, illiteracy • Male bias • Beliefs • Illegal migration

7. Effects of population explosion • Unemployment • Manpower utilization • Decreased production, increased costs • Burden: health care services

8. Population doubling time and population pressure • Time required for a population to double itself • The population pressure is due to: • Dramatic increase in population • High densities in different parts of the world This gives rise to disparity in resource availability 15% of the population controls resources of 85% of world’s population

9. Demography meaning • Scientific study: human population • Changes in population size • Composition of population • Distribution • Census, vital events registration

10. Demographic cycle • First stage- High stationary • High birth rate, death rate • Cancel ; stationary • India: in this stage-1920 • Second stage-Early expanding • Death rate decline, birth rate unchanged • South Asia, African countries

11. Continued….. • Third stage-Late expanding • Death rate declines further • Birth rate tends-fall • Birth>death-population grows • India • Fourth stage-Low stationary • Low birth, death rate • Stationary population- zero population growth • US, UK, Austria, Denmark, Sweden

12. Continued….. • Fifth stage-Declining • Birth rate less than death rate • So declines • Germany, Hungary

14. Birth and death rates • Crude birth rate: 20/1,000 population • Crude death rate: 7/1,000 population • Birth rates decline: • Government attitude • Education • Contraception services • Change in marriage patterns

15. Continued…. • Death rates decline: • Infant and child mortality reduced • Immunization • Diarrhoea, ARI treatment

16. Growth rates • CDR-CBR • Excludes migration • Railway trains • Slow, motion-time to bring: control • Mass and inertia=age distribution, marriage customs, cultural, social factors • 95%: developing countries • One-third: < 15-enter reproductive age group

17. Sex ratio • Number of females/1,000 males • Sex ratio at birth-India: 943, child: 919 • Female deficit syndrome

18. Causes: declining sex ratio • Male-child preference • Female infanticide, foeticide • Girl child neglect: higher mortality • Maternal mortality • Male bias: counting population • Easy availability: sex determination, abortion services • Solution??

19. Population/age pyramid • Graphical illustration :distribution of various age groups in population • 2 back-to-back bar graphs, with the population plotted : X-axis, age :Y-axis • Males, females in 5 year age groups

20. India • India: broad base, tapering top

21. Switzerland • Bulge in middle, narrower base

22. Dependency ratio

23. Dependency ratio • Proportion: people above 65 years and children below 15 years • Young age, old age • Use: study demographic burden • Decreases: early stages development-rapid decline: fertility • Rapid decline: child dependency-key factor: development

24. Continued…. • Demographic bonus: • Ratio declines: decline in fertility • Begins to rise: increased longevity • Lead to development • Invest: health care, education in this period- maximum advantage-high economic growth

25. Demographic bonus

26. Demographic burden • Increase total dependency ratio in any period • Mostly : old age dependency ratio • Inevitable: demographic transition

27. Urbanization • Causes: • Industrialization • Social factors: better quality of life, standard of living, education • Employment • Rural-urban transformation

28. Positive effects • Employment • Transport, communication • Education • Standard of living

29. Adverse effects • Slums- diseases • Cost of living • Disintegration : joint families • Crime rates • Stress • Pollution

30. Fertility • Actual bearing of children • 15-45/49 years • High in India: • Universality : marriage • Lower age : marriage • Low literacy • Limited use contraceptives • Beliefs

31. Factors influencing fertility • Age at marriage • Duration: married life • Spacing of children • Education • Economic status • Family planning • Others: customs, beliefs, status: women, industrialization

32. Fertility indicators • Birth Rate: • Simplest • Unsatisfactory • General Fertility Rate (GFR): • (No live births: area, 1 year/ MY female population (15-49 years) same area, year) X 1,000 • Better: denominator • Weakness: not all women-birth

33. Continued…. • General Marital Fertility Rate (GMFR): • (No live births/ MY married female population 15-49 years) X 1,000 • Age Specific Fertility Rate (ASFR): • (No of live births: particular age group/ MY female population: age group) X 1,000 • More precise • Highlights fertility pattern • Age groups eg: 15-19 years, 20-24 years

34. Continued…. • Age-specific Marital Fertility Rate (ASMFR): • (No of live births: particular age group/ MY married female population: age group) X 1,000

35. Continued…. • Total Fertility Rate (TFR): • Average number: children-woman have • Passes through reproductive years bearing children at same rates as women now in each age group. • Sum ASFR X 5/1,000

36. Continued…. • Total Marital Fertility Rate • Gross Reproduction Rate (GRR): • Avg no girls would be born to woman • If experiences: current fertility pattern-reproductive span • 5X ASFR for female births/1,000

37. Continued….. • Net Reproduction Rate (NRR): • No of daughters a newborn girl bear in lifetime • Assuming fixed age-specific fertility and mortality rates • NRR=1: small family

39. Family Planning

40. Outline • Definition • Objectives • Scope • Health aspects • Small family norm • Eligible, target couples • Couple Protection Rate

41. Definition Expert Committee 1971: • Way of thinking, living-adopted voluntarily • Upon basis : knowledge, attitude, responsible decisions by individuals, couples • To promote health and welfare of family • Overall social development of country

42. Objectives • Avoid unwanted births • Bring wanted births • Regulate intervals between pregnancies • Control time in which birth occurs in relation to parents age • Determine number of children in family

43. Scope of family planning services • Proper spacing, birth limitation • Advice on sterility • Education for parenthood • Screening –pathological conditions related to reproductive system (cervical cancer) • Genetic counselling

44. Continued…. • Premarital consultation, examination • Carrying out pregnancy tests • Prepare couples for arrival of first child • Provide services-unmarried mothers • Provide adoption services • Teach nutrition, home economics.

45. FETAL HEALTH WOMENSHEALTH INFANTS AND CHILDHEALTH Health aspects of family planning

46. Health aspects of family planning • Women’s health: • Pregnancy damages mother’s health • Risk increases after 3-4 children • Family planning improves health through: • Avoid unwanted pregnancies • Limit number of births and proper spacing • Timing of births

47. Continued… • Foetal health: • Congenital anomalies (Eg: Down’s syndrome): increasing maternal age • Avoided: timing births in relation to mother’s age • Quality of population improved : avoiding unwanted births

48. Continued… • Child health: • Child mortality: • Repeated births , rapid succession • Birth intervals: 2 to 3 years-reduce child mortality • Birth spacing, family size:

49. Small family norm • Small differences in family size: big difference in birth rate • Objective in India: stabilize population -1,533 million : 2050 • 1970s: Do Ya Teen Bas • 1980s: 2-child norm

50. Current emphasis