The document provides an overview of demography and family planning. It discusses key terminology like population, demography, population dynamics, and population size. It also describes the demographic cycle and its five stages. The composition of a population is explained through sex ratio and population pyramids. The main determinants of population change are fertility, mortality, and migration. Fertility and its regulation are discussed in detail. Population explosion and its effects are also summarized.

1. P R E P A R E D B Y
M S B A N H I P O K H A R E L
M S C N U R S I N G S E C O N D Y E A R
B A T C H 2 0 1 8
UNIT II
DEMOGRAPHY AND
FAMILY PLANNING

2. CONTENTS
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 Different terminologies.
 Introduction of the demography.
 Demographic cycle.
 Composition of population
 Population distribution
 Determinants of population change
 Population explosion

3. Terminologies
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 Population- Is a collective group of organisms of
the same species living in the same place at the same
time.
 A population is a summation of all the organisms
of the same group or species, who live in the
same geographical area, and have the capability of
interbreeding.

4. Terminologies cont…
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 Demography- it is the scientific study of human
population. It focuses on three phenomenon: change
in population, the composition of population and the
distribution of population.

5. Terminologies cont…
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 Population dynamics-It is the branch of life
sciences that studies short-term and long-term
changes in the size and age composition of
populations, and the biological and environmental
processes influencing those changes.
 Population Size- it refers to the number of
individuals in a population.

6. Terminologies cont…
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 Population Density- it is the number of individual
per unit in area.

7. Terminologies cont…
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 Population Dispersion- it is the pattern of
distribution in which a population exists.

8. Terminologies cont…
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 Population explosion- means very rapid and
unprecedented growth of population.

9. Introduction of Demography
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 Greek words
 ‘demos’ meaning people and ‘graphein’ meaning
record.
 It is the scientific study of human population.
 Focuses its attention on three readily observable
phenomena:
change in population size (growth or decline),
the composition of population and
the distribution of population in space.

10. Introduction of Demography cont…
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It deals with five “demographic processes”
 Fertility, mortality, marriage, migration and social
mobility.
 These five processes are continuously at work within
a population determining size, composition and
distribution.

11. Definitions of demography
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 Demography is a branch of science which studies the
human population and their elements. The elements
are change in size of population, structure of
population and their geographical distribution of
population.
 Demography is the scientific study of human
population such as changes in population size, the
composition of the population and distribution of
population in space.

12. Demographic Cycle
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 Demographic cycle, or population cycle, refers to the
evolution over time of the population profile of a
country, region or other defined geographical area.
 Demographic cycle describe changes in population
size and composition due to increase or decrease in
number of births and deaths.

13. Demographic Cycle
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The history of world population since 1650 suggests
that there is a demographic cycle of 5 stages through
which a nation passes:
 First Stage
 Second Stage
 Third Stage
 Fourth Stage
 Fifth Stage

14. Demographic Cycle cont…
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15. Demographic Cycle cont…
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i) First stage (High Stationary)
 It is characterized by high birth rate and high death
rate which cancel each other. So the population
remains stationary.
 India was in this stage till 1920.

16. Demographic Cycle cont…
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ii) Second stage (Early Expanding)
 There is a decline in death rate while the birth rate
remains unchanged. So the population expands.
 Many developing countries of Asia and Africa are in
this stage.
 Birth rates have increased in some of these countries
possibly as a result of improved health conditions,
and shortening periods of breast feeding.

17. Demographic Cycle cont…
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iii) Third stage (Late Expanding)
 Death rate declines further and birth rate begins to
fall. Yet there is an increase in population since birth
exceeds deaths.
 India appears to have entered this stage. In number
of countries birth rates have decline rapidly. (e.g.
China, Singapore)

18. Demographic Cycle cont…
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iv) Fourth stage (Low Stationary)
 Is characterized by Low birth rate and low death
rate. So the population becomes stationary.
 Most of the industrialized countries have gone a
demographic transition shifting from high birth and
death rates to low high birth and death rates.
 Belgium, Denmark and Switzerland are in this stage.

19. Demographic Cycle cont…
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v) Fifth stage (Declining)
 Population begins to decline as birth rate is lower
than death rate.
 East European countries like Germany and Hungary
are now in this stage

20. The composition of a population
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 The sex ratio and
 The age sex pyramid

21. The sex ratio
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 “The number of females per 1000 males”
 Sex Ratio has decreased from 99.8 in 2001 to 94.2 in
2011.
 In abstract number, there are 796,422 more females
than males in the country. (source; census 2011)

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23. Population pyramids
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 are graphical representations of the age and sex of a
population.
 also referred to as age-sex pyramids.
 Population pyramids usually have males on the left
side and females on the right.
 There is also a vertical line in the middle of the graph
that separates the males from the females.

24. Types of population pyramids
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25. Types of population pyramids cont…
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Expansive population pyramids depict
populations that have a larger percentage of people in
younger age groups.
 Populations with this shape usually have high
fertility rates with lower life expectancies.
 Many third world countries have expansive
population pyramids.

26. Types of population pyramids cont…
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Constrictive population pyramids:
 They are constricted at the bottom.
 There is a lower percentage of younger people.
Constrictive population pyramids show declining
birth rates, since each succeeding age group is
getting smaller and smaller.
 The United States has a constrictive population
pyramid.

27. Types of population pyramids cont…
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Stationary population pyramids:
 That show a somewhat equal proportion of the
population in each age group.
 There is not a decrease or increase in population; it is
stable.
 Austria has a stationary population pyramid.

28. Population distribution
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 Population distribution means the pattern of where
people live.
 World population distribution is uneven.

29. Determinant of Population Change
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 Fertility
 Mortality
 Migration
(sex composition, literacy, life expectancy)

30. Fertility
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 One major indicator and determinant of
demographic change is fertility.
 It is a measure of the actual number of offspring
produced.

31. Fertility cont…
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 Fertility refers to the child bearing performance and
fecundity to the child bearing capacity. Fertility is a
voluntary biological process; fecundity is an inherent
physiological capacity.
 Fertility means actual bearing of children; fertility
varies between individuals depending upon their
reproductive behavior.

32. Determinants of fertility
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 Age at marriage
 Duration of marriage
 Spacing of children
 Child survival
 Education status
 Economic stability
 Cultural belief and practices

33. Principles of fertility regulation
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Avoid untimely pregnancies
Avoid too close pregnancies
Avoid unwanted pregnancies
Avoid too many pregnancies
Avoid risky pregnancies

34. Benefits of fertility regulation
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35. Approaches to fertility regulation
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 Educational approach
 Service approach
 Motivational approach
 Legal approach
 Integrated approach

36. Methods of fertility regulation
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 Contraception
 Termination
 Sterilization

37. Determinant of Population Change
cont…
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b) Mortality
 Mortality is the second major variable that shapes
population trends.
 A population's age structure is an important factor
influencing its death rate.
 Death rates are highest among infants, young
children, and the elderly.

38. Determinant of Population Change
cont…
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b) Mortality cont…
 Developed countries with good medical services have
more people in older age brackets than developing
countries.
 Life expectancy serves as a measure of the general
health of the population, which depends on the
satisfaction of many basic human needs.

39. Determinant of Population Change
cont…
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c)Migration
 The third major factor that drives population trends
is migration.

40. Determinant of Population Change
cont…
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c)Migration
 Migration is less predictable over long periods than
fertility or mortality, since it can happen in sudden
waves—for example, when refugees flee a war—or
slowly over many years.

41. Population explosion
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 Population explosion is a self-created catastrophe,
which the mankind has brought upon itself.
 Population is one of the primary factor which has
brought in its way a widespread pollution of air,
water and land as well as deforestation,
desertification, accidents involving chemicals and
the danger of extinction of some plant and animal
species.

42. Population explosion cont…
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Effects of population explosion
 Population explosion absorbs national income
 Lowers the standard of living
 Reduced food production
 Environmental pollution
 More deforestation
 Industrial pollution
 Poverty/unemployment
 Behavioral problems
 Social problems

43. Summarization
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 What do you mean by demography? What are the
different stages of demographic cycle? (2+5=7)
 What are the Determinants of Population Change?
Explain them. (2+5=7)

44. Assignment for next day
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 What are the different methods of family planning?

45. References
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 Park K. Text book of preventive and social Medicine, 22rd edition. Jabalpur:
Bhannarsidas Publishers, 2011
 Clement I Manual of Community Health Nursing, 1st edition, New Delhi, Jaypee
Brothers Medical Publishers; 2012
 Kamalam S.Essentials in community health nursing practice, 3rd edition, New Delhi,
Jaypee Brothers Medical Publishers; 2017
 Gulani K.K. Community Health Nursing Principles and practices, 1st edition,kumar
publishing house, Pitampura,Delhi 2011
 Tuitui R. Dr.Suwal S.N. A Textbook of Community Health Nursing,
VidyarthiPrakasan(P.) Ltd kamalpokhari,Kathmandu, Nepal 2006.s
 Ghimire B, A text Book of Community Health Nursing, 2nd edition, Heritage
Publishers & Distributors P. Ltd
 https://study.com/academy/lesson/population-pyramids-definition-types-
stages.html retrieved on 9/2/2019.
 https://ec.europa.eu/eurostat/statistics-
explained/index.php/Glossary:Demographic_cycle retrieved on 9/3/2019.
 https://www.internetgeography.net/topics/what-is-population-distribution/
retrieved on 9/3/2019.

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47. PREVIOUS CONTENTS
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 Different terminologies.
 Introduction of the demography.
 Demographic cycle.
 Composition of population
 Population distribution
 Determinants of population change
 Population explosion

48. CONTENTS
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 Terminologies
 World population growth through history
 Implication of population studies in Community
Health Nursing
 Family planning
 Health aspects of family planning
 Contraceptive methods/ fertility regulation methods

49. Terminologies
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Median age
 is the age that divides a population into two
numerically equal groups - that is, half the people are
younger than this age and half are older.
 It is a single index that summarizes the age
distribution of a population

50. Terminologies
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Dependency Ratio
 The dependency ratio is a measure of the number of
dependents aged zero to 14 and over the age of 65,
compared with the total population aged 15 to 64.
 This indicator gives insight into the number of
people of nonworking age, compared with the
number of those of working age.

51. Terminologies
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Marital status
 the distinct options that describe a person's
relationship with a significant other.
 Married, single, divorced, and widowed are examples
of such status and sometimes may be a source of
discrimination

52. Terminologies
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Family size:
A fundamental social group in society typically
consisting of one or two parents and their children.

53. Terminologies
Crude birth rate
 Is the simplest indicator of fertility and is define as
"the number of life births per 1000 estimated mid-
year population in a given year”
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54. Terminologies
Crude birth rate
Number of live births during the year x 1000
Estimated mid-year population
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55. Terminologies
General Fertility Rate
 It is the "number of live births per 1000 women
in the reproductive age-group (15-49 years) in a
given year".
 It is better measure of fertility then the CBR
because denominator is restricted to the
number of women in the child bearing age,
rather then the whole population
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56. Terminologies
General Fertility Rate
Number of live births in an area
during the year x 1000
Midyear female population age (15- 49)
in the same area in same year
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57. Terminologies
Age specific Fertility
 A more precise measure of fertility and is defined as
the "number of live births in a year to 1000 women
in any specified age-group".
Number of live births in a
particular age group x 1000
Midyear female population of
the same age group
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58. Terminologies
Total fertility rate
 The average number of children a woman would
have if she were to pass through her reproductive
years bearing children at the same rates as the
women now in each age group.
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59. Terminologies
Total fertility rate
 It is computed by summing the age-specific fertility
rates for all ages; if 5-year age groups are used, the
sum of the rates is multiplied by 5.
45-49
5 x ∑ASFR
TFR= . 15-19 .
1000
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60. Terminologies
Crude death rate (CDR)
 The number of death per 1000 in a given time period
and place divided by the population at risk or total
mid-year population.
No. of deaths occurred in a year * 1000
Mid-year population
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61. Terminologies
It is important to recognize and summarize the effect
of two factors;
 Population composition
 Age specific death rates which reflect the
probability of dying
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62. Terminologies
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Specific Death Rates;
The Specific Death Rates may be;
 Causes or disease specific,e.g. T.B, HIV/AIDS,
Cancer, Accidents etc.
 Related to specific group, i.e. age, sex, and age / sex
specific
 Specific death rate gives accurate picture of mortality
rate for male and female of each age.

63. Terminologies
 For eg, case specific death rate due to tuberculosis
 Specific death rate for males
 Case specific death rate due to tuberculosis =
Number of deaths from tuberculosis year
during a calendar year * 1000
Mid-year population
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64. Terminologies
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Net migration rate:
 is the difference between the number of immigrants
(people coming into an area) and the number of
emigrants (people leaving an area) throughout the
year.
 N = (I - E) / M X 1,000

65. Natural increase of population
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 The difference between the birth and death is
the natural increase in population.
 The rate of natural increase is one at which the
population is increasing or decreasing in a given year
whether or not birth are surplus over death and
expressed as a percentage of the base population.
 Rate of Increase = Births –deaths /Total mid-year
Population*100

66. Natural increase of population cont…
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 Growth rate: It is the rate at which population
increase or decreases in a given year because of
natural increase and net migration. It is expressed in
Percentage.
 Growth rate = Rate of Natural increase± Net
Migration rate

67. Population Doubling Time
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 The amount of time for a given population to double
based on the annual growth rate
 To determine doubling time, divide 70 by the growth
rate as a percentage. i.e., a growth rate of 3.5
represents a doubling time of 20 years.
 The world's current (overall as well as natural)
growth rate is about 1.14%, representing a doubling
time of 61 years.

68. World Population Growth
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 Many threats, from diseases to climate fluctuations
kept life expectancy short and death rates high in
pre-industrial society, so it took until 1804 for the
human population to reach one billion.

69. World Population Growth through
History
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 Human population has grown very slowly for most of
its existence on earth.
 Scientists currently estimate that modern human
beings (Homo sapiens) evolved roughly 130,000 to
160,000 years ago.
 Through the early decades of the Industrial
Revolution, life expectancies were low in Western
Europe and the United States.

70. World Population Growth through
History cont…
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 Thousands of people died from infectious diseases
such as typhoid and cholera.
 But from about 1850 through 1950, a cascade of
health and safety advances radically improved living
conditions in industrialized nations.
 Growth rate- 1.8% in 1950s.
 Growth rate peaked at 2.2% in 1963.
 Declined to below 1.1% by 2012.

71. Measurement of population change
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The population change over time can be expressed based
on the relationship among the three component of
population change i.e. births, deaths and migration.
P2 = P1± (B-D) ± (I-E)
Where:
 P2=Population at the later date
 P1=Population at the earlier date
 B=Birth between two dates
 D=Death between two dates
 I=Immigration
 E=Emigration between two dates

72. World Population Growth through
History cont…
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 Total annual births- 138 billion in 1980s.
 Total annual births- 134 million in 2011.
 Total deaths- 56 million per year (Are expected to
increase to 80 million per year by 2040).

73. World Population Growth through
History cont…
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 Demographers currently project that Earth's
population will reach just over nine billion by 2050,
with virtually all growth occurring in developing
countries.
 World population growth in the 21st century will be
different from previous decades in several important
ways.

74. Population growth in Nepal
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 From 1960 to 2018 the population of Nepal
increased from 10.06 million to 28.09 million
people.
 This is a growth by 179.1 percent in 58 years.
 The highest increase in Nepal was recorded in 1979
with 3.06%.
 The biggest decrease in 2013 with - 0.27%.

75. Implication of Population studies in
Community Health Nursing
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 Help nurses to plan and manage need based health
care services for the community at large.
 Help to analyze health needs, morbidity and
mortality pattern, utilization of health care services
and accordingly plan and manage health care
services.

76. Implication of Population studies in
Community Health Nursing cont…
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 Help to know about the ratio of young and elderly
population. It helps nurses to determine economic
burden.
 Distribution and concentration of population in the
community will help to identify areas where services
are needed most.
 Specific death rates help to identify population
groups at risk, specific causes of death etc. and to
plan and implement preventive and control
measures.

77. FAMILY PLANNING
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78. FAMILY PLANNING
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Introduction
 Family planning movement started in Nepal as early
as 1959.
 Nepal had already included family planning in its
national plan in 1966.
 Family planning is a basic human right, recognized
by UN in 1967.

79. FAMILY PLANNING
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Family planning services are designated to provide a
constellation of contraceptive method/services
that reduced:
 Fertility,
 Enhance maternal and neonatal health and Child
survival,
 Contribute to bring about a balance in population
growth and socio- economic development
(that will help to improve their quality of life.)

80. Definition
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 Family planning (FP) refers to a conscious effort by a
couple to limit or space the number of children
through the use of contraceptive methods.

81. Definition
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An Expert Committee (1971) of the WHO defined
family planning as "a way of thinking and living that is
adopted voluntarily, upon the basis of knowledge,
attitudes and responsible decisions by individuals and
couples, in order to promote the health and welfare of
the family group and thus contribute effectively to the
social development of a country”.

82. Definition
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(A WHO expert committee in 1971) ‘Family Planning
refers to practices that help individuals and couples to
attain certain objectives’ as follows.
(a) to avoid unwanted births
(b) to bring about wanted births
(c) to regulate the intervals between pregnancies
(d) to control the time at which births occur in relation
to the ages of the parent; and
(e) to determine the number of children in the family.

83. Family planning is the Basic Human rights
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 The United Nations Conference on Human Rights at
Teheran in 1968 recognized family planning as a
basic human right.
 The Bucharest Conference on the World Population
held in August 1974 stated in its plan of action that
“all couples and individual have basic human
right to decide freely and responsibly the
number and spacing of their children and to
have the information, education and means
to do so.“

84. Health aspects of family planning
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Women's health:
 Maternal mortality, morbidity of women of child-
bearing age, nutritional status (weight changes,
haemoglobin level, etc.) preventable complications of
pregnancy and abortion.

85. Health aspects of family planning cont…
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Foetal health:
 Foetal mortality (early and late foetal death);
abnormal development.
Infant and child health:
 Neonatal, infant and pre-school mortality, health of
the infant at birth (birth weight), vulnerability to
diseases.

86. The Welfare Concept
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 Family planning is associated with numerous
misconceptions – One of them is its strong
association in the minds of people with sterilization.
Others equate it with birth control.

87. The Welfare Concept cont…
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 The recognition of its welfare concept came only a
decade and half after its inception, when it was
named Family Welfare Programme (1977).
 The Family Welfare Programme aims at achieving
a higher end- that is, to improve the quality of
life of the people.

88. Eligible couple
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 An "eligible couple" refers to a currently married
couple where in the wife is in the reproductive age,
which is generally assumed to lie between the ages of
15-45.

89. Target couples
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 In order to pin-point the couples who are a priority
group within the broad definition of "eligible
couples", the term "target couple" was coined.
 Hitherto, the term target couple was applied to
couples who have had 2-3 living children, and family
planning was largely directed to such couples.

90. Target couples
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 The definition of a target couple has been gradually
enlarged to include families with one child or even
newly married couples with a view to develop
acceptance of the idea of family planning from the
earliest possible stage.

91. Contraceptive methods
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 Also known as Fertility Regulating Methods
 Are preventive methods to help women avoid
unwanted pregnancies.
 Includes all temporary and permanent measures to
prevent pregnancy resulting from coitus.

92. Cont…
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93. Contraceptive methods cont…
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 There is no single method likely to meet the social,
cultural, aesthetic and service needs of all individuals
and communities.
 The search for an "ideal contraceptive" has been
given up.
 The present approach in family planning
programmes is to provide a “cafeteria choice"

94. Contraceptive methods cont…
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Spacing methods
Terminal methods

95. Spacing methods(temporary methods)
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 Barrier methods: physical methods, chemical
methods, combined methods
 Intra-uterine devices
 Hormonal methods
 Post- Conceptional method
 Miscellaneous

96. Spacing methods(temporary methods)
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97. Terminal methods(permanent method)
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 Male sterilization
 Female sterilization

98. References
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 Park K. Text book of preventive and social Medicine, 22rd edition. Jabalpur:
Bhannarsidas Publishers, 2011
 Clement I Manual of Community Health Nursing, 1st edition, New Delhi,
Jaypee Brothers Medical Publishers; 2012
 Kamalam S.Essentials in community health nursing practice, 3rd edition,
New Delhi, Jaypee Brothers Medical Publishers; 2017
 Gulani K.K. Community Health Nursing Principles and practices, 1st
edition,kumar publishing house, Pitampura,Delhi 2011
 Tuitui R. Dr.Suwal S.N. A Textbook of Community Health Nursing,
VidyarthiPrakasan(P.) Ltd kamalpokhari,Kathmandu, Nepal 2006.s
 Ghimire B, A text Book of Community Health Nursing, 2nd edition,
Heritage Publishers & Distributors P. Ltd
 https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.p
df retrieved on 9/5/2019
 https://www.worlddata.info/asia/nepal/populationgrowth.php retrieved
on 9/5/2019

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