Menoufiya University

Faculty of Nursing
Psychiatric Department
Woman and Reproductive Health
Fourth Year

Supervised by

Assistant Prof. Inas

Kassem

Prepared by:
1- Sally Said AboEl-Yazid
Shaldam.
2- Tahany Fawzy Keshk.
3- Aml Shawky El-Morshedy.
4- Samar Hamdy Gobashy.
5- Ingy Nabil Fayez.
6- Samar Abd El-Aziz Anbr.
7- Asmaa Mosad EL-Bably.
8- Hanan El-Sayed Nada.
9- Hanan Gamal El-Breedy.
10- Doaa Tarek Dawood.
11- Eman Salem Omara.
12- Ayat Esawy Abd El-Aal.
13- Samar Abd El-Fatah Ragab.
14- Elham Ramzy El-feki.
15- Asmaa El-Mohammdy El-
Etewy.
16- Inas Salah Metwaly.
17- Basma Fawzy El-Zanaty.
18- Doaa Mohammed El-Shehaly.
19- Hosn Mahroos Abd El-Salam.
20- Amira Rabea Saleh.
21- Basma El-Sayed El-Daly.
22- El-Shimaa Mahmoud Shams
El-Deen.
23- Asmaa Arabi Saad.
24- Samar Shawky Askar.
25- Eman Mohammed Shaban.
26- Amal Abd El-Razek Sadah.
27- Asmaa Ahmed Serag El-Deen.
28- Zhraa Mohammed Badr.
29- Samah Sebak Salem.
:Outlines
.Introduction-1
2-Measuring Fertility,
Mortality, and Population growth

Fertility*
*Fertility rate
*General fertility rate

*Total fertility rate

*Why is fertility rate important?

*Crude Birth Rate, Crude

Death Rate, Total Fertility Rate

*Crude birth rate

*Other methods of measuring
birth rate
*Factors affecting birth rate
Mortality rate*

Factors affecting a given death*

rate
*Infant mortality
*Infant mortality rate
*Infant mortality rate in countries
Egypt Infant mortality rate*
*Perinatal mortality
*Fetal mortality
*Neonatal mortality
*Perinatal Mortality Rate
*Maternal mortality
*Maternal Mortality Ratio (MMR)
*Maternal death rates in the 20th
century
3-Migration
*Types of migration
:The growth rate-4

Population Growth: NATURAL

*INCREASE

Fertility control-5
*References

1-Introduction:
• Earth's population is increasing by over 140 people every
minute ... equivalent to another Los Angeles plus another Chicago
every month.

• Right now, with "only" 6.4 billion of us: (1) We are driving
over 50 species of plants and animals to extinction per day! (2) We
are destroying rain forests many times faster than they can
regenerate. (3) We are consuming stored solar energy (fossil fuels)
at rates thousands of times faster than it is regenerating. (4) There
are regions in the U.S. where we are consuming fresh water at least
10 times faster than it is being replenished. (5) We are causing soil
salinization and erosion several-fold faster than rates of restoration.
(6) We are over-fishing our oceans, radically changing the species
balance in many places.

• For several years population has been increasing faster than

many vital non-renewable and renewable resources.

• This means the amount of these resources per person is

declining, in spite of modern technology.

• Other massive social and environmental problems ... political

instability, loss of freedoms, vanishing species, rain forest
destruction, desertification, garbage, urban sprawl, water shortages,
traffic jams, toxic waste, oil spills, air and water pollution,
increasing violence and crime ... continue to worsen as our numbers
increase by more than 70 million more people every year. Solving
these problems will be much less difficult when we stop increasing
the number of people affected by them.

• Two billion people live in poverty, more than the population

of the entire planet less than 100 years ago.

• Today there are more people suffering in misery and

starvation in the world than ever before in history.

• In many developing countries, couples are still averaging 4 to

 6 children. Nearly half of them would like to have fewer children,
but they lack access to family planning (not including abortion).
Providing the education and supplies they need would cost only a
few dollars per year.

• While populations of some industrialized countries have

stabilized, over three billion people live or struggle to exist in
countries where population is still growing rapidly with doubling
times of less than thirty years.

2- Measuring Fertility, Mortality,

and Population growth
-The population of a country can change in only three ways
births,deaths,or migration

-Fertility refers to the actual reproductive performance of the

population.

Fertility Rate
Definition: The number of live births per 1000 women of the childbearing
age group (15-44).
Also Known As: general fertility rate
Examples: As a country's fertility rate decreases, the birth rate will also
decrease because fewer babies will be born.

General fertility rate

A refined measure of fertility in a population; the numerator is the number
of live births in a year, the denominator is the number of females of child-
bearing age, usually defined as ages 15-44 (but increasingly recognised as
extending to age 49).

Total fertility rate (TFR)

The mean number of children a woman is expected to bear during her
child-bearing years. It is also independent of the age-sex structure of the
population.
Why is fertility rate important?
Fertility rate is, basically, the number of children that the average woman
will have in her lifetime.

If the average woman has exactly two children in her lifetime, this is just
enough to replace herself and one man, and thus maintain the population.

Ultimately, this is the only thing that matters in determining long-term

population growth. If the average woman has two children, then the
number of people in the next generation will be the same as the number
of people in this generation. You often hear people say that improved diet
or medicene or other things that cause people to live longer cause
population to grow, or that wars or other disasters cause population to
shrink. But this is only true indirectly: only if it changes the number of
children that the average woman has in her lifetime. That is, if many
women die while still young, they may not live long enough to have all
the children that they otherwise might have had. But beyond that, how
long people live doesn't matter. Everybody still dies sooner or later. If a
war wipes out a large number of people, this causes an immediate drop in
the population, of course. For the time that the war lasts population
growth becomes negative. But once the war is over, if the number of
children per woman is the same, the old population growth rate will
immediately resume. There is a temporary change in the total numbers,
but the rate of growth does not change.

Crude Birth Rate, Crude Death Rate, Total Fertility Rate

The Crude Birth Rate (CBR) and Crude Death Rate (CBR) are statistical
values that can be utilized to measure the growth or decline of a
population.

The Crude Birth Rate and Crude Death Rate are both measured by the
rate of births or deaths respectively among a population of 1000. The
CBR and CDR are determined by taking the total number of births or
deaths in a population and dividing both values by a number to obtain the
rate per 10000.

For example, if a country has a population of one million and 15,000

babies were born last year in that country, we divide both the 15,000 and
1,000,000 by 1000 to obtain the rate per 1000. Thus the Crude Birth Rate
is 15 per 1000.
The Crude Birth Rate is called "crude" because it does not take into
account age or sex differences among the population. In our hypothetical
country, the rate is 15 births for every 1000 people but the likelihood is
that around 500 of those 1000 people are men and of the 500 who are
women, only a certain percentage are capable of giving birth in a given
year.

Crude Birth Rates of more than 30 per 1000 are considered high and rates
of less than 18 per 1000 are considered low. The global Crude Birth Rate
in 2005 is 20.15 per 1000.

The Crude Death Rate measures the rate of deaths for every one thousand
people in a given population, such as a country.

Crude Death Rates of below ten are considered low while Crude Death
Rates above twenty per 1000 are considered high. Many African
countries have very high Crude Death Rates.

The global Crude Death Rate in 2005 was 8.78 and in the United States
the rate was 8.25 per 1000.
The term total fertility rate is used to describe the total number of
children the average women in a population is likely to have based on
current birth rates throughout her life. The number, which ranges from
more than 7 children per woman in developing countries in Africa to
around 1 child per woman in Eastern European and highly-developed
Asian countries.

Associated with total fertility rate is the concept of replacement rate. The
replacement rate is the number of children each woman needs to have to
maintain current population levels or what is known as zero population
growth for her and her partner.

In developed countries, the necessary replacement rate is about 2.1. Since

replacement can not occur if a child does not grow to maturity and have
their own offspring, the need for the extra .1 child (a 5% buffer) per
woman is due to the potential for death and those who choose or are
unable to have children. In less developed countries, the replacement rate
is around 2.3 due to higher childhood and adult death rates.
Crude birth rate
-Is the natality or childbirths per 1,000 people per year.

-It can be represented by number of childbirths in that year, and p is the

current population. As of 2007, the average birth rate for the whole world
is 20.3 per year per 1000 total population, which for a world population
of 6.5 billion comes to 134 million babies per year.

-Another indicator of fertility is frequently used: the total fertility rate

average number of children born to each woman over the course of her
life. In general, the total fertility rate is a better indicator of (current)
fertility rates because unlike the crude birth rate it is not affected by the
age distribution of the population.

-Fertility rates tend to be higher in less economically developed countries

and lower in more economically developed countries.

-The birth rate is an item of concern and policy for a number of national
governments. Some, including those of Italy and Malaysia, seek to
increase the national birth rate using measures such as financial
incentives or provision of support services to new mothers. Conversely,
others aim to reduce the birth rate. For example, China's One child
policy; measures such as improved information about and availability of
birth control have achieved similar results in countries such as Iran.

*Other methods of measuring birth rate

Total number of births in the United States, 1934 to present

• General fertility rate (GFR) – This measures the number of

births per 1,000 women aged 15 to 44 or 15 to 49.

• Standardised birth rate (SBR) – This compares the age-sex

structure to a hypothetical standard population.

• Total fertility rate (TFR) – The mean number of children a

woman is expected to bear during her child-bearing years. It is also
independent of the age-sex structure of the population.

• Child to woman ratio – This measures the number of

children below five to the number of women of child-bearing years
 (age 15 to 44). In the past, when there is no universal registration
of births, this ratio is a relatively good indicator of fertility since it
can be measure using data from the Census. However, high infant
mortality rate would cause huge difference between child to
woman ratio and general fertility rate (GFR).

Factors affecting birth rate

• Pro-natalist policies and Antinatalist policies from
government
• Existing age-sex structure
• Availability of family planning services
• Social and religious beliefs - especially in relation to
contraception and abortion
• Female literacy levels
• Economic prosperity (although in theory when the economy
is doing well families can afford to have more children in practice
the higher the economic prosperity the lower the birth rate).
• Poverty levels – Children can be seen as an economic
resource in developing countries as they can earn money.
• Infant Mortality Rate – A family may have more children if
a country's IMR is high as it is likely some of those children will
die.
• Urbanization
• Typical age of marriage
• Pension availability
• Conflict

Mortality rate
Mortality rate is a measure of the number of deaths (in general, or due to
a specific cause) in some population, scaled to the size of that population,
per unit time. Mortality rate is typically expressed in units of deaths per
1000 individuals per year; thus, a mortality rate of 9.5 in a population of
100,000 would mean 950 deaths per year in that entire population. It is
distinct from morbidity rate, which refers to the number of individuals in
poor health during a given time period (the incidence rate) or the number
who currently have that disease (the prevalence rate), scaled to the size of
the population.

One distinguishes:
 1. The crude death rate, the total number of deaths per 1000
people. The crude death rate for the whole world is currently about
9.6 per 1000 per year (based on 62 million deaths in 2006, for a
population of 6470 million[1]).
2. The perinatal mortality rate, the sum of neonatal deaths
and fetal deaths (stillbirths) per 1,000 births.
3. The maternal mortality rate, the number of maternal
deaths due to childbearing per 100,000 live births.
4. The infant mortality rate, the number of deaths of children
less than 1 year old per thousand live births.
5. The child mortality rate, the number of deaths of children
less than 5 year old per thousand live births.
6. The standardised mortality rate (SMR)- This represents a
proportional comparison to the deaths that would have been
expected if the population had been of a standard composition in
terms of age, gender, etc..[2]
7. The age-specific mortality rate (ASMR) - This refers to the
total number of deaths per 1000 people of a given age (e.g. 16-65
or 65+).

In regard to the success or failure of medical treatment or procedures, one

would also distinguish:

1. The early mortality rate, the total number of deaths in the

early stages of an ongoing treatment, or in the period immediately
following an acute treatment.
2. The late mortality rate, the total number of deaths in the
late stages of an ongoing treatment, or a significant length of time
after an acute treatment.

Note that the crude death rate as defined above and applied to a whole
population of people can give a misleading impression. The crude death
rate is affected by birth rate and life expectancy. For example, the number
of deaths per 1000 people can be higher for developed nations than in
less-developed countries, despite life expectancy being higher in
developed countries due to standards of health being better for example.
This happens because developed countries have a relatively lower birth
rate. A more complete picture of mortality is given by a life table which
summarises mortality separately at each age. A life table is necessary to
give a good estimate of life expectancy.
Factors affecting a given death rate
• Age of country's population
• Nutrition levels
• Standards of diet and housing
• Access to clean drinking water
• Hygiene levels
• Levels of infectious diseases
• Social factors such as conflicts and levels of violent crime
• Amount and quality of health care available

Infant mortality
Infant mortality is defined as the number of deaths of infants (one year
of age or younger) per 1000 live births. The most common cause of infant
mortality worldwide has traditionally been dehydration from diarrhea.
Because of the success of spreading information about Oral Rehydration
Solution (a mixture of salts, sugar, and water) to mothers around the
world, the rate of children dying from dehydration has been decreasing
and has become the second most common cause in the late 1990s.
Currently the most common cause is pneumonia. Major causes of infant
mortality in more developed countries include congenital malformation,
infection and SIDS.

Infanticide, abuse, abandonment, and neglect may also contribute to

infant mortality Related statistical categories:

• Perinatal mortality only includes deaths between the foetal

viability (22 weeks gestation) and the end of the 7th day after
delivery.
• Neonatal mortality only includes deaths in the first 28 days
of life.
• Post-neonatal death only includes deaths after 28 days of
life but before one year.
• Child mortality includes deaths within the first five years
after birth

Infant mortality rate

Infant mortality rate (IMR) is the number of newborns dying under a year
of age divided by the number of live births during the year. The infant
mortality rate is also called the infant death rate. It is the number of
deaths that occur in the first year of life for 1000 live births.

In past times, infant mortality claimed a considerable percentage of

children born, but the rates have significantly declined in the West in
modern times, mainly due to improvements in basic health care, though
high technology medical advances have also helped. Infant mortality rate
is commonly included as a part of standard of living evaluations in
economics. [1]

The infant mortality rate is reported as number of live newborns dying

under a year of age per 1,000 live births, so that IMRs from different
countries can be compared.

Infant mortality rate in countries

Nearly two orders of magnitude separate countries with the highest and
lowest reported infant mortality rates. The top and bottom five countries
by this measure (taken from the The World Factbook's 2008 estimates)
are shown below.

Infant mortality rate

Rank Country
(deaths/1,000 live births)

1 Angola 182.31

2 Sierra Leone 156.48

3 Afghanistan 154.67

4 Liberia 143.89

5 Niger 115.42

218 Iceland 3.25

219 Hong Kong 2.93

220 Japan 2.80

221 Sweden 2.75

222 Singapore 2.30

*Egypt Infant mortality rate

Year Infant mortality rate Rank Percent Change Date of Information
200
35.26 86 2003 est.
3
200
32.59 79 -7.57 % 2004 est.
4
200
32.59 78 0.00 % 2005 est.
5
200
31.33 78 -3.87 % 2006 est.
6
200
29.5 79 -5.84 % 2007 est.
7
200
28.36 80 -3.86 % 2008 est.
8

Definition: This entry gives the number of deaths of infants under one
year old in a given year per 1,000 live births in the same year; included is
the total death rate, and deaths by sex, male and female. This rate is often
used as an indicator of the level of health in a country.
Perinatal mortality
Perinatal mortality (PNM), also perinatal death, refers to the death of a
fetus or neonate and is the basis to calculate the perinatal mortality rate.
Variations in the precise definition of the perinatal mortality exist
specifically concerning the issue of inclusion or exclusion of early fetal
and late neonatal fatalities. Thus the WHO ‘s definition "Deaths
occurring during late pregnancy (at 22 completed weeks gestation and
over), during childbirth and up to seven completed days of life" is not
universally accepted. The perinatal mortality is the sum of the fetal
mortality and the neonatal mortality.

Fetal mortality
Fetal mortality refers to stillbirths or fetal death. It encompasses any
death of a fetus after 20 weeks of gestation or 500 gm. In some
definitions of the PNM early fetal mortality (week 20-27 gestation) is not
included, and the PNM may only include late fetal death and neonatal
death. Fetal death can also be divided into death prior to labor, antenatal
(antepartum) death, and death during labor, intranatal (intrapartum) death.
Fetal mortality can be decreased by good preconception health among
women before they get pregnant.

Neonatal mortality
Early neonatal mortality refers to a death of a live-born baby within the
first seven days of life, while late neonatal mortality covers the time after
7 days until before 29 days. The sum of these two represents the neonatal
mortality. Some definitions of the PNM include only the early neonatal
mortality. Neonatal mortality is affected by the quality of in-hospital care
for the neonate. Neonatal mortality and postneonatal mortality (covering
the remaining 11 months of the first year of life) are reflected in the
Infant Mortality Rate.

Perinatal Mortality Rate

The PNMR refers to the number of perinatal deaths per 1,000 total births.
It is usually reported on an annual basis. It is a major marker to assess the
quality of health care delivery. Comparisons between different rates may
be hampered by varying definitions, registration bias, and differences in
the underlying risks of the populations.

PNMRs vary widely and may be below 10 for certain developed

countries and more than 10 times higher in developing countries. The
WHO has not published contemporary data.

Maternal mortality
Maternal death, or maternal mortality, also "obstetrical death" is the
death of a woman during or shortly after a pregnancy. In 2000, the United
Nations estimated global maternal mortality at 529,000, of which less
than 1% occurred in the developed world. However, most of these deaths
have been medically preventable for decades, because treatments to avoid
such deaths have been well known since the 1950s.

Maternal Mortality Ratio (MMR)

Maternal Mortality Ratio is the ratio of the number of maternal deaths per
100,000 live births. The MMR is used as a measure of the quality of a
health care system. "Lifetime risk of maternal death" accounts for number
of pregnancies and risk. In sub-Saharan Africa the lifetime risk of
maternal death is 1 in 16, for developed nations only 1 in 2,800.

Maternal death rates in the 20th century

The death rate for women giving birth plummeted in the 20th century.

The historical level of maternal deaths is probably around 1 in 100 births.

Mortality rates reached horrible proportions in maternity institutions in
the 1800s, sometimes climbing to 40 percent of birthgiving women. At
the beginning of the 1900s, maternal death rates were around 1 in 100 for
live births. The number today in the United States is 11 in 100,000, a
decline by orders of magnitude.[11]
The decline in maternal deaths has been due largely to improved asepsis,
use of caesarean section, fluid management and blood transfusion, and
better prenatal care. Recommendations for reducing maternal mortality
include access to health care and emergency obstetric care, funding and
intrapartum care.[12] Moreover, political will and support play a major role
and without it reforms to reduce maternal mortality cannot be made.

Migration-3
Is the movement of people across a specified boundary for the purpose-
.of residing

Types of migration*

a-Involuntary: slavery, ethnic persecution, wars, natural disasters,

famines

b-Voluntary: to seek jobs (skilled or unskilled), to get an education,

because of marriage, upon retirement
------------------------------
a-Internal migration: within a country e.g. rural to urban

b-International migration: skilled professionals to other countries

Migrants (workers, prostitutes, truck drivers) may spread infectious-

diseases e.g. HIV/AIDS, TB, diphtheria

Jet travel speeds up disease transmission-

Migrants often live in urban slums and experience adjustment-

(problems (these can affect their physical or mental health

:The growth rate-4

Is the rate at which population is increasing or decreasing in a given area-
due to natural increase at net migration expressed as a percentage of base
.population
Population Growth: NATURAL INCREASE*
Natural increase is a simple measure of population growth which
examines the differences between births (fertility) and deaths
(mortality) in a given group. It is usually determined by subtracting
the crude death rate from the crude birth rate. Natural increase is
generally expressed as a percentage figure. e.g. an annual natural
increase of 0.8 means that a country is increasing its population by 0.8
.per cent each year
If the death rate is greater than the birth rate, then a population may be
experiencing natural decrease

Fertility control-5
Fertility control is the regulation over the reproductive system as a-
whole, not just as it applies to child bearing, whereas birth control is the
regulation of the number of children via management or prevention of
contraception through a variety of methods. These methods include, but
are not limited to, the use of oral contraceptives and the condom.
Population control, as its name implies, is the direct control of a
.country's, or community's, or segment of society's population

Reproduction may be controlled by late marriage or by decline in the-

.population of married to un married individuals in the population

:A couple may control their fertility in three ways

.First: delay the birth of their first child by using contraception

.Second: practicing birth spacing

Third: finally having completed their family size to stop childbearing to

adopt the previous strategies.Couples must have the ability to make a
conscious choice about their reproductive behavior, or control of
reproduction must be socially acceptable.There must be perceived social
.or economic advantages to reduce fertility
References
1.Http://mdgs.un.org/unsd/mdg/Metadata.aspx?
IndicatorId=0&SeriesId=562.

2. Presumably, they are registered as stillbirths rather than infant

deaths if the infant dies shortly after birth.

3. Barbara A. Anderson; Brian D. Silver (December 1986). "Infant

Mortality in the Soviet Union: regional differences and measurement
issues". Population and Development Review 12 (4): 705–737.
doi:10.2307/1973432. http://links.jstor.org/sici?sici=0098-
7921%28198612%2912%3A4%3C705%3AIMITSU%3E2.0.CO
%3B2-E.

4. Maternal Mortality in Central Asia, Central Asia Health Review

(CAHR), 2 June, 2008

5. Koonin, Lisa M.; Hani K. Atrash, Roger W. Rochat, Jack C. Smith

(12/1/1988). "Maternal Mortality Surveillance, United States, 1980–
1985". MMWR 37 (SS-5): 19–29.

6. Deneux-Tharaux, D; Berg C, Bouvier-Colle MH, Gissler M, Harper

M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P.
(2005). "Underreporting of Pregnancy-Related Mortality in the United
States and Europe". Obstet Gynecol 106: 684–692.

7. Nour NM (2008). "An Introduction to Maternal Mortality". Reviews

in Ob Gyn 1: 77–81.
 8. Maternal Mortality in Central Asia, Central Asia Health Review
(CAHR), 2 June, 2008.

9. Http://www.who.int/whosis/mme_2005.pdf Maternal Mortality in

2005], access date=08-230-2008

10. Thaddeus, S; Maine D (1994). "Too far to walk: Maternal

mortality in context". Social Science & Medicine 38 (8): 1091–1110.
doi:10.1016/0277-9536(94)90226-7.

11. See for instance mortality rates at the Dublin Maternity Hospital
1784–1849

12.Http://www.who.int/whosis/mme_2005.pdf Maternal Mortality in

2005], access date=08-230-2008

13.Richardus JH, Graafmans WC, Verloove-Vanhorick SP,

Mackenbach JP. The perinatal mortality rate as an indicator of quality
of care in international comparisons. Med Care. 1998 Jan;36(1):54-66
PMID 9431331

14. Everitt, B.S. The Cambridge Dictionary of Statistics, CUP. ISBN

0-521-81099-x

15. See "Fertility rates"; Economic Geography Glossary at University

of Washington

16.Espenshade TJ, Guzman JC, and Westoff CF (2003). "The

surprising global variation in replacement fertility". Population
Research and Policy Review 22: 575.
doi:10.1023/B:POPU.0000020882.29684.8e.

17."How Fertility Changes Across Immigrant Generations." Research

Brief #58, Public Policy Institute of California, 2002.

-Http://www.health.state.pa.us/hpa/stats/techassist/fertility.htm

-From Wikipedia, the free encyclopedia

-More than half of the global population lives where fertility is below
replacement level (Chris Wilson and Gilles Pison, Population &
societies, no. 405, October, 2004)

-Fertility Below Replacement Level (Chris Wilson, 2001, Science 304

(no. 5668), pp. 207-209)

-United Nations Population Division, World Population Prospects: the

2002 Revision

-United States Census Bureau, International Data Base