NATIONAL FAMILY HEALTH SURVEY

INTRODUCTION:
National Family Health Survey (NFHS-3) 2005-06 is third in a series of national surveys,
earlier NFHS surveys were carried out in 1992-93 (NFHS-1) and 1998-99 (NFHS-2) and all
three surveys were conducted under the stewardship of the Ministry of the Health and Family
Welfare, Government of India with the International Institute for Population Sciences Mumbai
serving as the nodal agency. ORC macro, Calverton, Maryland, USA, provided technical
assistance for all three surveys. NFHS-1 and NFHS-2 were funded by the United States Agency
for International Development (USAID) with supplementation finding from UNICEF.
NFHS-3 funding was provided by the United States Agency for International
Development (USAID), the Department for International Development (DFID, United
Kingdom), the Bill and Melinda gates foundation, UNICEF, the United National Population
Fund and the Government of India. Assistance for the HIV component of the NFHS-3 survey
was provided by the National AIDS control organization and the National Research Institute
(NARI).
SURVEY GOAL:
 To provide essential data on health and family welfare needed by the Ministry of Health
and Family Welfare and other agencies for policy and program purposes
 To provide information on important emerging health and family welfare issues.
SURVEY OBJECTIVE:
 To meet the first of these two goals, NFHS-3, like NFHS-1 and NFHS-2
 Provides estimate of important family welfare and health indicator by background
characteristics at the national and state level.
 Measure trends in family welfare and health indicator over the time at national and state
level.
PROVIDES INFORMATION ON SEVERAL NEW AND EMERGING ISSUES
INCLUDING:
 Perinatal mortality, male involvement in family welfare, adolescent reproductive health,
high-risk sexual behavior, family life education, safe injections, tuberculosis and malaria.
 Family welfare and health condition among slum and non-slum dwellers in eight cities
(Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai and Nagpur).

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  HIV prevalence for adult women and men at the national level for Uttar Pradesh, and for
five high HIV prevalence state namely Andhra Pradesh, Karnataka, Maharashtra,
Manipur, and Tamil Nadu.
METHODS
STUDY TOOL:
Three different interview schedule were used for collecting household data and interviewing
eligible women and men.
PROCEDURE MANUALS:
The main uniform family survey procedure across the state and minimize non-sampling errors,
eight different comprehensive manual were prepared. They are follow as:
 Manual for household listing and mapping
 Interview manual
 Supervisors and editors manual
 Training guidelines.
 Anthropometry, anemia and HIV testing field manual.
 Training interview to implement the household relation section (section 10) of the
NFHS-3 women’s questionnaire
 Project directors manual
 Manual for secondary data edits.
In NFHS -3 interviews were conducted with eligible respondents using a Household
Interview Schedule, a Women’s Interview Schedule ( For women aged 15-49 years) and a
Men’s Interview Schedule (For men aged 15-54 years).

HOUSEHOLD INTERVIEW:
 Interview with the household head or any adult household member.
 Also as part of the household interview, cooking salt was tested for iodine content.
 Individual respondent’s interview.
 Measurement of height, weight, hemoglobin content in the blood of interviewed women,
men and children born in January 2000 (January 2001 for the second round of
interviewing or later were at least 6 months old) using the Hemocue instrument.

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  Collection of blood sample on filter paper cards from men aged 15-54 years and women
aged 15-49 years for HIV testing.

SURVEY PROCESS:
The survey was conducted in five phases these were:
 Project planning and management
 Survey preparation and interview schedule design
 Research organization involved in NFHS -3 fieldwork
 Training program
 Data collection
PROJECT PLANNING AND MANAGEMENT: Decision about policies and procedure for
NFHS -3 were reviewed by three project committees, namely-
 Steering committee: which provide overall guidelines to the project chaired by the
Secretary, Ministry of Health and Family Welfare.
 Administrative and finance committee: Provided guidance on issues related to finances,
chaired by Additional secretary and Financial advisor, GOI.
 Technical advisory committee: Provided technical support to the project on matters of
sampling interview schedule content format of the reports and the tabulation plan, chaired
by Director, National Institute of Medical Statistics in New Delhi. The Project
Management Unit (PMU) was responsible for implementation of the project.
SURVEY PREPARATION AND INTERVIEW SCHEDULE DESIGN:
The preparatory activities included designing the sample preparation of interview schedule
and their translation into Hindi and selection of the research organizations (ROs) for conducting
the fieldwork. IIPS translated the interview schedule into Hindi the language of interview in 10
out of 29 state( including Delhi), the interview schedules were subsequently translated into 19
additional Indian languages.
RESEARCH ORGANIZATION INVOLVED IN NFHS-3 FIELDWORK:
18 research organizations were selected for NFHS-3 data collection.

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TRAINING PROGRAMS:
 Given the large number of organizations involved in the survey as well as the number of
individuals and skills required to successfully implement all of the different stages of
NFHS-3 several types of training workshops were held.
 Health coordinator’s training: eight health coordinators, medical personnel, specially
employed by IIPS for the NFHS-3 project for the supervision of data collection on
biomarkers were trained for two weeks at IIPS in methods of blood collection
hemoglobin, and height/weight measurement. The training involved classroom sessions
and practice sessions in the classroom at health Centre and in the community.
HOUSEHOLD LISTING AND MAPPING WORKSHOPS:
Two workshops for three days duration were organized for household and mapping. The
workshops for the state participating in the first phase of fieldwork was held in 2005 and for the
second phase in 2006. Two person responsible for coordinating, mapping and household listing
from each research organizations were trained in mapping and household listing operations. The
training involved classroom sessions and field practice in rural and urban areas.
TRAINING OF TRAINERS (TOT) WORKSHOPS:
Two training workshops were held. Training workshops were held for training the trainer of
field staff of the research organization. At least two trainer for each state were trained in training
interviewers, supervisors and editors. The training involved discussion on the questionnaires,
lecture of guest speakers on special topic of HIV/AIDS, domestic violence and family planning
methods.
HEALTH INVESTIGATORS TRAINING:
The centralized training of two week duration was organized for all the health investigator
separately for phase 1 and 2 states.
DATA PROCESSING TRAINING:
Two coordinator from each research organizations were trained in office editing of data and data
entry software.
DATA COLLECTION AND PROCESSING:
 NFHS-3 fieldwork was carried out in two phase activities started in august 2005 and data
collection was done from December 2005 to May 2006. The second phase started in

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 January 2006 and data collection was carried out from April to August 2006, in the first
phase 12 states were covered and in the second phase the remaining 17 states were covered.
 Data processing involved office editing, data entry using CSPro software, verification of
data entry secondary editing and final cleaning of data for quality assurance, field check
tables were generated on a regular basis, starting soon after a few questionnaires were
entered.
SAMPLE SIZE:
 Since most of the key indicators in NFHS-3 were to be estimated referred to ever-married
women in the reproductive age of 15-49 years. , the target sample size for NFHS-3 in each
state was estimated in terms of the numbers of ever-married women in the reproductive age
group to be interviewed. In NFHS-3 the initial targets sample size was calculated to be
4000 completed interview with ever-married women in state with a 2001 census population
of more than 30 million, 3000 completed interview with ever-married women in state with a
population between 5 and 30 million (as per 2001 census) and 1500 completed interview
with every married women in state with population of less than 5 million.
In addition, sample size adjustment were made to meet the need for HIV prevalence
estimates for the high HIV prevalence estimate for the high HIV prevalence state and for
slum and non-slum estimate in selected cities. Therefore, the sample size in some state was
higher than that fixed by the above criteria.
 The sample size of HIV tests was estimated on the basis of the assumed HIV prevalence
rate, the design effect of the sample, and the acceptable level of precision. With an assumed
level of HIV prevalence of 1.25% and 15% relative standard error the estimated sample size
came out be 6400 tests each for men and women in high HIV prevalence state. At the
national level the assumed level of 1,25000 HIV tests were needed. The HIV tests were
carried out only in a subsample of household in which men were interviewed.
SAMPLE DESIGN:
 The urban and rural sample within each state were drawn separately and to the extend
possible. The sample within each state was allocated proportionally to the size of the
state’s urban and rural population. A uniform sample design was adopted in all the states.
In each state, the rural sample was selected in two stages: the selection of primary
sampling units which are villages, with probability proportional to population size (PPS)

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 at the first stage, followed by the random selection of household within each PSU in the
second stages.
 In the first stages, wards were selected with proportional to population size sampling in
the next stages, one census enumeration block (CEB) was randomly selected from each
sample ward. In the final stage, households were randomly selected within each sample
CEB.
SAMPLE SELECTION:
 In rural areas the 2001 census list of villages served as the sampling frame. The list
stratified by a number of variables. The first level of stratification was geographic with
district being subdivided into contiguous regions.
 Within each of these regions, villages were further stratified using selected variables from
the following list: village size percentage of males working in the non-agriculture sector,
percentage of the population belonging to scheduled castes or scheduled tribes and
female literacy.
MAPPING AND LISTING OPERATION:
A mapping and household listing operation was carried out in each sample areas in every
state. The listing provided the necessary frame for selection of household listing operation
involved in preparing up-to-date national and layout sketch maps of each selected primary
sampling units, assigning numbers to structure, recording addresses of these structure identifying
residential structures, and listing the names of head of all the household in residential structures
in the selected primary sampling units.
HIV TESTING:
 In response to an urgent need to have nationally-representative data on HIV prevalence
and comprehensive information on knowledge and attitudes about HIV/AIDS, high-risk
sexual behavior and practices related to HIV testing in India. It was proposed to
incorporate these issues in NFHS-3.
 It was planned to provide HIV seroprevalence levels for the population of women age 15-
49 years and men age 15-54 years at the national level and for each of the six high HIV
prevalence states as identified by National AIDS Control Organization (NACO), namely
Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamilnadu.

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 Considering the large sample size in Uttar Pradesh it was further decided to provide
estimates of HIV prevalence for the state of Uttar Pradesh also.
 NFHS-3 is the first large scale nationwide survey in which a technique of testing dried
blood spots was used for HIV testing.
 The survey approach was different in the six high HIV prevalence states from the rest of
India. The HIV testing was anonymous. No names or other contact informations were
recorded on the dried blood spot sample.
LABORATORY TESTING PROTOCOL:
The current recommendation of WHO/USAID for population-based seroprevalence estimation
were followed. This algorithm involved the following steps.
STEP 1: select two antibody tests from different manufactures (Assays A and B)
STEP 2: test the sample using Assay A: if the result is negative report the final result as
negative.
STEP 3: if the result is positive test the sample using Assay B: if the result is again positive
report the final results as positive.
STEP 4: if the result with Assay B is negative retest the sample with both Assay A and B: if the
2nd pair of results are both negative report the final result as negative.
If the 2nd pair of results are both positive, report the final result as positive.
If the 2nd pair of results are inconsistent (1 positive and 1 negative) report the final as
indeterminate.
RESULT OF THE NFHS-3 SURVEY:
According to the NFHS-3:
 67.4% of the population lived in rural area.
 Mean household size was 4.8%. 68% household in India had electricity.
 42% of population had piped drinking water as compared to 39% and 33% at the time of
NFHS-2 and 1 respectively.
 Only 44.5%of the household had toilets as compared to 36% and 30% of households had
toilet facility at the time of NFHS-2 and NFHS-1 respectively.
 About 68% of population above 6 years were literate (81% male and 61.3% of female) in
NFHS-3.

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  Fertility continues to decline in India and there is increasing trends of contraceptive use.
Decrease in mortality rates has also been observed. The various indicator measured in all
3 NFHS.
VACCINE COVERAGE: It has improved as shown in NFHS-3 but failed to reached the goals
of National Population Policy 2000 (NPP-2000)
WEAKNESSES:
 Sample did not include union territories that gave under-representation of urban and well
performing areas.
 Survey is based on large sample but cannot be considered to be representative to India’s
diversification.
 HIV testing included only adult population leaving most vulnerable group i.e. adolescents
and children. Some of the high risk groups are also not included such as truck drivers,
commercial sex workers, street children and drug addicts, etc.
 Large number of interviewers were recruited that may have introduced interviewer bias
and due to lack of privacy, information bias could also be a cause of concern that affect
internal validity.
COMMENTS:
 Political will is lacking because after three successful phase of NFHS the fourth survey is
still pending. This should be concurrently done with census which could have provided
very strong data.
 Levels of malnutrition among children below three years remain unacceptably high. In
2006-07, 40% of children under three year of age were underweight, 45% were stunted
and 22% were wasted.
 At the national level, the high levels of child malnutrition can be explained in part by the
limited access to and reach of health services. Equally striking is the poor feeding habits
largely responsible for the onset of malnutrition in the early stages of a child’s life.
 Progress in reducing undernourishment among children over the past seven years has
been poor which indicates the poor access to health services.
 Preliminary results of NFHS-3 confirmed the continuing neglect of health, inadequate
reach and efficacy of health services.

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  In vaccination coverage there is hardly any improvement since NFHS 1 particularly in
DPT 3 though lot of investment has been made in vaccination program.
 Despite launching of RCH program there is not much improvement in mother’s health.

NATIONAL FAMILY HEALTH SURVEY-4:

NFHS-4 is the fourth survey in the NFHS series of survey from 2015-16 and was conducted
under the stewardship of MOHFW, International Institution for Population Sciences (IIPS),
which was the nodal agency for NFHS-1, NFHS-2, and NFHS-3 has also been appointed the
nodal agency for NFHS-4 technical assistance for the NFHS was provided mainly by ORC
macro (USA) and other organization on specific issues. The funding has been provided by
USAID, DFID, the Bill and Melinda gates foundation, UNICEF, UNFPA and MOHFW, GOI.
FEATURE:
 In this round information on malaria prevention migration in the context of HIV abortion,
violence during pregnancy etc. have been added.
 The scope of clinical, anthropometric, and biochemical testing (CAB) or biomarker
component has been expanded to include measurement of blood pressure and blood
glucose levels.
 Computer assisted personal interviewing (CAPI) is distinct feature of this survey.
 For the first time NFHS-4 provided district level estimates with separate estimates for
urban-rural area for 157 districts having level of urbanization from 30-70%.
SPECIFIC OBJECTIVES:
 Provide estimates of the level of fertility, infant and child mortality and other family
welfare and health indicators by background characteristics at the national and state
levels.
 Measure trends in family welfare and health indicator over time at the national and state
levels.
EXPANDED OBJECTIVES:
 Ownership of physical and economic assets for women.
 Malaria prevention
 Expanded domain of clinical anthropometric and biochemical (CAB)
 Consanguinity in marriage

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  Age at puberty and menstrual hygiene
 Family welfare and health condition among slum dwellers
 Non-communicable disease
 Use of emergency contraception
 Abortion
 JSY, JSSK and out of pocket expenditure for institutional delivery
 Migration in the context of HIV
 HIV testing during ANC visits
 Violence during pregnancy
METHODOLOGY:
 All 640 districts as per 2011 census were covered. Interview was conducted with ever
married and never- married (age 15-49). Similar to NFHS-3, slum/non slum estimates
were given for eight cities (Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut,
Mumbai, and Nagpur). The survey uses three questionnaires namely household
questionnaire, women’s questionnaire and men’s questionnaire.
 This is the total sample of 628,826 women and 94,324 men eligible for the interview. In
these selected household information on approximately 267,272 children below age 5
years was collected.
 The domain of clinical, anthropometric and biochemical testing is being further expanded
in NFHS-4 to include random blood glucose and hypertension measurement with
estimates to be reported at the district level for women age 15-49 years and men age 15-
54 years. As with anaemia testing of these new CAB component in the field is conducted
using portable equipment.
BIOMARKERS IN NFHS-4:
 BMI
 Anemia testing
 Salt iodization
 HIV testing
 Hypertension
 Blood glucose

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FINDINGS:
 15 states showed that 37% of children under the age of five in these state in stunted a fall
of just five percentage point in a decade.
 Bihar and Madhya Pradesh are the worst off with 48 and 42% respectively.
 22% of children under the age of five in these state are wasted. 34% of children under the
age of five in these state arte underweight.
 The proportion of anemia children aged 6 to 59 months fell just five percentage points to
61% in 2014 and over half of women aged 14-59 years are still anemic. Of all men aged
15-40 years a quarter are suffering from anemia as was in 2004.
 After the last round of National Family Health Survey in 2005-06, infant mortality has
declined in all first phase 15 state/union territories for which trend datas are available.
 All 15 state/union territories have rate below 51 deaths per 1000 live birth, although there
is considerable variation among the state/union territories.
 Infant mortality rate range from a low of 10 in Andaman and Nicobar island to a high of
51 deaths per 1000 live births in Madhya Pradesh.
 10.6% female consume tobacco.
 46.8% female consume tobacco.
 3.5% female consume alcohol
 38.27% male consume alcohol
 Sex ratio is 985 per 1000 males.
 Institutional deliveries has increased to 80.4% prevalence of diabetes (>140mg/dl) and
hypertension (>140mm/hg) of few state are given.
Salient findings of NFHS-4
The results from the first phase of the National Family Health Survey-4 has been made
available. Findings for the 13 States of Andhra Pradesh, Bihar, Goa, Haryana, Karnataka,
Madhya Pradesh, Meghalaya, Sikkim, Tamil Nadu, Telangana, Tripura, Uttarakhand, West
Bengal and two Union Territories of Andaman and Nicobar Islands and Puducherry have been
released. Data collection for the second phase in States and Union Territories is currently
ongoing. 
The salient findings are as follows:

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 Fewer children are dying in infancy and early childhood - All 15 States/Union
Territories have rates below 51 deaths per 1,000 live births, although there is
considerable variation among the States/Union Territories. Infant mortality rates range
from a low of 10 in Andaman and Nicobar Islands to a high of 51 deaths per 1000 live
births in Madhya Pradesh.
 Better care for women during pregnancy and childbirth contributes to reduction of
maternal deaths and improved child survival- Almost all mothers have received
antenatal care for their most recent pregnancy and increasing numbers of women are
receiving the recommended four or more visits by the service providers. More and more
women now give birth in health care facilities and rates have more than doubled in some
states in the last decade. More than nine in ten recent births took place in health care
facilities in Andaman and Nicobar Islands, Andhra Pradesh, Goa, Karnataka, Puducherry,
Sikkim, Tamil Nadu, and Telangana, providing safer environments for mothers and
newborns.
 Overall, women in the First Phase States/Union Territories are having fewer
children - The total fertility rates, or the average number of children per woman, range
from 1.2 in Sikkim to 3.4 in Bihar. All First Phase States/Union Territories except Bihar,
Madhya Pradesh and Meghalaya have either achieved or maintained replacement level of
fertility– a major achievement in the past decade.
 Overall, women in the First Phase States/Union Territories are having fewer
children - At least 6 out of 10 children have received full immunization in 12 of the 15
States/Union Territories. In Goa, West Bengal, Sikkim, and Puducherry more than four-
fifths of the children have been fully immunised. Since the last round of National Family
Health Survey, the coverage of full immunization among children has increased
substantially in the States of Bihar, Madhya Pradesh, Goa, Sikkim, West Bengal and
Meghalaya.
 Married women are less likely to be using modern family planning in eight of the
First Phase States/Union Territories - There has been an increase in the use of modern
family planning methods only in the States of Meghalaya, Haryana, and West Bengal.
The decline is highest in Goa followed by Karnataka and Tamil Nadu. Despite the

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 decline, about half or more married women are using modern family planning in eight of
the 15 States/Union Territories.
 Fewer children under five years of age are now found to be stunted, showing intake
of improved nutrition. Anaemia has also declined, but still remains widespread. More
than half of children are anaemic in ten of the 15 States/Union Territories. Similarly,
more than half of women are anaemic in eleven States/Union Territories. Over-nutrition
continues to be a health issue for adults. At least 3 in 10 women are overweight or obese
in Andaman and Nicobar Islands, Andhra Pradesh, Goa, Puducherry, and Tamil Nadu.
 Over two-thirds of households in every State/Union Territory have access to an
improved source of drinking water, and more than 90% of households have access
to an improved source of drinking water in nine of the 15 States/Union Territories
- More than 50% of households have access to improved sanitation facilities in all First
Phase States/Union Territories except Bihar and Madhya Pradesh. Use of clean cooking
fuel, which reduces the risk of respiratory illness and pollution, varies widely among the
First Phase States/Union Territories, ranging from only about 18% of households in Bihar
to more than 70% of households in Tamil Nadu and more than 80% of households in
Puducherry and Goa.
 Lack of HIV awareness in Indian adults - Nearly 82 % women and nearly 70 % men in
the 13 States lacked comprehensive knowledge of HIV/AIDS and safe sex practices. A
comparison with NFHS 3 revealed that while 45% men had ‘heard of’ HIV in 2005
(across the 13 States for which partial data has been released), only 30% currently are
aware of the disease. For women, the figure fell from 24% in 2005 to 18% in 2016. The
most drastic fall in awareness is in Andhra Pradesh.
 Tobacco use among men has fallen from 50 per cent in 2005-06 to 47 per cent in 2015.
Similarly, alcohol consumption among men has fallen from 38 per cent to 34 per cent.
Over the last decade, consumption of alcohol among men has fallen in Madhya Pradesh,
Bihar, Uttarakhand, Haryana, West Bengal and Meghalaya.

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 NGOS IN POPULATION CONTROL
Human population control:
Human population control is the practice of artificially altering the rate of growth of a
human population. Historically, human population control has been implemented by limiting the
population's birth rate, usually by government mandate, and has been undertaken as a response to
factors including high or increasing levels of poverty, environmental concerns, religious reasons,
and overpopulation
Methods of Population control:
May use one or more of the following practices although there are other methods as well:
 Contraception
 Abstinence
 Abortion
 Emigration
 Decreasing immigration
 Starvation, famine
 Pestilence, plague
 War
NGOs in population control:
SAHARA MANCH:
It is one of the fast growing Non-Government Organizations (NGO) in the field of Social
Development, which was registered under M.P. Societies Registration Act 1973 on 31 March
1995. The society has been founded and promoted by a group of professionals with a
multidisciplinary background and considerable grass-root experiences. Experts realize that
natural resources like land, water and forest, which are the assets for providing livelihood, have
turned into liabilities due to its over-exploitation and neglect and Sahara Manch is trying to focus
in this gray area.
Aims & Objectives
 To achieve complete literacy and to work for promotion of education.
 To work towards elimination of practice of Child Labour and to take appropriate steps for
their improvement.

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  To create awareness and implement various projects on Public Health and Family
Welfare and to organize Awareness Movement for population control.
 To organize and conduct programmes on health, education and sanitation; create public
awareness to control population and to prevent epidemics and to arrange for basic
facilities.
 To create public awareness about AIDS and other diseases and to work for preventive
measures. Also to promote blood donations and organize camps for the same.
 Their role in removing deep-rooted beliefs favoring large families and male children,
improving female literacy, raising age at marriage of girls, essential new-born care, birth
spacing, etc., can be very significant.
Some of these schemes are:
 Helping NGOs to the extent of 90% of the cost of the project on promotion of small
family norm and population control schemes.
 Wide publicity of the government for informing voluntary organizations to come
forward to undertake these schemes.
 Holding of a number of regional conferences in last four to five years to increase the
involvement of the NGOs.
 Recognizing six larger organizations (in Delhi, Mumbai, Calcutta, Chennai and
Lucknow) as Mother Units for identifying small NGOs in their areas and giving them
grants for approval schemes.
 Setting up State Standing Committees on Voluntary Action set up under the chairmanship
of the Family Welfare Secretary with power to sanction up to Rs. 10 lakh per project.
MISSION FOR POPULATION CONTROL SILIGURI NGO:
 Established in 2000, Mission for Population Control in an NGO working in the field of
population control and primary education.
 Mission for Population Control is actively engaged in creating awareness about the
benefits of small families and creating opportunities for permanent family planning by
conducting ligation and vasectomy operations.
Population Foundation of India
 Population Foundation of India (PFI) is a national non-government organization leading
policy advocacy efforts and working as a think tank on population issues in the country.

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   PFI collaborates with central, state and local government institutions for effective policy
formulation and planning.
 It supports governmental and non-governmental organizations in the implementation of
programmes that focus on Reproductive and Child Health (RCH), Family Planning,
Adolescent Reproductive and Sexual Health (ARSH), Community Action for Health
(CAH) and Urban Health.
 The foundation also works with corporate organizations as part of their Corporate Social
Responsibility (CSR). PFI reaches out to the underserved and the unserved areas of the
country through NGO partners.

THEORIES OF POPULATION
INTRODUCTION:
 Thomas Robert Malthus enunciated his views about population in his famous book,
Essay on the Principle of Population as it affects the Future Improvement of Society,
published in 1798. Malthus revolted against the prevailing optimism shared by his father
and Godwin that a perfect state could be attained if human restraints could be removed.
 Malthus objection was that the pressure of increasing population on the food supply
would destroy perfection and there would be misery in the world. Malthus was severely
criticised for his pessimistic views which led him to travel on the continent of Europe to
gather data in support of his thesis.
 He incorporated his researches in the second edition of his Essay published in 1803. The
Malthusian theory explains the relationship between the growth in food supply and in
population.
The Malthusian doctrine is stated as follows:
1. There is a natural sex instinct in human beings to increase at a fast rate. As a result,
population increases in geometrical progression and if unchecked doubles itself every 25
years. Thus starting from 1, population in successive periods of 25 years will be 1, 2, 4, 8, 16,
32, 64, 128, 256 (after 200 years).
2. On the other hand, the food supply increases in a slow arithmetical progression due to the
operation of the law of diminishing returns based on the supposition that the supply of land is

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 constant. Thus the food supply in successive similar periods will be 1, 2, 3, 4, 5, 6, 7, 8, and 9
(after 200 years).
3. Since population increases in geometrical progression and the food supply in arithmetical
progression, population tends to outrun food supply. Thus an imbalance is created which
leads to over-population. This is depicted in Figure 1.

The food supply in arithmetical progression is measured on the horizontal axis and the
population in geometrical progression on the vertical axis. The curve M is the Malthusian
population curve which shows the relation between population growth and increase in food
supply. It rises upward swiftly.
4. To control over-population resulting from the imbalance between population and food
supply, Malthus suggested preventive checks and positive checks. The preventive checks are
applied by a man to control the birth rate. They are foresight, late marriage, celibacy, moral
restraint, etc.
If people fail to check growth of population by the adoption of preventive checks, positive
checks operate in the form of vice, misery, famine, war, disease, pestilence, floods and other
natural calamities which tend to reduce population and thereby bring a balance with food supply.
According to Malthus, preventive checks are always in operation in a civilized society, for
positive checks are crude. Malthus appealed to his countrymen to adopt preventive checks in
order to avoid vice or misery resulting from the positive checks.

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Malthus doctrine is illustrated below.

Criticisms of the Malthusian Doctrine:

The Malthusian theory of population has been widely discussed and criticised during the 19th
and early 20th century.

Some of the criticisms are as follows:

(1) Mathematical Form of the Theory Wrong:
The mathematical formulation of Malthus’ doctrine that food supply increases in arithmetical
progression and population increases in geometrical progression in 25 years have not been
proved empirically.
(2) Failed to foresee the Opening up of New Areas:
 Malthus had a narrow vision and was particularly influenced by local conditions in
England. He failed to foresee the opening up of new areas of Australia, the United States
and Argentina where extensive farming of virgin lands led to increased production of
food.
 As a result, countries like England on the continent of Europe have been provided with
abundant supplies of cheap food. This has been made possible with rapid improvements
in the means of transport, a factor almost overlooked by Malthus. No country need fear

18
 starvation and misery if it does not produce sufficient for its increasing population these
days.
(3) Applied a Static Economic Law to a Period of Time:
 The Malthusian notion that the food supply increases in arithmetical progression is based
on a static economic law at any one time, i.e. the law of diminishing returns. Malthus
could not foresee the unprecedented increase in scientific knowledge and agricultural
inventions over a period of time which has stayed the law of diminishing returns.
Consequently, the food supply has increased much faster than in arithmetical progression.
Malthus has been proved wrong not only in the advanced countries but also in developing
countries like India with the ‘green revolution’.
(4) Neglected the Manpower Aspect in Population:
 According to Cannan,that “a baby comes to the world not only with a mouth and a
stomach, but also with a pair of hands.”
 This implies that an increase in population means an increase in manpower which may
tend to increase not only agricultural but also industrial production and thus makes the
country rich by an equitable distribution of wealth and income. As rightly pointed out by
Seligman “The problem of population is not merely one of mere size but of efficient
production and equitable distribution.” Thus the increase in population may be necessary.
(5) Population not related to Food Supply but to Total Wealth:
 The Malthusian theory rests on a weak relationship between population and food supply.
In fact, the right relationship is between population and total wealth of the country. This
is the basis of the optimum theory of population. The argument is that if a country is rich
materially and even if it does not produce enough food for its population, it can feed the
people well by importing food stuffs in exchange for its products or money.
 The classic example is of Great Britain which imports almost all its food requirements
from Holland, Denmark, Belgium and Argentina because it concentrates more on the
production of wealth rather than on food products. Thus the very basis of the Malthusian
doctrine has been proved wrong.
(6) Increase in Population the Result of declining Death Rate:
 The Malthusian theory is one sided. It takes the increase in population as the result of a
rising birth rate. whereas population has grown considerably the world over due to a

19
 decline in death rate. This has been particularly so in underdeveloped countries like India
where the Malthusian theory is said operate.
(7) Empirical Evidence proves this Theory Wrong:
 Empirically, it has been proved by demographists that population growth is a function of
the level of per capita income. When per capita income increases rapidly, it lowers the
fertility rate and the rate of population growth declines. Dumont’s “social capillarity
thesis” has proved that with the increase in per capita incomes, the desire to have more
children to supplement parental incomes declines.
(8) Preventive Checks do not pertain to Moral Restraint:
 People have sexual desire but they do not want to have more children. Thus moral
restraint alone cannot help to control the increase in population which Malthus suggested.
Family Planning is essential as a preventive check.
(9) Positive Checks not due to Over-population:
 Malthus’ pessimism and religious education led him to believe that over-population was a
heavy burden on the earth which was automatically lessened by God in the form of
misery, wars, famines, floods, diseases, pestilence, etc. But all these are natural calamities
which are not peculiar to over-populated countries. They visit even those countries where
the population is on the decline or stationary, such as France and Japan.
(10) Malthus a False Prophet:
 The Malthusian theory is not applicable to countries for which this was propounded. In the
western European countries, the bogey and pessimism of Malthus has been overcome. His
prophecy that misery will stalk these countries if they fail to check the growth of population
through preventive checks has been proved wrong by a decline in birth rate, adequacy of
food supply, and increase in agricultural and industrial production. Thus, Malthus has
proved to be a false prophet.
Its Applicability:
 The Malthusian doctrine may not be applicable now to its place of origin, but its
influence spreads over two-third of this universe.
 India is one of the first countries to adopt family planning on state level to control
population. Positive checks like floods, wars, droughts, diseases, etc. operate. The birth
and death rates are high. The growth rate of population is about 2 per cent per annum.

20
  The real aim of population policy is, however, not to avoid starvation but to eliminate
poverty so as to raise output per head in an accelerated manner. Thus the Malthusian
theory is fully applicable to underdeveloped countries like India. Walker was right when
he wrote: “The Malthusian theory is applicable to all communities without any
consideration of color and place”
THE OPTIMUM THEORY OF POPULATION:
The optimum theory of population was propounded by Edwin Cannan in his book Wealth
published in 1924 and popularized by Robbins, Dalton and Carr-Saunders. Unlike the
Malthusian theory, the optimum theory does not establish relationship between population
growth and food supply. Rather, it is concerned with the relation between the size of population
and production of wealth.
DEFINITIONS:
 Robbins defines it as “the population which just makes the maximum returns possible is
the optimum population or the best possible population.”
 Carr-saunders: defines it as “that population which produces maximum economic
welfare.”
 According to Dalton, “Optimum population is that which gives the maximum income
per head.”
ASSUMPTIONS:
 The natural resources of a country are given at a point of time but they change over time
 There is no change in techniques of production.
 The stock of capital remains constant.
 The habits and tastes of the people do not change.
 The ratio of working population to total population remains constant even with the
growth of population.
 Working hours of labour do not change.
 Modes of business organization are constant.
The Theory:
 Given these assumptions, the optimum population is that ideal size of population which
provides the maximum income per head. Any rise or diminution in the size of the
population above or below the optimum level will diminish income per head.

21
 Given the stock of natural resources, the technique of production and the stock of capital
in a country, there is a definite size of population corresponding to the highest per capita
income. Other things being equal, any deviation from this optimum-sized population will
lead to a reduction in the per capita income.
 If the increase in population is followed by the increase in per capita income, the country
is under-populated and it can afford to increase its population till it reaches the optimum
level. On the contrary, if the increase in population leads to diminution in per capita
income, the country is over- populated and needs a decline in population till the per
capita income is maximised. This is illustrated in Figure 2.

 In the figure, OB population is measured along the horizontal axis and per capita income
on the vertical axis. In the beginning, there is under-population and per capita income
increases with population growth. The per capita income is BA population which is less
than the maximum per capita income level NM. The ON size of population represents the
optimum level where per capita income NM is the maximum.
 If there is a continuous increase in population from ON to OD then the law of
diminishing returns applies to production. As a result, the per capita production is
lowered and the per capita income also declines to DC due to increase in population.
Thus ND represents over-population. This is the static version of the theory. But the
optimum level is not a fixed point.
 It changes with a change in any of the factors assumed to be given. For instance, if there
are improvements in the methods and techniques of production, the output per head will
rise and the optimum point will shift upward.

22
 What the optimum point for the country is today, may not be tomorrow if the stock of
natural resources increases and the optimum point will be higher than before. Thus the
optimum is not a fixed but a movable point.
 According to Cannan, “At any given time, increase of labour up to a certain point is
attended by increasing proportionate returns and beyond that point further
increase of о labour is attended by diminishing proportionate returns.” The per
capita income is the highest at the point where the average product of labour starts
falling. This point of maximum returns is the point of optimum population.

 This is illustrated in Figure 3. The size of population is measured on the horizontal axis 2
and the average product of labour on the vertical axis. AP is the average product of
labour or income per head curve. Up to OP level, increases in population lead to a rise in
the average product of labour and per capita income.
 Beyond OP, the average product of labour and per capita income falls. Hence when
population is OP, the per capita income is the highest at point L. Thus, OP is the optimum
level of population. To the left of OP, the country is under-populated and beyond OP, it is
over-populated.
 However, OP is not a fixed point. If due to inventions there are improvements in the
techniques of production, the average product of labour might increase and push the level
of per capita income upward so that the optimum point rises. This is shown in the figure

23
 where the AP1 curve represents the higher average product of labour and point L shows
the maximum per capita income at the new optimum level of population OP1.
Dalton’s Formula:
 Dalton has deduced over-population and under-population which result in the deviation
from the optimum level of population in the form of a formula. The deviation from the
optimum, he calls maladjustment. Maladjustment (M) is a function of two variables, the
optimum level of population О and the actual level of population A.
 The maladjustment is M = A-0/0
 When M is positive, the country is over-populated, and if it is negative, the country is
under-populated. When M is zero, the country possesses optimum population. Since it is
not possible to measure O, this formula is only of academic interest.
Its Superiority Over the Malthusian Theory:
The optimum theory of population is superior to the Malthusian theory on the following
grounds:
(1) The Malthusian law is a general study of the population problem because it is applicable to
all countries irrespective of their economic conditions.
(2) The optimum theory is superior to the Malthusian theory because it studies the population
problem in relation to the economic conditions of a particular country.
(3) Malthus had a narrow vision. He related the growth of population to food supply. The
Malthusian theory is a static concept which applies to a period of time.
(4) The optimum theory is a dynamic one because over a period of time the per capita income
may rise with the expansion in output due to improvements in knowledge, skill, capital
equipment and other elements in production.
(5) This belief arises from the operation of the law of diminishing returns in agriculture. But the
optimum theory takes a realistic view when according to this, the law of diminishing returns
does not operate in agriculture immediately but after the optimum point is reached. In other
words, first the law of increasing returns operates up to the optimum point and the law of
diminishing returns after it.
(6) Malthus was essentially a pessimist who portrayed a gloomy picture about the future of
mankind which was full of misery, vice, floods, droughts, famines and other natural
calamities.

24
IT’S CRITICISMS:
(1) No Evidence of Optimum Level:
The first weakness of the optimum theory is that it is difficult to say whether there is anything
like an optimum population. There is no evidence about the optimum population level in any
country.
(2) Impossible To Measure Optimum Level:
It is impossible to measure the optimum level quantitatively. As pointed out by Prof. Bye, it is
“impossible to calculate it with any semblance of m exactness for any country at any time.”
(3) Optimum Level Vague:
Optimum population implies a £ qualitative as well as a quantitative ideal population for the
country. The qualitative ideal implies not only physique, knowledge and intelligence, but also the
best age composition of population. These variables are subject to change and are related to an
environment. Thus the optimum level of population is vague.
(4) Correct Measurement of Per Capita Income not Possible:
Another difficulty pertains to the measurement of per capita income in the country. It is not an
easy task to measure changes in the per capita income. The data on per capita income are often
inaccurate, misleading and unreliable which make the concept of optimum as one of doubtful
validity.
(5) Neglects the Distributional Aspect of increase in Per Capita Income.:
Even if it is assumed that per capita income can be measured, it is not certain that the increase in
population accompanied by the increase in per capita income would bring prosperity to the
country. Rather, the increase in per capita income and population might prove harmful to the
economy if the increase in per capita income has been the result of concentration of income in
the hands of a few rich. Thus the optimum theory of population neglects the distributional aspect
of increase in the per capita income.
(6) Optimum Level not fixed but oscillating:
The concept of the optimum population assumes that the techniques of production, the stock of
capital and natural resources, the habits and tastes of the people, the ratio of working population
to total population, and the modes of business organisation are constant. But all these factors are
constantly changing. As a result, what may be the optimum at a point of time might become less
or more than the optimum over a period of time. This is illustrated in Figure 4.

25
  AP is the average product of labour or per capita income curve. Suppose there is an
innovation which brings a change in the techniques of production. It shifts the per capita
income curve to AP1 As a result, the optimum level of population rises from OP 1 to
OP2 with the increase in per capita income from P 1M1 to P2M2. If the per capita income
rises further due to a change” in any of the above assumed factors, the AP 2 curve will
shift upward.
 The AP2 or AP1 curve can also shift downward if, for instance, the capita income falls
due to an adverse change in the given factors. If the locus of all such points like
M1 M2 etc., are joined by a line, we have the PI curve which represents the path of the
movement of the optimum population as a result of changes in the economic factors.
 If, however, the actual level of population is assumed to be OP 0 and the optimum level
OP1 then the country is over-populated. If OP2 is the optimum level, then the country is
under-populated. Thus the optimum is not a fixed level but an oscillating one.
(7) Neglects Social and Institutional Conditions:
 The optimum theory considers only the economic factors which determine the level of
population. Thus it fails to take into consideration the social and institutional conditions
which greatly influence the level of population in a country.
 A lower level of optimum population may be justified from the economic viewpoint, but
such a level may be harmful keeping into view the defense considerations of the country.
For instance, economic consideration may prevent us from having a large population but

26
 the danger from foreign aggression may necessitate a very large population to safeguard
our territorial integrity. Thus the optimum theory is imperfect and one-sided.
(8) No Place in State Policies:
 The concept of optimum population has no place in the policies of modern states. While
fiscal policy aims at increasing or stabilizing the level of employment, output and income
in a country, no reference is made to the optimum level of population. This theory is,
therefore, of no practical use and is regarded as useless.
(9) Does not explain Determinants of Population Growth:
 It does not explain the reasons for rise or fall in birth and death rates, the influence of
urbanization and migration on population growth, etc.
 The theory fails to explain about the nature of an optimum path of population growth.
 It does not explain how the optimum level once reached is maintained.
BIOLOGICAL THEORIES OF POPULATION:
1. Thomas Doubleday’s Diet Theory:
 Thomas Doubleday, a social philosopher and an English economist, was born in 1790. He
expressed his views regarding various natural laws which govern population. According
to him, the rate of population increase will be less when the quantity of food supply is
greater.
 It means that the increase in population and food supply are inversely related. Doubleday
mentions two states of food supply, i.e., (i) The Plethoric state having good food supply
where the fertility is low, and (ii) the Deplethoric state in which due to food shortage we
find diminution of proper nourishment where the fertility is high.
 According to Doubleday, fertility is affected by leanness in all plants and animals. An
overfed plant can be revived only when the plants are depleted either by ringing the bark
or by extreme lopping or the trenching of the roots.
 Besides, the sterility in plant life is possible when the application of fertilizers is
excessive. He also believes that thin birds or animals give birth to more offspring, while
bulky or fat birds or animals give birth to less. Similarly, this becomes true about trees
and plants. It means that fertility depends on the fatness of living beings, according to
Doubleday.

27
  Moreover, Doubleday also observes that high fertility has been found in those persons
who are vegetarians, or who eat more rice or whose staple diet is rich, whereas fertility
will be low in non-vegetarian persons.
DOUBLEDAY DIVIDES SOCIETY INTO THREE GROUPS:
(1) The first group includes those who are in a state of affluence and are well supplied
with luxuries. Their number is on constant decrease. While the number of those who are
engaged in mental or physical activities and are living busy life, is on the increase.
(2) The second group consists of the poor people who have less supply of food. Their
number is increasing rapidly. In other words, the constant increase in population is found
in the group where people are worst supplied with food. This happens in all societies.
(3) The third group has those people who form the mean and median between two
opposite states and who fall under the average income group and those who are tolerably
well supplied with good food or who get a normal diet and do not overwork and yet are
not idle. Their number is stationary.
Criticisms of Thomas Doubleday’s Diet Theory:
Thomas Doubleday’s diet theory has been criticised on the following grounds:
1. Doubleday’s observation regarding an inverse relationship between food supply and fertility
has no scientific basis.
 According to Doubleday, the fertility is low in the Plethoric state due to good food supply and is
high in Deplethoric state due to food shortages and diminution of proper nourishment. However,
such things have not happened in reality. Even in Plethoric state the population goes on
increasing.
3. Doubleday believes that the rich people have less children whereas the poor have more. In
reality, this is far from true, because in many cases we find more children in rich families and
less in the poor ones.
4. Doubleday opine that the number of those persons who get a normal diet and who come under
the average income group remains stationary. But experiences has shown that even in such an
income group the number has always been increasing.
5. Doubleday is of the view that fertility depends on fatness. As the rich persons are fat, fertility
is low with the increase in fatness. In this regard, Spencer has criticized this presumption of
Doubleday. According to him, in reality every rich person may not be always fat.

28
2. JOUSE DE CASTRO’S PROTEIN CONSUMPTION THEORY:
Jouse De Castro expressed his views in his famous book The Geography of Hunger regarding the
correlation between the fertility and the consumption of protein. Castro accepted the findings of
R.J. Solankar who conducted experiments on rats in 1920. In these experiments Solankar found
that with the increase in protein consumption in diet, the fecundity will decrease and it will
increase with low protein content in diet.
His experiment led to the following conclusions:
 When 10 per cent protein was given to a female rat, per mated female rat gave 23.3 births;
 When 18 percent protein was given to each female rat, per mated female rat gave 17.4
births; and
 When the quantity of protein was increased to a level of 22 percent to each female rat, the
birth per mated female rat reduced to 13.8 births.
 Through these experiments Castro came to the conclusion that the fatness is affected by the
consumption of protein. The fatness increases with the protein rich diet, which leads to
lower fertility. This concept of Castro is similar to the Doubleday’s diet theory that the rate
of population increase is influenced by food supply.
 Moreover, Castro also found a direct relation between the functioning of the liver and that
of the ovaries.
 In the words of Castro, “It is known that there is a direct connection between the
functioning of the liver and the ovaries, the role of the liver being to inactivate the excess
estrogens which the ovaries throw into the blood stream. Fatty degeneration of the liver and
the tendency to cirrhosis are some of the characteristic result of protein deficiency when
degeneration of the liver occurs, it begins to operate less efficiently, and is less effective at
its job of inactivating excess oestrogents. The result is a marked increase in the women’s
reproductive capacity.”
 According to Castro, balanced food is not available to the poor and therefore poor people
are always getting less protein in food which results in sluggish liver function.
Consequently, when males have defective liver, the estrogens in women’s body cannot be
neutralised, and with the increase in estrogens the women’s reproductive capacity increases.
This results in high birth rate. Therefore, compared to the rich, the birth rate in the poor

29
 people with chronic hunger (malnutrition) is high. But in the case of acute hunger, sexual
activity goes down.
 According to Castro, people or societies are blamed for the high birth rate in the poor
countries, which is not proper. For this the rich countries or the people of affluent societies
should be blamed, because the imperial or colonial powers have not taken any steps to
improve the standard of living of their people nor have they made attempts to provide good
food.
 On the contrary, instead of concentrating more on the increase of food production, imperial

powers have concentrated on the purchase of raw materials and food supplies at low rates
and finished products have been sold out at high rates in their colonies.
 As a result, due to high prices and low wages, the people’s food intake becomes imbalanced
and they cannot get enough protein content in their diet. With the reduction or absence of
protein contents in their food, the capacity to produce more children increases which
ultimately results in the increase in poverty. When poverty increases, again due to the
imbalanced food, people get less protein, which again leads to the increase in the capacity
to produce more children. Such a vicious cycle goes on.
 It was painful for Castro when he observed that adequate attention had not been given to the
problems of the imbalance food by the rich, the capitalists, the scientists or the imperialists.
They had given importance only to the commercial activities rather than to the social
aspects of poverty.
 Castro reflected on the issue with reference to India that out of the total number of children
born in India, almost fifty percent suffer from starvation and die before they reach the age
of marriage.
 On the basis of data for different countries relating to the association of fertility with
consumption of protein, Castro concluded that in 1952 two-third of the world population
experienced chronic hunger, i.e., malnutrition, disease or early death.
 Castro pointed out that to eradicate chronic hunger, priority should be given to the problem
of balanced food.
 This is only possible through economic development leading to rising income of the poor
which increases their protein consumption.

30
CRITICISMS OF JOUSE DE CASTRO’S PROTEIN CONSUMPTION THEORY:
Castro’s theory of protein consumption has the following defects:
 High fertility has been experienced in many developed countries with the increase of
protein in diet.
 Scientifically, it cannot be proved that protein rich diet leads to lower fertility.
 Fertility always does not increase in poor people because it is not true that chronic hunger
will always give more importance to sex.
 In poor countries, the reasons for high birth rate are poverty and imbalanced food.
However, factors like agriculture based economy, social, religious or cultural structure of
the society, education; existence of joint family system, marriage at early age, etc. cannot
be ignored in influencing population growth.
 Economists do not accept the view that human fertility depends on diet alone. According
to Coontz, fluctuations in fertility during trade cycle cannot be explained in terms of diet.
3. MICHAEL THOMAS SADLER’S DESTINY THEORY:
 Michael Thomas Sadler, an Economist and a British social reformer, was born in 1780.
He was a contemporary of Malthus. He expressed his ideas about population in his book
The Law of Population. According to Sadler, the law which regulates the growth of
animals and plants is primarily the same as the law which regulates the growth of human
population.
 He was of the opinion that “The fecundity of human beings is in the inverse ratio of the
condensation of their numbers.”
 Moreover, the fertility rate decreases with the increase in the density of population. In the
agriculture based or pastoral countries where the density of population is low, the fertility
rate of the population becomes high. In such countries, people have the capacity to work
hard and hardworking people give birth to more children.
 With the passing of time, when there is industrialization and the population becomes
more civilized and literate, the density of population increases. Here people would limit
the size of family and in such socio-economic conditions they will be happier and there
will be prosperity.
 Sadler was a great critic of Malthus. He did not accept Malthus’s view that population
increases in geometrical progression and food supply increases in arithmetical

31
 progression. According to Sadler, such increase of population and food supply in
mathematical terms just cannot happen, because when population increases density too
will increase.
 And when density increases, the capacity to produce children goes down and thus with
the increase in density, the fertility rate declines. He believed that population adjusts
itself with the times.
 He did not accept the fear of Malthus that positive checks by nature take place with the
growth of population. He also did not believe in the preventive measures of birth control
described by Malthus. Sadler was very optimistic and he tried to establish a link between
population and food supply.
 He was of the view that if the fertility rate of population increases, people will be able to
produce food according to their needs and the food supply and population will get
adjusted to each other.
CRITICISMS OF MICHAEL THOMAS SADLER’S DESTINY THEORY:
If we compare Sadler’s theory to the Malthusian theory of population, it can be said that
the theory of Sadler is very optimistic. When Sadler’s book was published in 1830, many
economists, sociologists and demographers were under the spell of pessimism created by
Malthus in his population theory. In such an atmosphere to give optimistic thoughts itself was a
great achievement.
BUT THE THEORY OF SADLER IS ALSO CRITICISED ON DIFFERENT GROUNDS:
 Sadler failed to distinguish between fecundity and fertility. He said that the fecundity of
human beings is in the inverse ratio of the condensation of their numbers. But in fact no
biological reason is found to prove the idea that if density brings down ‘fertility’, it will
bring down ‘fecundity’ also. This is because in slums the density is very high and at the
same time fertility is also high among slum dwellers.
 Moreover, in many countries of the world where the density is high, the fertility rate is
also high. Even in India, in some states like Delhi, Kerala and West Bengal where the
density is high, the fertility is not low in comparison with the fertility of other states.
 Another point of criticism is the paradoxical statement of Sadler that with the increase in
density, the fertility rate decreases. At the same time, he was of the view that with the

32
 increase in density the death rate will increase and consequently, to compensate for the
loss of population the fertility rate also increases.
 It means that the fertility rate will not decrease, but it will increase with the increase of
density. Thus, Sadler’s statements are self-contradictory.
 Sadler’s view that with industrialization the population decreases has not been proved
true. In a country like India, industrialization has not led to the decline in the growth of
population.
4. HERBERT SPENCER’S BIOLOGICAL THEORY:
 Herbert Spencer, a famous English philosopher and sociologist, propounded the
biological theory of population in his book The Principles of Biology. Spencer argued
that fecundity decreases when the complexity of life increases.
 According to him, changes in the growth of population occur due to natural change in the
reproductive capacity of human beings. Therefore, his theory has been known as a natural
theory of population which is similar to the theory of Sadler and Doubleday.
 Spencer believed that “there exists antagonism between individuation (survival) and
genesis (reproduction)”. When any individual does hard work for his personal
development at his work place, the desire for reproduction decreases.
 In other words, when more energy has been utilised for one’s self-development, the
energy available for reproduction will be less and consequently the population growth
will be less. Thus, with the development of society and for one’s success and survival
(individuation), life becomes more complex which results in reduction in the capacity of
reproduction.
 This is observed from the fact that fertility is more in rural individuals whose life is not
complex, whereas fertility is low in an industrial society where life is more complex, the
pressure of education is more and the brains are overtaxing.
We have four different situations which explain the relation between individuation and
genesis:
 The individuation will automatically below when there is high genesis. This situation we
find among the poor.
 The genesis will be low when there is high individuation. Such a situation we find
among the rich.

33
  The individuation will improve when the genesis is low.
 The genesis will be high when the individuation is low. In poor people, we find less
individuation and more genesis.
According to him, people can be divided in three groups:
(i) Poor people who live a simple life whose fertility is high;
(ii) Middle class people whose fertility is correspondingly low; and
(iii) People who live developed or complex life whose fertility is fairly low.
 According to Spencer, in societies where people, especially woman, are educated and
belong to rich families, their reproductive power is low, as compared to the poor who are
uneducated and whose reproductive power is high.
 In the words of Spencer, “In its full sense, the reproductive power means the power to
bear a well-developed infant, and to supply that infant with the natural food for the
natural period. Most of the flat chested girls who survive their high- pressure education
are incompetent to do this. Were their fertility measured by the number of children they
could rear without artificial aid, they would prove relatively very infertile.”
 Spencer believed that if population increases we get more manpower through which
natural resources can be exploited and the socio-economic and cultural standards of the
people can be raised. Thus, he was of the opinion that increase in population was
beneficial rather then harmful.
 Further, as per Spencer, a determining factor for birth fate and death rate is longevity.
The expectancy of life increases and the death rate decreases when life becomes more
complex. He, therefore, suggested increase in life expectancy in order to reduce the birth
rate.
Criticisms of Herbert Spencer’s Biological Theory:
Spencer’s theory of population has been criticised on the following counts:
1. Spencer’s population theory is not a real theory but a biological theory.
2. The view of Spencer that fertility decreases due to more complex life has no empirical
evidence. There is high fertility rate even in rich families or industrialised societies where
people’s life is more complex.
3. The problem of population growth itself is a complex phenomenon and therefore it cannot be
explained as a biological one.

34
4. Spencer’s view that educated women whose individuation is high would prove relatively
infertile, is not realistic. Even educated women have high reproductive power.
5. Spencer’s theory that fertility is affected by the natural process of individuation has no
justification because when Spencer propounded this theory the birth rate was high in the western
countries
4. CORRADO GINNIS’S BIOLOGICAL POPULATION THEORY:
 Corrado Ginnis, a sociologist, was born in Italy in 1884. He had deep interest in the study
of population changes which affect the evolution of society and that of a nation.
According to Ginni, fertility will be very high in a nation when it is in the primary stage.
Due to high fertility, the population increases and consequently social and economic
problems become complex.
 Further, the problems of trade and industry also become more complex.
 At this time, fertility starts declining. “He thought that the evolution of a nation or any
society was closely linked to the changes in their rates of population growth and to the
varying propositions of this growth coming from the different social classes.”
 Ginni was of the opinion that only biological factors are responsible for the increase in
population and therefore his theory of population can be characterised as a natural law
theory. According to Thomson and Lewis, “Ginni invokes some mystical biological
changes, quite beyond man’s control, as the basic factors determining not only man’s
quantitative growth, i.e., his fertility, fecundity, and survival but also his qualitative
development, i.e., the distinctive characteristics of man’s different civilization.”
 Moreover, the biological traits of population change at various rates of increase in the
different classes of population. According to Ginni, “There is first a period of slower
growth and mature achievement which, in turn, passes into a period of senescence, during
which numbers decline and the quality of utilization deteriorates.”
 Ginni was of the view that social and economic factors can influence the population
growth but the reasons for the increase or the decrease in population growth are only
biological. Thus this theory is based on biological aspects.
 According to Thomson and Lewis, “Ginni believed that the biological factor in declining
fertility was the fundamental factor, that it really underlays the influence of economic and
social factors, which only apparently determined the decline in fertility.”

35
  Ginni believed that the population growth is similar to the cyclical growth of an
individual. In the first stage, the growth of population is very rapid while in the second
stage, the growth is comparatively slow. In the third stage which is known as senescence,
population decreases and there is deterioration in the quality of civilization.
 As pointed out by Thomson and Lewis, “Every nation in its youth is simple and
undifferentiated in structure and has a high rate of fertility, because each generation
springs from the people who are hereditarily most prolific, i.e., highly fecund.”
 Ginni was of the opinion that due to high fertility population increases and consequently
social and economic problems become complex. Along with that industrial and trade
problems also become more complex, the pressure of population is ultimately reduced
through war or colonisation or both.
 According to Ginni, first the fertility rate declines among the rich. After that when the
energetic and prolific poor people enter the rich class, their fertility also decreases. When
the whole society or country becomes rich, there is decline in population growth due to
the weakening of the reproductive instinct.

SOCIAL AND ECONOMIC THEORIES OF POPILATION:

1.Dumont’s Theory of Social Capillarity:
Arsene Dumont (1849-1902) has propounded the Theory of Social Capillarity. Social
attraction or repulsion to a thing is known as Social Capillarity. Dumont studied the growth of
population in France in the later part of nineteenth century and found that the reason for low
fertility in France was high intellectual and aesthetic development.
In the words of Dumont, “The development of number in a nation is in inverse ratio to the
development of individual.”
According to him, “The direct cause of decline in birth rate was the movement of individual
from the lower to the upper class.The individual tends to rise to higher levels in his social
environment by process similar to physical capillarity.” Further, “what gravity is to the physical
world, capillarity is to the social order.”
According to Dumont, there are three principles of population that are related to the stages
of social development:

36
 1. In the preventive stage, the Malthusian theory of population applies where human beings
live like animals. On what they can find, they increase in geometrical progression.
2. In the intermediate stage, Quillard’s principle of population applies. According to
this, “Population proportions itself automatically.” In such a society, population
increases as food supply increases because population can produce food itself. Here positive
checks do not become necessary.
3. In a modern civilised society, Dumont applies his social capillarity principle. In such a
society, every individual wants to achieve higher economic and social status. For this, a
small family is imperative, because one cannot climb high on the social ladder with the
burden of more children on its back.
 When an individual earns more income and wealth, his ambition for better position and
higher social prestige goes up and consequently the number of children decreases.
Therefore, in a civilized society due to social capillarity, fertility goes down. When
people migrate to cities from rural or backward areas, their fertility declines.
 Thus social capillarity has direct relation with social development, and birth rate and
social capillarity are inversely related to each other. The number of children is less when
people become more civilized. In the words of Dumont, “Just as a column of liquid must
be thin in order to rise under the force of capillarity so must a family be small to rise in
the social scale.” According to Dumont, the poor can achieve capillarity if they divert
their time, energy and wealth for vertical mobility.
 This is possible only when they restrict their families to one or two children. According
to him, the birth rate in rural areas is high while it is low in urban areas. The reasons for
high birth rate in rural areas are poverty, illiteracy, orthodoxy and lack of vigour.
 The reasons for low birth rate in urban areas are people’s ambition for vertical mobility,
liberal environment, high standard of living, more income and wealth, capacity of
rational thinking, high socio-economic status of women, progressive ideals, high cost of
living, the desire of middle class to move into the upper class, etc.
 As enough opportunity for social capillarity is not available in a socialist society, Dumont
believes that socialism leads to the destruction of social capillarity.
CRITICISMS:
Dumont’s social capillarity theory has been criticised on the following counts:

37
1. Nature of other factors: Dumont’s view that low birth rate leads to high position in society is
not true because besides birth rate, other factors like social, economic, political, etc. are
responsible for moving upward in society.
2. Not a Universal Truth: It cannot be accepted as a universal truth that one cannot climb high
on the social ladder with the burden of more children on one’s back because in reality there are
many people with more children who have climbed high and there are many people having less
children who are living at the bottom.
If we accept this view of Dumont, the childless couples will be at the top of society. Besides,
there are many people in society who have low social status and their standard of living is also
low but who have less number of children. Therefore, the number of children or the size of
family has not direct relation to the low or high position in the society.
3. Concept not Clear: Which type of capillarity an individual has to choose as his ideal is not
clear in Dumont’s social capillarity concept.
4. Not Applicable to Underdeveloped Societies: Dumont’s observation that birth rate in rural
areas remains high while it is low in cities has also been criticised. It is true that compared to
rural areas, birth rate in urban areas is low, but in a country like India, when labourers migrate
from rural to urban areas, they come alone and keep their families in rural area. This is one of the
reasons for low birth rate in urban areas. So it is not applicable to underdeveloped societies.
5. Not a Complete Theory:
Dumont’s principle is not a complete population theory because social capillarity is one of the
motives that can lead to reduction in birth rate.
6. Applicable to Socialist Societies: Dumont’s assertion that socialism leads to the destruction
of social capillarity has been proved wrong. Even in a socialist country like China people are
following the social capillarity principle. They want to move higher on the social ladder and are
reducing fertility.
4. KARL MARX’S THEORY OF SURPLUS POPULATION:
 Karl Marx, the famous author of Das Kapital, did not propound any specific theory of
population like Malthus. However, he rejected the Malthusian theory as completely
imaginary and false. He did not accept Malthus’s view that population increases in
geometrical progression and means of subsistence in arithmetical progression. Marx’s
views about population growth are based on his theory of surplus value.

38
 According to him, the problem of population arises only in a capitalist society which fails
to provide jobs to all workers because the supply of labour is more than its demand. As a
result, there is surplus population.
 But there is no surplus population in a socialist society where the means of production are
in the hands of workers. All able bodied workers are employed and there is no surplus
labour. So there is no need to check the growth of population in a socialist country.
 Capitalism, according to Marx, is divided into two classes – the workers who sell their
‘labour-power’, and the capitalist who own the ‘means of production’ (factories). Labour-
power is like any other commodity. The labourer sells his labour for its value. And its
value, like the value of any other commodity is the amount of labour that is required to
produce labour-power. In other words, the value of labour-power is the value of the means
of subsistence (i.e., food, clothing, housing, etc.) necessary for the maintenance of the
labourer.
 This is determined by the number of hours necessary for its production. But the value of
commodities necessary for the subsistence of the labourer is never equal to the value of
the produce that labourer produces. If a labourer works for ten hours a day, but it takes
him six hours’ labour to produce goods to cover his subsistence, he will be paid wages
equal to 6 hours’ labour. The difference worth 4 hours’ labour goes into the capitalist
pocket in the form of profit. Marx calls this unpaid work “surplus value”.
 According to Marx, this surplus value leads to capital accumulation. The capitalist’s main
aim is to increase the surplus value in order to increase his profit. He does so by “the
speeding up of labour”, which means increasing the productivity of labour.
 When the productivity of labour increases, the labourer produces the same commodity in
less hours, say 4 hours, or he produces more (two) commodities, say in 6 hours. This
raises the surplus value and hence the capitalist’s profit.
 The increase in the productivity of labour requires a technological change that help in
increasing total output and lowering the cost of production. He introduces labour-saving
machines which increase labour productivity.
 This process of replacing labour by machines creates an industrial reserve army which
increases as capitatism develops. The industrial reserve army is the surplus population.

39
 The larger the industrial reserve army, the larger the surplus population and the worse are
the conditions of the employed labourers.
 This is because the capitalists can dismiss dissatisfied and troublesome workers and
replace them from the ranks of the reserve army. Capitalists are also able to cut down
wages to a semi-starvation level and raise more surplus value, while the surplus
population increases.

 The Marxian theory of surplus population is explained in Fig. 1 where the labour force is
taken on the horizontal axis and the wage rate on the vertical axis. DD is the demand
curve for labour and SS is the supply curve of labour. At the wage rate OW, there is
increase in the industrial reserve army or surplus population equal to RA (=LL1). As the
industrial reserve army expands, the capitalists start adopting labour-saving machines in
order to increase the surplus value and hence profits.
 Consequently, the supply curve of labour SS starts sliding towards the right and becomes
horizontal at S1. The capitalists also start reducing the wage rate simultaneously to the
minimum subsistence level OM in order to have more surplus value and profits. Now at
this wage rate, the horizontal supply curve MS1 equals the demand curve for labour at
point E1. Thus at the subsistence wage rate OM the entire working population
OL1becomes the surplus population.

40
Marx explains his surplus theory of population thus:
“It is the working population which, while effecting the accumulation of capital also produces
the means whereby it is itself rendered relatively superfluous, is turned into a relatively surplus
population, and it does so to an ever increasing extent. This is a law of population peculiar to the
capitalist method.”
Criticisms:
Marx’s theory of surplus population has been criticised on the following grounds:
(1) Unrealistic Theory:
The Marxian theory is unrealistic because it is based on the theory of surplus value. The concept
of surplus value has not been accepted even in socialist countries since it is unrealistic.
Therefore, the very basis of his population theory does not exist.
(2) Not Applicable to Socialist Countries:
Marx’s contention that there is no population problem in a socialist country has been proved
wrong. China, the largest socialist country of the world, has been faced with the problem of
population growth. It has been trying to control it by adopting “one-child” norm.
(3) Technological Progress reduces Industrial Reserve Army:
According to Marx, with increasing technical progress the industrial reserve army expands
which, in turn, leads to surplus population. This is an exaggerated view because the long run
effect of technical progress is to provide more employment.
(4) No Explanation of Determinants:
Marx does not explain the determinants of population growth like birth rate, death rate,
migration, etc.
Thus Marx’s explanation of population growth is not a theory in the true sense but simply a
view.
5. LEIBENSTEIN’S MOTIVATIONAL THEORY OF POPULATION GROWTH:
 Leibenstein’s theory of population growth forms part of his Critical Minimum Effort
Thesis on economic development. It is based on his empirical evidence that the rate of
population growth is a function of the level of per capita income which, in turn, depends
on the stage of economic development.

41
 Leibenstein’s view is based on Dumont’s “Social-capillarity Thesis” which states that
with the increase in per capita income, the desire to have more children as productive
agents declines.
 This means that as per capita income rises with economic development, the fertility rate
declines. Similarly, the mortality rate also declines, as there is improvement in public
health measures with economic development. But the decline in the mortality rate is fast
as compared to the decline in the fertility rate. This creates a “fertility gap” which
continues to widen for quite some time.
 Leibenstein explains the fertility gap in terms of the cost-benefit analysis of bringing up
an additional child. There are three types of benefits or utilities which parents derive from
an additional child.
They are:
 Consumption utility which they get out of love and pleasure by rearing a child;
 Productive utility when the child starts earning from childhood and is a source of
income for his parents; and
 Old age security utility which the child possesses when he supports his parents in
old age who are unable to earn.
 The costs of bringing up an additional child are of two types – direct and indirect. The
direct costs relate to expenditure on feeding, clothing, education, etc. These expenses are
incurred by parents till the child starts earning and become self-supporting.
 The indirect costs relate to the opportunities foregone by parents when an additional child
is born. Such opportunities foregone are earnings lost by the mother during and after the
pregnancy, less social and spatial mobility of parents due to additional responsibility in
bringing up the additional child, etc.
 Lack of spatial mobility means potential loss of income. On the whole, the cost of
bringing up an additional child is less to parents with low per capita income and high
with high per capita income.
 There are three types of effects which influence the utilities and costs of bringing up an
additional child during the process of economic development. They are the income,
survival and occupational distribution effects. With economic development, as per capita

42
 income increases, the chances of survival increase and there are changes in the
occupational distribution.
 Leibenstein explains these three effects in relation to the utilities and costs during the
process of economic development. We first explain the per capita income effect in Fig. 2.

 Per capita income of the family is shown on the horizontal axis while utilities and costs
per child are taken on the vertical axis. The consumption utility curve is assumed as
constant because it is independent of the family per capita income. It is the pleasure and
satisfaction that the parents get in rearing a child which has nothing to do with their per
capita income. This is shown by the horizontal curve C in the figure.
 The curves S and P depict security utility and productive utility respectively which
decline as the per capita income increases. As the per capita income increases, parents
become wealthier to provide for their own security and depend less on the child in old
age. 
 Similarly, as the per capita income increases, there is no need for the child in the family
to earn during childhood in order to support the family. Schooling is extended and the
child is less valuable as a productive agent. Thus the P curve also slopes downward as per
capita income increases.

43
  The direct and indirect costs of bringing up an additional child increase in proportion to
the rise in per capita income of the family. This is shown by the 45° straight line curve
through the origin.
 So far as the survival effect is concerned, the increased survival rates raise the three
utility curves. The reason is that when an additional child is expected to survive for long
years of life, there are more expected years of satisfaction for the parents. But the
survival effect reduces the motivation to have an additional child on the part of parents.

Its Criticisms:
Leibenstein’s theory has the following weaknesses:
(1) Population Growth Rate Related to Death Rate:
 The theory is based on the assumption that the rate of growth of population is an
increasing function of the level of per capita income up to a point, but beyond that it is a
decreasing function of the latter. But the first process is related to the decline in the
mortality rates due to the advancements in medical science, and improvements in public
health measures in underdeveloped countries, and not to an increase in the level of per
capita income.

44
  In India, there has been a decline in crude death rate from 24 per thousand in 1960 to 8 in
2001, not due to a rise in the per capita income which is almost stationary but as a result
of the above mentioned factors.
(2) Decline in Birth Rate not due to Increase in Per Capita Income:
 Similarly, the decline in the birth rate cannot be attributed to an increase in the per capita
income at the critical minimum level which surpasses the growth rate of population, as is
supposed by Leibenstein. His conclusions are based on the experience of advanced
Western countries and Japan.
 But in underdeveloped countries the problem of declining birth rate is mostly socio-
cultural in nature. What is required is change in ‘the attitude, understanding, education,
social institutions and even certain intellectual perceptions.’ Rise in per capita income
alone cannot perform the trick.
 There is no guarantee that with the decline in the birth rate, population would start
decreasing as per capita income increases in underdeveloped countries.
(3) Ignores State Efforts to Reduce Birth Rate:
 Leibenstein ignores the state action in bringing down the fertility rate. As the experience
of japan has shown, no underdeveloped country can afford to wait for the per capita
income to rise above the critical minimum level so that the birth rate may start declining
automatically.
 In such a situation, she may reach the stage of the population explosion thereby creating
more problems than she can solve by the rise in the per capita income.

THE THEORY OF DEMOGRAPHIC TRANSITION:

 Introduction to the Theory of Demographic Transition: The theory of demographic
transition or of population stages or of population cycle has many versions. It has been
propounded by W.S. Thomson and F.W. Notestein. They explain the theory in three
stages.
 But the two famous versions are C.P. Blacker’s five stages of population growth which
have been explained here, and Karl Sax’s four stages of population growth, namely, High
Stationary, Early Explosive Increase, Late Explosive Increase, and Low Stationary. He

45
 does not explain Blacker’s Declining Stage, while his four stages almost resemble
Blacker’s other stages.
Explanation of the Theory of Demographic Transition:
 The theory of Demographic Transition explains the effects of changes in birth rate and
death rate on the growth rate of population. According to E.G. Dolan, “Demographic
transition refers to a population cycle that begins with a fall in the death rate, continues
with a phase of rapid population growth and concludes with a decline in the birth rate.”
 The theory of demographic transition is based on the actual population trends of
advanced countries of the world. This theory states that every country passes through
different stages of population development.
According to C.P. Blacker, they are:
(i) The high stationary phase marked by high fertility and mortality rates;
(ii) The early expanding phase marked by high fertility and high but declining mortality;
(iii) The late expanding phase with declining fertility but with mortality declining more rapidly;
(iv) The low stationary phase with low fertility balanced by equally low mortality; and
(v) The declining phase with low mortality, lower fertility and an excess of deaths over births.
These stages are explained in the Fig. 1 (A) & (B) In the figure, the time for different stages is
taken on the horizontal axis and annual birth and death rates on the vertical axis. The curves BR
and DR relate to birth rate and death rate respectively. P is the population curve in the lower
portion of the figure.
First Stage – High stationary phase
 In this stage the country is backward and is characterised by high birth and death rates
with the result that the growth rate of population is low. People mostly live in rural areas
and their main occupation is agriculture which is in a state of backwardness. There are a
few simple, light and small consumer goods industries.
 The tertiary sector consisting of transport, commerce, banking and insurance is
underdeveloped. All these factors are responsible for low incomes and poverty of the
masses. Large family is regarded as a necessity to augment the low family income.
Children are an asset to the society and parents. The existence of the joint family system
provides employment to all children in keeping with their ages.

46
  More children in a family are also regarded as an insurance against old age by the
parents. People being illiterate, ignorant, superstitious and fatalists are averse to any
method of birth control. Children are regarded as God-given and pre-ordained.
 All these economic and social factors are responsible for a high birth rate in the country.
Along with high birth rate the death rate is also high due to non-nutritional food with a
low caloric value, lack of medical facilities and the lack of any sense of cleanliness.
 People live in dirty and unhealthy surroundings in ill ventilated small houses. As a result,
they are disease-ridden and the absence of proper medical care results in large deaths.
The mortality rate is the highest among the children and the next among women of child-
bearing age. Thus the birth rates and death rates remain approximately equal over time so
that a static equilibrium with zero population growth prevails.
 According to Blacker, this stage continued in Western Europe approximately up to 1840
and in India and China till 1900. This is illustrated in Fig. 1 (A) by the time period HS-
“High Stationary” stage and by the horizontal portion of the P (population) curve in the
lower portion of the figure.

Second Stage- Early expanding phase

 In the second stage, the economy enters the phase of economic growth. Agricultural and
industrial productivity increases, and means of transport develop. There is greater

47
 mobility of labour. Education expands. Incomes increase. People get more and better
quality food products, medical and health facilities are expanded.
 Modern drugs are used by the people. All these factors bring down the death rate. But the
birth rate is almost stable. People do not have any inclination to reduce the birth of
children because with economic growth employment opportunities increase and children
are able to add more to the family income.
 With improvements in the standard of living and the dietary habits of the people, the life
expectancy also increases. People do not make any effort to control the size of family
because of the presence of religious dogmas and social taboos towards family planning.
 Of all the factors in economic growth it is difficult to break with the past social
institutions, customs and beliefs. As a result of these factors, the birth rate remains at the
previous high level. With the decline in the death rate and no change in the birth rate,
population increases at a rapid rate. This leads to Population Explosion.
 This is an “Early Expanding” (EE) stage in population development when the population
growth curve is rising from A to B as shown in Fig. 1(B), with the decline in death rate
and no change in birth rate, as shown in the upper portion of the figure. According to
Blacker, 40% of the world population was in this stage up to 1930. Many countries of
Africa are still in this stage.
Third Stage- Late expanding phase
 In this stage, birth rate starts declining accompanied by death rates declining rapidly.
With better medical facilities, the survival rate of children increases. People are not
willing to support large families. The country is burdened with the growing population.
People adopt the use of contraceptives so as to limit families.
 Birth rates decline a initially in urban areas, according to Notestein. With death rates
declining rapidly, the population grows at a diminishing rate. This is the “Late
Expanding” stage as shown by LE in Fig. (A) and BC in Fig. (B). According to Blacker,
20% of the world population was in this stage in 1930.
Fourth Stage- Low stationary phase
 In this stage, the fertility rate declines and tends to equal the death rate so that the growth
rate of population is stationary. As growth gains momentum and people’s level of income

48
 increases, their standard of living rises. The leading growth sectors expand and lead to an
expansion in output in other sectors through technical transformations.
 Education expands and permeates the entire society. People discard old customs, dogmas
and beliefs, develop individualistic spirit and break with the joint family. Men and
women prefer to marry late. People readily adopt family planning devices. They prefer to
go in for a baby car rather than a baby.
 Moreover, increased specialisation following rising income levels and the consequent
social and economic mobility make it costly and inconvenient to rear a large number of
children. All this tends of reduce the birth at further which along with an already low
death rate brings a decline in the growth rate of population.
 The advanced countries of the world are passing through this “Lower Stationary” (LS)
stage of population development, as shown in Fig (A) and CD in Fig. (B). Population
growth is curtailed and there is zero population growth.
Fifth Stage- Declining phase
 In this stage, death rates exceed birth rates and the population growth declines. This is
shown as D in Fig. (A) and the portion DP in Fig. (B). A continuing decline in birth rates
when it is not possible to lower death rates further in the advanced countries leads to a
“declining” stage of population.
 The existence of this stage in any developed country is a matter of speculation, according
to Blacker. However, France appears to approach this stage.
Criticisms of the Theory of Demographic Transition:
1. Sequences of Stages not Uniform:
Critics point out that the sequences of the demographic stages have not been uniform. For
instance, in some East and South European countries, and in Spain in particular, the
fertility rates declined even when mortality rates were high. But in America, the growth
rate of population was higher than in the second and third stage of demographic
transition.
2. Birth Rate not declined initially in Urban Areas:
Nolestein’s assertion that the birth rate declined initially among urban population in
Europe has not been supported by empirical evidence. Countries like Sweden and France

49
 with predominantly rural populations experienced decline in birth rates to the same extent
as countries like Great Britain with predominantly urban populations.
3. Explanations of Birth Rate decline Vary;
 The theory fails to give the fundamental explanations of decline in birth rates in Western
countries. In fact, the causes of decline in birth rate are so diverse that they differ from
country to country.
 Thus the theory of demographic transition is a generalisation and not a theory.
 Not only this, this theory is equally applicable to the developing countries of the world.
Very backward countries in some of the African states are still in the first stage whereas
the other developing countries are either in the second or in the third stage. India has
entered the third stage where the death rate is declining faster than the birth rate due to
better medical facilities and family welfare measures of the government.
 But the birth rate is declining very slowly with the result that the country is experiencing
population explosion. It is on the basis of this theory that economists have developed
economic- demographic models so that developing countries should enter the fourth
stage.
 One such model is the Coale-Hoover model for India which has also been extended to
other developing countries. Thus this theory has universal applicability, despite the fact
that it has been propounded on the basis of the experiences of the European countries.

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 FAMILY PLANNING METHODS

INTRODUCTION
India was the first country in the world to have launched a National Programme for Family
Planning in 1952. With its historic initiation in 1952, the Family Planning Programme has
undergone transformation in terms of policy and actual programme implementation. There
occurred a gradual shift from clinical approach to the reproductive child health approach and
further, the National Population Policy (NPP) in 2000 brought a holistic and a target free
approach which helped in the reduction of fertility.
DEFINITION:
WHO defined family planning as a way of living and thinking that is adopted voluntarily
upon the basis of scientific knowledge, attitude and responsible decision by individuals and
couples, in order to promote the health and welfare of the family group and thus contribute
effectively to the social and economic development of the country.
Another definition refers to the practices that help the individual or couples to attain the
following objectives:
 To avoid unwanted births
 To bring about wanted births
 To regulate the interval between the pregnancies
 To control the time at which births occur in relation to the age of the parents.
 To determine the number of children in the family.
NEEDS FOR FAMILY PLANNING:
 Demographic
 Socioeconomic
 Health
DEMOGRAPHIC GROUNDS:
 Population explosion due to high growth rate of mare than 2 percent.
 Broad based population pyramid indicating high proportion of children and adolescents.
 Decline in the sex ratio (i.e decline the number of female per 1000 male)
 Increased in the population density
 Increased urbanization.

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SOCIOECONOMIC GROUND:
Good socioeconomic condition is conductive for better acceptance of small family-norm
resulting in low fertility and vice versa i.e performance in family planning low fertility results in
better socioeconomic condition thus one influencing the other. Social consequence of family
planning would be poverty, illiteracy, unemployment problem, living problem, prostitution,
antisocial activities like theft, murder, juvenile delinquency, etc.
WOMENS HEALTH:
Even though pregnancy is a normal physiological process, it is associated with a great potential,
resulting in increased maternal morbidity and mortality MMR in developing country is 15-20
times higher than that of developing countries. adopting FP directly reduces MMR by improving
women’s health (by having only one or two children with spacing it prevents the depletion of
maternal reserve thus promoting her health)
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).

SCOPE OF FAMILY PLANNING SERVICES:

 To potential parents
 To couple after marriage
 Genetic counseling
 Marriage counseling
 Supply of contraception
 Sterilization facilities
 Care of such pregnant women
 Termination of pregnancy if it is caused by rape
 Services to unmarried women
 Screening for diseases of reproductive organ
 Premarital consultation and examination
 Providing adoptive services
 Teaching home, economic, and nutrition

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  The proper spacing and limitation of birth
FAMILY PLANNING METHODS:
 A contraceptive method is the one which helps the women to avoid unwanted
pregnancies resulting from coitus. There are many methods of contraception. Each has
got its own merits and demerits
 An ideal contraceptive method is the one which is safe effective, acceptable, inexpensive,
reliable, reversible, simple long lasting independent of coitus and require less and
medical supervision.
SPACING METHOD:
1. Barrier method
- Physical method
- Chemical method
- Combined method
2. Intrauterine device
3. Hormonal method
4. Post-conceptional method
5. Miscellaneous method
TERMINAL METHODS:
1. Male sterilization
2. Female sterilization
BARRIER METHODS
A variety of barrier or "occlusive" methods, suitable for both men and women are available. The
aim of these methods is to prevent live sperm from meeting the ovum. Barrier methods have
increased in popularity quite recently because of certain contraceptive and non-contraceptive
advantages. The main contraceptive advantage is the absence of side-effects associated with the
"pill" and IUD.
PHYSICAL METHODS
MALE CONDOM:
It is named after the inventor Dr. condom who recommended it to king Charles II to prevent
illegal off spring. It is a health made up of latex a kind of plastic. It is cylindrical shaped

53
measuring 15 to 20cm length 3 cm diameter and 0.003 cm thick. It is closed at one end with a
tear –end and open at the other end with an integral rim
Condoms can be a highly effective method of contraception, if they are used correctly at every
coitus. Failure rates for the condom vary enormously. Surveys have reported pregnancy rates
varying from 2-3 per 100 women years to more than 14 in typical users. Most failures are due to
incorrect use.
Advantages:
 They are easily available
 Safe and inexpensive
 Easy to use; do not require medical supervision
 No side effects
 Light, compact and disposable, and
 Provides protection not only against pregnancy but also against STDs.
Disadvantages:
 Allergy to latex or collagenous tissue
 Inability to maintain erections
 Inability to use properly
FEMALE CONDOM
The female condom is a pouch made of polyurethane, which lines the vagina. An internal ring in
the close end of the pouch covers the cervix and an external ring remains outside the vagina. It is
pre lubricated with silicon, and a spermicide need not be used. It is an effective barrier to STD
infection. However, high cost and acceptability are major problems. The failure rates during the
first year use vary from 5 per 100 women-years pregnancy rate to about 21 in typical users
DIAPHRAGM
The diaphragm is a vaginal barrier. It was invented by a German physician in 1882. Also known
as "Dutch cap/ the diaphragm is a shallow cup made of synthetic rubber or plastic material. It
ranges in diameter from 5-10 cm (2-4 inches).
Advantages :
The primary advantage of the diaphragm is the almost total absence of risks and medical
contraindications.

54
Disadvantages:
Initially a physician or other trained person will be needed to demonstrate the technique of
inserting the diaphragm into the vagina and to ensure a proper fit. After delivery, it can be used
only after involution of the uterus is completed. Practice at insertion, privacy for this to be
carried out and facilities for washing and storing the diaphragm precludes its use in most Indian
families, particularly in the rural areas. Therefore, the extent of its use has never been great.
VAGINAL SPONGE
It is a small polyurethane foam sponge measuring 5 cm x 2.5 cm, saturated with the spermicide,
nonoxynol-9. The sponge is far less effective than the diaphragm, but it is better than nothing.
The failure rate in parous women is between 20 to 40 per 100 women and in nulliparous women
about 9 to 20 per 100 women.
CHEMICAL METHODS
In the 1960s, before the advent of IUDs and oral contraceptives, spermicides (vaginal chemical
contraceptives) were used widely. They comprise four categories:
a) Foams: foam tablets, foam aerosols
b) Creams, jellies and pastes squeezed from a tube
c) Suppositories inserted manually, and
d) Soluble films - C-film inserted manually.
INTRA-UTERINE DEVICES:
FIRST GENERATION IUDs
 The first generation IUDs comprise the inert or non-medicated devices, usually made of
polyethylene, or other polymers. They appeared in different shapes and sizes loops,
spirals, coils, rings, and bows. Of all the models, the Lippes Loop is the best known and
commonly used device in the developing countries.
 Lippes Loop is double-S shaped device made of polyethylene, a plastic material that is
non-toxic, non-tissue reactive and extremely durable. It contains a small amount of
barium sulphate to allow X-ray observation. The Loop has attached threads or "tail" made
of fine nylon, which project into the vagina after insertion. The tail can be easily felt and
is a reassurance to the user that the Loop is in its place. The tail also makes it easy to
remove the Loop when desired.

55
 SECOND GENERATION IUDs
It occurred to a number of research workers that the ideal IUD can never be developed
simply as a result of obtaining changes in the usual shape or size. A new approach was tried
in the 1970s by adding copper to the IUD. It was found that metallic copper had a strong
anti-fertility effect. The addition of copper has made it possible to develop smaller devices
which are easier to fit, even in nulliparous women. A number of copper bearing devices are
now commercially available: ·
Earlier devices:
- Copper- 7
- Copper T -200
Newer devices :
Variants of the T device
 Cu-T-220 C
 Cu-T-380 A
- Nova T
- Multiload devices
 ML-Cu-250
 ML-Cu-375
Advantages of copper devices
 Low expulsion rate
 Lower incidence of side-effects, e.g., pain and bleeding
 easier to fit even in nulliparous women
 better tolerated by nullipara increased contraceptive effectiveness
 effective as post-coital contraceptives, if inserted within 3-5 days of unprotected
intercourse
THIRD GENERATION IUDs
The most widely used hormonal device is progestasert, which is a T -shaped device filled
with 38 mg of progesterone, the natural hormone. The hormone is released slowly in the uterus
at the rate of 65 mcg daily. It has a direct local effect on the uterine lining, on the cervical
mucus and possibly on the sperms. Because the hormone supply is gradually depleted, regular
replacement of the device is necessary.

56
EFFECTIVENESS:
The IUD is one of the most effective reversible contraceptive methods. The "theoretical
effectiveness" of IUD is less than that of oral and injectable hormonal contraceptives. But since
IUDs have longer continuation rates than the hormonal pills or injections, the overall
effectiveness of IUDs and oral contraceptives are about the same in family planning
programmes.
The IUD has many advantages :
a) Simplicity i.e., no complex procedures are involved in insertion; no hospitalization is
required
b) Insertion takes only a few minutes
c) Once inserted IUD stays in place as long as required
d) Inexpensive
e) Contraceptive effect is reversible by removal of IUD
f) Virtually free of systemic metabolic side-effects associated with hormonal pills
g) Highest continuation rate, and
h) There is no need for the continual motivation required to take a pill daily or to use a
barrier method consistently; only a single act of motivation is required. However, as with
most contraceptive methods, the IUD can produce.
i) Side-effects such as heavy menstruation and/or pain.
CONTRAINDICATIONS ABSOLUTE :
(a) Suspected pregnancy
(b) Pelvic inflammatory disease
(c) Vaginal bleeding of undiagnosed aetiology
(d) Cancer of the cervix, uterus or adnexia and other pelvic tumours
(e) Previous ectopic pregnancy
RELATIVE :
(1) Anaemia
(2) Menorrhagia
(3) History of PID since last pregnancy
(4) Purulent cervical discharge
(5) Distortions of the uterine cavity due to congenital malformations, fibroids

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 (6) Unmotivated person
THE IDEAL IUD CANDIDATE:
The Planned Parenthood Federation of America (PPFA) has described the ideal IUD
candidate as a woman : -
 Who has borne at least one child has no history of pelvic disease
 Has normal menstrual periods
 Willing to check the iud tail
 Access to follow-up and treatment of potential problems, and is in a monogamous
relationship
TIMING OF INSERTION
Although the loop can be inserted at almost any time during a woman's reproductive years
(except during pregnancy), the most propitious time for loop insertion is during menstruation or
within 10 days of the beginning of a menstrual period. During this period, insertion is technically
easy because the diameter of the cervical canal is greater at this time than during the secretory
phase.
SIDE-EFFECTS AND COMPLICATIONS:
1. Bleeding
2. Pain
3. Pelvic infection
4. Uterine perforation
5. Expulsion
6. Fertility after removal
7. Cancer and teratogenesis
HORMONAL CONTRACEPTIVES
Hormonal contraceptives when properly used are the most effective spacing methods of
contraception. Oral contraceptives of the combined type are almost 100 per cent effective in
preventing pregnancy. They provide the best means of ensuring spacing between one childbirth
and another. More than 65 million in the world are estimated to be taking the "pill" of which
about 9.52 million are estimated to be in India
CLASSIFICATION HORMONAL CONTRACEPTIVES
Currently in use and/or under study may be classified as follows :

58
A. Oral pills
 Combined pill
 Progestogen only pill (POP)
 Post-coital pill
 Once-a-month (long-acting) pill
 Male pill
B. Depot (slow release} formulations
 Injectables
 Subcutaneous implants
 Vaginal rings
ORAL PILLS:
Combined pill The combined pill is one of the major spacing methods of contraception. The
"original pill" which entered into the market in the early 1960s contained 100-200 mcg of a
synthetic oestrogen and 10 mg of a progestogen. Since then, a number of improvements have
been made to reduce the undesirable side-effects of the pill by reducing the dose of both the
oestrogen and progestogen. At the present time, most formulations of the combined pill contain
no more than 30-35 mcg of a synthetic oestrogen, and 0.5 to 1.0 mg of a progestogen.
TYPES OF PILLS
The Department of Family Welfare, in the Ministry of Health and Family Welfare, Government
of India has made available 2 types of low-dose oral pills under the brand names of MALA-N
and MALA-D. It contains Levonorgestrel 0.15 mg and Ethinyl estradiol 0.03 mg.
 Mala-D in a package of 28 pills (21 of oral contraceptive pills and 7 brown film coated 60
mg ferrous fumarate tablets) is made available to the consumer under social marketing at a
price of Rs. 3 per packet.
 Mala-N is supplied free of cost through all PHCs, urban family welfare centres, etc.

PROGESTOGEN-ONLY PILL (POP)

This pill is commonly referred to as "minipill" or "micropill". It contains only progestogen,
which is given in small doses throughout the cycle. The commonly used progestogens are
norethisterone and levonorgestrel. The progestogen-only pills never gained widespread use
because of poor cycle control and an increased pregnancy rate.

59
POST-COITAL CONTRACEPTION
Post-coital (or "morning after") recommended within 72 hours of intercourse. Two methods
are available:
(A) IUD: The simplest technique is to insert an IUD, if acceptable, especially a copper
device within 5 days.
(B) Hormonal: More often a hormonal method may be preferable. In India Levonorgestrel
0.75 mg tablet is approved for emergency contraception. It is used as one tablet of 0.75 mg
within 72 hours of unprotected sex and the 2nd tablet after 12 hours of 1st dose.
 Two oral contraceptive pills containing 50 mcg of ethinyl estradiol within 72 hours
after intercourse, and the same dose after 12 hours.
 Four oral contraceptive pills containing 30 or 35 mcg of ethinyl estradiol within 72
hours and 4 tablets after 12 hours.
 Mifepristone 10 mg once within 72 hours.

3. ONCE-A-MONTH (LONG-ACTING) PILL

Experiments with once-a-month oral pill in which quinestrol, a long-acting oestrogen is
given in combination with a short-acting progestogen, have been disappointing. The
pregnancy rate is too high to be acceptable. In addition, bleeding tends to be irregular.

4. MALE PILL
The search for a male contraceptive began in 1950. Research is following 4 main lines of
approach :
 Preventing spermatogenesis
 Interfering with sperm storage and maturation
 Preventing sperm transport in the vas, and
 Affecting constituents of the seminal fluid. Most of the research is concentrated on
interference with spermatogenesis.
Mode of action of oral pills
The mechanism of action of the combined oral pill is to prevent the release of the ovum from
the ovary. This is achieved by blocking the pituitary secretion of gonadotropin that is necessary
for ovulation to occur. Progestogen-only preparations render the cervical mucus thick and scanty

60
and thereby inhibit sperm penetration. Progestogens also inhibit tubal motility and delay the
transport of the sperm and of the ovum to the uterine cavity.
Effectiveness
Taken according to the prescribed regimen, oral contraceptives of the combined type are
almost 100 per cent effective in preventing pregnancy. Some women do not take the pill
regularly, so the actual rate is lower. In developed countries, the annual pregnancy rate is less
than 1 per cent but in many other countries, the pregnancy rate is considerably higher.
Adverse effects
- Cardiovascular effects
- Carcinogenesis
- Metabolic effects
Contraindications
(a) Absolute : Cancer of the breast and genitals; liver disease; previous or present history of
thromboembolism; cardiac abnormalities; congenital hyperlipidaemia; undiagnosed
abnormal uterine bleeding.
(b) Special problems requiring medical surveillance: Age over 40 years; smoking and age
over 35 years; mild hypertension; chronic renal disease; epilepsy; migraine; nursing
mothers in the first 6 months; diabetes mellitus; gall bladder · disease; history of
infrequent bleeding, amenorrhoea
Duration of use
The pill should be used primarily for spacing pregnancies in younger women. Those over
35 years should go in for other forms of contraception. Beyond 40 years of age, the pill is
not to be prescribed or continued because of the sharp increase in the risk of
cardiovascular complications
INJECTABLE CONTRACEPTIVES
There are two types of injectable contraceptives. Progestogen-only injectables and the newer
once-a-month combined injectables.
A. Progestogen-only injectables:
Thus far, only two injectable hormonal contraceptives both based on progestogen -
have been found suitable. They offer more reliable protection against unwanted
pregnancies than the older barrier techniques. These are :

61
 - DMPA (Depot-medroxyprogesterone acetate)
- NET-EN (Norethisterone enantate)
- DMPA-SC

SUBDERMAL IMPLANTS
The Population Council, New York has developed a subdermal implant known as Norplant
for long-term contraception. It consists of 6 silastic (silicone rubber) capsules containing 35 mg
of levonorgestrel. More recent devices comprise fabrication of levonorgestrel into 2 small rods,
Norplant (R)-2, which are comparatively easier to insert and remove. The silastic capsules or
rods are implanted beneath the skin of the forearm or upper arm. Effective contraception is
provided for over 5 years. The contraceptive effect of Norplant is reversible on removal of
capsules.
VAGINAL RINGS
Vaginal rings containing levonorgestrel have been found to be effective. The hormone is
slowly absorbed through the vaginal mucosa, permitting most of it to bypass the digestive
system and liver, and allowing a potentially lower dose. The ring is worn in the vagina for 3
weeks of the cycle and removed for the fourth.

POST-CONCEPTIONAL METHODS
Menstrual regulation:
It is a relatively simple method of birth control is "menstrual regulation". It consists of
aspiration of the uterine contents 6 to 14 days of a missed period, but before most pregnancy
tests can accurately determine whether or not a woman is pregnant. Cervical dilatation is
indicated only in nullipara or in apprehensive subjects. No after-care is necessary as a rule.
The immediate complications are uterine perforation and trauma. Late complications (after 6
weeks) include a tendency to abortion or premature labour, infertility, menstrual disorders,
increase in ectopic pregnancies and Rh-immunization .
Menstrual induction:
This is based on disturbing the normal progesterone prostaglandin balance by intrauterine
application of 1-5 mg solution (or 2.5-5 mg pellet) of prostaglandin F2. Within a few minutes of
the prostaglandin impact, performed under sedation, the uterus responds with a sustained

62
contraction lasting about 7 minutes, followed by cyclic contractions continuing for 3-4 hours.
The bleeding starts and continues for 7-8 days.
Oral abortifacient:
Mifepristone (RU 486) in combination with misoprostol is 95 per cent successful in
terminating pregnancies of upto 9 weeks duration with minimum complications. The commonly
used regimen is mifepristone 200 mg orally on day 1, followed by misoprostol 800 mcg
vaginally either immediately or within 6-8 hours. Commercially it comes as MTP kit having
combipack tablets of mifepristone 200 mg one tablet and misoprostol 200 mcg 4 tablets (800
mcg). The other regimen is a dose of mifepristone 600 mg on day one, followed by 400 mcg
orally of misoprostol on day three.
The patient should return for a follow-up visit approximately 14 days after the
administration of mifepristone to confirm by clinical examination or ultrasonographic scan that a
complete termination of pregnancy has occurred. Patients who have an ongoing pregnancy at this
visit have a risk of foetal malformation resulting from the treatment. Surgical termination is
recommended to manage medical abortion treatment failures.
Contraindication-
(1) History of allergy or known hypersensitivity to mifepristone, misoprostol or other
prostaglandin
(2) Confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass;
(3) IUD in place
(4) Chronic adrenal failure
(5) Haemorrhagic disorder or concurrent anticoagulant therapy
(6) Inherited porphyria
(7) If a patient does not have adequate access to medical facilities equipped to provide
emergency treatment of incomplete abortion and blood transfusion.
ABORTION
Abortion is theoretically defined as termination of pregnancy before the foetus becomes
viable (capable of living independently). This has been fixed administratively at 28 weeks: when
the foetus weighs approximately 1000 g. Abortion is sought by women for a variety of reasons
including birth control. In fact, in some countries (e.g., Hungary) the legal abortions exceed live
births.

63
THE MEDICAL TERMINATION OF PREGNANCY ACT 1971
The Medical Termination of Pregnancy Act, 1971 lays down:
1. The conditions under which a pregnancy can be terminated.
2. The person or persons who can perform such terminations.
3. The place where such terminations can be performed.
1. The conditions under which a pregnancy can be terminated under the MTP Act. 1971:
There are 5 conditions that have been identified in the Act:
a. Medical - where continuation of the pregnancy might endanger the mother's life or cause grave
injury to her physical or mental health.
b. Eugenic - where there is substantial risk of the child being born with serious handicaps due to
physical or mental abnormalities.
c. Humanitarian - where pregnancy is the result of rape.
d. Socio-economic - where actual or reasonably foreseeable environments (whether social or
economic) could lead to risk of injury to the health of the mother.
e. Failure of contraceptive devices - The anguish caused by an unwanted pregnancy resulting
from a failure of any contraceptive device or method can be presumed to constitute a grave
mental injury to the health of the mother. This condition is a unique feature of the Indian law and
virtually allows abortion on request, in view of the difficulty of proving that a pregnancy was not
caused by failure of contraception.

TERMINAL METHODS
Voluntary sterilization is a well-established contraceptive procedure for couples desiring no
more children. Currently female sterilizations account for about 85 per cent and male
sterilizations for 10-15 per cent of all sterilizations in India, inspite of the fact that male
sterilization is simpler, safer and cheaper than female sterilization.
GUIDELINES FOR STERILIZATION
 The age of the husband should not ordinarily be less than 25 years nor should it be over 50
years. b. The age of the wife should not be less than 20 years or more than 45 years. The
motivated couple must have 2 living children at the time of operation. d. If the couple has
3 or more living children, the lower limit of age of the husband or wife may be relaxed at
the discretion of the operating surgeon, and

64
  It is sufficient if the acceptor declares having obtained the consent of his/her spouse to
undergo sterilization operation without outside pressure, inducement or coercion, and that
he/she knows that for all practical purposes, the operation is irreversible, and also that the
spouse has not been sterilized earlier.
MALE STERILIZATION
Male sterilization or vasectomy being a comparatively· simple operation can be performed even
in primary health centres by trained doctors under local anaesthesia. When carried out under
strict aseptic technique, it should have no risk of mortality. In vasectomy, it is customary to
remove a piece of vas at least 1 cm after clamping. The ends are ligated and then folded back on
themselves and sutured into position, so that the cut ends face away from each other. This will
reduce the risk of recanalization at a later date. It is important to stress that the acceptor is not
immediately sterile after the operation, usually until approximately 30 ejaculations have taken
place.

COMPLICATIONS:
(a) Operative: The early complications include pain, scrotal haematoma and local infection.
Wound infection is reported to occur in about 3 per cent of patients. Good haemostasis
and administration of antibiotics will reduce the risk of these complications
(b) Sperm granules: Caused by accumulation of sperm, these are a common and
troublesome local complication of vasectomy. They appear in 10-14 days after the
operation.
POST-OPERATIVE ADVICE:
1. The patient should be told that he is not sterile immediately after the operation; at least 30
ejaculations may be necessary before the seminal examination is negative.
2. To use contraceptives until aspermia has been established.
3. To avoid taking bath for at least 24 hours after the operation.
4. To wear a T-bandage or scrotal support (langot) for 15 days and to keep the site clean and
dry.
5. To avoid cycling or lifting heavy weights for 15 days. There is, however, no need for
complete bed rest.
6. To have the stitches removed on the 5th day after the operation.

65
NON SCALPEL VASECTOMY
No scalpel vasectomy is a new technique that is safe, convenient and acceptable to males.
This new method is now being canvassed for men as a special project, on a voluntary basis
under the family welfare programme. Under the project, medical personnel all over the country
are to be trained. Availability of this new technique at the peripheral level will increase the
acceptance of male sterilization in the country. The project is being funded by the UNFPA
FEMALE STERILIZATION
Female sterilization can be done as an interval procedure, postpartum or at the time of abortion.
Two procedures have become most common, namely laparoscopy and minilaparotomy.
LAPAROSCOPY
 This is a technique of female sterilization through abdominal approach with a specialized
instrument called "laparoscope".
 The abdomen is inflated with gas (carbon dioxide, nitrous oxide or air) and the
instrument is introduced into the abdominal cavity to visualize the tubes.
 Once the tubes are accessible, the Falope rings (or clips) are applied to occlude the tubes.
This operation should be undertaken only in those centres where specialist obstetrician-
gynaecologists are available.
 The short operating time, shorter stay in hospital and a small scar are some of the
attractive features of this operation.
PATIENT SELECTION :
 Laparoscopy is not advisable for postpartum patients for 6 weeks following delivery.
However, it can be done as a concurrent procedure to MTP.
 Haemoglobin per cent should not be less than 8. There should be no associated medical
disorders such as heart disease, respiratory disease, diabetes and hypertension.
 It is recommended that the patient be kept in hospital for a minimum of 48 hours after the
operation
COMPLICATIONS :
Although complications are uncommon, when they do occur they may be of a serious nature
requiring experienced surgical intervention. Puncture of large blood vessels and other potential
complications have been reported as major hazards of laparoscopy
(B) MINILAP OPERATION

66
  Minilaparotomy is a modification of abdominal tubectomy.
 It is a much simpler procedure requiring a smaller abdominal incision of only 2.5 to 3 cm
conducted under local anaesthesia.
 The minilap/pomeroy technique is considered a revolutionary procedure for female
sterilization. It is also found to be a suitable procedure at the primary health centre level
and in mass campaigns.
 It has the advantage over other methods with regard to safety, efficiency and ease in
dealing with complications. Minilap operation is suitable for postpartum tubal
sterilization.

NATIONAL FAMILY PLANNING INDEMNITY SCHEME

CLAIMS ARISING STERILIZATION OPERATION AMOUNT
A Death at hospital / within sterilization operation 200,000
B Death following sterilization (8th-30th day from discharge) 50,000
C Expense for treatment of medical complication 25,000
D Failure of sterilization 30,000
E Doctors/facilities covered for litigation upto 4 cases per year 2,00,000(per
including defence cost case)

JOURNAL REFERENCE:
“Unmet need for family planning among married women of reproductive age group in
urban Tamil Nadu”
M Malini, Bhattathiry and Ethirajan N.
Abstract:
Unmet need for family planning (FP), which refers to the condition in which there is the desire to
avoid or post-pone child bearing, without the use of any means of contraception, has been a core
concept in the field of international population for more than three decades.
Objectives: The very objective of this study is to determine the prevalence of “unmet need for
FP” and its socio-demographic determinants among married reproductive age group women in
Chidambaram.

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Materials and Methods: The study was a community-based cross-sectional study of married
women of the reproductive age group, between 15 and 49 years. The sample size required was
700. The cluster sampling method was adopted. Unmarried, separated, divorced and widows
were excluded.
Results: The prevalence of unmet need for FP was 39%, with spacing as 12% and limiting as
27%. The major reason for unmet need for FP among the married group was 18%, for low
perceived risk of pregnancy, 9%, feared the side effects of contraception 5% lacked information
on contraceptives, 4% had husbands who opposed it and 3% gave medical reasons. Higher
education, late marriage, more than the desired family size, poor knowledge of FP, poor
informed choice in FP and poor male participation were found to be associated with high unmet
need for FP.
Conclusion: Unmet need for younger women was spacing of births, whereas for older women, it
was a limitation of births. Efforts should be made to identify the issues in a case by case
approach. Male participation in reproductive issues should be addressed.

BIBILIOGRAPHY:
 K.Park; Text Book of Preventive and Social Medicine. 24th Ed. Bhanot Banarsidas
Publishers. 2017
 AH Suryakantha. Community Medicine With Recent Advances. 2nd Ed. New Delhi.
Jaypee Publishers. 2010
 Kishore J. National health Programs of India. National Policies and legislation related to
health. 11th edition. New Delhi
 http://www.populationfoundation
 http://www.economicsdiscussion.net/theory-of-population
 http://www.yourarticlelibrary.com/population/theories-of-population-malthus-theory-
marxs-theory-and-theory-of-demographic-transition
 M Malini, Bhattathiry and Ethirajan N. Unmet need for family planning among married
women of reproductive age group in urban Tamil Nadu. J Family Community Medicine.
2014;21:53-7

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