Demography Demography Study of the demographic processes and their consequences for population distributions Demographic Processes: • Natality • Mortality • Marriage • Migration • Social mobilisation Demographic Indicators Population density The number of people living per square kilometer of land area 382/sq. km (Census 2011) India population – 130 crores Rural- 69%, urban – 31% Literacy • A person above the age of seven years who can read and write is considered literate. Crude literacy rate = No. of literates X 100 Midyear population Effective literacy rate = No. of literates ____________ X 100 Midyear population above seven years of age Literacy rate 74% Male literacy rate 82% Female Literacy rate 65% Highest Literacy Kerala- 94% Highest female literacy Kerala- 92% Lowest Literacy Bihar- 64% Lowest female literacy Rajasthan- 53% Economic dependency Those under 15 and those over 65 Proportion of person < 15yrs of age and >65yrs of age % Age Dependency ratio = ---------------------------------------------------------------------- X 100 Proportion of persons 15-64 yrs. age % Age dependency ratio- 53.3% Life expectancy • Life expectancy is the average number of years, which a person of that age may be expected to live according to the mortality pattern prevalent in that country. • India- 67.8 years • Male life expectancy – 66.7 years • Female life expectancy – 69.1 years Crude birth rate • The number of live births in an area during one year per 1000 midyear population Number of live birth which occurred in a year in a specific area CBR = ----------------------------------------------------------------------------------- X 1000 Midyear population of the area in the same year India- 20.4 Crude Death rate Number of deaths which occurred in a year in a specific area CDR = ----------------------------------------------------------------------------------- X 1000 Midyear population of the area in the same year Crude Death Rate (per 1000 mid-year population) India- 6.5 Total fertility rate Completed family size Completed Family Size is defined as total number of children borne by a woman during her entire reproductive period. • Total Fertility Rate (per woman in reproductive age) India- 2.2 GRR & NRR Gross reproductive rate- • The gross reproduction rate (GRR) is the average number of daughters that would be born to a woman (or a group of women) if she survived at least to the age of 49 and conformed to the age-specific fertility rate of a given year. Net reproductive rate • The average number of female live births that will occur to a newborn female as she grows up and passes through her entire reproductive age group provided she was subjected to the current rates of fertility as well as mortality. Sex Ratio Number of females Sex ratio = ----------------------------- X 1000 Number of males Number of females live births Sex ratio at birth = ------------------------------------ X 1000 Number of males live births Number of females (0-6 years) Child Sex ratio = ------------------------------------ X 1000 Number of males (0-6 years) Sex Ratio 940 (933 in 2001) Child sex ratio 914 (927 in 2001) Sex Ratio at Birth 908 Eligible couples • It refers to currently married couple wherein the wife is in the reproductive age group, between 15 and 49 years. • There are 170 such couples per 1000 population (17%) Contraceptive Prevalence Rate Total no. of eligible couples protected by any of approved methods CPR = ------------------------------------------------------------------------------------ X 100 Total no. of eligible couples in the community Contraceptive prevalence rate is the proportion of women of reproductive age who are using (or whose partner is using) a contraceptive method at a given point in time NRR=1 can be achieved only when CPR exceeds 60. Population pyramid Population pyramid • The symmetry of the pyramid will indicate the sex distribution of the population. • The height of the pyramid indicates the life expectancy/ survival of the population • The age dependency ratio can also be calculated. • The shape of the pyramid can indicate whether it’s a High- income (developed), Middle-income (developing) or Low- income country (under-developed). Demographic Transition model High stationary / Pre-transitional (first stage): • Very high birth rates and very high death rate (30-50 per 1000)` Early expanding / early transitional (second stage): • Decline in the death rate while the birth rate remains unchanged Late expanding / Middle transitional (third stage): • Further decline in the death rate while birth rate tends to fall Low stationary / Late transitional (fourth stage): • Low birth rate and low death rate Declining / post-transitional (fifth stage): • Birth rate lower than death rate Growth rate The growth rate of a population refers to the number of individuals growing per year per 100 individuals of that population Annual growth rate = CBR-CDR 10 In calculating Dependency ratio, the numerator is expressed as- (AIIMS-2003) a) Population under 10 years and 60 and above b) Population under 15 years and 60 and above c) Population under 10 years and 65 and above d) Population under 15 years and 65 and above The number of live births per 1000 women in the reproductive age group in a year refers to- (AIIMS 2003) a) Total fertility rate b) Gross reproductive rate c) Net reproductive rate d) General fertility rate The age and sex structure of a population may be described by a (AIIMS 2003, 2005) a) Life table b) Correlation coefficient c) Population pyramid d) Bar chart True about late expanding phase of demographic cycle- (AIPGME 2009) a) Birth rate is lower than death rate b) Death rate begins to decline, while the birth rate remains unchanged c) Death rate declines still further and the birth rate tends to fall d) High birth rate and high death rate WHO defines adolescent age between- (AIPGME-2005) a) 10-19 years b) 10-14 years c) 10-25 years d) 9-14 years The net reproduction rate of 1 can be achieved only if the following rate exceeds 60% (UPSC CMS 2013) a) Total fertility rate b) Total marital fertility rate c) Age specific marital fertility rate d) Couple protection rate The best indicator of “completed family size”, that is the number of children a woman would have through her reproductive years is (UPSC CMS 2011) a) General fertility rate b) Total fertility rate c) Gross reproduction rate d) Net reproduction rate At what point in time is the population assessed for calculation of the crude birth rate? (AIIMS 2001) a) 1st January b) 1st May c) 1st July d) 31st December Contraception Ideal Contraceptive An ideal contraceptive is safe, effective, acceptable, inexpensive, reversible, simple to use, independent of coitus, long lasting, requiring minimum medical supervision. There is no Ideal contraceptive Natural Family Planning methods Natural family planning is family planning without use of any drugs or contraceptives. Basis of Natural methods: • A woman ovulates at only one time during her cycle, and an ovum can survive for only 12–24 hours. • Cervical mucus is necessary for fertility • Spermatozoa live only one to three days • Menstruation will occur about 2 weeks after ovulation. Calendar method It is based on the fact that ovulation occurs 14 days before the onset of menstruation. The days on which conception is likely to occur is calculated as- Shortest cycle minus 18 days gives the first day of the fertile period Longest cycle minus 10 days gives the last day of the fertile period Basal Body Temperature Method • Normal BBT is between 96 and 98 degrees, and after ovulation rises to 97 to 98 degrees. • A rise in temperature that persists for at least 3 days indicates that ovulation has occurred. • The safe period begins from the fourth day (first day being the day of ovulation) to the last day of the next period. Cervical mucus method • Based on the observation of changes in the characteristics of cervical mucus • At the time of ovulation, cervical mucus becomes watery clear • After ovulation under the influence of progesterone, the mucus thickens and lessens in quantity. Lactational Amenorrhoea Method • Frequent intense suckling disrupts the pattern of pulsatile release of GnRH from the hypothalamus and thus LH from pituitary. This disrupts follicular development in the ovary and suppresses ovulation. • Three criteria for effectiveness • Exclusively breastfeeding • Up to six months after delivery • Menstruation have not resumed after delivery Failure rate:0-6months-2/HWY Male Condom Types of Condoms: • Latex Condoms • Polyurethane Condoms • Vytex • Polyisoprene • Natural membrane Condoms Advantages of condom • Easily and freely available • Safe • Inexpensive or free of cost • Can be used easily without any medical supervision • No side effects • Light, compact and disposable • Also protects against STI Disadvantages of condom • Slippage or tearing is common due to improper use or inappropriate size. • Interferes with sexual pleasure in some cases. • May cause allergy in those sensitive to latex. Failure rate of condom With perfect use- 3 per HWY With typical use – 10-14 per HWY Consistent and correct use of condoms Consistent use means using a new condom during every sexual interaction. Female Condom • These are sheaths or lining made that fit loosely inside a woman's vagina. • They have flexible rings at both ends, one ring at the closed end helps to insert the condom. • The ring at the open end holds part of the condom outside the vagina. • It is lubricated with a silicone-based lubricant on the inside and outside. • It can be kept inside the vagina up to 8 hours. Failure rate: Perfect use: 5/HWY Typical use: 21/HWY Contraindication: The female condom should not be used with simultaneously with male condom IUD First generation These are inert or non-medicated devices. IUDs Lippe’s loop Second It consists of copper or silver containing IUDs generation IUDs Cu T 380- A, Cu 375 Third generation This consists of hormone releasing IUDs. IUDs Levonorgestrel releasing IUD- Mirena Mechanism of action of IUCD Foreign body reaction- cellular and biochemical changes in the endometrium and the uterine fluids, which in turn impairs the viability of the products of conception.