# Chapter 18 Reproductive Health by TEACHING CARE online tuition and coaching classes

Chapter 18 Reproductive Health by TEACHING CARE online tuition and coaching classes

## Introduction.

History of man is only about 50,000 years old. In the course of human history there have been three major explosions, each corresponding to a major changes in the environment. The first population explosion occurring about 20,000 years ago. It was brought about by the use of tools that allowed improvement in hunting and food gathering methods. The second revolution occurred about 6,000 years ago, and was brought by improvements in farming. The third revolution was brought about 300 years ago and was caused by improvement in food production, industry and medicine. If the present birth rate is maintained, it is stated that only one square feet of the earth surface will be available per one person within the next 700 years.

Definition : The term population refers to the total number of individuals of the same species occupying a particular geographic area at a given time. This definition of population was given by Clark in 1954.

Demography : The scientific study of human population is called demography. It deals with

• Change in population e. growth or decline in population.
• Composition of population e. age groups, sex ratio etc.
• Distribution of population in

Census : Census is an official count of the people of a country, state, or district, with statistics as to age, sex, employment, education, etc. In India census started in 1891, and, since then, it has been conducted uninterruptelly every ten years. Census is conducted as per the provision made under the census Act, 1948, as amended.

## Population Dynamics.

• Population density : Population density is the number of individuals present per unit area or volume at a given time. For instance, number of animal per square kilometer, number of trees per area in a forest, or number of plank tonic organism per cubic meter of If the total number of individuals is represents by letter N and the number of units of space by Letter S, the population density D can be obtained as D=N/S. Space is indicated in two dimensions (m2) for land organisms, and in three dimensions (m3) for aquatic organisms and for the organisms suspended in space.
• Birth rate or Natality : The birth rate of a population refers to the average number of young ones produced by birth, hatching or germination per unit time (usually per year). In the case of humans, it is commonly expressed as the number of births per 1000 individuals in the population per

The maximum birth rate of a species can achieve under ideal environmental conditions is called potential natality. However, the actual birth rate under the existing conditions is much less. It is termed realised natality. Crude birth rate is the number of births per 1000 persons in the middle of a given year i.e. on July. Natality increases the population size (total number of individuals of a population) and population density.

• Death rate or mortality : The death rate of a population is the average number of individuals that die per unit time (usually per year). In humans it is commonly expressed as the number of death per 1000 persons in a population per year. Lowest death rate for a given species in most favourable conditions is called potential mortality, while the actual death rate being observed in existing conditions is called realized mortality. Crude death rate is the number of deaths per 1000 persons in the middle of a given year e. on July. Mortality decreases the population size and population density both.

### Difference between Natality rate and Mortality rate

 Character Natality rate Mortality rate (1) Definition Number of births population per year. per 1,000 individuals of a Number of deaths population per year. per 1,000 individuals of a (2) Population density Increases population size and population density. Decreases population size and population density.

• Vital index : The percentage ratio of natality over mortality is known as vital index e. natality / mortality

×100. It determines the growth of a population.

• Immigration : It is permanent entry of additional person into the existing population of a country or region from out Example; Many Nepalese and Chinese come to settle in India.
• Emigration : It is the permanent departure of some persons from the existing population of a region to a different state or a foreign Example; Many Indians go to Western countries to settle there.

Immigration and emigration bring about redistribution of population, and are common in animals. These occur for various reasons, such as search for food, escape from competition due to overcrowding, need of shelter etc.

• Sex ratio : The number of females in a population per 1000 males is called sex ratio.

Sex ratio = No. of females

1000(males)

• Age structure : The age structure of a population is the percentage of individual of different ages such as young, adult and old. Age-sex structure of a population can be shown by a pyramid-like diagram by plotting the percentage of population of each sex in each age-group. Figure shows the age-sex structural pyramids for India over the 20-year period from 1971 to These pyramids show that Indian population may still take many years to be

stabilized.

Age 70+

Females 60-69

(A)

Percent of population

(B)

Fig : Comparative age-sex pyramids for India : (A) Year 1971 (B) Year 1991

• Age distribution : The relative abundance of the organisms of various age groups in the population is called age distribution of With regard to age distribution, there are three kinds of population.
• Rapidly growing or Expanding population : It has high birth rate and low death rate, so there are more number of young individuals in the
• Stationary or stable population : It has equal birth and death rates, so population shows zero population

• Declining population : It has higher death rate than birth rate, so the population of young members is lower than that of old members g. Japan (Ageing population) .

Human population has three age groups : Pre reproductive, Reproductive, and post reproductive.

Postreproductive

Reproductive

Prereproductive

Expanding population

Stable population

Declining population

### Factors affecting the age composition

• Number of infants below one year of age and the older people as these have higher mortality rate than individuals of other age
• Proportion of reproductive active males and females in a
• Number of females in active reproductive age (i.e. between 15 to 44 years)
• Change in Population Size and Growth Rate : Whether a population grows, declines or maintains it size depends upon the balance between the above factors:

The above expression in words may be represented in a simple way by a mathematical model. suppose N = population size and t = time. The Greek letter delta, D , indicates change. We can now represent change in

population as D N, and time interval as Dt . The verbal equation can be written as DN/Dt=(B+I) – (D+E) in which

B is absolute number of births in the population during the time interval, and D =the absolute number of deaths during that interval; I means immigrant and E, emigrants. I and E , being insignificant, may be ignored. Then the equation simplifies to DN/Dt =B-D.

Migration is a two-way movement of a population for adjusting to seasonal changes. It occurs in some fishes (Anguilla, an eel), birds (Siberian crane), and mammals (fur seal). Migration is not considered a determinant of population size.

Annual average growth rate is the percentage of increase in population size per year. It can be calculated with the help of following equation :

æ P2 – P1 ö

Where P1= Population size of previous census. P2= Population size of present census.

N= Number of years between the two census.

## Growth of Human Population.

Population growth refers to the increase in its size. It is determined by the number of individuals added to the population and the number of individuals lost from the population. Addition occurs by births and immigration. Loss results from deaths and emigration. If more individuals are added than are lost i.e., the vital index is more than 100, the population will increase or show positive growth. If more individuals are lost than are added i.e., the vital index is less than 100, the population will decrease or show negative growth. If addition and loss are balanced, i.e., the vital index is 100, the population will become stationary or show zero growth.

• Malthus Theory of Human Population Growth : Thomas Malthus, a British political economist, put forward a theory of human population growth in 1778. Malthus in his “Essay on the principle of population” pointed out that population tends to increase in geometric progression while food supply increase only in arithmetic Faster growth of population than of its requirements causes an imbalance between the two. When this imbalance reaches a certain limit, environmental factors like famine, epidemic of a disease, earth quake, flood, war etc reduce the population to a size, the available resources can support. The factors that control the population size were called positive checks by Malthus.
• Natural Control of Population Growth : Growth of a population is controlled by an interaction between three factors : biotic potential, environmental resistance and carrying capacity of
• Biotic or reproductive potential : Biotic potential is the natural capacity of a population to increase at its maximum rate under ideal environmental conditions and stable age and sex The biotic potential for all animals is very high. If unchecked, the numbers of any species will quickly over run the world. Biotic potential in the human female is estimated to be about 12 per female during its reproductive period between the puberty and the menopause period.
• Environmental Resistance : In nature full biotic potential of an organism or population is never realized, since conditions are rarely Various harmful environmental (abiotic) factors like non-availability of food and shelter, natural calamities like drought, cloud bursts, floods, fires, temperature fluctuations, accidents, etc. and certain biotic factors like pathogens, parasites, predators etc. check the biotic potential from being realized. The sum of all these inhibitory factors is called environmental resistance. Thus, actual increase is the balance between biotic potential and environmental resistance. Thus environmental resistance does not allow population growth so soar towards infinity.
• Carrying capacity : It is defined as “Feeding capacity of an environment of an ecosystem for a population of a species under provided set of conditions”. It is also defined as the “Level beyond which no major increase can occur”. This limit is a constant and represented by K. When a population reaches the carrying capacity of its environment, the population has zero growth rate. So the population generally stabilizes around the carrying The carrying capacity of the earth for human population is considered to be about 8 to15 billions. Carrying capacity of the environment for a population depends upon three major components :
• Productive systems which produce food and fibre g. croplands, orchards, etc.
• Protective systems which buffer air and water cycles

and keep moderate environmental temperatures e.g. ocean etc.

• Assimilative systems which utilize the wastes produced by human activities g. waterways, wetlands, etc.

Productive system and protective systems collectively form the life-supporting capacity, while assimilative systems collectively form the waste assimilative capacity.

• Population fluctuations and population cycles : The populations are not stable and do change due to a number of extrinsic as well as intrinsic factors. These variation in the population size are of two types :

Biotic potential           curve (J-shaped)

Time

Environmental

resistance        Carrying capacity

Stabilized population level

Population growth curve (S-shaped)

• Population fluctuations or irruptive variations : In these changes, population density tends to fluctuate irregularly above and below some steady-state These are

Fig : The theoretical relationships between biotic potential, environmental resistance and carrying capacity

characterized by sudden increase in population in short time which is followed by equally quick decrease in population size. These are caused by random seasonal or annual changes in availability of resources (food or energy) or extrinsic factor (e.g. temperature, rainfall etc.) e.g. more birds during early summer due to their hatching period, more insects during summer months and more weeds in rainy season.

• Population cycles : These are regular changes in the population size. In these, population size is nearly constant over long period of time. These are caused by seasonal changes in environment e.g. population cycles (of 3 to 4 years) of lemmings of Tundras (Elton, 1942) Lemmings (Lemmus lemmus) (small mouse-

Irruptive fluctuations Cyclic fluctuation

Time

Carrying capacity

like rodents found in arctic regions of Canada and Norway) increase in their number for a period of about 3 years when it reaches a peak

Fig : Cyclic and irruptive fluctuations in

populations

beyond the carrying capacity of that area. They eat up all the available food. In the winter months, the lemmings migrate in large numbers in the sea and swim till they are drowned due to exhaustion. The surviving lemmings multiply and repeat the process.

• Patterns of Population Growth : Growth of a population can be expressed by a mathematical expression, called growth curve in which logarithm of total number of individuals in a population is plotted against the time Growth curves represent interaction between biotic potential and the environmental resistance.

### Two basic types of growth curves :

• Sigmoid or S-shaped growth curve : It is shown by yeast cells and most of organisms. It is formed of five phases :
• Lag phase. In which the individuals adapt themselves to the new environment, so there is no or very little increase in
• Positive Acceleration It is the period of slow increase in population in the beginning.
• Logarithmic or Exponential phase : It is the period of rapid rise in population due to availability of food and requirements of life in plenty and there being no
• Negative Acceleration phase : In which again there is slow rise in population as the environmental resistance
• Stationary (Plateau) phase : Finally, growth rate becomes stable because mortality and natality rates become equal to each other. So there is zero growth rate. A stable population is said to be in equilibrium, or at saturation level. This limit in population is a constant K and is imposed by the carrying capacity of the environment. S-shaped curve is also called logistic Sigmoid growth curve was described by Verhulst, (1839)
• J-shaped Growth curve : It is shown by small population of Reindeer experimentally reared in a natural environment with plenty of food but no It has only two phases:
• Lag phase : It is period of adaptation of animals to new environment so is characterized by slow or no growth in
• Logarithmic or Exponential phase : It is characterized by rapid growth in population which continues till enough food is But with the increase in reindeer population, there is corresponding decrease in the availability of food and space, which finally become exhausted, which leads to mass starvation and mortality. This sudden increase in mortality is called population crash. Lemming of Tundra, some insect, algal blooms and annual plants also show J-shaped curves. The population growth curve is S- shaped in most of the organisms, Human population also shows S-shaped curve.

# Reproductive Health

Fig : The S-shaped growth curve of yeast cells

Fig : The J-shaped growth curve of reindeer

### Difference between S-shaped and J-shaped Growth curves.

 S.No. S-shaped Growth Curve J-shaped Growth Curve (1) It is formed of 5 phases : lag phase, positive acceleration phase, exponential phase, negative acceleration phase and stationary phase. (1) It is formed of 2 phases : lag phase and exponential phase. (2) Finally the population shows zero growth rate as birth rate equals death rate. (2) Finally, the population shows a population crash due to rapid increase in mortality rate. (3) Examples. Yeast cells in a culture medium. (3) Examples. Reindeers, algae blooms, lemmings of Tundras
• Human Population Growth Curve : The modern man (Homo sapiens sapiens) appeared about 25,000 years ago. For a very long time, the human population remained in the lag phase, having little or very slow growth. By the year 1 D., there were about 0.25 billion people in the world, and by 1600 about 0.5 billion. Thus, it took 1600 years for the population to become double. The exponential phase of growth of the human population started about 1750. Since then, the time taken by the population to become double has considerably shortened. It doubled in 200 years (1600-1800 A.D.), becoming 1 billion; then doubled in 130 years (1800-1930 A.D.), growing to 2 billion; then doubled in only 45 years

(1930-1975 A.D.), reaching about 4 billion.

At present, the world human population grows at a rate of 2 percent a year, and it has now reached 6 billion. If the present growth rate persists, there would be 8 billion people on earth by the year 2017.

World population gain is 2 persons every second; 200,000 people every day; 8 million every month; and 70 million every year. The high rate of growth is often referred to as “population explosion” The word “explosion” may be defined as a rapid and expansive change of state.

The future of human population is difficult to predict. It may stabilize and have S-shaped growth curve or decline rapidly and have J-shaped growth curve. The population will stabilize if the birth and death rates are balanced in the near future. It will rapidly decline if it overgrows the carrying capacity of the environment.

Fig : Projected world population growth rate between 1950 and 2050 (based on United States census bureau, international data)

### A demographic cycle is formed of 5 stages

 (a) First stage (High stationary) High birth rate and high death rate. Population stationary. India till 1920. (b) Second stage (Early expanding) Declining death rate but high birth rate. Many countries in S. Asia and Africa. (c) Third stage (Late expanding) Declining birth and death rates but still birth rate higher than death rate. India, China and Singapore. (d) Fourth stage (Low stationary) Low birth rate and low death rate. Population stationary. Austria (with zero growth rate during 1980- 85) Denmark, Sweden, Belgium etc. (e) Fifth stage (Declining) Birth rate lower than death rate. Germany and Hungary.

a      Total population b        Death rate

c       Birth rate

Stages    1                      2                      3                 4

Time

Fig : Different stages of the demographic transition

1. High birth rate but fluctuating death rate
2. Declining death rate and continuing high birth rate
3. Declining birth and death rate
4. Low death rate but fluctuating birth rate

Population Trends in the world and India.

### (i) Population Trends in the World

The distribution of human population is not uniform throughout the world. Only about one third of the total land area is inhabited. Of the inhabited areas, some are thickly populated, others sparsely. This depends upon the availability of the requirements of life. About 56% of the total world population resides in Asia alone. Bangladesh is the most thickly populated country, and Australia, the most thinly populated.

### Annual Birth, Death and Growth Rates for Human Population in 1973

 S. No Region Population (Millions) Average Annual Birth Rate per 1,000 Individuals Average Annual Death Rate per 1,000 Individuals Annual Growth Rate Percent (1) World 3860 33 13 2.0 (2) Developed Countries 1120 17 9 0.8 (3) DevelopingCountries 2740 39 14 2.5

Birth and Death rates in selected countries in 1979

 S.No. Country Birth Rate Death Rate (1) Sweden 11.6 11.0 (2) England 13.0 12.1 (3) Japan 14.6 6.0 (4) Canada 15.5 8.3 (5) USA 15.8 8.7 (6) China 18.0 6.0 (7) India 35.0 13.6 (8) Bangladesh 45.7 14.2 (9) Pakistan 45.7 14.2

### (ii) Population Trends in India

• Population : India with a population of 1027 million as 2001 census stands second in the world. The world leader in the matter of population is China with a population of 1160 India has only 2.42% of the world’s land area but supports over 15.5% of the world’s population. Thus, one in every 6 persons in the world is an Indian. India’s population has been steadily rising since 1921. However, from the year 1921, often called the “big divide“, its population started to swell up sharply. India’s population has increased 3 times since independence (1947) when its population was 340 million. About 1800 individuals are born every hour, 17 million every year. India’s population crossed one billion (100 crores) mark on May 11, 2000.
• Sex Ratio : Sex ratio is defined as the number of females per thousand males in a country or Sex composition is affected by three factors : (i) differentials in male-female ratio at birth, (ii) differentials in mortality conditions of males and females, and (iii) sex-selective migration. India is one of the few countries where the males

are more than the females. There has been a steady decrease in the female population since 1901 except during the period 1971-81 when there was some increase. There are at present 531,277,078 males and 495,738,169 females in our country. The sex ration is 933 females per 1,000 males. In Kerala, there are 1058 females per 1000 males, highest sex ratio among the states, In Daman & Diu, there are only 709 females per 1000 males. In Haryana, there are 861 females per 1000 males, lowest sex ratio among the states.

• Literacy Rate : The literacy rate was 28% according to the 2001 census. It was 76.40 % for males and 54.16% for females. The literacy rate has been steadily increasing since 1951. Among the Union Territories, Lakshadweep has the highest literacy rate of 87.52%. Literacy rate is highest in Kerala (90.92%) and lowest in Bihar (47.53%). Any person who can read and write with understanding in any language is recorded as literate in census. All children below 7 years are shown as illiterate in the census.

### (d)  Factors Favouring Population Growth

• Decrease in death
• Increase in average life
• Better medical
• Control of insect vector’s of fatal diseases and
• Better
• Proper care of new-born children and their
• Better nutrition and life
• Protection against wild life and adverse whether through living in

### Details of India’s Population of 1981, 1991 and 2001

 Data 1981 Census 1991 Census 2001 Census Rise/ Fall Population : Total 683,329,097 843,930,861 1,027,015,247 + Males 364,214,409 437,597,929 531,277,078 + Females 319,114,688 406,332,932 495,738,169 + Decennial Population Growth : Absolute 135,169,445 160,601,764 183,084,386 + Percentage 24.66% 23.50% 21.34% – Annual Population Growth Rate 2.46% 2.35% 2.13% – Population Density per square Kilo metre 216 267 324 + Sex Ratio 934 Females Per1000 Males 929 Females Per1000 Males 933 Females Per1000 Males + Literacy Rate : Total 43.56% 52.11% 65.38% + Males 56.37% 63.86% 75.85% + Females 29.75% 39.42% 54.16% +

Density of Population India, 1901-2001                            Sex Ratio (Females per 1000 Males) In India, 1901-2001

 Year Density per Km2 Year Sex Ratio 1901 77 1901 972 1911 82 1911 964 1921 81 1921 955 1931 90 1931 950 1941 103 1941 945 1951 117 1951 946 1961 142 1961 941 1971 177 1971 930 1981 216 1981 934 1991 267 1991 927 2001 324 2001 933

### Percentage Age Groups in India

 0-14 Years 15-59 Years 60 plus Years 1970 42 54.5 3.5 1980 40 54.8 6.2 1990 36 57.5 6.5 2000 31.7 60.8 7.6

Parameters of 2001 census

• Population………………………… 015

(+183 million)

Males =531.277 million Females = 495.738 million

• Population density………………….. 324 persons/sq. (+60 persons/sq. Km.).
• Sex ratio………………… 933 F : 1,000
• Absolute decennial population growth…………………………… +183 million.
• Percent decennial population growth………………….. 34%(-2.52).
• Literacy rate……………………… 38%(+13.27%).
• Male literacy……………………. 85%.
• Female literacy……………….. 16%(+14.74%).
• Birth rate……………….. 26 per 1,000.
• Death rate……………. 8 per 1,000.

Other Information about Census 2001 :

• Most populous state of India = Uttar Pradesh (166 millions) (18.17%).
• Second Most populous state of India = Maharashtra (95 millions).
• Least populous state of India = Sikkim (5.40 lakh).
• Most densely populated state of India = West Bengal (904 persons per Km.).
• Second most densely populated state of India = Bihar (880 persons per Km.).
• Least densely populated state = Arunachal Pradesh (13 persons per Km.).
• Union territory with maximum population density = Delhi (9,294 persons per Km.).
• Union territory with minimum population density = Andaman and Nicobar (43 persons per Km.).
• State with highest Decennial population growth = Nagaland (64.41%).
• State with lowest Decennial population growth = Kerala (9.42%).
• Average life expectancy in India = 64
• Sex ratio in Kerala state = 1,058 F :1,000
• State with highest literacy rate = Kerala 92% (94.2% in males and 88% in females).

### Important Tips

National Population Policy-2000 : Main objective

• Aims for population stabilization by 2045 D.
• Compulsory school education upto 14 years of
• Reduction of infant mortality rate from the current 72 per 1,000 live births to 30 by
• Reduction of maternal mortality rate from 407 per 100,000 live births to
• Reduction of TFR from 3 to 2.1 by 2010.
• To promote delayed marriage for girls, not earlier than age 18 preferably after age
• 100 per cent registration of births, death, marriage and even
• Promotion of small family norms
• A people-centered family welfare
• Promoting the two-child
• Freeze on current Lok Sabha strength to be extended from 2001 to
• Facilities for safe abortion to be
• Strict enforcement of Child Marriage Restraint Act and Pre-Natal Diagnostic Technique
• A National Commission of Population chaired by the Prime Minister has been announced to guide and implementation of the

First Human Development Report (April, 2002) :

• Best stated to live in : Kerala (1); Punjab(2); Tamil Nadu(3); Maharashtra(4) and Haryana(5).
• Human development index improved by 3% a year from 1993-94 to Urban-rural disparities declined.
• Percent of people below the poverty line declined from 5% in 1983 to 36% in 1993-94.
• Gender equality index moved from 62% in the 1980s to 67.6% in the 1990s.
• Kerala has been declared as the “First baby-friendly state of world”.
• In 1991-2001 decade, Andhra Pradesh achieved the sharpest decline in the annual growth rate of population (from 2.2 per cent in 1981 –91 to 3 per cent).

• In India, Tamil Nadu and Karnataka state have attained replacement levels of
• Government of India is planning to introduce a Bill in Parliament to make education upto eight standard
• In India, marriageable age is 18 years for female and 21 years for

## Methods of Birth Control.

Meaning : The regulation of conception by preventive methods or devices to limit the number of offspring is called birth control.

Methods : A variety of methods are known for birth control. The birth control methods which deliberately prevent fertilization are referred to as contraception. These methods are of 2 main types : temporary and permanent.

• Temporary Methods : These are further of many types –
• Safe Period (Rhythm Methods) : A week before and a week after menses is considered the safe period for sexual The idea is based on the following facts-
• Ovulation occurs on about the 14th day (may be 13 th to 16th day) of
• Ovum survives for about 1-2
• Sperms remain alive for about 3

This method may reduce the chances of pregnancy by about 80 percent. However, a great care is needed in its use. Rhythm method is also called natural family planning. It is also termed temporary abstinence because it requires refraining from sexual intercourse when conception is most likely, i.e., a few days before and a few days after ovulation. Changes in cervical mucus and body temperature during the menstrual cycle mark the ovulation time. Thus, the natural family planning requires adequate knowledge of these physiological signs. Some couples use the natural family planning method of increase the chances of conception so that unplanned pregnancies are avoided.

• Coitus Interruptus : This is the oldest method of birth control. It was in use over 2,000 years ago. It involves withdrawal of the penis from the vagina by the male before ejaculation so that semen is not deposited in the vagina and there is no fertilization. This method also has some drawbacks. Male produces some lubricating fluid from his Cowper’s glands before This fluid contains many sperms. A lapse in timing or willpower may result in late withdrawal and hence pregnancy.
• Spermicides : Foam, tablets, jellies, pastes and creams, if introduced into the vagina before sexual intercourse, adhere to the mucous membrane and immobilise and kill the These contain seprmicides such as lactic acid, citric acid, boric acid, potassium permanganate and Zinc sulphate.
• Mechanical Means : These are of 3 types :
• Condom (Nirodh) is a thin sheath, usually made of rubber, to cover the erect It is the most widely used contraceptive by males in India as it is cheap and easily available. It is given free also by government. It checks pregnancy by preventing deposition of semen in the vagina. Condom should be used regularly and put on before starting coital activity, otherwise sperm-containing lubricating fluid may be left in the vagina. Condom should be discarded after a single use. Condom is also a safeguard against infection of AIDS and sexual diseases.
• Diaphragm and cervical cap are dome-shaped rubber plastic covers that are fitted on the cervix in the female’s vagina, and check the entry of sperms into the uterus. These must be kept fitted for at least six hours after

sexual intercourse. They are smeared with a spermicidal jelly or cream each time they are used. The diapharm and cervical cap are the counterparts of condoms in the female

• Intrauterine devices (IUDs) are plastic or metal object placed in the uterus by a These include loop, copper-T, spiral, ring, bow, shield, etc. They prevent the fertilization of the egg or implantation of the embryo. Their presence perhaps acts as a minor irritant and this makes the egg to move down the Fallopian tubes and uterus rather quickly before fertilization or implantation. Drawbacks of IUDs include their spontaneous expulsion, even without the woman’s knowledge; occasional haemorrhage; perforation of uterus; tubal pregnancy (implantation of the embryo) in the oviduct; and chance of infection. Use of mechanical contraceptives have pregnancy rates of less than 10%.
• Physiological (Oral) Devices : Birth control pills (oral contraceptives) check ovulation by inhibiting the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that are necessary for ovulation. Hence, no eggs are released in a woman on the pill and conception cannot The birth control pills have side effects such as nausea, breast tenderness, weight gain and break-through bleeding (slight blood loss between menstrual periods) and high blood pressure. On the other hand, the oral contraceptives reduce the chances of certain types of cancer to occur in their users. A combined pill is the most commonly used birth control pill. It contains synthetic progesterone and estrogen in doses high enough to check ovulation. Pill Mala D is taken daily, and the pill Saheli is taken weekly. Oral contraceptives have pregnancy rates less than 1%. Birth control pills are likely to cause cardiovascular problems.
• Other Contraceptives : Certain contraceptives, such as progestin minipill, are implanted under the skin of the upper arm. They prevent pregnancy for 3 to 4 years. They steadily release a tiny amount of progestin into the Injectable one- month contraceptives are made in Germany, Maxico and China. These are marketed to many countries.
• Abortion : Abortion is the medical termination of pregnancy (MTP) before the foetus becomes viable. It is one of the most widely used methods of fertility control in Certain pills act as abortants. They function by inducing menstruation which checks the implantation of the zygote or detaches the implanted egg. There are movements against abortion practically all over the world. A drug named RU-486, an analogue of progesterone, developed in France terminates pregnancy within the first few weeks, It blocks the progesterone receptors in the uterus, thereby preventing progesterone from maintaining pregnancy.
• Abstinence : The best and 100% reliable way to avoid conception is to abstain from sexual intercourse. It is an unnatural mode of birth control, and seems Some couples practice abstinence at certain times with success.
• Permanent Method : Sterilization provides a permanent and sure birth control. It is called vasectomy in man and tubectomy in woman. It involves the removal of a short segment of each vas deferens or oviduct and tying up of the remaining ends tightly with surgical thread. The operations are minor, usually performed under local anesthesia, give very little discomfort, and do not affect the sexual life. Contrary to common belief, man with vasectomy is still capable of ejaculation, but the latter consists only of secretions of various glands, and has no sperms are still produced but reabsorbed into the body. Production of testosterone continues and its distribution does not need the ducts.
• Laparoscopy : Now a telescopic instrument called laparoscope is used in tubal ligation. This blocks the fallopian Eggs continues to be produced because the ovaries are intact, but they fail to pass into the uterus and sperms fail to reach the eggs for fertilization.

• Most Effective Birth Control : Sterilization is at present the most effective means of birth control. It is difficult to
• Extent of Contraceptive Use : According to a UN report in the Tribune dated 24.8.87, half of the world couples use contraception and one in three chooses,
• Medical Advice : The birth control measures should be used with the guidance of qualified The government provides these facilities free at the family planning centres. Contraceptives are given free or at nominal prices at these centres to the couples of reproductive age desirous of preventing conception.
• Advice for Fertility : The couples who are not getting children can also seek advice and remedy at the family planning
• Abortion or Medical Termination Pregnancy (MTP) : has now been legalised in
 S. No Method Action (1) Rhythm method No intercourse during woman’s fertile period (day 12-20). (2) With drawl Penis is withdrawn before ejaculation. (3) Tubectomy / Tubal ligation Woman’s fallopian tubes are cut and tied, permanently blocking sperm release. (4) Vasectomy Man’s vasa deferentia are cut and tied permanently blocking sperm passage. (5) Intrauterine device (IUD) Small plastic or metal device placed in the uterus, prevents implantation. Some contain copper, other release hormones (6) Oral contraceptive Synthetic estrogens and progesterones prevent normal menstrural cycle; primarily prevent ovulation. (7) Male condom Thin rubber sheath on erect penis collects ejaculated semen. (8) Female condom Plastic pouch inserted into vagina catches semen. (9) Diaphargm Soft rubber cup covers entrance to uterus, prevents sperm from reaching egg and holds spermicide. (10) Cervical cap Miniature diaphragm covers cervix closely, prevents sperm from reaching egg and holds spermicide. (11) Foams, creams, jellies, etc. Chemical spermicides inserted in vagina before intercourse, prevent sperm from entering uterus. (12) Implant ( Norplant) Capsules surgically implanted under skin, slowly release hormone that blocks ovulation. (13) Injectable contraceptive (Depo-Provera) Injection every 3 months of a hormone that is slowly released and prevents ovulation.

## Amniocentesis.

• Aim : It is a technique to determine :
• Sex of the developing
• Genetically controlled congenital
• Metabolic disorders in

So amniocentesis is a pre-natal diagnostic technique.

• Procedure : It involves following steps :

• Location of the foetus is determined by a technique called sonography (using high frequency ultrasound waves) to prevent accidental damage to the
• A fine hollow needle is passed through the abdominal and uterine wall of a pregnant female (about 14th to 15th week after conception) into the amniotic
• A small amount of amniotic fluid is It contains foetal skin cells and a number of proteins, especially enzymes. The cells can be cultured in vitro for further examination.

Placenta

Uterine wall

Amniotic cavity

Amniotic fluid withdrawn

Fig : Amniocentesis

### (iii) Significance

• Sex determination : The somatic cells of foetal skin drawn with the amniotic fluid are stained to determine the presence of sex chromatin (barr body). Presence of barr body indicates that the developing foetus in female as female is with 2 X-chromosomes out of which one X-chromosome is active, while other X-chromosome is heterochromatised into a darkly stained barr
• Congential disease : By Karyotypic studies of somatic cells, abnormalities due to changes in chromosome number like Down’s syndrome, Turner’s syndrome, Klinefelter’s syndrome can be determined.
• Metabolic disorder : By the enzyme analysis of amniotic fluid, different types of inborn metabolic disorders like phenylketonuria, alcaptonuria etc. can be detected. These inborn errors are caused by the absence or inactivity of specific enzymes due to gene So with the help of amniocentesis, if it is confirmed that the child is likely to suffer from some incurable, congenital defect, the mother can go for abortion.
• Drawback : However, these days, the amniocentesis is being misused also. Mothers even get their normal foetus aborted if it is a female. This is just equivalent to killing of a normal child. So Govt. of India enforced the Pre- natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, since January 1, 1994 under which all genetic counselling centres and laboratories are required to apply for The violation of this Act can bring a fine of Rs. 50,000 and imprisonment for two years. The doctor’s registration is also cancelled till the complaint is disposed of.
• Chorionic Villus Sampling (CVS) : Amniocentesis is possible without a chance of injuring the foetus with the needle only after the sixteenth week of pregnancy. At this time, abortion is not A new technique, named Chorionic Villus Sampling (CVS), can be done during the eighth to tenth week of pregnancy when abortion

is safe for the woman. For CVS, cells are sucked into a catheter passed through the cervix. CVS technique provides a mass of rapidly dividing foetal cells, thus facilitating the examination of chromosomal disorders.

## Test Tube Babies.

The technique of in-vitro fertilization and in-vitro development followed by the embryo-transfer in the uterus of the normal female to start the development and finally leading to normal birth, is called test tube baby.

• History : First attempt to produce a test tube baby was made by a Italian scientist, Petrucci (1959 A.D.). Although, this human embryo survived for only 29 days, but his experiment opened a new filed of biological science. The first test tube baby was born to Lesley and Gilbert Brown on July 25, 1978, in Oldham, England. Mrs. Brown had obstructed Fallopian tubes. Dr.Patiricke Steptoe and Dr. Robert Edward both from England experimented on Mrs. Brown successfully. the world’s first test tube baby (a baby girl) was named as Louise Joy Brown. Later, test tube babies were also born in Australia, United States and some other countries. India’s first test tube baby was born on 3rd October, 1978 in Kolkata. Her name was Kanupriya Aggarwal and was created by Dr. Subash Mukherjee.
• Procedure : It involves the following steps :
• Removal of unfertilized ovum from reproductive tract of a
• Ovum is kept under aseptic
• Fusion of sperm and ovum in a culture medium, outside the female body, to form the
• Zygote is stimulated to develop in vitro upto 32-celled stage.
• Developing embryo is implanted on the endometrium of the uterus at 32-celled stage. So the pregnancy in the woman starts and further development of the child continues in the womb till it is Such a baby called a test tube baby.

### (iii) Significance

• It is boon to infertile
• It can be used for men with Oligospermia (low sperm count).
• Old superior cows can donate

Embryos can be frozen and preserved in an embryo tank for 10 years for future use.

In very rare cases, a surrogate mother may have to be used to bring up in vitro fertilized ovum to maturity. Though biological realization of a test baby is a remarkable achievement, it has raised several ethical and legal problems like the right over the child.

### Important Tips

• China (1234 million) and India (953 million) are two most populous countries; USA (265.8 million) and Indonesia (200.6) come
• India’s population growth rate is about 2% a year and China’s 4%.
• Maximum population growth rate in the world is in Kenya (5.5%).
• Austria has shown a negative growth
• The most thickly populated country of the world is
• Greenland is the most thinly populated country (45/Km2) followed by
• The International Conference of Population and Development (ICPD) was held at Cairo in September
• Mumbai will become the second largest megapolis in the world by the turn of the century with a population of 9 million.

• Tokyo is the largest city with 5 million people.
• The first census in India was carried out in
• In last census Nagaland registered the highest growth rate of 86% while Kerala the lowest, 13.98%.
• The most thickly populated state of India is West Bengal (766/Km2); the most sparsely populated area of the country is Arunachal Pradesh (10 Km2).
• The first district to become 100% literate is Ernakulam in
• The first state to become 100% literate is also
• Chandigarh has the lowest number of females per 1000 males with
• Bihar stood at the bottom with a literacy rate of 48% with Rajasthan being close to it having 38.55 literacy percentage.
• National average of infant mortality rate is 72, where as U.P., It was 86, in Bihar 73, In Rajasthan 85 and In M.P. 89 while that of Kerala is only
• Indian population is a young population, while the population of USA, England, Germany, is ageing population.
• In china, more than 8,000 live for more than 100 years, about 8 million above 80 years, about 20 million above 70 years and about 120 millions people above the age of 60
• Population explosion : Also called Population It is high growth rate of human population.
• Nearly half of the world population is distributed in four countries : China (1120 million), India (844 million-1991 census),USSR(291 million) and USA (251 million).
• World Population Day : 11 (since 1987 when on 11 July on that year, the world population crossed five billion).
• In July, 1997, Indian population was growing at the rate of 16 million per year which means 45,000 per day and 31 per
• Minimal decennial growth is reported from Kerala (13.98%) while maximal decennial growth is reported from Nagaland (58.86%). It was due to better fertility awareness among rural women
• Indian Population Project-VI (IPP-6) ended in March,
• According to revised estimates, if the present trend continues, India will surpass China in 2050 A.D. With population of 2160
• China’s birth rate is 18 births per 1,000 population and its TFR is 2.2 children per Conversely, India’s birth rate and TFR are

30.5 per 1,000 persons and 3.5 per women respectively (1991 census).

• After 40 years of age, contraceptive pills increase the chances of cardiovascular
• Matez Gasper : World’s fifth billion child, a male infant born in Zagreb (Yugoslavia) on July 11,1987.
• Fatima : World’s 6th billion child, a female infant born in Sarajevo (Kosovo) on October 14,
• India till 1920 was in the first stage (high stationary) of demographic cycle but now India has entered third stage (late expanding) of the
• In China, person is considered as of “one year age” at the time of
• Most natural population is an open population in which individuals undergo immigration or emigration, while yeast population in a test tube is a closed population in which individual do not undergo immigration or
• Couple protection rate : Bringing eligible couples under the umbrella of various modes of
• Family Planning Programme was adopted as a National Programme in 1995 A.D. Now it has been renamed as Family Welfare
• Government-sponsored Family Planning Programme was started in India in
• Mirena : A new contraceptive plastic coil coated in copper and is fitted in the uterus. Copper acts as a spermicide while coil releases small amounts of an artificial hormone, gastrogen, which further increase the spermicidal effect of copper. It combines both mechanical and hormonal contraceptive methods and has been found to have more than 99% It is introduced by a German company.

• Central Drug Research Institute (Lucknow) has developed a plant-based spermicidal cream “Consap” from Reetha (Sapindus mukrosii).
• NIm-76 : It is neem-based, pre-coital vaginal contraceptive cream having spermicidal properties. It has been developed by Defence Institute of Physiology and Allied Sciences (DIPAS), New Delhi. It has been found to be safe, non-hormonal and non-toxic with no side Nim-76 punctures the sperm skin causing leakage of cellular contents so preventing the capacitation of sperms. It also has both anti-bacterial and anti-fungal properties.
• Contraception : Method of birth control to check
• Sterilization is the most effective method of birth
• Laparoscope : Instrument to aspirate the oocytes from the ovary for IVF ( In Vitro Fertilization)
• UN Population Award, 1992 was awarded to an Indian Industrialist, R.D. Tata, for his efforts to stabilize Indian population.
• UN Population Award, 1998 : It was jointly awarded to a group of Ugandan Elders (credited to reduce the practice of female genital mutilation) and head of Jamacia’s Family Planning Board
• India’s first test baby was “kanpuriya Aggarwal”. India’s second test tube baby was “Kumari Harsha” She was born on August 6,
• Vas aplasia : Absence of both vasa
• Ogino (1930) : Described Safe period or Calander period to control pregnancy .
• Success rate of test tube baby is less than 20%.
• Literacy rate : 2001 = 38%; 1991 = 52.11%; 1997 =62% (+10%).
• I.F.T. Gametic Intra- Fallopian Transfer is the latest technique to produce the child.
• Gamete-Intra Fallopian tube transfer : Sperm (obtained by masturbation / electro ejaculation) and ovum obtained by laproscopy are injected into the mid part of the oviduct by a separate catheter in a cycling female (in proliferative stage).