Rakesh Singh – DEMO

Nuptiality: refers to marriage as a population phenomenon, including the rate at

which it occurs, characteristics of people united in marriage, and the dissolution
of such unions (through divorce, separation, widowhood, and
annulment/nullification).

Marital status is an important determinant of fertility behavior

particularly -where most of the births take place within marital union (as in Nepal).

Sources of Nuptiality Data

•National Census
•Sample Survey
•Vital Registration
•U. N. Publications
-Demographic Year Book
-Population Prospect
Five categories on marital status:
Never married Never been in a union.
Married Was in marital union at the moment of the Census, legally or not
Divorced Has been separated from his or her spouse through a court decision
Separated Has separated temporarily and is awaiting court decision
Widowed Lost his or her spouse by death, not yet remarried

Factors affecting Nuptiality: Urbanization, Social norms, education

Nuptiality Indices: Proportion Single (Is), Proportion married (Im), Proportion Widowed (Iw),
Proportion Divorced (Id), Proportion Separated (Ip)
Singulate Mean Age at Marriage (SMAM)
•It is an estimate of the average number of years lived as “Single or Never
married” by those who marry before the age of 50.
•It is an indirect estimate of mean age at marriage.
•A high value of SMAM means postponement of marriage to a higher age.
•A high SMAM for females reduces lifetime fertility.
SMAM=

Proportion Married
•Proportion of currently married
•Child Marriage (16 18 20): before 2002 girl 16 with parent, boys 18 with parent.
Girls 18 self. Boys 20 self. After 2002 amendment girls and boys 18 with parent.
And 20 on self.
RANK: 20 on age 18... 27 on age 15.
•More than one spouse (Polygamy=polyandry+ polygyny) Polyandry-woman with
more than one husband, Polygyny-man with more than one wife)
•Re-marriage
Median Age at Marriage: Age by which half of the population have been married.
For e.g. if its 17.3 than half of the pop have married at this age.
Family Planning: Concept: gap, number of children i.e. family size
Conception= prevention of conception. Family planning= conception+
interception (termination of pregnancy)
Family Planning refers to practices that help individuals or couples to attain
certain objectives:
a) To avoid unwanted births
b) To bring about wanted births
c)To regulate the intervals between pregnancies
d)To prevent early & too late pregnancy and
e) To determine number of children in the family.
FAMILY PLANNING METHODS: NATURAL + ARTIFICIAL
Natural Family Planning Methods: @ RCB SLOW
1. Rhythmical / Calendar: regular cycle, avoiding intercourse during the days
before and after ovulation. 28 days cycle -14 =14. 14+-4or5 sex must be
avoided. Ovulation time predicted: Increase in body temp by 0.5 during
ovulation, cervical mucous, LH surge measure.
Record first day of period for six months. Measure duration of cycle i.e.
from 1st day of your period to the 1st day of your next period. Find shortest
and longest cycle in that period i.e. e.g. 28 and 35 respectively. Subtract 18
from shortest and 11 from longest i.e. 10 (first day of your fertile phase)
and 24 (last day of your fertile phase). Avoid sex during this phase.

2. Cervical Mucous Method: Every morning takes sample of secretions coming

out of vagina to examining putting it in thumb and index finger. If it shows
clear and thread like white egg type then you are about to ovulate.
3. Basal Body Temperature:
4. Symptothermal Method: sympto+ thermal so sympto means thickening of
mucous as a symptom and thermal means basal body temperature.
5. Lactational amenorrhea Method:
6. Ovulation awareness Method:
7. Withdrawal Method (Coitus interruption): Failure rate 15% @pandhre
Artificial Family Planning Methods:
Mechanical:
1. Male condoms: thin latex or plastic sheath, Effectiveness: 94%-98%
2. Female condoms: polyurethane sheath, 95% effective
3. Diaphragms/cervical caps: dome of rubber which is fitted by the woman
over her cervix before sex, should be used with a spermicidal cream,
diaphragm must stay in place for six hours after sex. only needs to be used
when the couple has sex. Spermicides may cause irritation or an allergic
reaction. Effectiveness:92%-96% if used correctly.
4. Spermicidal: as creams, gels, sponges or pessaries. can increase the
effectiveness of certain barrier methods of contraception such as a
diaphragm. However, they don't provide reliable contraception when used
alone.
5. Intrauterine devices (IUD): containing copper or levonorgestrel (hormonal)
MOA: Both types of IUD prevent fertilization of the egg by damaging or
killing sperm. The IUD also affects the uterine lining (where a fertilized egg
would implant and grow
Hormonal IUD: release levonorgestrel (progesterone) prevent pregnancy
for 3 to 5 years. MOA: This IUD prevents fertilization by damaging or killing
sperm and making the mucus in the cervix thick and sticky, so sperm can't
get through to the uterus. It also keeps the lining of the uterus
(endometrium) from growing very thick. This makes the lining a poor place
for a fertilized egg to implant and grow.

Copper IUD: most commonly used IUD. Copper wire is wound around the
stem of T shaped IUD prevent pregnancy for 10 years. MOA: Copper is toxic
to sperm. It makes the uterus and fallopian tubes produce fluid that kills
sperm. This fluid contains white blood cells, copper ions, enzymes, and
prostaglandins.
6. Sponge: soft synthetic saturated with spermicide. Left in vaginal for 6 to 8
hrs. after intercourse works similar to diaphragm. 18 to 28 pregnancy/100.
Good for newly married couples.
Hormonal:
7. Skin patch: looks like a square band-aid, applied to the abdomen, buttocks,
upper arm, or upper trunk. The Patch is changed each week for a schedule
of 3 wks. on and 1 wk. off. works by slowly releasing a combination of
estrogen and progestin hormones through the skin. These hormones
prevent ovulation and thicken the cervical mucus, creating a barrier to
prevent sperm from entering the uterus. 99% effective
8. Vaginal ring: 2 inches in diameter, delivers low doses of estrogen and
progestin into the body. MOA: same as skin patch. The ring is inserted into
the vagina and left for 3 weeks. It is then removed for 1 week, during which
a woman menstruates, and a new ring is inserted after the 1-week "break."
@ just opposite of skin patch. 98% effective
9. Pills (Combined, Minipill, Emergency): combined pills: 99% Nilocon white /
Sunaulo Gulaf:
Chemical composition:
•21 beige-colored tablets, each containing Levonorgestrel0.15 mg and
Ethinylestradiol0.03 mg.
•7 brown tablets, each containing Ferrous Fumarate75 mg.
Minipill: 98%
Advantages: the pill does not interfere with the spontaneity of sex.
@read more from review Govind raj
Emergency contraceptives: e-con can be taken 120 hrs. of unprotected sex.
Two pills at interval of 12 hrs. also IUD Copper T within 5 days of
unprotected sex as e-con.
10.Injection: provides a longer-acting alternative to the pill. It works by slowly
releasing the hormone progesterone into the body to stop ovulation. Each
injection lasts for 8-12 weeks. Periods can become irregular or stop
altogether. It can take over a year for fertility to return to normal after
stopping contraceptive injections, so if patient is planning to start a family
in the near future, it may not be suitable.
Advantages: unlike the pill don’t need to remember to take a tablet every
day. Effectiveness:99%.
Sangini (Depo-Provera) :(Depot-medroxyprogesterone acetate 150mg)
•Progesterone only, once injected works for three months.
•Suitable during breastfeeding.
11.Implants: small stick containing the hormone progesterone which is
inserted under the skin in the arm. The hormone is slowly released into the
body, ADV: long-term contraceptive, as each implant lasts for three years.
Periods can become irregular or stop altogether.
Effectiveness:99%.
Sub-dermal, levonorgestrel releasing.
•Norplant I consist of Six plastic tubes (rods) are implanted under the skin
of the upper arm in a fan shape, which constantly release progesterone.
Effective up to 7 years.
•Norplant II (Jadelle) has only two tubes and is effective up to 5 years.

Side effects of Hormonal family planning methods

•Nausea, Weight gain, Headache, Breast tenderness, Breakthrough
bleeding, vaginal infections, mild hypertension, depression
Absolute Contraindications of Hormonal family planning methods
•Breast feeding, family history of CVA or CDA (Coronary artery disease),
history of liver disease, undiagnosed vaginal bleeding

Possible Contraindication of Hormonal family planning methods:

•Age > 40 years, Breast or reproductive tract malignancy, DM, Elevated
cholesterol and triglyceride, High bp, Mental depression, Migraine and
other types of vascular headache, Obesity, Pregnancy, Seizure disorders,
Smoking
Surgical:
12. Vasectomy (male): vas deferens closing off
13. Tubal Ligation (female)- minilaprotomy and laparoscopy: fallopian tube
ligated so ovum does flow across fallopian tube
NO contraception is completely effective
Abstinence =100%
Abstinence gives you freedom. Freedom from:
1. Guilt or dishonesty to oneself or family
2. Loss of future goals or plans.
3. Sexually transmitted diseases
4. Unwanted pregnancy
5. Difficult abortion or adoption decision
6. Negative reputation
7. Birth control side effects
8. Broken heart or rejection
Modern Methods includes: male and female sterilization, injectables,
intrauterine devices (IUDs), contraceptive pills, implants, male condoms,
lactational amenorrhea, and emergency contraception
Informed choice indicates that women were informed at the time they
started the current episode of method use about the method’s side effects,
about what to do if they experience side effects, and about other methods
they could use.
Family planning indicators in the context of Nepal
•Contraceptive prevalence rate: the percentage of women who are currently using, or
whose sexual partner is currently using, at least one method of contraception, regardless of the
method used. It is usually reported for married or in-union women aged 15to49

•Contraceptive discontinuation:

Three out of every five women (58%) who began using a contraceptive method in the 5 years
before the survey discontinued the method within 12 months (NDHS 2016).

•Unmet Need for Family Planning and demand of family planning:

 Unmet need is especially high among groups such as:Adolescents,Migrant,
Urban slum dwellers,Refugees,Women in the postpartum period
•Couple years of protection: Express the number of the years for which the
couple would have been protected from being pregnant by modern
contraceptive methods provided during the years.
CYP is calculated as:
•VSC=13 CYPs
•Implant=5CYPs
•IUCP=8 CYPs
•13 pills cycle=1 CYPs
•4 doses depo=1 CYPs
•150 condoms=1 CYPs

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Reasons for not using contraceptive method

1. Fertility-related reasons: Not having sex, Infrequent sex,
Menopausal/hysterectomy, Postpartum amenorrhea, Breastfeeding,
Fatalistic (events are predetermined)
2. Opposition to use: Respondent opposed, Husband opposed, Others
opposed, Religious prohibition
3. Lack of knowledge: Knows no method, Knows no source
4. Method-related reasons: Health concerns, Fear side effects, Lack of
access/too far, Costs too much, Inconvenient to use, Interference with body
processes
Extra Notes:
Migration: Migration is the movement of people from one political or
administrative area to another involving a permanent change in residence
during a given migration interval
Mover: A person who changes usual or legal residence
Migrant: A person who moves for one political area to another during a
migration interval
Non-migrant: Non-movers and local movers (According to census
definition, persons enumerated in the districts where they were born is
considered as non-migrants)
Life-time migrants: Person enumerated in a place different from the place
of birth (According to census definition, a life-time migrant is one who was
enumerated in a district different from his/her district of birth)
In-migrant: A person who moves in a political area within the same country
Out-migrant: A person who moves out of a political area within the same
country
In-migration: Movement of population into a particular area within a
country
Out-migration: Movement of people out of a particular area within a
country
Immigrant: An international migrant who enters the area from a place
outside the country
Emigrant: An international migrant departing to another country by
crossing international boundary
Immigration: Movement of alien population into the country during a
migration interval
Emigration: Movement of native population outside the county (Nepal)
Net migration: The difference between in-migrants and out-migrants (or
the difference between immigrants and emigrants)
Gross migration: In-migrants + out-migrants (or Immigrants + emigrants) =
Migration turnover
Migration stream: Movement of people having a common origin and
destination in a given migration interval (period)
Migration counter stream: Opposite direction of stream
Place of origin (place of departure): The place from where a migrant move
to another place
Place of destination (place of arrival): The place where migrant terminate
his movement or arrives from another place
The push-pull factors: The factors which compel persons to leave their
place of residence or origin is known as push factors. The factors which
stimulate people to leave area of origin or attack people to come to
particular area is known as pull factors.
Source of data: Surveys, Census, Register.

There are two types of migration

•Internal Migration: Movement of population from one area to another
within a country
•International Migration: Movement of population from one country to
another across international boundary

Types of internal migration

On the basis of stream
–Rural to Rural
–Rural to Urban
–Urban to Urban
–Urban to Rural

On the basis of duration of migration

–Permanent migration: long term migration, more than 5 years
–Semi-permanent migration:1 year to 5 years
–Temporary migration: 6 months to 1 years
–Seasonal migration: less than 6 months

Types of international migration

•Forced migration: It includes refugees, asylum seekers and people forced
to move due to external factors
•Free migration or open migration: Individuals are not forced to move
•Legal migration: Legally enter into the country, have a valid immigrant
visa and proper documentation
•Illegal migration: Migration across borders, without fulfillment of
appropriate documents
Crude measures of internal migration
1.In-migration rate= I/P*1000
2.Out-migration rate= O/P*1000
3.Net migration rate= I-O/P*1000
4.Gross migration rate= I+O/P *1000
Crude measures of international migration
1.Immigration rate= I/P*1000
2.Emigration rate= E/P*1000
3.Net migration rate=I-E/P*1000
4.Gross migration rate=I+E/P*1000

RESIDUAL METHOD:

Consequences of Migration from rural to urban

•Rapid Urbanization?
•High Population Density

Measures of Urbanization
•Percentage distribution
•Extent of urbanization (Concept of growth rate, doubling time, Primate
Cities i.e. largest city at least twice large than next larger city and twice as
significant….)
•Rank-size rule
•Gini Concentration Ratio and Lorenz Curve (x= population, y=locality);
gini measures degree of inequality in population distribution
Population Projection-Forecast of population change using estimates of
fertility, mortality, and migration
•Projections may extend for varying numbers of years into the future
•Note:
–Extrapolation = projection (estimation of a value based on extending a
known sequence of values or facts beyond the area that is certainly known)
–Interpolation = estimation (estimation of a value within two known values
in a sequence

A population projection is:

–An extrapolation of historical data into the future
–An attempt to describe what is likely to happen under certain explicit
assumptions about the future as related to the immediate past
–A set of calculations, which show the future course of fertility, mortality
and migration depending on the assumptions used

Projection Methodology:
Projection methodologies can be divided into two main categories:
–procedures for projecting the population considering fertility, mortality,
and migration, by age and sex (component method)
–procedures for projecting the population using mathematical functions
applied to population figures but not to each of the components (ratio
method)

Although, census data is crucial for resource allocation and planning.

However, because it is carried out only every ten years, other methods
are required for planning in the intervening years.

Inaccuracies in population estimation

•Questionable accuracy with regard to internal migration. Data on
migration are difficult to obtain, particularly at local level.Some migrant
workers may only stay a few months and it is hard to measure change.
•Estimation of target population for smallest geo-political units (ward,
VDC, Municipality, district etc.) is difficult in Nepal as population based
data are NOT available for them. Nepal does not have a good “vital”
and/or “sample” registration system

Process of Population Estimation in Nepal

•Population distribution up to ward level from two census are taken.
•Using these information, Annual Growth Rate is calculated.
•Population estimation is done using the latest census data and the
obtained growth rate.
•The process is similar to the calculation of the “Mid-Year Population”.

Types of Population Projection

•There are three types of population projection:
–Short term projection (less than 10 years): It is used for short term
educational planning, medical facilities and other services
–Middle term projection (10-25 years): This type of projection is used for
planning of education and medical facilities and services, housing needs
–Long term projection (above 25 years): Long term projections are used in
connection with the development of natural resources, planning for
provision of food, for transportation and recreational facilities.

According to variant, there are three types of population projection: High

variant, Medium variant,and Low variant.
•High variant: high birth rate, low death rate, high immigration and low
emigration
•Medium variant: medium birth rate, medium death rate, medium
increase in immigration and medium emigration
•Low variant: low death rate, low birth rate and low immigration and low
emigration
•All variants are applicable but medium variant is most applicable.

Some mathematical models

•1. Linear growth model,
•2. Geometric growth model,
•3. Exponential growth model.
•When size of population of two census dates are available, population
estimation can be made by using mathematical methods.