c

c 

The population on the planet earth is increasing very fast because of declining death rate
and high birth rate. The fast increasing population is creating problems of imbalance in the Echo
system affecting socio-economic aspects and quality life. It is neutralizing the developments
achieved in agriculture, textile industries, housing, and educational facilities, employment
opportunities, health care facilities etc

The demographers, bio-statisticians, economists, and health administrators have been

highlighting the implications and consequences of global increase in population growth. It has
been recognized by all nations in the world that efforts should be put in not only for socio-
economic developments, resource management but also for limiting the population growth by
limiting the birth rate

 
 c 


c c
c  Demography is defined as the 2


 2 

   
 

 


 22 
  2

 

2

2

2


 
2




The population size, its composition and distribution are determined by the number of birth,
death and migration which are occurring all the time in any place.

 
 c



The world wide history of population growth depicts changing trends in the population size and
composition due to increase or decrease in number of births and deaths. It suggests definite
stages of its growth which are as given below

G? ¢igh stationary stage: In this stage there is no change in the size of the population due to
high birth rate and high death rate which nullify each other¶s effect. Until the middle of
seventeenth century the world¶s population was in this stage. Up to 1920, India¶s
population was in this stage
 G? Early expansion stage: In this stage there is some increase in population because death rate
begins to decrease but the birth rate remains same. The world population was in this stage
in the middle seventeenth to middle of nineteenth century. Whereas India¶s population was
in this stage from 1921-1950.
G? ate expansions: In this stage the birth rate begins to decline and death rate further
decreases. A number of developing countries are in this stage.
G? ow stationary: In this stage both death and birth rates are low and neglect the effect of
each other on population change.
G? Declining stage: In this stage the birth rate is lower than death rate. There is negative
growth in population.


c  c

c 



There are two major factors which influences population increase. These are decrease in
death resulting in longevity and sustained high birth rate. It takes nearly 70 years for the
nation to double its population to double its population when death rate in 10 and birth rate is
20 per annum. It takes much more time nearly 75 to 100 years to double its population when
death rate is 8 and birth rate is less than 20. The contributing factors for increase in survival
at birth and longevity are improved environmental sanitation, regular and complete
immunization, health and medical care facilities, effective pharmaceuticals. Better nutrition,
occupational health, better living standards etc.


c   c  



Population is not static. It changes with time i.e. it is dynamic. The changes are due to births,
deaths& migration process which keep happening in any population. The population may
increase decrease or remain stationary or may decline. Rates and ratios are the tools used to
analyze the influence of these processes on population change.


 By and large rates are calculated from the total number of events which occur in a
defined geographic area during a calendar year. These are therefore annual rates. These rates can
be  2

 
p  This is based on middle year population.

CRUDE RATE= Number of total events in an area during the year *1000

Estimated mid-year population of the same area during the same year



  This is based on the specific population by age, sex etc.

SPECIFIC RATE = Number of total events in specific population in an area during an year*1000

Estimated mid-year population of the same area during the same year

The components which constitute rate includes numerator, denominator, time specification
which is usually a calendar year and a multiplier. The multiplier is usually 1000 but it can be
selected as 10,000 or 100,000 to avoid fraction.


c The ratio manifests the relative size of the quantities of two variables. Ratio is the
result of the dividing quantity of one variable with the quantity of other variable. The following
formula is used to express ratio

X: Y or X/Y

The number of males with STDs in INDIA at a specific period

The number of females with STDs in INDIA at a specific period

¢ere the numerator and denominator are two different variables that is numerator is not the
component of denominator.


c  It is the ratio which shows the relation in magnitude i.e. (how much) of a
proportion of the whole and is expressed in percentage. In this enumerator is a part of the
denominator. The formula used are

PROPORTION= Total number of deaths due to a specific disease in an year * 100

Total number of deaths from all diseases in the same year

The various rates and ratios related to birth, death and migration are as follows
‰c
 
cc



‰c

It refers to the number of live births per 1000 on estimated mid-year
population in a defined area per year. This is crude rate because it is based on estimated mid-year
population. It is very simple and valid measure of number of children being born in a population
in a given year. But this measure does not depict the true picture of natality because the entire
population is not exposed to child bearing


cc

There are number of fertility rates which are computed on the basis of
women population in the reproductive age i.e. period of 15-45/49 years.

A.? ïENERA FERTIITY RATE (ïFR): It refers to the number of live births per 1000 women
aged 15-45 in a year. This measure is better than crude birth rate because it is based on the
population at a risk of giving birth i.e. women aged 15-45 and not the entire population. The
only drawback in this rate is that not all the women in the reproductive age are exposed to the
risk of child bearing.
B.? ïENERA MARITA FERTIITY RATE (ïMFR): It refers to the number of live births
per 1000 married women aged 15-45 in a year. This measure is better than ïFR because the
denominator is limited to married women in the reproductive age who are exposed to the risk
of giving birth.
C.? AïE SPECIFIC FERTIITY RATE (ASFR): It refers to the number of live births per 1000
women in any specific age group during the reproductive period. The calculation of ASFR
for every age group of 5 year interval during the reproductive age group depicts a fertility
pattern. ASFR give information about specific population at risk of child bearing. This
information is used to plan and motivate family planning.
D.? AïE SPECIFIC MARITA FERTIITY RATE (ASMFR): It refers to the number of live
births per 1000 married women in any specific age group in a particular year.
E.? TOTA FERTIITY RATE (TFR): It refers to the average number of children that would be
borne alive to a woman if she experiences through all her child bearing years confirming to
the age specific fertility rates currently prevalent in the community. TFR is a hypothetical
measure but it is important because it gives information about the possible number of
children the women are having.TFR shows births per women during her life time.
 
ù






TFR gives the approximate size of the completed family size.



 
c

G? 

 It is defined as the number of deaths per 1000 estimated midyear
population in a year in a defined area. The crude death rate is used to measure the change in
population size over a specified year.
CDR=Number of deaths during the year in an area *1000
Midyear population in the same year in the same area
But crude death rate cannot be used to compare two population of different composition
because this rate is not influenced by their age composition and age specific death rates.
G? cc 
 
 To know the specific death rates and associated factors
specific death rates are computed. The specific death rate helps to identify population group
at risk, specific causes of deaths etc.
A.? AïE SPECIFIC DEAT¢ RATES: It refers to the number of death in a particular age group
per 1000 midyear population of that age group in a year in a particular area. The infant
mortality rate which includes deaths under one year of age is a very sensitive index of health
and socio economic development in a country.
B.? SEX SPECIFIC MORTAITY RATES: It refers to the number of deaths by sex per 1000
midyear population of particular sex.
C.? AïE SEX SPECIFIC MORATITY RATES: It refers to the number of deaths by particular
age and sex per 1000 midyear population of the same age and sex.
D.? OT¢ER VARIABES: It is the specific death rates based on many other variables such as
occupation, religion, income etc.
E.? CAUSE SPECIFIC DEAT¢ RATES: It refers to death due to any specific cause per 1000
midyear population.
F.? MATERNA MORTAITY RATES: It refers to the number of deaths of pregnant women
due to any pregnancy related causes within 42 days of termination of pregnancy per 1000
live births
G? 
c

: The case fatality rate is the ratio of deaths to cases. It refers to
percentage of deaths due to particular disease.
= Total number of deaths due to disease * 1000
Total number of cases due to the same disease

G? 
c  
c
 
 It refers to the number of deaths due to

particular disease per 100 or 1000 total deaths.

 = Number of deaths due to particular cause in a year * 1000

Total number of deaths occurring in the same year

c

c 

In addition to births and deaths, migration is another basic process which influences change in
size and composition of population of a place. It refers to facial or geographic movement of
population involving a change of usual residence between clearly defined geographic units. This
change in residence is not temporary but permanent for the purpose of residing.
Migration is both international and internal. Demographers distinguish the two which are
discussed below:-

c   ! It refers to movement of people involving permanent

change of residence from one country to another. It is designed as emigration from
nation left and as immigration to the receiving nation. A country losses emigrants and
receives immigrants.

c  !It refers to movement of people involving change in permanent

residence from one area to another within a country. It is designed as out-migration
instead of emigration and in-migration instead of immigration.

c"" ! It refers to the number of immigrants (in-migrants) arriving at a

particular place(destination) per 1000 population at that destination in a given year.

c"" Number of immigrants in a year

 Total mid-year population of destination

" ! It refers to the number of emigrants departing an area of origin

per 1000 population at that area of origin in the same year.

" #$Number of emigrants in a year

Total mid-year population of area of origin

  # $!The net migration rate shows the net effect of immigration and
emigration on area¶s population, expresses as increase (+) or decrease (-) per 1000 population of
the area in a given year.

  # $No of immigrant ± No of emigrants

Total mid-year population

For example in year 2000, India had net migration rate-5 per 1000 population i.e. net decrease
of 5 persons per 1000 population

%&"'((&)* 

The population change over time can be expressed based on the relationship among the three
components of population change i.e. births, deaths and migration by the following balancing
equation.

+(,#‰!$,#!$

Where:

+(&*-.%/'0"(+1

(&*%-.%/'0"(+1

‰‰*%23*3-%1

*%23*3-%1

cc"" !" 1

" -&!" 23*3-%1



The difference between births and deaths (B-D) is the natural increase in population. The
difference between the immigration and emigration is the net migration. According to this
equations population over the time may increase, decrease or remain same depending upon the
resultant effect of natural increase / decrease and plus/minus net migration.

*  ' & c)% ! The rate of natural increase is the one at which the
population is increasing or decreasing in a given year whether or not births are surplus over
deaths and expressed as a percentage of the base population. The formula is as under.

Rate of Natural Increase = Births ± Deaths

Total mid-year population

3*! It is the rate at which the population is increasing or decreasing in a given year
because of natural increase and net migration, It is expressed in percentage of the base
population. The formula is given below.

ïrowth Rate = (B-D) + (1-E)

Total mid- year population

OR

ïrowth Rate = Rate of Natural Increase + Net Migration Rate.

The growth rate takes into account all the components of population change (births, deaths
and migration). But in countries where migration account is not maintained and or where
population base is too large and net migration is negligible, growth rate is computed on the basis
of rate of natural increase which is computed as under:-

ïrowth Rate = (B - D)

Total Mid-Year population

 OR

ïrowth Rate = Rate of Natural Increase.

c)%&%(&* !It refers to the difference between the population of previous
census (PI) and the population of the subsequent census (P2) of the same area. It is denoted as
under:

IC = P2 ±P1

The Intercensus change in percent can be used to determine and compare the growth of
different population

IC % = P2-P1 /P1 * 100

It is very important for community health nurses to know population static that describes the size
and composition of population and population dynamics which determines change in population
ever time. It helps her to identify the changing health needs and the type and bulk of health care
service which are required by the community.

c c  
 c c

India's population stood at about 350 million at the time of independence in 1947.
Belying Malthusian fears, it grew at an unprecedented rate to reach the one billion mark at the
dawn of the new millennium. The Census of 2001 has put the population figure provisionally at
1,027 million, even though it registered a significant reduction in the growth rate of population.
With the emergence of 'the component method' of projection, the art of making population
forecasts has acquired the rigour of a science. The rationale of the component method rests on
the undisputable fact that the growth of population is determined by fertility, mortality and
migration rates. The accuracy of demographic projections can be gauged by examining how
close they have come in predicting the India's population at 2001. It is to be noted that
demographers generally make 'high', 'medium' and 'low' projections; but the high and low
variants are often presented for pedagogical purposes only, and are not to be treated as serious
forecasts.

*"  
2
-%

Over the coming decades, the United States will face six global trends that will help shape its
national security policies:

(&Population will increase by 1.2 billion to over 7 billion by 2010. About 95% of this
growth will be in developing countries. This growth will also be accompanied by increased
urbanization: about half of the world's population will live in cities compared with one-third
today. There will be many more mega-cities with populations in excess of 8 million, mostly in
developing countries. Countries such as Mexico and Saudi Arabia that hold key geopolitical
positions will be among those heavily affected by population pressures. In some societies
a "youth bulge"--the growing number of people between 15 and 24--will strain educational
systems, infrastructure, and the job market. Population growth will also fuel migration pressures
--¢aiti's population, for example, is expected to double over the next 20 years.

For the industrialized world, the population problem will not be associated with growth but with
increasing lifespan and decreasing birth rates. The "Social Security-Medicare" debate already
reverberating throughout the developed world will be acute. ïovernments will struggle to
provide social welfare and health services to an aging population, while the labor force--the pool
whose taxes help finance these services--shrinks.

In the former Soviet Union the issue is not buttressing a safety net, but creating one to cope with
a wide range of economic and social problems that will take many years and concerted effort in
the areas of health, the environment, and economic progress to reverse. In Russia the extent of
demographic ills is reflected in a sharp and unprecedented decline in male life expectancy.

3*(c)" The triumph of the West in the closing days of the 20th century
carried an economic component as well as the commonly recognized ideological one: the
universal acceptance of the notion--and the expectation--of material progress. This will place a
premium on stable political and social systems accompanied by incentives for effort and risk-
taking.
We project real growth in per capita income of over 2 percent per year between now and 2010.
Fueled by accelerating global trade, knowledge-based technologies, and the integration of capital
markets, economic growth will bring unprecedented wealth to a greater number of states. Many
of these states will channel this growth into providing services to its citizens; others, however,
will translate their resources into building military capabilities for aggressive purposes against
their neighbors, or to defend themselves against potentially aggressive neighbors.

ïrowth will be uneven; not every state, nor every citizen in every state, will benefit equally.
Some will not benefit at all, or may lose out. The pace of technological change will be rapid and
the fear of being left behind will lead to tensions between countries--and between groups within
them--as income gaps widen. More winners will be in East Asia and the West; more losers will
be in Africa and the Middle East. Among relative losers will be those states that, unwilling to
accept the consequences of their failure to cope with change, will use force to alter their status.

ïrowth will carry new demands on infrastructure--water, energy, communications, waste

disposal, urban transportation, public health, housing, and education. Failure to accommodate
these demands will trigger disaffection with government, backlashes against the concept of
modernization--and clashes against Western policies, philosophies, and presence.

Finally, the speed of post-industrial economic development will accelerate the growth of new
economic centers of power, whether they be states like Indonesia, or global multinational
businesses which in some cases could rival the resources available to lesser states.

-The problem of feeding a burgeoning population is not agriculture or science, but rather
political stability, transportation and distribution. Indeed, food production is likely to keep pace
with overall demand. We anticipate genetic engineering fueling a fourth agricultural revolution
by the end of this time span. As in the past, shortages will be man-made. Serious pockets of
poverty will put people in developing countries--particularly in Africa--at risk of death from
disease and starvation.

""&)% The continued digital data and communications revolution will shrink
distances and weaken barriers to the flow of information. Communications technology will
become so inexpensive that most countries will be able to pay the cost of connecting to the
global information infrastructure (ïII). Optical fiber will add enormous capacity for data
transmission among nodes around the globe. The United States, Europe, Asia, and atin America
will be in the forefront of this communications revolution. To compete, businesses will continue
to move beyond regional or national perspectives to optimize global trade. ïovernments will
benefit from the success of these businesses. ¢owever, communications will also thwart
government efforts to control the flow of information, which, in some instances, will undermine
their authority.

 / ïrowing populations and per capita income will drive the demand for more energy,
particularly as the Chinese and Indian economies expand. By 2010 the world will require added
production of petroleum on the order of what OPEC produces now. Technological advances,
however, can meet this demand. Problems will arise not out of overall shortages but out of short-
term disruptions in the flow of oil stemming from political-military instabilities. Improvements
in the efficiency of solar cells and batteries will result in greater use of these and other renewable
energy resources, but they are unlikely to significantly affect global reliance on fossil fuels
during this time period.

/
)* /) Precision- guided munitions and information technologies

will continue to be the hallmarks of the revolution in military affairs. Other countries will have
technologically advanced military equipment at their disposal, obtained from arms merchants
and other governments. ¢owever, no power will be able to match US battlefield technological
capabilities during this time frame, and potential adversaries are unlikely to repeat Iraq's mistake
in challenging the United States via set-piece conventional warfare.

Admitting technological inferiority will not mean acquiescing in American policies. Potential
adversaries will attempt to blunt our military superiority in other ways: improving their
capabilities relative to their neighbors, and using unconventional and often asymmetric means--
ranging from the increased use of terrorism to the possible use of weapons of mass destruction.
Because of the high cost of developing a nuclear capability, these countries will focus more on
chemical and biological weapons. Their aims will be to threaten our allies, undermine our
presence in their respective regions, and weaken US public support for use of the US military
abroad. In sum, our military technological prowess will not be enough to guarantee that our
interests will be protected, and we may find what some would call a "doctrine of massive
technological superiority" as limited in the future as the doctrine of massive retaliation was forty
years earlier.

 
 c
 c c c
" (*/ is the scientific study of human population. A sloganfor family planning-
³Delay the first, postpone the second and prevent the third´
India is the 2nd most populous country in the world, next only to China, whereas 7th in land
area. With only 2.4 % of the world¶s land area, India is supporting about 16.87 % of the world¶s
population. India¶s population is currently increasing at the rate of 16 million each year. India¶s
population numbered 238 million in 1901, doubled in 60 years to 439 million (1961);doubled
again ,this time in only 30 years to reach 846 million by 1991.India¶s population to crossed 1
billion mark on 11 May 2000,and is projected to reach 1.53 billion by the year 2050.This will
then make India the most populous country in the world, surpassing China
 -0)"(%
The proportion of population below 15 years is showing decline, whereas the proportion of
elderly in the country is increasing. This trend is to continue in the time to come. The increase
in the elderly population will impose a greater burden on the already outstretched health services
in the country.
0
Sex ratio is defined as ³the number of females per1000 males´. One of the basic demographic
characteristics of the population is the sex composition. In any study of population, analysis
of sex composition play a vital role. The sex composition of the population is affected by the
differentials in mortality conditions of males and females, sex selective migration and sex ratio at
birth. The sex ratio in India has been generally adverse to women, i.e., the number of women per
1000 men has generally been less than 1000.Apart from being adverse to women, the sex ratio
has also declined over the decades. In 1901 the sex ratio of India was 972 females per 1000
males and afterwards the ratio is continuous decreasing and in 2001 the ratio was 933 females
per 1000 males. Kerala has a ratio of 1058 females per 1000 males in 2010.It is only state with a
sex ratio favorable to females.

(-)/
The proportion of persons above 65 years of age and children below 15 years of age are
considered to be dependent on the economically productive age group (15-64years).The ratio of
the combined age groups 0-14 years plus 65 years and above to the 15-65 years age group is
referred to as the total dependency ratio. It is also referred to as the%) -(-)/
 and reflects the need for a society to provide for their youngerand older population groups.
The dependency ratio can be subdividedinto/&  -(-)/ (0-14 years); and-
  -(-)/  (65 years and more).These ratios are, however, relatively crude, since
they do not take into consideration young persons who are employed or working age persons
who are unemployed. Trends in dependency ratio in India-Total and child dependency are
decreasing but old-age dependency is increasing continuously.
%/'((&
One of the important indices of population concentration is the density of population. In the
Indian census, density is defined as the number of persons, living per square kilometer. Density
of population in India in 1901 was 77 persons/sq.km.but in 2001, 324 persons/sq.km.
"/%4
It refers to the total numbers of persons in a family. The family size depends upon numerous
factors, like, duration of marriage, education of couple, the number of live births and living
children, preference of male children, desired family size, etc

24
ïrowing urbanization is a recent phenomenon inthe developing countries. The proportion of the
urban population in India has increased from 11% in 1901 to 27.8 % in 2001.The United Nations
defines mega-cities as those with a population of 10 million or more. In 1950 only New York
was classified as mega-city. By 1995 the number rose to 14 mega-cities and Mumbai, Kolkata
and Delhi were included in the list. Population projections indicate that by 2015
¢yderabad will also become a mega-city. The increase in urban population has been attributed
both to natural growth(through births) and migration from villages because of employment
opportunities, attraction of better living conditions and availability of social services such as
education, health, transport, entertainment etc.
)/--&)
The1948, the Declaration of ¢umanRights stated everyone has a right to education. Education is
a crucial element in economic and social development. Spread of literacy is generally associated
with modernization, urbanization, industrialization, communication and commerce. ¢igher levels
of education and literacy lead to greater awareness and also contribute to improvement of
economic conditions, and are required for acquiring various skills and better use of health care
facilities. It was decided in 1991 census to use the term literacy rate for the population relating to
7 years age and above. A person is deemed as literate if he or she can read and write with
understanding in any language. A person who can merely read but cannot write is not considered
literate. The national percentage of literates in population above 7 years of age is about 66% with
literate males about 76% and females lagging behind with about 54%.State Kerala has occupy
the top rank in the country with 92% literates. ïovernment of India has made education
compulsory up to age 14 years in the country

'0())/
ife expectancy ± or expectation of life ± atgiven age is the average number of years which a
person of that age may expect to live, according to the mortality pattern prevalent in that country.
ife expectancy at birth has continued to increase globally over the years. Most countries in the
world exhibit a sex differential in mortality favoring women ± females live longer than males.
Contrary to this biological expectation, the life expectancy of women in Nepal and Maldives is
lower than that of men, while in Bangladesh and India it is almost equal. Trends in life
expectancy show that people are living longer, and they have a right to a long life in good health,
rather than one of pain and disability. Japan leads in life expectancy for both males and females,
77.7 and 84.7 years respectively for the year 2001

c c  
 c c!++5
The population of India is expected to be around 1.4 billion in 2025. Interestingly, the
population size is expected to reach this mark whether India attains the goals of the National
Population Policy for 2010 or not. By 2025, India's population would almost be equal to that of
China's. But India's population would still be growing at a rate of one percent per annum, even
though the level of fertility required for long-run population stabilization would have been
achieved by then.
8? Even though population has been estimated to increase by 400 million between 2000 and
2025, as much as 86 percent of the total growth would be in the age interval 15-64 years. The
age interval of 65 years and over would account for another11 percent of the growth while
the share of the interval 0-14 would be just 3 percent of the total. This should have a far
reaching impact on the Indian economy.
8? As much as 63 percent of India's population growth in the first quarter of twenty-first
century would be in the northern states of Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan,
Orissa, Jharkhand, Chhattisgarh and Uttaranchal. Consequently, their share in India's
population is expected to rise from 45 to 50 percent. The population in this region would still
be growing at about 1.4 percent per annum.
8? On the other hand, south India would have completed the demographic transition, and the
growth rate of the native population would be extremely moderate, at about 0.5 percent per
annum. The population there would have also begun to 'age', as nearly 10 percent of the
population would be aged 65 years or more. The demographic imbalances may have begun to
induce significant immigration flows from the north.
8? By 2025, India would have begun to come out of the 'demographic bonus' phase where the
growth rate of working-age population exceeds that of total population. India is expected to
go through this phase during 2000-20. This one-time gift of the demographic transition is
expected to provide a window of opportunities to raise the productivity of labour. If
appropriate policies were pursued to realize the demographic gift, India would be in a
comfortable position in the year 2025. Otherwise, higher levels of unemployment and its
associated social evils would be on the cards.
8? The demographic transition also accrues a more lasting bonus in the form of women wanting
to enter the labour force. The decline of fertility would reduce by half the time spent by
women in raising children while mortality decline would double the life span remaining after
the cessation of childbearing. Slowly, but surely, this would bring a revolution in sex roles.
8? ¢owever, the expected rapid expansion of the male labour force during the next quarter
century may delay the entry of women to the labour market in significant numbers. By 2025,
about 40 percent of India's population is expected to be urban. The urban growth would
account for over two-thirds of total population increase in the next quarter century. This
would certainly accentuate the already existing pressure on urban amenities. But, if India
 finds a way of harnessing the demographic gift, urban centres would be full of buoyancy
rather than despair.


c 

c 


As population grows, it affects the socio economic aspects of the nation.

Moderate population growth is considered essential because it promotes socio-economic
developments as there is increasing demand & market for various for goods and opportunities for
employment for people.

But when population increases fast under the influence of various factors it has its
impact on nature and manmade resources and socio economic conditions. The natural resources
get exhausted; manmade resources cannot keep pace with the increasing needs and demands of
growing population. The result is shortages and misdistribution of resources and also affects their
quality and cost.

G? 
c
.   ‰ c6
c 
India is a developing country. Basically it has agrarian economy and 72 to 74
percent of people live in rural area. The main source of income is agriculture. Several
millions of them are either marginal farmers or work on hired labour and struggle for bare
necessities of life. In addition India has rapid population growth and limited cultivation land
area. This further decreases per capita agricultural production and causes decreases in per
capita income of the country.
To supplement marginal incomes, the farmers, especially the agricultural laborer
employee their children in farms. This becomes a motivating factor for having large family
size. It becomes a vicious cycle for affecting the per capita production and income. This
socio economic situation also pressurizes rural people to migrate to urban area in search of
job which creates civic and socio economic problems in urban areas.
G?   
c
c 
The most direct impact of rapid population growth is on feeding the ever
increasing large population and on maintaining their nutritional standards. Despite good
production of crops the per capita food consumption has not improved significantly.
 Nutrition of people is related to food consumption and its quality. Rapid
population growth is one of the factors responsible for decreased per capita consumption and
quality of food. Improper distribution and lack of purchasing power are the other reasons for
lower level of per capita consumption and quality of food. The most affected sections of
population are women and children. Poor nutrition also lowers the productivity of workers.
G? c
 
c 
As far as literacy and education is concerned, the literacy rate has improved
gradually but the absolute number of illiterate has been increased because of population
increase and backlog adult literacy. The number of educational institution, Universities,
libraries, trained teachers, laboratories, equipments, etc has increased gradually but could not
keep pace with the growing demand of increasing population.
G? ‰   

India¶s labour force in absolute number is on the increase because of large proportion
of young population and due to high birth rate. This has increased the magnitude of problem
of unemployment. In spite of jobs being created and filled and opportunities being provided
for self-employment, the number of unemployed has outnumbered the employment
opportunities because of ever increasing young population due to rapid population growth.
Also because of illiteracy or low literacy and lack of technical skills the cheap labour
is made available in plenty in the labour market. This situation is also affecting the national
productivity and per capita income which is increasing day by day. But this increase4 is very
slow because of large growing population.
G? 
c
  c

Next to food, clothing and housing are the basic necessities of human being. These
demands are barely being met partially because of low increase in per capita income, poverty
and large family size and partially because of scarcity due to rapid population in spite of their
increase in production1
G? 
7c
Since independence there has been significant improvement in health care
infrastructure both in urban and rural area but these have been inadequate, inaccessible and
have not been able to have optimal impact. Rapid growth in population has been one of the
reasons for this.
G? 
  7c 

There has been sufficient increase in safe water supply, transport facilities and
generation of electricity but these could not meet the demand of increasing population due to
rapid population growth. The increasing population has created problem of management of
large quantity of liquid and solid waste and maintenance of sanitation on both rural and urban
areas.
Forest is being destroyed to satisfy the needs of increasing population. This is
effecting ecological changes like soil erosion, floods, changes in weather condition etc. All
these have implication on agricultural production, socio economic condition and health of
people. There has been overall degradation of environment like population of air, water, &
soil etc. This is mainly due to increasing transport facilities, industrialization and
urbanization which are required to meet demands of increasing population.

 
c 


Population growth depends upon total fertility and net reproduction rate. On an
average, an Indian woman gives birth to six or seven children if she goes through full span of her
married life. The factor which promote fertility include age at marriage, duration of married life,
socio cultural aspects as a values of children and place of women in society, breast feeding,
feeling of maleness and womanliness etc.

But there are some other factors which has inverse effects of fertility. These
include education and economic status and participation of married women in labour force. The
total number of children born decreases with the increase in education and economic status and
participation of women in living hood. Family planning and limitation is another important factor
in fertility control.

Thus considering these factors, alternative approaches, which can be devised for
fertility control to stabilize population, includes the following:

G? ccc c 


Social policies pertain to age at marriage, education, economic development,
and gender sensitivity for women status, participation of women in labour force etc. Specific
 policies are formed and acts are enacted like child marriage Restraint act of 1978 to increase
the legal age of marriage for girls for 15 to 18 years and for boys 18 t0 21, compulsory
elementary education for all, better opportunities for higher and technical education,
reservation of seats for under privileged and backward sections of population, involvement of
women in socio political decision making etc. Socio policies will be determined by political
situations which are unstable most of the times. Such situations affect the formulation of acts
and policies and affect the implementation of act and policy decisions. Thus these methods
may not demonstrate immediate impact on population control. But these are important to be
continued to have long term permanent impact and bring attitudinal changes in society.
G? c 7
 

cc


The involuntary approaches to fertility control which has been proposed and
adopted from time to time includes
R? Temporary sterilization which is reversible.
R? Compulsory sterilization.
R? Restriction of marriage to those couples who can support family.
R? Infanticide especially female babies.
R? Administration of fertility control agents in water supply.
All these methods are unethical, unacceptable, and are not feasible in democratic &
socialistic societies. These methods cannot last for long politically and
administratively. Compulsory sterilization after 2 children norm was one of the main
causes for the fall of Indira ïandhi government in 1970s.
G?  c c
  

cc


Family planning is the most direct method of limiting the size of the family and
there by controlling the size of the family and population. Family planning is universally
accepted method of population control. Small family norms and the practices of family
planning are appreciated by all people from various cultures, religions, socio-economic status
both from rural and urban community all over the country.


 
c  c
 

c
c7 


The concerns about fertility levels and population growth were initially voiced during the 2nd
decade twentieth century in India. An excess of population was considered as the major factor
interfering with combating and overcoming evils of ill health, illiteracy and ignorance, death and
poverty from the society.

The first family clinic was opened at pune by prof. R.D. Karve in 1923. In 1946, a ¢ealth
Survey and Development committee chaired by Sir Joseph Bhore, advised for deliberate
limitation for family size and recommended the provision of integrated preventive, promotive
and curative primary health care services with high priority for improving nutritional and health
status of mother and child.

}? The National Family Planning Programme was launched during the First Five Year Plan in
1952 with the establishment of a few clinics. The services were rendered to clinic approach
to those who attended the clinic. Contraceptive supplies and educational material were
distributed as required. Training and research was conducted as necessary.
}? During the Second Five Year Plan (1956-61) it was suggested to integrate family planning
and health education activities with community development (then synonymous to rural
development) to systematize the programme. The major change in this approach came about
in (1966-67) the last year of third Five Year Plan.
}? During the Third Five Year Plan (1961-66) the family planning programme was considered
as the centre of planned approach for overall development. There was a shift room clinic
approach to extension education approach. The services were extended to community level in
the villages and urban areas both through extension educators to motivate people for small
family norm and provide contraceptives. In 1965 ippies oop was introduced. A separate
department of family planning was set up in 1966 in the Ministry of ¢ealth.
}? During the period 1966-69, there were annual plans and Fourth Five Year Plan was delayed
due to Political reason. Family Planning Program me although voluntary in nature but
became time bound and target oriented. Specific annual targets were fixed for the different
 fertility regulating methods. The family planning infrastructure, which included, urban
family planning centers, district and state bureaus, was strengthened.
}? During the Fourth Five Year Plan (1969-74), Family Planning Programmes was given top
priority by the ïovernment of India. The family planning services were rendered through
subcentres, primary health centers and MC¢ and family welfare centers as integral part of
MC¢ services from these centers. All India ¢ospital Post Partum program me was started in
1970 to motivate mother for family planning soon after delivery. In 1972, Medical
Termination of Pregnancy Act.71 was implemented.
}? During the Fifth Five Year Plan (1974-79) to start with, the family planning programmes
received major setback because of rigid implementation of target based approach and forcible
sterilization campaigns during emergency. The parliament was dissolved. ¢owever in 1977
the new (janta) ïovernment, formulated new population policy which reaffirmed the
voluntary nature of the family planning program me and prohibited all forcible measures.
The department of family planning was renamed as Department of Family Welfare, The
population control and family planning were made as concurrent subject in January 1977 by
the 42nd amendment of the constitution. The programme got further boosting since 1977 from
rural health scheme and from involvement of village health guides, indigenous trained dais
and local opinion leaders etc.
}? During the sixth five year plan (1980-85) as a result of commitment of health for all by 2000
AD, by primary health care approach the government of India accepted a national health
policy in 1983 which had laid down long term demographic goals to be achieved by 2000
AD. They were:

Net reproductive rate:««««..1 (2-child norm)

Crude birth rate:«««««««21/1000live birth

Crude death rate:««««««..9/1000 population

Couple protection rate:««««.60%

The national health policy has also laid emphasis on reorganization and strengthening of
health care delivery system to achieve these goals. Efforts were put in during the sixth five year
plan to achieve these demographic goals.
}? During the seventh five year plan (1985-90) to start with, the department of family welfare
was carved out from the rest while ministry of health in order to provide focused attention to
population activities, in participation to the planning, formulation, and administration of
projects and programmes for improving the coverage and outreach of basic and primary
health services for all segments of population. The various maternal and child health services
were started in this five year plan.
}? During the eighth five year plan (1992-97) achieving a slow rate of population growth was
considered as one of the most important priorities facing the nation. The major thrush areas
included focus on delivery of quality services and integrate with other sectors. Target free
approach was renounced and adopted in the year 1996. The target free approach emphasized
on providing quality services on demand based on needs of the people. The reproductive and
child health was launched and the scope of family welfare was widened. The RC¢
programme included:
1.? All the components of the safe motherhood programme with the added component of
RTI & STD.
2.? All the components of child survival.
3.? Fertility regulation with a focus on quality care.
4.? Aims to improve the management of services at central, state, district and block level.
5.? Seeks to attain holistic approach in implementation of programme
6.? Focuses on neglected geographical area
7.? Also focuses on previously neglected segments of population such as slums, men,
adolescents etc

}? During the ninth five year plan (1997-2002), reduction in the population growth has been
recognized as one of the priority objectives along with meeting all the felt needs for
contraception, reducing infant mortality and morbidity. The target free approach was
renamed as community need assessment approach in the year 1997. According to this
approach annual action plan are to be prepared in the beginning of each year by the
concerned state health family welfare authority at various levels starting from the grass root
workers at peripheral level. A comprehensive national population policy 2000 has been
formulated to promote family welfare programme and achieve the set goals and objectives.
Reduction in the population growth rate has been recognized as one of the priority objectives
during the Ninth & Tenth Plan period. The strategies are:
i) To assess the needs for reproductive and child health at P¢C level and undertake areas
specific micro planning.
ii) To provide need-based, demand-driven, high quality, integrated reproductive and child
health care reducing the infant and maternal morbidity and mortality resulting in a reduction
in the desired level of fertility.
CONTRACEPTIVES
The National Family Welfare Programme provides the following contraceptive services for
spacing births:
a) Condoms
b) Oral Contraceptive Pill
c) Intra Uterine Devices (IUD)
Whereas condoms and oral contraceptive pills are being provided through free distribution
scheme and social marketing scheme, IUD is being provided only under free distribution
scheme. Under Social Marketing Programme, contraceptives, both condoms and oral pills are
sold at subsidized rates. In addition, contraceptives are commercially sold by manufacturing
companies under their brand names also. ïovt. of India does not provide any subsidy for the
commercial sale.
COPPER-T
Cu-T is one of the important spacing methods offered under the Family Welfare Programme.
Cu-T is supplied free of cost to all the States/UTs by ïovt. of India for insertion at the P¢Cs,
Sub-centres and ¢ospitals by trained Medical Practitioners/trained ¢ealth Workers. The earlier
version of Cu-T 200 µB¶ (IUDs) has been replaced by Cu-T 380-A from 2002-03 onwards which
provides protection for a longer period(about 10 years) as against Cu-T 200 µB¶ which provided
protection for about 3 years only.
EMERïENCY CONTRACEPTIVE PI (ECP) was introduced under Family Welfare
Programme during 2002-03. The emergency contraceptive is the method that can be used to
prevent unwanted pregnancy after an unprotected act of sexual intercourse (including sexual
assault, rape or sexual coercion) or in contraceptive failure. Emergency Contraceptive is to be
taken on prescription of Medical Practitioners.

 c  

Under National Family Welfare Programme following Terminal/ Permanent Methods are being
provided to the eligible couples.
A) TUBECTOMY
i) Mini ap Tubectomy
ii) apro Tubectomy
aparoscopic sterilization is a relatively quicker method of female sterilization.
B) VASECTOMY
i) Conventional Vasectomy
ii) No-Scalpel Vasectomy
It is one of the most effective contraceptive methods available for males. It is an improvement on
the conventional vasectomy with practically no side effects or complications. This new method is
now being offered to men who have completed their families. The No-Scalpel Vasectomy project
is being implemented in the country to help men adopt male sterilization and thus promote male
participation in the Family Welfare programme.


 c
c  c7c

The ministry of health family welfare at the centre and states play an important role in the
government effort in the delivery of health and family welfare services to people in the country.
The function of central government, state government and central & state government together
are defined in the three constitutional lists namely central list, state list and concurrent list
respectively. The population control and family planning programme is listed in the concurrent
list i.e. it¶s the responsibility of both central and state government.

But the population control and family planning is a program of national importance which is
centrally sponsored programme. The family welfare programme is fully funded by central
government and is implemented through states.
ORïANIZATION AT T¢E CENTRE

The union ministry of health and family welfare consists of three departments which include:

R? Department of health
R? Department of family welfare
R? Department of indigenous system of medicine and homeopathy

The department of family welfare deals with family welfare matters. The secretary to the
government of India in the ministry of health and family welfare is overall in charge of the
department of family welfare. There is an additional secretary and commissioner family
welfare for this department. ¢e is assisted by a number of senior administrative and technical
officers. The additional secretary and commissioner family welfare supervises the
implementation of the programme in the state and coordinates the activities of and the
function of technical divisions and the secretariat side of the department of family welfare.
On the technical side, the following divisions are functioning:

G? Programme appraisal coordination and training and sterilization divisions.

G? Technical operation divisions
G? Maternal and child health division
G? Evaluation and child health division
G? Mass education and media division
G? Nirodh marketing division
G? Transport division
G? Area projects division
On the secretariat side the following divisions are functioning
G? Policy division
G? Aided programme division
G? An organized sector and voluntary organization division
G? A planned budget division
ORïANISATION IN STATES AND UNION TERRITORIES

The ministry of health and family welfare in each state has a family welfare department which
has the responsibility of implementing family welfare programmes as planned and directed by
the central government. At present there are 27states family welfare bureaus functioning in the
country. To coordinate the family welfare activities between the state government and the central
government, the family welfare cell has been sanctioned for each state and union territory.

ORïANIZATION AT T¢E DISTRICT EVE

At the district level a family welfare bureau consisting of three divisions has been sanctioned.
These divisions include:

R? Administrative division headed by the district family welfare officers

R? Mass education and media division headed by mass education and media officer
R? An evaluation division headed by a statistical officers

 cc 



Family welfare programme is implemented through the state government setup. The
infrastructure division of the department of family welfare looks after the programme in respect
to urban and rural family welfare services in India.

 c7cc ‰ 

G?
* (%(&" ( "" This programme was started during the year 1969 in 59
district level hospitals. The post partum programme is defined as maternity centered hospital
based approach to family welfare program to motivate women within the reproductive age
group (15-44 years) or their husband to adopt small family norms through education and
motivate particularly during pre-natal, natal and postnatal period. The success of the
programme at the district level encouraged the government of India to expand the post
 partum programme to sub divisional, taluk level hospitals as well. Under the postpartum
programme, a set pattern of inputs in the form of staffs, equipment constructions of a ward
and operation theatre etc are provided.

G? %"%')/( ""For early detection of cervical cancer among women,

this programme has been approved by the government of India in 105 medical colleges
which are equipped with fully-fledged department of pathology and services of senior
pathologist. Under this programme, a post of cyto-technician for preparation and examination
of slides and contingent expenditure for purchase of glass wares and chemicals etc have been
provided by the government of India.


G? 4 2- %)*" This programme was introduced during 1964 by reservation of
sterilization beds in government or voluntary organizations and local body institutions. The
purpose of introducing the scheme was to provide facilities for Tubectomy operation, as the
bed for such cases were not readily available in the hospitals. Under this scheme a total of
3217 beds are functioning at present. A recurring amount of Rs 4500 per bed per annum is
admissible for maintenance for the sterilization beds to local bodies or voluntary organization
on achievement of 60 Tubectomy per bed per annum.

G? 2 8"(  %)*" This scheme has been introduced with a view to improved
service delivery outreach services of primary health care, family welfare and maternity
services in urban area particularly in slum areas

G? 2'"/3')%#%): Urban Family Welfare Centers have functioning

since 1950 to provide Family Welfare Services in urban areas. There are three types of urban
family centers based on the population covered by them. In all there are 1083 Urban Family
Centres functioning in the States /Union as on 1st April, 2000. These UFWCs will be
reorganized in to ¢ealth Posts gradually, as and when these cities are considered for
expansion under the Urban Revamping Scheme.
  c7cc 
The Primary health care infrastructure has been developed as a three ties system and is
based on the following population norms given below:

centre Population norms

 Plain area hilly/tribal area

Village health post 1000 1000
Subcentres 5000 3000
P¢Cs 30000 20000
Community health 120000 80000
centres

G? 7  *%At the village level health posts ate created which manned by village
health guides to our reach services to people with their active participation. One village
health posts serves 1000 people and is manned by one village health guide preferably a
woman. She or he is responsible for giving information¶s to and motivation of eligible
couples and supply them condom.
Indigenous dais is another village level works that are trained to conduct safe normal
deliveries and motivate mothers for family planning. The target is to have one trained dai for
1000 population. Both these local ³village level workers´ are link between the community
people and the village level health functionaries.
G? &2!% #%$ The Sub-centers are the most peripheral contact point between the
primary health care system and the community. These centers have mainly promotional and
educational functions relating to Maternal Child ¢ealth, Family Welfare, Nutrition,
Immunization, Diarrhoeal Control and control of communicable Diseases programmes. The
sub-centres are also provided with basic drugs for minor ailments needed for taking care of
essential health needs of women and children. It is manned by one multipurpose worker male
and one multipurpose worker female or an ANM. It has been decided during the year 1997
that the state will have the choice of opening new sub-centres out of the fund provided to
them under the basic minimum service programme (BMS). Under this scheme there is
 provision for salary of female health worker or ANM and health assistant female, honorarium
for voluntary workers, rentals, contingencies and medicines. The salary of male health
worker is provided by the state government.
G? "/**)%# %$The primary health centre is the first contact point between
the village community and the medical officer. These are established and maintained by the
state government under the minimum needs or basic minimum services programme. A P¢C
is manned by medical officer, health assistant female and male, health worker female or
ANM, nurse and midwives, block extension educator, pharmacist, lab technician and is
supported by a 14 Para medical and other staff. It acts as a referral unit for 6 sub centres and
has 4-6 beds. The activities of P¢C include curative, preventive, promotive and family
welfare services.
G? ""&/ ** )% # %$ The community health centres are established and
maintained by the state government under MNP/BMS programme. It is manned by four
specialists i.e. surgeon, physician, gynecologist pediatrician, 7 nurse mid wives; one each
pharmacist, dresser, lab technician radio grapher and other staff. It has 30 indoor beds with x-
rays, labour room, operation theatre and lab facilities. It serves as a referral centre for 4 P¢Cs
and also provides facilities of obstetric care, specialized consultations. The total number of
C¢Cs functioning at present is 2935.
G? & '"/ 3' )% #%$ There are 5435 RFWCs functioning in the
country. These were established in the block level P¢Cs. These states have integrated the
RFWCs in their primary health care system. Therefore there is no separate identity for these
RFWCs today. The government of India how ever continues to provide financial support for
maintaining these centres.

 c  c
 
The nurses are in an excellent position to participate in family planning activities that is
through the provision of daily care; those working in hospital quickly gain the confidence of
sick person. The confidence provides an effective base for preventive care. Those employees
in community health agencies, perhaps because of the comprehensive nature of the care they
give are in a unique position for participation in family welfare programme. The role of the
nurses in family welfare will be governed by the policy of the government and / or of the
health institution employing them. Policies may vary from those that require nurses to
participate in family welfare activities to those that forbid them to do so or that limit their
participation to giving advice to high risk mothers eligible because of specific health reasons.
The ethical aspects of nursing care are of extreme importance in programme which deal with
human fertility, its promotion or its control. Because these programmes involve social as well
as sexual matters of an intimate nature, nurses are expected to use discretion and sensitivity
in their use and evaluation of any information provided by individuals or couples. The role of
nurses in family welfare programme will include in :
R? Administrative role
R? Supervisory role
R? Functional role
R? Educational role
R? Role in research
R? Role in evaluation
Brief description of these roles as follows

-"%8
Nurses who are in senior positions may be called upon the participate in the organization
of Family Welfare Programmes at national, regional or community level and in the
development of nursing activities within the frame work of these programmes.

&(8%/
Nurses who are responsible for the practical experience supervision and in service
education of other health workers professional and auxiliary nursing and midwifery
personnel, new staff students, volunteers assisting in the activities of nursing understand the
policy of family welfare. As a supervisor community health nurses should encourage their
staff to watch carefully for indication that mother or couples would accept advice on how to
space their children and so on.


&)
The primary function of nursing in family planning in case- finding, i.e. finding eligible
couples and making referral to adopt suitable family planning method. In addition that nurses
will have routine clinical functions which includes assisting doctors in prenatal, postnatal
examination and with various clinical and biological tests. And also help the client choose
one of the more simple and/ or suitable methods of contraception and follow-up services.

-&)
Usually all nurses have an educational role to fulfill with their patients and the
community. As a basis for counseling in family planning, nurses must have sound knowledge
of the biology of human reproduction, of education for family life, of the concepts and
principles underlying family planning, of the factors which influence it, of existing method of
regulating fertility, and of the facilities and services available in this respect. Moreover, they
must be able to transmit this knowledge effectively. The counseling on fertility can be held
with their clients in hospital, health centres, schools homes, community centres by using
proper audio visual aids.

%)*
Nurses are essential members of the multidisciplinary research team and then nursing as
a science or a practice must be systematically studies research mindedness, gradually being
introduced in to the basic education of nurses, is being reinforced in post basic programmes,
and increasingly being advocated as an approach to the solution of problems. Nurses know to
keep careful records and reports relating to their relating activities and can now begin to keep
systematic record and reports related to family planning activities, i.e. methods of
contraception used, their side effects and contraindications if any, the consistency with which
they are used, their efficacy, and any other patient information. These provides valuable data
upon which research may be based.

'8&
Evaluation is an important part of planning for nursing services including those related
to the regulation of fertility and should be build into the plan as it is being formulated. When
nurses asked to participate in the establishment of criteria whereby achievement may be
evaluated, they should be responsible for criteria related to nursing and midwifery
component of the Family Welfare Programme.
The concern of nurses and midwives with individual, family and community health has
led to their increasing interest and involvement in health services related to family planning,
human reproduction and population dynamics. Contraception has become an integral part of
life for many people. Every birth control method available for use today, has risks and
benefits associated with its use each method carries responsibilities on the part of the user to
learn about the side effect, advantages and disadvantages. All education about family
planning is based on the firm understanding of the anatomy and physiology of reproduction.
Using this knowledge nurses can counsel and support individuals in their choices and in
health care.
)&%
The population of India is expected to be around 1.4 billion in 2025. Interestingly, the population
size is expected to reach this mark whether India attains the goals of the National Population
Policy for 2010 or not. By 2025, India's population would almost be equal to that of China's. But
India's population would still be growing at a rate of one percent per annum, even though the
level of fertility required for long-run population stabilization would have been achieved by then.

')%
? Park.K.K, Preventive and social medicines S.chand publication.17th edition. Pp no 63-78
? ïulani K.K. Community health nursing. Jaypee publications. 2nd edition. Pp no 346-79
? Bhat, P. N. Mari (1998). Demographic estimates for post-independence India: A new
Integration. Demography India 27(1):23-57.
? Findings of National Family ¢ealth Survey: Regional analysis. Economic and Political
Weekly 34, October 16-23.
? ïeneralized growth-balance method as an integrated procedure for evaluation of
completeness of censuses and registration systems: A case study of India, 1971-1991.
Delhi: Institute of Economic ïrowth.
? Bloom, David E. and Jeffrey ï. Williamson (1998). Demographic transitions and
economic miracles in emerging Asia. The World Bank Economic Review 12(3): 419-55.