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Straight Answers


 
World Population Gender and Population
What is Demographic Transition? What needs to be done to reduce maternal mortality?
Why are developing countries slow in achieving demographic transition? How is antenatal care important for mother and child survival?
   
India and Population Child Health and Population
What is meant by population stabilisation? Why are so many children born with low birth weight in India?
Why is the population increasing so fast even when the average number of children per woman is decreasing?
What are the factors that influence population growth?
     
Sex Ratio and Population Contraception and Population
What does the sex ratio of a country indicate? What is contraception?
Why is there concern about falling sex ratio in the 0-6 age group? What is the pattern of contraceptive use of "method mix" in India?
What is being done to prevent sex selective abortions? Why have we not been able to bring about a change in the contraceptive behaviour of people in spite of our mass media campaigns?
Does a decrease in the number of women enhance their position? Why is the use of spacing methods so low in India?
What's wrong with preferring a male child? Why is spacing of births important for population stabilization?
How is the preference for a son an impediment to population stabilisation? How can spacing methods be promoted?
Why is it that fewer couples opt for male sterilization?
If people prefer a particular method over others what is wrong in promoting that method on a large scale?
Why do some groups oppose the introduction of injectable contraceptives in India?
 
Development and Population Youth and Population
Is population a development issue?  Why do we need to focus on youth? Doesn't reproductive health start at marriage?
Can we focus on development and let population grow unchecked? Does giving sex education to adolescents encourage sexual promiscuity ?
How does increase in age at marriage affect population stabilization?
   
Poverty and Population HIV/ AIDS and Population
Is sterilizing people an option? Why should we focus on HIV/ AIDS issues in population programme?

How do we reach out to tomorrows parents?
India has 348 million people in the 15-34 age group. This large base, however, has limited opportunities for attaining their full potential because of skewed social and economic development. The youth in India demand opportunities to develop skills, pursue education and gain employment. This should be the focus of all our development efforts not only in urban agglomerations but also in rural India, where a majority of Indians live.

Will these young people raise families like previous generations, when contraceptive choices were limited and health services were poor, or will they be informed and empowered people to adopt a path which moves toward population stabilisation? The challenge lies in ensuring that these 348 million draw the benefits of health and contraceptive services because they will decide the rate at which India's population will grow in the future.

The concern should also be to reach out to the 0-14 age group with nutrition, health care and primary education because they represent the foundations of the future. Investments made in good time in formative years will run the long haul to make for an informed and educated citizenry.

World Population

What is Demographic Transition?
"Demographic transition" is a model that describes population change over time. It defines four clear stages of population growth that nations often traverse in tandem with their socio-economic development.

Stage 1: Typically seen in less developed countries where birth rates are high but a large number of people die of preventable causes leading to a stable population.

Stage 2: Death rates fall steeply as deaths from preventable causes are reduced by better food supply and improved public health, but birth rates remain high due to high fertility, poor social development and limited access to health and contraceptive services. This often leads to a spurt in population.

Stage 3: Birth rates fall but population continues to grow because there are a large number of people in the reproductive age group due to the high fertility of the previous generations.

Stage 4: Countries achieve a stable population once again with low birth and low death rates but at a higher level of social and economic development. Population is stable but higher than in stage one.

This transition from a stable population with high mortality and high fertility to a stable population with low mortality and low fertility is called demographic transition. India is currently at the third stage.

Why are developing countries slow in achieving demographic transition?

Developing countries are slow in achieving demographic transition because of historical reasons. It the developed world, the industrial revolution in the 1800s led to overall development and prosperity, resulting in lower death and birth rates. The developing world missed these opportunities which have been attributed to colonisation, and the attendant lack of growth. Endemic poverty, low levels of education, and weak family planning programmes have kept the average number of children born to each woman to more than six in many parts of the developing world. This prolonged phase of high population growth has resulted in a large base of young population which imparts high momentum to population growth and prolongs the period of demographic transition.

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India and Population

What is meant by population stabilisation?
Population stabilisation is a stage when the size of the population remains unchanged. It is also called the stage of zero population growth. Global population is said to be stabilizing when births equal deaths. However, in the case of individual countries, movement of people into and outside the country is also taken into account. Country level population stabilisation occurs when births plus in-migration equals deaths plus out-migration.

For population stabilisation, a person must die for every one who is born. But when there are more young couples starting families than older people dying, the population continues to grow. This is called population momentum.

Thus, there is often a gap of a few decades between achieving replacement level fertility (two children per couple) and population stabilisation. India has set itself the goal of attaining replacement levels of fertility by 2010 to achieve the larger goal of population stabilisation by 2045 - a gap of 35 years to account for population momentum.

Why is the population increasing so fast even when the average number of children per woman is decreasing?
India continues to add about 18 million people per year because more than 50% of the population is in the reproductive age group. It is this large base of young people which imparts momentum to the growth of population. Also, the number of people entering the reproductive age group increases by the year due to the high birth rate of the previous years.

Population momentum can be checked by delaying marriage and child bearing, and by spacing births.

What are the factors that influence population growth?
Natural increase denotes the difference between the number of births and deaths. The country has seen declining death rates but the birth rates remain high; birth rates are high due to two factors. The first is unwanted and unplanned fertility - children who are born because of lack of poor access to contraceptive services, also known as the "unmet need". The birth of three and above three children accounts for 45% of the 26 million births that take place each year.

Second is the desire for larger families (called "wanted fertility") because of socio-cultural reasons, particularly preference for a male child and high infant mortality. This accounts for 20% of births.

More significantly, the momentum brought in by the young age profile of the population spurs growth. This phenomenon will continue to add large numbers to India's population in the coming decades.

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Sex Ratio and Population

What does the sex ratio of a country indicate?
When men and women have near equal chances for survival, there are bound to be near-equal number of males and females in society. In India, however, the female population is much lower than the male population due to higher mortality among females, particularly during their reproductive span.

The sex ratio in the Indian population has been falling consistently. From 972 women per 1,000 men in 1901, the sex ratio fell to 933 women per 1,000 men in 2001. This is a cause for concern as it is a telling indicator of the health and social status of women in society, which has a direct and immediate bearing on other key indicators like child mortality.

Sex ratio is also calculated for various age groups, the most important being 0-6 years. An adverse sex ratio here shows that less girls are being born compared to boys and so indicates discrimination against the female foetus - this could be at the time of conception, gestation or delivery. An adverse 0-6 sex ratio also reveals that socio-cultural factors are determining survival chances of the female.

Why is there concern about falling sex ratio in the 0-6 age group?
The fall in the sex ratio for the 0-6 age group is particularly worrisome as it points to increased incidence of pre-birth selection. The easy availability of sex selection procedures and the unethical practice of pre-birth sex selection are responsible for the current situation to a large extent.

The fact that some of the States which fare well on social and economic development indicators also have low 0-6 sex ratio calls for introspection. Six of the States that have recorded the steepest declines are from among the most economically developed ones. These States and Union Territories are Chandigarh, Delhi, Gujarat, Haryana, Himachal Pradesh and Punjab. It is likely that the aggressive promotion of the small family norm without the required community interventions to change the preference for a male child, along with the easy availability of sex selective procedures, could be playing havoc with the birth and survival of female children.

Sex Ratio of 10 Most Populous Countries
World 990
Bangladesh 952
Brazil 1,031
China 943
India 933
Indonesia 1,000
Japan 1,041
Nigeria 990
Pakistan 952
Russian Fed. 1,136
USA 1,031

Source: "World Population Prospects. The 2002 Revision", United Nations Population Division. The World Population Prospects, 2002 report cited here lists India's sex ratio as 943. The figure for India quoted in this table, however, cites the latest Indian census figures.

0-6 Sex Ratio
Chandigarh 845
Delhi 868
Gujarat 883
Haryana 819
Himachal Pradesh 896
Punjab 798
India 927

Source: India Census 2001

What is being done to prevent sex selective abortions?
Sex selective abortions are illegal in India. The Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, was enacted and brought into operation from 1st January, 1996, in order to check female foeticide. Rules have also been framed under the Act. The Act prohibits determination and disclosure of the sex of foetus. It also prohibits any advertisements relating to pre-natal determination of sex and prescribes punishment for its contravention. The person who contravenes the provisions of this Act is punishable with imprisonment and fine.

Recently, PNDT Act and Rules have been amended keeping in view the emerging technologies for selection of sex before and after conception and problems faced in the working of the implementation of the Act. These amendments have come into operation with effect from 14th February, 2003.

Under the Act, a person who seeks help for sex selection can face, at first conviction, imprisonment for a three-year period and be required to pay a fine of Rs.50,000. Medical professionals involved in sex selection can lose their registration and the right to practice, if convicted under the Act. However, officials admit that the Act is difficult to implement because sex selection happens within the confines of doctor-patient confidentiality.

Several Non-Government Organisations are active in fighting pre-birth sex selection. The issue is receiving attention of several health authorities which have begun monitoring clinics and hospital records for evidence of sex selection to mount action against them.

Does a decrease in the number of women enhance their position?
No. India remains a highly patriarchal society where women are marginalised and denied development benefits. The falling sex ratio is a reflection of the existing gender bias.

In some districts with low sex ratios, the adverse impact is already visible with many men not being able to find wives. Practices like polyandry are being reported, as also "bride price" and "bride selling" under which women are "bought"/ "sold" for a price. Thus, in the prevailing social context, a further fall in numbers will only lead to increased violence against women and denial of rights rather than empowerment.

What's wrong with preferring a male child?
Indian society has a marked preference for a male child, both for perceived economic and traditional reasons. Apart from being seen as the rightful and capable heir to family property and name as well as an important means to carry the lineage forward, sons are also seen as providing support to parents in their old age. A male child is also valued for the perceived final salvation of the parents through the performance of their last rites.

Girls are often seen as a burden because of the social evil of dowry that requires parents to spend large amounts on their marriage. Investments in a daughter are thought to be wasteful as she leaves for her husband's home after marriage, and often cannot share earnings with her parents.

Where such a preference exists, parents tend to make more investments in a male child than in the female child, be it on nutrition, health, education or a career. Such discrimination, overt or covert, is bound to limit development opportunities available to the girl child which further reinforces gender bias.

The obsession to have at least one male child places tremendous psychological pressure on women, with many undergoing frequent abortions following sex-determination tests. The felt need, indeed demand, for a male child is also an important trigger for domestic violence, with women bearing the brunt for their perceived "inability" to provide a male child. This is often used as an excuse for bigamy and desertion. Preference for a male child is clearly wrong because it devalues the female child and denies her basic rights for survival, growth and development. Further, male preference takes its toll on women's lives, reinforcing male domination and making it difficult to build a fair, just and equitable society. In such a skewed situation there can be no progress in empowering women to become equal members in society.

How is the preference for a son an impediment to population stabilisation?
Son preference is a major impediment to population stabilisation as it makes couples opt for larger number of children in order to ensure at least one male child in the family.

Son preference is evident in every State. However it is more pronounced in Uttar Pradesh, Rajasthan, Bihar, Haryana, Madhya Pradesh, Orissa and Arunachal Pradesh. These are also the States with high population growth rates. The weakest son preference is found in Tamil Nadu, Kerala, Karnataka and Goa, which are also the States that have achieved or are near achieving replacement level fertility. They also have better male-female ratio and higher female literacy levels. In richer States like Punjab, Haryana and Gujarat, couples are opting for smaller families but male preference leads to sex selection leading to adverse sex ratios.

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Development and Population

Is population a development issue? 
Yes, it is. Population is often seen as an issue of ever growing numbers of people but the fact is that growing numbers merely mirror the lack of social and economic development. Simply put, the lower the levels of socio-economic development, the greater the chances that couples in that group would have more children.

This is best seen in differences in the various States of India. For example, Uttar Pradesh has 56.3% literacy and only 14% of women receive complete antenatal care. Uttar Pradesh records an average of four children per couple, almost double the figure of two children per couple in Kerala, where almost every person is literate and every woman receives complete antenatal care and delivers in a health institution. Thus, Kerala with its advanced social development indices had reached what is called the "replacement level fertility" two decades ago while Uttar Pradesh will take another 20 years to reach that mark, as it continues to have a high fertility rate (TFR 4.4)

Can we focus on development and let population grow unchecked?
No. Since socio-economic development benefits take longer time to percolate, it is important to take steps that would improve people's access to quality health services which have a direct bearing on their reproductive health behaviour. Providing quality health services, which include contraceptive services, to those who do not wish to have children but have no access to methods of family planning (meeting the "unmet need"), would avert as many as 20% of births in India.

Reaching contraceptive services itself has three parts to it - a) counselling covering why, when and how to use a particular method, b) ensuring easy availability and accessibility of the chosen method and c) follow up care to ensure continued and trouble free use of the method.

Alongside, adolescent sexual and reproductive health services need to reach out particularly to young persons to empower them to make informed and responsible decisions regarding their sexual and reproductive behaviour, including the age at which they would like to marry and start a family. This will help the youth to the use of condoms for safe sex and other contraceptive methods for delaying the first child and for spacing subsequent pregnancies.

The goal of child nutrition must be addressed separately. The "mid-day-meal" scheme in schools has increased enrolment as well as improved the nutritional status of children. This has proved to be effective in improving child survival and reduced the desire for larger families.

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Poverty and Population

Is sterilizing people an option?
Any form of coercion is in principle wrong and militates against basic human values and violates human rights. The suggestion that coercive sterilisation is an option flows from a mindset that looks at people as targets rather than as human beings with their own rights and needs.

That apart, experience of some of the Indian States clearly shows that it is possible to achieve replacement levels of fertility without compromising human rights and liberties. A comparison of the fertility decline in China and Kerala shows that Kerala achieved more than China without ever having to adopt any coercive policies. China's Total Fertility Rate (TFR) of 2.8 in 1979 dropped to 2.0 in 1991, while Kerala's TFR of 3.0 in 1979 dropped to 1.8 in 1991. Tamil Nadu had a similar decline from TFR of 3.6 in 1979 to 2.2. in 1991. Easy access to health services and women's education helped the fall in fertility rate in Kerala, while the most important factor in Tamil Nadu was the successful child nutrition support programme with focused interventions to meet contraceptive needs.

One of the most important factors which would bring down fertility levels is to meet the unmet need for contraception. This step can reduce fertility levels by almost 20%. Ensuring child survival can prevent another 20% of births.

The goal of child nutrition must be addressed separately. The "mid-day-meal" scheme in schools has increased enrolment as well as improved the nutritional status of children. This has proved to be effective in improving child survival and reduced the desire for larger families.

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Gender and Population

What needs to be done to reduce maternal mortality?
The first step to reducing maternal mortality is to ensure quality antenatal, natal and post-natal services that identify high risk pregnancies and provide timely support. Safe delivery practices must be ensured through promotion of institutional deliveries and training of birth attendants as well as by making safe delivery kits easily available to women who still deliver at home.

It is also important to strengthen the management of obstetric complications and increase availability of emergency obstetric services. Sensitising family and community members to the danger of obstetric complications, providing community based transport facilities, and ensuring quality emergency obstetric care at the health centres would greatly reduce deaths due to delayed medical attention at the time of delivery.

Adolescent sexual and reproductive health programmes help the youth adopt responsible sexual behaviour, resulting in less number of teenage pregnancies or unwed pregnancies, which often culminate in unsafe abortions in India due to the stigma attached to pregnancies out of wedlock. Providing easy access to safe abortion services would help women terminate unwanted pregnancies without risking their lives. Efficient contraceptive service delivery also goes a long way in avoiding unwanted pregnancies and illegal abortions.

Improvements in the overall health and nutritional status of the girl child and woman are equally important in improving the survival chances of women during pregnancy. The dominant cultural mores and practices often undermine the health and nutritional requirements of a woman. As a result, women are not encouraged to actively seek services often with disastrous consequences. Hence, there is a need to work at the individual, family and community level to bring a change in mindset so that society comes to regard a woman, more so a pregnant woman, as a person deserving the highest priority.

How is antenatal care important for mother and child survival?
Antenatal care covers at least five basic services - pregnancy monitoring, tetanus toxoid vaccine, iron and folic acid tablets (IFA) and nutrition/ safe delivery counselling. These can help women go through the pregnancy safely and ensure that the new born is in good health.

However, many women are not able to access these basic services, resulting in avoidable complications like anaemia, night blindness, babies with low birth weight or delivery related haemorrhage.

The impact of antenatal care on the health and survival of the mother and the child cannot be overemphasized. States which reach out good antenatal care show a marked decline in infant mortality.

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Child Health and Population

Why are so many children born with low birth weight in India?
A baby weighing less than 2.5 kilograms at birth is considered a low birth weight baby. In India, as many as 70% of children are not weighed at birth.

A child's nutritional future begins with a women's nutritional status in adolescence and in pregnancy. Low birth weight occurs because of poor maternal health and nutrition and poor foetal growth. These infants may suffer from infections, weakened immunity, learning disabilities, impaired physical development and, in severe cases, die soon after birth.

A mother chronically undernourished from youth is more likely to give birth to an underweight baby, perpetuating the intergenerational cycle. Inadequate diet or rest, smoking, infections, cultural practices that restrict diet during pregnancy discourage women from gaining weight and long hours of physical labour increase the chances of low birth weight babies.

Timing and frequency of pregnancies are also of great importance, with high risks encapsulated in the phrase "too young, too old, too many or too close".

Inadequate intake of other micronutrients - Vitamin A, iodine, folate, zinc - has a profound impact on both the mother and the foetus, and on the outcome of the pregnancy.

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Contraception and Population

What is contraception?
Contraception is the deliberate prevention of the conception of offspring by any of various means. In general, birth control or contraception is anything that prevents a woman from becoming pregnant. The most basic form of contraception is abstinence. However, abstaining from sex entails fighting the natural human sex drive. Medical technology allows contraception through various means, which can be temporary or permanent, so that those not practicing abstinence can control conception.

The right to decide freely and responsibly the number and spacing of children and to have the information, education and means to do so is well recognized as an important component of reproductive rights. Contraceptives enable men and women to exercise these rights.

What is the pattern of contraceptive use of "method mix" in India?
Modern medicine has provided us with a range of contraceptive choices. The distribution pattern of usage of various methods to prevent pregnancies is called "method mix". India is unique in that female sterilization is the predominant method with most couples preferring to achieve their desired family size and opting for a permanent method.

Why have we not been able to bring about a change in the contraceptive behaviour of people in spite of our mass media campaigns?
Mass media campaigns have the potential to provide visibility to a product, spread information, build interest and influence public opinion. They can lead people to the shop, but cannot always make them buy the product. The inherent quality of the product, salesmanship, inducements to try the product, and after-sales service are what ultimately influence the decision towards the purchase and successful use of the product.

Often, these basics are ignored when it comes to promoting contraceptive use, a subject that demands a higher level of communications skills because it concerns personal and intimate choices. The very successful mass media campaigns of the 1960s and 1970s brought near-universal knowledge about contraceptives in India. However, they failed to translate information into action because the health system lagged behind in service delivery.

People in different phases of change process require different communication inputs. The various phases of the change process (understanding, experimenting, adopting and advocating) require counselling, service support, follow-up and creation of opportunities to espouse the cause. Such a systematic communication strategy, also called Behaviour Change Communication, was absent or not operational till a decade ago.

Why is the use of spacing methods so low in India?
The low prevalence of spacing methods is attributed to :

  • Lack of knowledge/access to these methods

  • Poor counselling and follow-up services

  • Incidence of method-related complications aggravated by the poor health status of women, like anaemia, reproductive tract infections and sexually transmitted diseases.

  • Dovetailing of the contraceptive services with mother and child health made it difficult to promote the use of condoms, which requires the male partner to be involved. However, in the light of the looming threat of HIV/AIDS, efforts are being made to promote condom as a dual protection method

  • Couples prefer to have the desired number of children in quick succession and opt for sterilization, which reduces their need for spacing methods

  • Excessive focus of the family welfare programme on sterilization also sidelines promotion of spacing methods

  • India's family planning programme has largely failed to encourage the use of reversible methods, particularly among young women (age 15-30) who are in the most fertile years of their reproductive period. While it has been easier to design communication campaigns on small family norms, promoting spacing has not been successful in the prevailing context of excessive preference for sterilization.

Why is spacing of births important for population stabilization?
Irrespective of the number of children, the timing of births has an independent impact on population stabilization. Spacing, or the gap between two successive pregnancies, would naturally help reduce the momentum of population growth because children born later would in turn reach their reproductive phase at a later date.

Spacing also ensures better maternal and child health, which in turn leads to better survival of children and so diminishes the desire for larger families.

Spacing is important not only for reducing births but also for improving the quality of life of a population. Well spaced and fewer births not only promote better mother and child health but also improve the development opportunities available for men and women, be it education, employment or social cultural participation. These in turn reduce "wanted fertility" - the number of children a couple desires to have in the family.

Hence, policies and programmes that encourage spacing between births through temporary methods of family planning need to be promoted in a big way.

How can spacing methods be promoted?
The key to increasing the use of spacing methods is enhanced communications on the one hand, and efficient service delivery on the other. The importance of communications is brought out by the fact that 99% of married women are aware of at least one modern contraceptive method. However, knowledge about all the methods, which is a prerequisite for informed choice, is only 58%, and only 42.8% use any modern method at all. This is so because counselling and inter-personal communications, so essential for informed choice, are not pursued as an integral part of service delivery by the health workers.

Communications and counselling services are essential to address myths and misconceptions that abound as also to address method-related problems that inevitably lead to discontinuation of contraceptive use. Women need to be treated with greater respect, and empowered to make informed choices by educating them about the various methods and related side-affects. Follow-up care, particularly in the event of method related complications, is also crucial.

Alongside, it is important to improve the availability of quality contraceptives as in their absence no communication effort can be successful. Social franchising of services through local practitioners, community based service providers, and social marketing through corporates are being tried out in the country under various programmes.

Why is it that fewer couples opt for male sterilization?
Over a period of time, the population programme in India has become women-centric, a sea change from the days when vasectomy or male sterilization was the dominant method. Of the couples opting for a permanent method of contraception, as many as 67.3% chose vasectomy in 1963. This increased to 75% during 1976-1977 but dropped steeply to 21.4% in 1980-81, 6.2% in 1990-91 and 2.3% in 2000-2001.

The drop is directly attributed to excesses committed when a target drive mindlessly pushed vasectomies. The development and promotion of laparoscopic techniques in female sterilization had also made it easier for women to undergo the procedure.

Though equally easy, non-scalpel vasectomy is not being preferred due to various myths and misconceptions. Fear of loss of libido and strength, method failure, and an attitude that makes birth control as the responsibility of the woman explain in large part the poor acceptance of the method.

Apart from increasing access to male sterilization services by making them available on a regular basis at the level of the primary health center, there is a need to strengthen communication support to the programme at the field level and at the macro level through mass media campaigns.

If people prefer a particular method over others what is wrong in promoting that method on a large scale?
The contraceptive needs of couples vary depending on their life situation. For instance, a newly married couple may need a spacing method while a couple completing their family size may opt for a permanent method. Also, the needs of a lactating mother are different from a woman who has infrequent sex. Logically, it is not possible for people to opt for any particular method on a large scale. Ideally, women and men of varying age groups and family situations should have the option to pick and choose from a variety of methods available.

But if one method is preferred over all the others, it is often due to poor information and knowledge about other options, limited access to services, cost factors or myths and misconceptions.

Often, it also reflects aggressive promotion of a particular method by service providers concerned about meeting programme targets. A case in point is sterilization, which is irreversible, needs limited follow up and therefore tends to get promoted over other methods. This should not be construed to automatically mean that sterilization is that most preferred method.

Promoting a single or few methods limits contraceptive choice to only women in certain life situations. Thus, the excessive emphasis on female sterilization in India means that only those women who have attained their desired family size are able to use contraception. For sustained decline in fertility rates, it is imperative that we have a more balanced "method mix".

Why do some groups oppose the introduction of injectable contraceptives in India?
New contraceptive technologies such as the hormonal injectables and implants are invasive, longer acting, provider-controlled and have a high potential for abuse when they are targeted at women in developing countries. Besides, injectables also have higher associated health risks that cannot be easily addressed with the poor health infrastructure in India. So, while the usage may spread with ease, it may simultaneously breed a new set of health problems for which the woman may have nowhere to go.

Most Indian women have poor health status and poor awareness levels, and when this segment receives invasive technology, the results can be disastrous. Screening and follow-up is the key to effective use of these technologies. Since these two cannot be ensured in a system which is hard pressed for infrastructure and human resources, many argue that it is best to keep out such methods, particularly from the public health service system. Injectable contraceptives are not a part of the public sector health and family welfare programme in India but are available in the market.

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Youth and Population

Why do we need to focus on youth? Doesn't reproductive health start at marriage?
How India's population would grow in the future depends largely on the 189 million-plus people in the 15-24 age group. Meeting their needs for information and guidance regarding sexual and reproductive health behaviour, apart from education and employment opportunities, thus constitutes an important aspect of population and development programmes.

Adolescent sexual and reproductive health programmes enable them to make responsible and informed decisions. This is particularly important in the case of young women, who should be empowered to exercise their right to greater control over their sexual and reproductive lives, free of coercion, discrimination and violence. Better communication about sexuality, about gender relations, and about the avoidance of unwanted pregnancy and sexually transmitted diseases will improve the quality of life of young people.

The importance of focusing on the adolescent girls and boys is supported by the following:

  • About 25% of girls in the 15-19 age group have their first child before the age of 19 in India

  • Pregnancy before age 18 carries many health risks. Teenagers are more likely to die in pregnancy or childbirth than women aged 20-24

  • Adolescent mothers will have more children as they are less equipped to negotiate contraceptive use

  • Adolescents account for 14% of abortions in India, according to the International Planned Parenthood Federation

  • Raising the mother's age at first birth from 18 to 23 could reduce population momentum by over 40%, according to the United Nations Population Fund (UNFPA)

  • Those under age 25 account for half of all HIV infections in India, according to the Joint United Nations Programme on HIV/AIDS.

Does giving sex education to adolescents encourage sexual promiscuity ?
No. Contrary to popular belief, sex education does not lead to promiscuity. In fact, such programmes lead to reduction in anxiety associated with unsafe sexual encounters and promote safe sex practices.

In a review by the World Health Organisation of 1,050 scientific articles on sex education programmes, researchers found "no support for the contention that sex education encourages sexual experimentation or increased activity. If any effect is observed, almost without exception, it is in the direction of postponed initiation of sexual intercourse and/or effective use of contraception".

Failure to provide appropriate and timely information "misses the opportunity of reducing the unwanted outcomes of unintended pregnancy and transmission of sexually transmitted diseases,, and is, therefore, in the disservice of our youth", the report says.

Adolescent reproductive and sexual health programmes should take parents and the community into confidence to build a supportive environment for the adolescents to exercise their choices. In the absence of such an integrated approach, there is a danger of the programme being resisted on misplaced fears of increased promiscuity. There is a need to work with both boys and girls together so that they appreciate the sexual and reproductive processes in both the sexes. This also leads to a proper understanding and exercising of sexual rights.

How does increase in age at marriage affect population stabilization?
Marriage is near universal in India. Age at marriage is directly related to the education and employment opportunities available to women, with those better educated and employed marrying later than those who are uneducated and/or unemployed.

The mean age at marriage has increased steadily - from 17 years in the 1960s to 20 years in 1990s. Still, around 43% of women get married before 18 years, which is the legal age of marriage in India for women. One of the reasons for early marriage is also the fear that the girl may lose her virginity, the protection of which is considered as a responsibility of the family and seen as discharged by marriage.

Early marriages often lead to early pregnancies, as most women also conceive immediately because they lack knowledge and access to contraceptive services as well as face family pressure to present an heir within the first year of marriage. On the other hand, the desire to prove his "masculinity" by siring a child prevents a man from using contraceptive methods immediately after marriage. Giving birth to a child is also seen as a means of securing the marriage as there is greater pressure on the man to take responsibility for his wife when she is the mother of his child. Infidelity and desertion are more common when the woman has not had a child. Adolescent pregnancy, within marriage or otherwise, poses a threat to the health and survival of the mother and child. Loss of children makes the couple desire larger families.

At the macro level, early marriages and early child bearing result in faster replacement of generations, impeding population stabilization even when the couples opt for one or two children.

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HIV/ AIDS and Population

Why should we focus on HIV/ AIDS issues in population programme?
Young men and women who are sexually active and who constitute the workforce of the country are the most vulnerable to HIV/AIDS. Every 14 seconds, a youth is infected with HIV/AIDS and youth (increasingly women) account for nearly half of the new cases of HIV infection worldwide, according to the United Nations Population Fund (UNFPA) State of the World Population Report 2003.

High mortality among youth will result in loss of productive labour and an increase in the number of dependants - children and the elderly. This clearly will bring with it greater impoverishment, ill-health and economic decline. Since the ultimate aim of population programmes is to ensure an improved quality of life for the people, not merely reduce numbers, prevention of HIV/AIDS becomes an important component of population programmes.

Worldwide, population growth has been brought down by reducing death rates and limiting fertility, not by allowing people to succumb to disease.

 
 
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