Factors Affecting Fertility and Public Health Interventions

1. Overview of Factors Affecting
Fertility and Public Health
Interventions in Nepal
Mohammad Aslam Shaiekh
Master of Public Health (MPH)
School of Health & Allied Science
Pokhara University (P.U.)

2. Fertility:
Major demographic process are : fertility, mortality
and migrations
Fertility (Natality): Fertility is the actual
reproductive performance of a woman or a group of
women.A woman's reproductive period is roughly from
15 to 49 years of age.
Fertility Indicators are:
•Crude birth rate
•Fecundity rate
•General fertility rate
•Age specific fertility rate
•Total fertility rate

3. Factors Affecting Fertility:

4. Biological Determinants:
Age:
• Reproductive age of women ranges from 15-44 or from
15-49.
• Men: 13-??
Health and Nutrition:
• Poor health and/or nutrition can reduce fertility.
• Linked with underweight children.
• Linked with child mortality rates.
Environment:
• Represents an undocumented impacts on fertility.
• Stressed populations tend to have less males than females.
• Possible correlation between sperm count and pollution.

5. Social Determinants:
The social norms and acceptance of practices affecting
fertility.
Differ from society to society.
Marriage:
• Particularly the average age of marriage.
• The percentage of people never married varies spatially
and affects fertility rates.
• Late marriage age generally involves less children.
Contraception and Abortions
• Used by 30-50% of all married couples.
• Availability of contraceptive devices and social attitudes
toward their use affect fertility rates.
• Sharp differences exist between MEDCs and LEDCs.
• Some notable exceptions, such as China and Cuba.

6. Social Determinants:
Abortion:
– Illegal abortions are common in most societies, even
where it is prohibited.
– Culture plays an important determining role in the
impact of abortion.

7. Economic Determinants:
The role of children, or their “value” affects fertility.
Inverse relationships:
• Fertility and income per capita.
• Fertility and urbanization.
Traditional rural societies:
• Children still play an important economic role and contribute
to family wealth,
• Fertility is likely to remain higher.
Industrial and post-industrial societies:
• Costs tend to increase with the development level of the
society. Deflate the fertility rate since parents must consider
the direct and opportunity costs of bearing additional
children.

8. General Factors affecting fertility
• Status of Women
• Marriage & Marital Disruptions
• Sterility
• Contraception
• Induced abortion
• Level of education
• Employment opportunities
• Type of residence
• Religion of parents
• Level of available health care
• Perceived cost of having children
• Pressure from the government

9. Fertility Motives:
• Factors associated with high fertility:
Increased infant and child mortality.
Economic factors: more children help to improve
the income of the family by being employed at
very young age.
Family welfare: there is a common belief that
large families are stronger. Also sons will carry the
family name.
Large family is the God’s will

10. Fertility Motives:
• Factors associated with high fertility:
large family makes the marriage happier, will
prevent divorce and gives more respect in the
community.
Large family gives welfare and strengths to the
community and nation.

11. Fertility Motives:
• Factors associated with low fertility:
1. To preserve the health of the mother and
children.
2. For better caring of the children who will get a
better chance in life.
3. For family welfare, to give better family life
and a higher standard of living.
4. For community development: to help the
community meet the needs of the population
for good education and public services.
5. To avoid problem of overpopulation.

12. Effect of rapid population growth on
national development
1. Food situation: - food production has not sufficiently increased to
cope with population growth resulting in increase in the food gap and
malnutrition among the fast growing population.
2. Health/ medical services: - the rapid increase in the population has
overtaken improvements in health/medical services.
3. Education opportunities: improvement of the capacity and quality
of our educational system has been hampered by the rapid increase of
the school age population.
4. Employment opportunities: rapid population growth has made it
difficult to increase employment opportunities.
5. Social services: are impaired by overpopulation.
6. Distribution of income wealth: evidently the share of the
individual families from the growth national production will be affected
by the increase in population number.

13. Management of the Over Population Problems
Long-term policy: long-term policy involves
rising of the socioeconomic standard of the
country that would manage the majority of the
fertility motives.
Short-term policy: it includes:
• Birth control through family planning programs.
• Promoting national production and investments.

14. Public Health Interventions to Control High Fertility
Family Planning Services
Safe motherhood Program
FCHV Programs
PHC/ORC Clinic
Adolescent, Sexual and Reproductive Health
Mobile sterilization camps

15. Fertility: Facts & Figures of Nepal

16. Fertility: Facts & Figures of Nepal

17. Flowering:

18. My Gratitude toYou