CHAPTER 4

Population and its Control

CONCEPTUAL THEORY

Terminology
Contraception: It is the device, a medication, a procedure or a behavior that prevents
pregnancy.
Family planning: It is the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and
timing of the births.
Migration: It is the seasonal movement of people from one region to another region.
Population explosion: It is the rapid increase in the size of the population by the sudden decline in infant mortality and increase in life
expectancy.
Small family norm: It is a nuclear family with parents and just one or two children.
Sterilization: It is the permanent method of family planning performed by surgery both in males and females.
Women empowerment: It is the process by which women strengthen their capacity individually and collectively to identify, understand
and overcome gender discrimination to take control of their lives.

POPULATION EXPLOSION Causes of Overpopulation

An increase in population is called population explosion. • High birth rate: One of the main factors contributing to
the population’s rapid expansion is the high birth rate.
Overpopulation This demonstrates that despite increased family planning
advertising, family assistance initiatives, and population
The rise in the number of persons in a population or dispersed education efforts, the birth rate has not decreased
group is referred to as population growth. Actual world significantly. The reasons for high birth rate are
population growth is roughly 83 million per year or 1.1% per ƒ Early puberty
year. The world’s population has increased from one billion in ƒ Universality of marriages
1800 to 7.9 billion in 2020. ƒ Early age at marriage
The two causes of population explosion are: ƒ High proportion of young adults in the population
1. Increase in the birth rate. ƒ Other causes like lack of education, illiteracy,
2. Decrease in the death rate. migration, early marriage, etc.
An increase in population is directly related to the birth • Low death rate: Due to advancements in medical science,
rate. The population in India is rising at a considerable speed, dreadful and chronic diseases such smallpox, cholera,
which results in various problems, including social, economic plague, and typhoid are no longer dreaded. Better facilities
and environmental. for sanitation and cleanliness, and provision of pre-natal
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and post-natal care have reduced infant mortality rates. • High cost of living
Community Health Nursing-II

The reasons included are as follows: • Global warming

ƒ Establishment of health infrastructure (primary • Conflicts and wars
health centers and subcenters) • Accidents
ƒ The launching of national health programs against • Demand for educational facilities
mass killer diseases.
ƒ The establishment of colleges for medical and Population Control
paramedical personnel.
Measures to control population explosion are:
ƒ Increase in food production.
ƒ The improvement in the supply of protected water.
• Social measures like raising the minimum age of marriage,
raising the status of women, spreading education to all,
• Early marriage: Marriage at young age may hove greater adoption, and social security measures for the population.
chances for potential childbearing.
• Economic measures like creating more employment
• Social and religious reasons: In India, marriage is a opportunities, improving agriculture and other
socially prescribed institution that requires everyone to sectors, improving the standard of living and reducing
get married. The majority of individuals believe that a urbanization.
family should have at least one male child. They continue
to grow their family in hopes of having a boy child.
• Sex education, tax benefits of concessions, incentives for
those who are adopting family planning methods.
• Polygamy: This system of marriage results in more
• Other measures like improvement of contraceptive
number of children.
methods, small family norms, health education and IEC
• Standards of living: Low-income individuals are more (Information Education and Communication)
likely to have more children since having a child is seen
as an asset rather than a liability. The majority of people WOMEN EMPOWERMENT
are ignorant; thus, they are unable to comprehend the
necessity of family planning. They don’t know that having Women empowerment can be defined as boosting women’s
fewer children will raise their standard of living. self-esteem, ability to make their own decisions, and right to
• Illiteracy: Illiteracy along with other factors line-poverty influence societal change for themselves and others.
lock of woman's education, etc.
Principles of Women Empowerment
Effects of Overpopulation
• Establish high-level corporate leadership for gender
• Increase in slum areas. equality.
• Rise in unemployment and underemployment. • Treat all women and men fairly at work; respect and
• Eradicating poverty and hunger becomes more difficult. support human rights and nondiscrimination.
• Providing better health and education facilities becomes • Ensure the health, safety and well-being of all women and
more difficult. men workers.
• This can lead to less availability of land, water, food and • Promote education, training and professional
other necessary resources. development for women.
• An increase in population may lead to the unavailability • Implement enterprise development, supply chain and
of food grains due to the excessive demands of people. marketing practices that empower women.
• Overexploitation of water and other natural resources • Promote equality through community initiatives and
results in no scope of replenishment, which is a recipe for advocacy.
a natural disaster. • Measure and publicly report on progress to achieve
• Increasing population increases air and water pollution, gender equality.
leading to an increase in diseases, which ultimately leads
to a rise in expenditure on healthcare. Need for Women Empowerment
• Lack of residential accommodation
Women are deprived of the following:
• Inadequate food production
• To enhance decision-making power
• Energy utilization
• To enhance freedom of movement
• Antisocial activities
• Access to education and employment
• Diminished resources
• Exposure to media
• Pollution

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 Population and its Control

Ways to Empower Women Slogans

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• Changes in women’s employment • In 1970, Do Ya Teen Bas- Two or three children are enough.
• Changes in women’s control in decision-making abilities • In 1980, Hum Do Hamare Do- We two, ours two.
• Education to women
• Providing minimum needs like nutrition, health, FAMILY PLANNING
sanitation, and housing.
• Encouraging women to develop in the fields they are Natural Family Planning Methods
good at and make a career. • Natural family planning methods do not include drugs,
• Changes in women’s access to and control over resources. devices or surgical procedures.
• Women’s access to laws and policies of the government. • These refrain from sexual activity during the fertile phase
• Providing social and financial security for women. of the menstrual cycle.

Types of Women Empowerment Abstinence

• Economic empowerment • No sexual activity.
• Health empowerment • It is 100% effective method to avoid unintended pregnancy.
• Educational empowerment • It prevents the occurrence of sexually transmitted
• Political empowerment infections including HIV.
• Suppression of a natural force may result in mood shifts
LIMITING FAMILY SIZE and nervous breakdown.

Small Family Norm Coitus Interruptus or Withdrawal Method

• The main objective of the family welfare program in India • During the sexual act, just before ejaculation, the man
is that people should adopt the “small family norm” to takes his penis out of the vagina. This action will prevent
stabilize the country’s population. seminal fluid entering the women thereby the sperm.
• It suggests that families should aim to limit the number • It is a readily available method without cost or chemical
of children they have, typically to one or two children per application and reduces the risk of sexually transmitted
couple, rather than having larger families with three or infections.
more children.
Lactational Amenorrhea
Planning commission working group’s report (1980)
suggested the following strategies: • During lactation, the elevated levels of prolactin and
• Developing the necessary level of demand decreased levels of gonadotropin releasing hormone at
• Provisions of the supply of services of all kinds needed by hypothalamus suppress ovulation.
the people. • This method promotes the involution of uterus, menstrual
cycle is suppressed, easy to adopt immediately after
Promotion of Small Family Norm childbirth and helps in postpartum weight reduction.
Governments, NGOs, and community organizations promote Birth Control Vaccine
the small family norm through various strategies:
• Providing access to family planning services, The birth control shot is an injection given to a girl every 3
contraceptives, and reproductive health education. months to help prevent pregnancy. The birth control shot
• Implementing economic incentives or subsidies for family contains a longer-acting form of the hormone progestin.
planning services.
Biological Family Planning Methods
• Educating the public about the benefits of smaller family sizes
through awareness campaigns and educational programs. The biological methods of family planning include the
• Advocating for policies that support gender equality, following:
women’s empowerment, and work-life balance. • Calendar (rhythm) method
• Integrating environmental education and sustainability • Cervical mucus method
initiatives into family planning programs. • Basal body temperature

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Calendar Method of Family Planning • Diaphragms

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• To follow this method, one must have knowledge of the

• Cervical cap
exact ovulation day and avoid intercourse during the
• Vaginal sponge
fertile days before and after ovulation. • Intrauterine devices
• The menses dates are recorded for 6 cycles (6 months)
Male condoms
to estimate the fertile period. To know the earliest day of
the fertile period 18 days are subtracted from the shortest Condoms worn on the penis are made from very thin latex
menstrual cycle. The latest day of the fertile period is (rubber), polyisoprene or polyurethane. They’re designed to
calculated by subtracting 11 from the longest cycle. stop a man’s semen from coming into contact with his sexual
partner. Condoms are the only contraception that protects
Advantage
against STIs and pregnancy.
Does not require any device
Female condoms
Disadvantages
Latex or soft, thin synthetic latex is used to make female
• Woman’s menstrual cycle must be regular condoms. To stop semen from entering the womb, they are
• It is possible only for educated and responsible people worn inside the vagina.
• It has a high failure rate
Diaphragms
Cervical Mucus Method (Billings Method)
• Before having sex, a round dome made of thin, soft silicone
• Cervical mucus looks watery and clear, thin and is placed inside the vagina to serve as a contraceptive
transparent during ovulation. The mucus then becomes diaphragm or cap.
scanty and dry under the influence of progesterone which • In order to prevent sperm from entering the uterus and
remains until the onset of the next menstrual period. fertilizing an egg, it covers the cervix.
• Sexual intercourse can take place 4 days after the maximal
cervical mucus until menstruation. Cervical Cap

Basal Body Temperature Method The cervical cap covers the cervix to prevent sperm from
entering the uterus. Before putting the cap snugly over the
• When ovulation occurs, the temperature of the body cervix, spermicide is inserted for further protection. The
increases. The progesterone causes 0.50C increase in cap needs to be left in for at least six hours following sexual
temperature and the couples should adopt the abstinence activity, but it can be put in several hours prior.
method during the preovulation period.
• This method is effective as there are no adverse reactions Vaginal Sponge
of the hormones and fertility remains immediately after
stopping the practice of the method.
• The contraceptive sponge, often known as “the sponge” or
birth control sponge, is a tiny, spherical sponge composed
Chemical Family Planning Methods of supple, soft plastic. Before having sex, the sponge is
inserted deeply into the vagina.
• These chemical methods contain spermicides which • Spermicide is included in the sponge, which covers the
attach themselves to spermatozoa and blocks the oxygen cervix and aids in preventing pregnancy. To make removal
supply and kills the sperm. easier, each sponge has a cloth loop connected to it.
• These chemical contraceptives cause irritation and toxicity
with high failure rates. Some of the examples are as follows: Intrauterine Devices
ƒ Foams
ƒ Creams, jellies and pastes
• A birth control method that a medical professional
puts into the uterus is called an intrauterine device or
ƒ Soluble films
IUD. The most popular kind of long-acting, reversible
contraception (LARC) is the intrauterine device (IUD).
Mechanical Family Planning Methods
• IUDs come in two varieties (i) hormonal (levonorgestrel)
Mechanical methods of family planning include the following: and (ii) copper. Both feature plastic frames that, once
• Male condoms within the uterus, expand up into a T shape. When
• Female condoms necessary, the medical professional can remove the IUD.
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 Population and its Control

• The major types are: • It doesn’t offer any protection against sexually transmitted

Community Health Nursing-II

ƒ Copper IUD: Releases small amounts of copper in infections (STIs).
the uterus which prevent sperms from reaching the • There is a slight risk (1 percent) of acquiring uterine
ovary. The copper IUD works by: infection during IUD insertion within 20 days of the
Š Making it harder for sperm to reach and fertilize procedure.
an egg. • If a woman becomes infected with an STI with an IUD
Š Making it harder for an egg to survive. in situ, pelvic inflammatory disease may result without
Š Changing the lining of the uterus so that if an adequate treatment.
egg was fertilized, it wouldn’t be able to implant. • Expulsion of the IUD may occur especially following or
ƒ Hormonal IUD: Releases progestin in the body which during the periods in the first three months.
prevents the formulation of eggs. The hormonal IUD • Uterine perforation may occur in 0.1 percent of women
prevents pregnancy by: during insertion. This may manifest as lower abdominal
Š Thickening the mucus at the entrance to the pain. Perforation will require surgical removal.
uterus, so sperm cannot get through. • There is a higher risk of ectopic pregnancy if conception
Š Making it harder for sperm to reach and fertilize occurs with an IUD in situ, though pregnancies are very
an egg. rare with this method.
Š Making it harder for an egg to survive.
Š Thinning the lining of the uterus. Hormonal Contraceptive Methods
Š Preventing ovulation (the release of eggs from Cervical Cap
the ovaries) in some people.
ƒ Nonmedicated IUDs:
• Cervical cap is a cup-shaped latex device fixed over
the base of the cervix. A groove found in the inner
Š First generation IUDs: Loops, spirals, coils,
circumference of the rim facilitates the seal with the base
rings and bows (e.g., Lippes loop)
of the cervix.
Š Second generation IUDs: Copper IUDs • It requires one-third of the cap to be filled with spermicide
Š Third generation IUDs: Hormone-releasing before insertion.
IUDs • It is inserted as long as 8 hours before coitus and can be
ƒ Medicated IUDs: Usually release either metal ions left in place for as long as 48 hours.
(copper) or hormones (polyethylene). • A cervical cap acts as both as mechanical barrier and
spermicide.
Advantages
• It is highly effective, with a 98-99 percent success rate over Advantages
five years of IUD use. • Repeated intercourse does not require additional
• It can be used by almost any woman including nulliparous. spermicide.
• Its action lasts for ten years if it is not removed in between. • The cervical cap does not call for the use of hormones.
• The onset of action is immediate.
Disadvantages
• It is independent of sexual activity.
• It doesn’t interfere with intercourse. • Cervical erosion may occur leading to vaginal spotting.
• It is suitable for lactating women. • The cervical cap insertion needs professional training.
• Fertility returns promptly on discontinuation. • It has a relatively high failure rate.
• It can be used by women who are on any type of • The ideal candidate must have normal results of pap tests.
medication.
Contraceptive Skin Patches
• It is not associated with cancer of any organ, unlike
hormonal contraception. • This looks like a square band-aid. It can be applied to
• It does not cause weight gain. the abdomen, buttocks, upper arm or upper torso. Every
single patch is fixed on the skin for 7 days. It means one
• It does not usually affect mood or sex drive.
patch is worn each week, continued with subsequent
Disadvantages patches for 3 weeks.
• The patch must be changed on the same day every week.
• Menorrhagia is a frequent complaint, as are dysmenorrhea This is called the “Patch change day”. The fourth week
and polymenorrhea. remains patch-free, allowing a menstrual period to occur.
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• The patch should never be removed off for more than 7 Combined Pill
Community Health Nursing-II

days. A new cycle is started following the seven patch-free

days. • The combined pill, also known as the combination pill, is a
type of oral contraceptive that contains synthetic versions
• Slowly, it releases a combination of estrogen and progestin
of the hormones estrogen and progestin. It’s taken daily to
hormones through the skin. These hormones prevent
prevent pregnancy by suppressing ovulation, thickening
ovulation and thicken the cervical mucus, to create a
cervical mucus to prevent sperm from reaching an egg,
barrier to prevent sperm from entering into uterus.
and thinning the lining of the uterus.
• If used in a correct way, it is 99% effective.
• This occurs by suppression of ovulation, thickening of
Advantages cervical mucus and thinning of uterine lining.
• It is 99% effective if taken correctly.
• It is simple to use
• Can be used by just one partner Progesterone-Only Pill (Mini-Pill)
• Highly effective if used properly, with almost 100 percent
This pill contains only progestin, a synthetic version of the
protection
hormone progesterone. It works by thickening cervical
• Needs to be applied only once a week and not in relation
mucus, making it difficult for sperm to reach an egg. It
to intercourse, improving patient compliance
may also thin the lining of the uterus, making it less likely
• Its presence can be verified by sight. for an egg to implant. Unlike the combined pill, it does not
• Does not detach with exposure to water or sweat contain estrogen. It’s taken daily at the same time each day for
• May improve menorrhagia and dysmenorrhea not due to maximum effectiveness.
organic conditions
• May improve acne in many cases. Once-A-Week Pill
• May improve bone strength due to the estrogen content.
This is a type of contraceptive pill that is taken once a
• May reduce the risk of benign breast disease, as well as week instead of daily. It typically contains both estrogen
uterine endometrial and ovarian cancers. and progestin. The once-a-week pill works similarly to the
Disadvantages combined pill by preventing ovulation, thickening cervical
mucus, and thinning the uterine lining. It offers convenience
• It does not provide protection against sexually transmitted for those who may have trouble remembering to take a pill
infections (STIs), including HIV. every day.
• Must be prescribed by a healthcare provider.
• The estrogen levels are higher with the patch than with Contraceptive Injection (Depo-Provera)
other hormonal methods. This is an injection of a progestin hormone that is
• The return of fertility may be delayed by up to two months administered by a healthcare provider every three months.
after stopping the use of the patch. It works by preventing ovulation and thickening cervical
• Skin irritation may occur in some women. mucus, similar to other hormonal contraceptives. It provides
• It can be seen by the partner. effective contraception without the need for daily or weekly
• It is sometimes felt inside the vagina by the partner. administration.

Vaginal Ring Contraceptive Implant (Implanon, Nexplanon)

• It is a soft, flexible vaginal ring measuring 2 inches in This is a small, flexible rod that is inserted under the skin
diameter and delivers low doses of estrogen and progestin of the upper arm by a healthcare provider. It continuously
into the body. releases a progestin hormone over several years, providing
• These hormones prevent pregnancy by suppressing long-term contraception. It works by preventing ovulation,
ovulation and thickening of cervical mucus that block thickening cervical mucus, and thinning the uterine lining.
sperm entering into the uterus. It offers a highly effective, low-maintenance contraceptive
• The ring remains in the vagina for 3 weeks and the ring is option for those who prefer not to take a daily pill or receive
removed for 1 week for menstruation. regular injections.

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 Population and its Control

Terminal Methods Disadvantages

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Tubectomy • Usually, irreversible
Tubectomy is performed as an interval procedure, postpartum
• Needs skilled medical personnel to perform the procedure
or at the time of abortion. This is done by laparoscopic • It does not provide protection against sexually transmitted
sterilization and mini-lap (laparotomy) procedure. diseases and infections including HIV
• Initial cost may be expensive
Laparoscopic Sterilization • Though there is no proven evidence, serious long-term
effects are possible.
Laparoscopic sterilization is also known as bilateral tubal
ligation. This is a permanent method of birth control as in this Instructions After Vasectomy
surgical treatment, a woman’s eggs are prevented from traveling
through the fallopian tube. Thus, any chances of fertilization • Avoid taking bath for 24 hours after operation.
by a sperm cell are prevented. This treatment blocks the • Avoid cycling and lifting heavy weight for 15 days
fallopian tubes through the technique of laparoscopy, which • Wear T bandage or scrotal support for 15 days
is minimally invasive. • Use contraceptives until aspermia is established

Mini-Lap Operation
• The person is not sterile after vasectomy immediately. At
least 30 ejaculations may be necessary before the seminal
Mini laparotomy, generally referred to as mini lap, is an examination is negative.
abdominal surgical approach to the fallopian tubes by an
incision less than 5 cm in length. As a sterilization procedure Emergency Contraception
for permanently occluding the fallopian tubes. Emergency contraception is a birth control measure, used
Advantages after sexual intercourse to prevent pregnancy.
• It is a permanent method to prevent unintended
Use of Emergency Contraceptives
pregnancies.
• It is effective immediately. • To avert an unplanned pregnancy, any woman or girl of
• Cost-effective. reproductive age may require emergency contraception.
• Does not interfere with sex. • There are no absolute medical reasons to avoid using
Disadvantages emergency contraception.

• More complicated than male sterilization.

• There are no age restrictions for using emergency
contraception.
• May not be reversible, resulting in possible regret.
• Does not protect against sexually transmitted infections Indications
including HIV/AIDS.
• Lifting heavy weights is not permitted for at least 6 months
• Breakage, slippage or inappropriate usage of a condom.
to avoid the occurrence of incisional hernia.
• 3 or more missed combined oral contraceptive tablets in a
row or 3 days late during the first week of the cycle.
Vasectomy • More than 3 hours late from the usual time of intake of
the progestogen-only pill (mini-pill) or more than 27
A vasectomy is a form of birth control. It prevents sperm from hours after the previous pill; more than 12 hours late from
being released during ejaculation. During the procedure, a the usual time of intake of the desogestrel-containing pill
tube called the vas deferens is cut or blocked. The vas deferens (0.75 mg) or more than 36 hours after the previous pill;
is the duct that carries sperm from the testicles to the urethra. more than 2 weeks late for the progestogen-only injection
norethisterone enanthate (NET-EN).
Advantages
• More than 7 days late for the combined injectable
• Permanent method of contraception contraceptive (CIC).
• Highly effective method • Dislodgment, breakage, tearing or early removal of a
• Very safe surgical procedure diaphragm or cervical cap.
• No compelling responsibility on the couple • Failed withdrawal (e.g., ejaculation in the vagina or on
• No long-term side effects external genitalia).
• Does not interfere with sex • Failure of a spermicide tablet or film to melt before
• Highly acceptable method intercourse.

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Safety of the ECPs MEDICAL TERMINATION OF PREGNANCY (MTP)

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• The side effects of ECPs are comparable to those of oral

ACT
contraceptives, including nausea and vomiting, little
Medical Termination of Pregnancy (MTP) is an act to provide
irregular vaginal bleeding, and exhaustion. Side effects
for the termination of certain pregnancies by registered
are uncommon, moderate, and usually disappear without
medical practitioners (1971).
the need for additional medicine.
• Emergency contraceptive drugs have no negative effects Objectives of MTP Act
on future fertility. There is no delay in resuming fertility
after using ECPs. • To improve the health of the mothers by preventing
unsafe abortions
Examples • To legalize the abortion services
• Progestin-only pill • To promote easy access to safe abortion services for
• Ulipristal women
• To offer protection to medical practitioners
COUNSELING
Permitted Conditions for MTP
Counseling help people in understanding and coping
effectively with their problems and lifestyle modifications.
• Medical: Injury to physical and mental health of women
• Eugenic: Risk of child being born with serious handicaps
Counseling Areas on Reproductive and Sexual Health • Humanitarian: Pregnancy caused by rape
• Socioeconomic: When the environment leads to the
• Early marriage and early pregnancy injury to the mother.
• Registration of eligible couples • Contraceptive failure in married couple
• Family planning
• Oral contraceptive pills and emergency contraception Circumstances for MTP by Registered Medical
• Safe abortion services Practitioners (RMP)
• Post-abortion contraceptives
• Pregnancy is not more than 12 weeks’ old
• Prevention of reproductive tract infections and sexually
ƒ Injury to the physical or mental health of the woman
transmitted infections
ƒ Complications of the to be born child
• Support of persons living with HIV-AIDS
• Pregnancy is between 12 weeks and less than 20 weeks
• Early diagnosis and regular treatment
ƒ Rape
• Personal hygiene
ƒ Failure of contraceptives
• Reproductive tract hygiene
ƒ Injury to the physical or mental health of the woman
Counseling Areas on Adolescent Health • Woman with 18 years or more with her written consent
• Woman with less than 18 years of age having any mental
• Improving nutrition disorders, with written consent of her guardian
• Sexual and reproductive health Persons who can terminate:
• Mental health • Registered Medical Practitioner whose name is registered
• Prevention of injuries and violence in a state medical register and has a recognized medical
• Substance misuse qualification.
• Healthy lifestyle • RMP has training experience as MTP rules
• Oral hygiene Eligibility to perform abortion up to 20 weeks
• Menstrual hygiene • RMP who holds a postgraduate degree or diploma in
• Peer counseling obstetrics and gynecology.
• Life skills education • RMP who has completed 6 months of house surgeon
• Prevention, early diagnosis and treatment of anemia with training in obstetrics and gynecology.
referral • RMP who has at least 1 year experience in the practice of
• Weekly Iron and Folic Acid supplementation program. obstetrics and gynecology at a hospital with full facilities.

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• RMP who is registered in the state medical register Table 4.1: Cash assistance for institutional delivery (in `)

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immediately before the commencement of the Act, has
experience in the practice of obstetrics and gynecology Category Rural area Urban area
for not less than 3 years. Mother’s ASHA’s Mother’s ASHA’s
package package* package package**
Place of Termination LPS 1400 600 1000 400
• Government hospital HPS 700 600 600 400
• Place approved by the government or a district-level *ASHA package of `600 in rural areas include `300 for ANC
committee with the chief medical officer or district component and `300 for facilitating institutional delivery
medical officer as the chairperson of the committee **ASHA package of `400 in urban areas include `200 for ANC
component and `200 for facilitating institutional delivery
MTP (Amendment) Bill, 2020 • Target Population: Janani Suraksha Yojana primarily
• Constitution of the medical board with a gynecologist, targets women from rural and marginalized communities.
a pediatrician, a radiologist or sonologist and any The scheme prioritizes pregnant women from Below
other number of members, as may be notified by the Poverty Line (BPL) households.
government. • JSY is implemented through a network of accredited
• A pregnancy may be terminated within 20 weeks with healthcare facilities, including government hospitals,
the approval of one RMP and termination between 20-24 community health centers, and accredited private
weeks with approval from two RMPs. institutions.
• Protection of privacy of women. JANANI SHISHU SURAKSHA KARYAKARAM
NATIONAL POPULATION STABILIZATION FUND/ Janani Shishu Suraksha Karyakram (JSSK) is a government
JANANI SURAKSHA YOJANA (JANSANKHYA initiative in India aimed at providing free maternal and
STHIRATA KOSH) neonatal healthcare services to pregnant women and newborns
to ensure their well-being.
• Janani Suraksha Yojana (JSY) is a safe motherhood
intervention under the National Rural Health Mission Objective
and was launched in April 2005 by modifying the National
Maternity Benefit Scheme (NMBS). To reduce financial barriers to accessing maternal and
neonatal healthcare services. It aims to ensure that no woman
• The scheme is under implementation in all states
or newborn suffers due to lack of financial resources during
and union territories and the special focus is on low-
childbirth and postnatal care.
performing states.
Major Initiatives
Goals
• JSSK covers a range of services for pregnant women
• To reduce maternal and infant mortality through and newborns, including antenatal care, institutional
institutional deliveries. delivery, postnatal care, and treatment of sick newborns.
• To assess the quality of antenatal and postnatal healthcare The program also includes transportation services for
by providing a continuum of care. pregnant women to reach healthcare facilities for delivery
and postnatal care.
Vision • Under JSSK, pregnant women and newborns are entitled
• To promote institutional deliveries. to receive a package of free services at government
• To reduce the overall maternal mortality ratio and infant
healthcare facilities, including public hospitals and health
centers. These services encompass antenatal check-ups,
mortality rate.
delivery, cesarean section (if necessary), postnatal care,
and treatment of sick newborns.
Major Initiatives
• Pregnant women are identified and enrolled in the JSSK
• Financial Incentives: Under JSY, eligible pregnant women program through antenatal clinics, community health
who opt for institutional delivery receive cash assistance workers, and outreach programs.
(`500) to cover the costs associated with transportation, • JSSK is implemented by state governments across India
delivery, and postnatal care (Table 4.1). through a network of government healthcare facilities.
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 Target High Next Nursing DECODE Final Year

• Free and cashless delivery • The government committed to collaborating with

Community Health Nursing-II

• Free C-section international organizations, civil society groups, NGOs,

• Free drugs and consumables and the private sector to leverage resources and expertise
• Free diagnostic evaluation for effective implementation of family planning programs.
• Free diet during the stay in the health institutions • Expansion of the family planning services to the private
• Free provision of blood
sector as well.
• Free transport from home to health institutions
• Enabling young people to access sexual and reproductive
health information and services.
• Free transport between facilities in case of referral
• Free drop back from institutions to home after 48 hours NATIONAL FAMILY WELFARE PROGRAM
of stay
• The first family planning clinic was opened by Prof. RD
FAMILY PLANNING 2020 Karve in 1923.
• Sir Joseph Bhore in 1946 recommended the provision of
• Family Planning 2020 (FP 2020) is a global partnership integrated preventive, promotive and curative primary
that supports the rights of women and girls to decide on healthcare services with high priority for improving
whether, when and how many children they want to have nutritional and health status of mother and child.
in their life. • National family planning program was launched in
• India launched child survival and development in 1951 with the aim of reducing the birth rate to the
February 2013 and the Reproductive, Maternal, Newborn, extent required for stabilization of population at a level
Child and Adolescent Health (RMNCH+A) strategy in consistent with the notional economy.
May 2013.
• The plus in the strategy denotes the inclusion of Objectives
adolescence as an important life stage that forms the basis
of healthy lifestyle.
• Promotion and adaption of small family norm.
• Enhance the use of spacing methods.
Family Planning 2020 Commitments of India • Adequate supply of contraceptives to all the eligible
couples.
• Expanding the range of contraceptive options like
injectable contraceptives, progesterone-only pills, and Role of a Nurse in Family Welfare Program
long-acting reversible contraceptives.
Family welfare includes not only planning of birth, but the
• India committed to expanding the reach of family planning
welfare of whole family by means of total family healthcare.
services, including contraceptives and reproductive health
Role of community health nurse in family welfare services:
information, to underserved communities, particularly in
rural and remote areas.
• Counselor: As a medical caretaker nurse runs over with
troublesome couples requiring uncommon consideration
• The government aimed to increase the availability and
and exhorts. The nurse has to clear their questions and
accessibility of a wide range of contraceptive methods to
help them in settling on choices for themselves.
cater to the diverse needs and preferences of individuals
and couples.
• Administrator: As an attendant the nurse should be a
member in the association of Family Welfare Department
• India pledged to empower women with information at national, regional and local level. One may need to
and resources to make informed decisions about their setup a family government assistance center and deal with
reproductive health, including family planning options the authoritative exercises.
and maternal healthcare. • Supervisor: Nursing faculties are liable for useful
• The country committed to strengthening its healthcare supervision and in-administration instruction of their
infrastructure, training healthcare providers, and wellbeing laborers and experts.
improving supply chain management to ensure consistent • Functional role: As a network wellbeing attendant, nurse
availability of family planning services and commodities. is mindful in finding qualified couples. He/she helps the
• India aimed to raise awareness about the importance of couples to pick an appropriate technique for contraception.
family planning, reproductive health, and gender equality He/she might be approached to run a center or help the
through educational campaigns, community outreach specialist for different exercises identified with family
programs, and media initiatives. arranging.

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 Population and its Control

• Educator: The fundamental job of a medical caretaker • Researcher: The medical caretaker ought to have to

Community Health Nursing-II

is to instruct individuals about Family Planning. The address the inquiries and discover the answers for it. As
wellbeing instruction can be held in the wellbeing habitats, an individual from the wellbeing group, she needs to have
emergency clinics, centers, schools, homes and so forth. enough information to respond to such inquiries.

CONCEPTUAL EXERCISES

Advantages
LONG ANSWER QUESTIONS
• It is a permanent method to prevent unintended
pregnancies
1. What do you mean by permanent methods of family • It is effective immediately
planning? Describe in detail about the permanent • Cost-effective
methods of family planning. Add a note on • Does not interfere with sex
miscellaneous methods of family planning. (MGR)
Disadvantages
Answer
• More complicated than male sterilization
Permanent Methods of Family Planning • May not be reversible, resulting in possible regret
• Permanent method of family planning include permanent
• Does not protect against sexually transmitted infections
including HIV/AIDS
contraception.
• The permanent contraception once done can never be • Lifting heavy weights is not permitted for at least six
changed and pregnancy will never occur to the couple months to avoid the occurrence of incisional hernias.
who has done it once.
Vasectomy
• The most common method of permanent contraception
includes vasectomy, tubal ligation, etc. • A vasectomy is a form of birth control.
• It prevents sperm from being released during ejaculation.
Tubectomy
• During the procedure, a tube called the vas deferens is cut
• This is performed as an interval procedure, postpartum or blocked.
or at the time of abortion. • The vas deferens is the duct that carries sperm from the
• This is done by laparoscopic sterilization and mini-lap testicles to the urethra.
(laparotomy) procedure.
Types of Vasectomy
Laparoscopic Sterilization
• Conventional vasectomy: During this surgery, small cuts
• Laparoscopic sterilization is also known as bilateral tubal are made in the scrotum in order to reach the vas deferens
ligation. This is a permanent method of birth control as tubes. A small piece of the tube is removed, leaving a
in this surgical treatment, a woman’s eggs are prevented small space between the two ends. Then, the two ends of
from traveling through the fallopian tube. Thus, any the tube may be tied together, or some tissue will be put
chances of fertilization by a sperm cell are prevented. in between them. The small cuts in the scrotum may be
• This treatment blocks the fallopian tubes through the then sutured together with dissolvable stitches, or allowed
technique of laparoscopy, which is minimally invasive. to heal on their own.
• No-scalpel vasectomy: Not scalpel cuts are made during
Mini-Lap Operation this process. A urologist feels for the vas deferens tube and
• Mini laparotomy, generally referred to as mini lap. then holds it in place with a clamp. A tiny hole is then
• It is an abdominal surgical approach to the fallopian tubes made in the scrotum so the tube can be taken out and
by means of an incision less than 5 cm in length. then cut or tied. Afterward, the vas deferens tube is put
• As a sterilization procedure for permanently occluding back in place.
the fallopian tubes.
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 Target High Next Nursing DECODE Final Year

Advantages • Symptothermal method: This method combines the

Community Health Nursing-II

temperature, cervical mucus and calendar techniques for

• Permanent method of contraception identifying the fertile period. The other name is billing
• Highly effective method method.
• Very safe surgical procedure
• No compelling responsibility on the couple Breastfeeding
• No long-term side effects
• The lactational amenorrhea method (LAM) is an age-old
• Does not interfere with sex
method. Breastfeeding acts to reduce the frequency of
• Highly acceptable method ovulation by increasing the levels of prolactin, a pituitary
Disadvantages hormone, which suppresses gonadotropin activity. The
LAM is suitable for women who are lactating under the
• Usually, irreversible following conditions:
• Needs skilled medical personnel to perform the procedure ƒ Within six months of childbirth
• It does not provide protection against sexually transmitted ƒ Complete amenorrhea persists
diseases and infections including HIV ƒ Exclusive breastfeeding is performed.
• Initial cost may be expensive.
Birth Control Vaccine
Miscellaneous Methods of Family Planning
The birth control shot is an injection given to a girl every 3
Abstinence months to help prevent pregnancy. The birth control shot
contains a longer acting form of the hormone progestin.
Means no sexual activity. It prevents the sexual partner from
contact with semen, vaginal fluids and blood.

Coitus Interrupts 2. Describe National Population Policy. (CCU)

During the sexual act, just before ejaculation the male takes
his penis out of the vagina. This action prevents the seminal Answer
fluid from entering the woman’s vagina. National Population Policy
Safe Period (Rhythm Method) India’s demands for reproductive and child health were
• To follow this method, one must have knowledge of exact
addressed by the National Population Policy, which was
presented on February 15, 2000, with the goal of reaching TFR
ovulation day and avoid intercourse during the fertile
(total fertility rate) by 2010.
days before and after ovulation.
• The menses dates are recorded for 6 cycles (6 months) National Population Policy 2000
to estimate the fertile period. To know the earliest day of
the fertile period 18 days are subtracted from the shortest • Target-free approach to provide family planning services.
menstrual cycle. The latest day of the fertile period is • The National Population Policy 2000 offers a national
calculated by subtracting 11 from the longest cycle. plan for pursuing objectives and emphasizing solutions
over the next ten years in order to reach the total fertility
Natural Family Planning Methods rate (TFR) by 2010 and meet the expectations of India’s
• Basal body temperature method: The basal body population in terms of reproductive and child health.
temperature (BBT) method helps determine the time to • It is predicated on the idea that government, industry, and
get pregnant. The body temperature rises slightly after the voluntary nongovernment sector work together to
ovulation. This is due to an increase in progesterone. promote maternal health, child survival, and contraception
Progesterone is a hormone responsible for preparing the while also raising awareness of and increasing exposure to
uterus for pregnancy. a full range of reproductive and pediatric health services.
• Cervical mucus method: It can be used to identify when
Goals of National Population Policy 2000
the women are most fertile. The mucus is thick, white and
dry before ovulation (when the ovary releases an egg). The main goals of India’s National Population Policy were to
Just before ovulation, the cervical mucus will turn clear increase universal access to and affordability of reproductive
and slippery. This consistency makes it easy for sperm to healthcare, as well as to address a number of issues related to
swim up to meet an egg at ovulation. maternal health, child survival, and contraception.
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 Population and its Control

• Temporary Objective: One of the specified objectives 3. Explain the consequences of population explosion.

Community Health Nursing-II

was the dispensing of contraception. It also entails (RUHS)
establishing a system for health protection and engaging
medical professionals. Answer
• Midterm Objective: The replacement level, or total
Population Explosion
fertility rate (TFR), was to be lowered to 2.1 by 2010.
• Long-term Objective: By 2045, population balance will • The rise in the number of persons in a population or
be achieved. dispersed group is referred to as population growth.
• Regulation of our population must be implemented at • Actual world population growth is roughly 83 million
a level that safeguards and fosters social, economic, and per year, or 1.1% per year. The world’s population has
environmental development as well as public safety. increased from one billion in 1800 to 7.9 billion in 2020.

Essential Objectives of NPP 2000 Consequences of Population Explosion

• Addressing the unmet needs for basic resources, • Poverty: Poverty and starvation are the ultimate result of
equipment, and services associated with maternity and overpopulation.
newborn care. • Unemployment: Overpopulation results in
• Reducing the percentage of boys and girls who drop out of unemployment as the available jobs cannot meet the
elementary and secondary school to less than 20% would requirements of the existing population.
need free and mandatory education up until the age of 14. • High cost of living: An increase in population, results
• Reduce the infant mortality rate to under 30 per 1000 live in increased prices of food, shelter, etc. This weakens the
births. buying capacity of people and puts extra burden on the
• Reduce the number of maternal fatalities per 100,000 live population.
births to less than 100. • Pollution: The increase in population causes an increase
• Make certain that all children receive vaccinations against in noise, air, and water pollution on earth thereby
all diseases for which there is a preventative measure. increasing the risk of diseases.
• Girls should be encouraged to postpone marriage until
• Inadequate food production: Food production needs to
be doubled to meet the challenges of overpopulation.
they are at least 18 years old, ideally till 20.
• Attain 80% of deliveries in institutions and 100% of
• Lack of accommodation: Overpopulation results in a
lack of houses and increased rentals and poor people are
deliveries by trained individuals.
compelled to live in poor accommodations.
• Achieve universal access to a wide range of informational
• Rise in antisocial activities: Overpopulation causes a
counseling services and services for controlling fertility
decreased number of jobs and reduced income. This
and contraception.
results in an increased rate of antisocial activities and
• The national population policy places great emphasis on socially unacceptable behavior.
the achievement of complete registration of births, deaths, • Diminution of resources: The increase in population
marriages, and pregnancies. causes increased demand for natural resources creating
• Stop the spread of AIDS and promote improved problems for food, water, and shelter.
collaboration between the National AIDS Control • Global warming: Overuse of coal, oil, and natural gas
Organization and the treatment of RTIs and STIs (sexually causes a great impact on air quality, and increased carbon
transmitted infections). dioxide in the air results in global warming.
• Control and avoid communicable diseases. • Increased energy utilization: An increase in population,
• Incorporate Indian systems of medicine (ISM) into the industrialization and urbanization results in the increased
provision of in-home outreach and services pertaining to requirement of energy, fuel wood, oil, gas, etc. to meet the
reproductive health and children. demand.
• To emphasize small family norms. • Rise in conflicts, wars and accidents: Overpopulation
• India’s population strategy places a strong emphasis on can cause conflicts between countries and within
making sure social sector programs are either related to countries for resources like land, water and food.
family welfare or handled in a way that prioritizes the • Demand for educational institutions: A greater number
needs of individuals. of educational institutions are required to meet the
educational needs of the growing population.

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 Target High Next Nursing DECODE Final Year

• Healthcare facilities: The increase in population requires 2. Role of community health nurse in family welfare
Community Health Nursing-II

a big proportion of the budget to meet the healthcare services. (CCU)

requirements of people.
Answer

Role of Community Health Nurse in Family Welfare

SHORT NOTES
Services
Counselor: As a medical caretaker nurse runs over with
1. Write a note on the principles of family health nursing. troublesome couples requiring uncommon consideration and
(DU) exhorts. One has to clear their questions and help them in
settling on choices for themselves.
Answer Administrator: As an attendant nurse might be called upon
to partake in association of Family Welfare Department at
Family Health Nursing
National, Regional and Local level. One may need to setup
The ability to do family development tasks with the necessary a family government assistance center and deal with the
resources and expertise is called family health services. authoritative exercises.
Family members receive extra attention to support their health, Supervisor: Nursing faculty are liable for useful supervision
stave against illnesses, and ensure the family’s well-being. and in-administration instruction of their well-being laborers
and experts.
Principles of Family Health Nursing Functional Role: As a network well-being attendant, the nurse
• Provide family health services without discrimination.
is mindful of finding qualified couples. Helps the couples to
pick an appropriate technique for contraception. One might
• Periodic and continuous appraisal and evaluation of
be approached to run a center or help the specialist with
family health services are important.
different exercises identified with family arranging.
• Proper maintenance of records and reports. Educator: The fundamental job of a medical caretaker is to
• Provide continuous family health services. instruct individuals about family planning. The well-being
• Health education, guidance and supervision are an instruction can be held in the well-being habitats, emergency
integral part of family health services. clinics, centers, schools, homes and so forth.
• Maintain good interpersonal relationships. Researcher: The medical caretaker ought to have an eager brain
• Plan and provide family health services with active to address the inquiries and discover the answers to them. As an
participation of family members. individual from the well-being group, one needs to have enough
• Family health services should be realistic and be provided information to respond to such inquiries. The nurse keeps
with available resources. precise records to break down the realities to help in further
• Encourage the family members to contribute toward the arranging the family exercises in general vicinity of the task.
community health.
• Active participation of the family members is important
in providing family health services. 3. Write a note on MTP Act. (CCU)
• Gather all relevant information about family to identify
the problem and set priorities. Answer
• Provide need-based support and services to the family to
improve their health status. Medical Termination of Pregnancy (MTP)
• Healthcare services should be provided to the family MTP is an act to provide for the termination of certain
irrespective of their age, sex, income, religion, etc. pregnancies by registered medical practitioners (1971).
• Duplication of health services should be avoided.
• Compile all relevant family information in order to Objectives of MTP Act
prioritize and identify issues.
• Help the family improve their health status by offering
• To improve the health of the mothers by preventing
unsafe abortions
need-based assistance and services.
• Healthcare services ought to be given to the family
• To legalize the abortion services
regardless of their age, sex, income, religion, or other
• To promote easy access to safe abortion services for
women.
characteristics.
• To offer protection to medical practitioners.
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 Population and its Control

Circumstances for MTP by Registered Medical reduce service costs, improve provider collaboration, and

Community Health Nursing-II

Practitioners (RMP) improve patient safety. Care coordinators ensure that
patrons obtain appropriate services across population
• Pregnancy is not more than 12 weeks old categories, therapeutic disciplines, and service venues by
ƒ Injury to the physical or mental health of the women thinking about their work on a community level.
ƒ Complications of the to-be-born child with a • Determine who wants to have children and who does not.
handicap • Listening, comprehending, counseling, and making
• Pregnancy is between 12 weeks and less than 20 weeks necessary fertility control referrals. Providing and
ƒ Rape interpreting family planning information for health
ƒ Failure of contraceptives providers and the community, as well as tapping into
ƒ Injury to the physical or mental health of the women community resources.
• Women with 18 years or more with her written consent • Organizing camps and planning, participating in, and
• Women with less than 18 years; any mental disorders with assessing family welfare services.
the written consent of her guardian • Supervising and guiding other female paramedics such as
H.V., ANMs, and others; initiating and participating in
Place of Termination research.
• Planning, implementing, and assessing community health
• Government hospital center-level training for additional paramedical staff,
• Place approved by the government or a district-level including Dais, in collaboration with Medical Officer.
committee with a chief medical officer or district medical
officer as the chairperson of the committee.

MTP (Amendment) Bill, 2020 5. Write in short about small family norms. (CCU)

• Constitution of the medical board with a gynecologist, Answer

a pediatrician, a radiologist or sonologist and any
other number of members, as may be notified by the Small Family Norm
government.
According to the notion of small family norms, it is a cultural
• A pregnancy may be terminated within 20 weeks with
expectation that families have a restricted number of children.
an approval of one RMP and termination between 20-24
This concept of small family norms varies based on the culture
weeks with an approval from two RMPs.
or nation in question, but it often refers to two or three children
• Protection of privacy of women. as the optimal family size.

Origin of The Small Family Norm

4. Discuss the role of nurses in population explosion. The Ministry of Health and Family Welfare was established
(CCU) in 1966 to oversee the new population policy known as the
Small Family Norm, which encourages families to have only
Answer two children.
Population Explosion Initially, the small family norm is represented using a red
inverted triangle as its symbol.
The rise in the number of persons in a population or dispersed
group is referred to as population growth. Recommendations of Small Family Norm
Actual world population growth is roughly 83 million per • Spread awareness and information with the use of
year, or 1.1% per year. The world’s population has increased multimedia and interpersonal communication strategies.
from one billion in 1800 to 7.9 billion in 2020. • Program to be an integral part of healthcare facilities to
enhance female literacy.
Role of Nurse in Population Explosion
• Laws related to minimum age of marriage should be
• Nursing care coordinators collaborate with individuals, effectively enforced.
groups, and communities to organize the resources that • Close monitoring and follow-ups at all levels.
patients require for optimal treatment. These nurses make • Maintenance of records of all marriages at all village or
certain that varied services complement one another and community levels.
achieve favorable patient outcomes. This effort helps to • Provide population education to all youth.
15
 Target High Next Nursing DECODE Final Year

Advantages of Small Family (0.75 mg), or more than 36 hours after the previous pill;
Community Health Nursing-II

more than 2 weeks late for the progestogen-only injection

• Mothers’ Health: Having a small family and enough norethisterone enanthate (NET-EN)
interval between the two children gives mothers enough
time to recoup the nutrients lost during prior pregnancies.
• More than 7 days late for the combined injectable
contraceptive (CIC)
• Better child care: Because a small home has fewer
• Dislodgment, breakage, tearing, or early removal of a
children, the mother has more time to show her children
diaphragm or cervical cap
love, affection, and attention.
• Involvement of women in constructive endeavors: In
• Failed withdrawal (e.g., ejaculation in the vagina or on
external genitalia)
small families, the mother has more time to devote to
productive endeavors such as education and job training.
• Failure of a spermicide tablet or film to melt before
intercourse
Women can boost their family’s income by engaging in
productive economic pursuits. Safety of the ECPs
• Benefits for children: A compact family environment
encourages physical and psychological development • The side effects of ECPs are comparable to those of oral
in children. Children in such households benefit from contraceptives, including nausea and vomiting, little
quality education, nutrition, and healthcare, as well as irregular vaginal bleeding, and exhaustion. Side effects
parental love and attention. are uncommon, moderate, and usually disappear without
• Advantage for society and country: A smaller family the need for additional medicine.
ensures fewer natural resource depletions. Everyone • Emergency contraceptive drugs have no negative effects
would have access to basic services such as schools and on future fertility. There is no delay in resuming fertility
hospitals. Small and well-planned families would provide after using ECPs.
joy, serenity, harmony, and wealth to the society and
country. Examples
• Progestin-only pill
• Ulipristal.
6. Write a note on emergency contraception. (CCU)

Answer 7. Write a note on Oral pills. (CCU)

Emergency Contraception
Answer
Emergency contraception is a birth control measure, used
after sexual intercourse to prevent pregnancy. Oral Pills
The combination oral contraceptive pill, sometimes known as
Mode of Action
the birth control pill or simply “the pill,” is a method of birth
Emergency contraception pills prevent pregnancy by delaying control that is taken orally by women. Progestin and estrogen
or stopping ovulation and do not induce abortion. are both present in the tablet.
The copper-containing IUD prevents fertilization by • Birth control pills are classified into two categories. Both
producing a chemical alteration in sperm and egg prior to have hormones that prevent you from becoming pregnant.
their meeting. • Estrogen and progestin are both present in combination
An established pregnancy cannot be disrupted or harmed by tablets. This is the most typical.
emergency contraception. • Progestin-only pills are referred to as “the mini pill.”
Indications Types of Oral Pills
• Breakage, slippage, or inappropriate usage of a condom • Mixed pills: E.g., Mala N and Mala D
• 3 or more missed combined oral contraceptive tablets in a • Mini pills: These contain only progesterone and are taken
row, or 3 days late during the first week of the cycle orally from the 5th day of the menstrual cycle to the 21st
• More than 3 hours late from the usual time of intake of day continuously with a short break of 7 days after 21 days
the progestogen-only pill (Minipill), or more than 27 during which the next cycle begins.
hours after the previous pill; more than 12 hours late from • Post coital pill: It should be taken within 48 hours of
the usual time of intake of the desogestrel-containing pill unsafe coitus. It has less harmful effects than estrogen pills.
16
 Population and its Control

• Male pill: It is for males after coitus. E.g., Gossypol. • Promote equality through community initiatives and

Community Health Nursing-II

• Nonsteroidal weekly oral pill: It is taken once a week advocacy.
and has side effects of nausea, vomiting, weight gain and • Measure and publicly report on progress to achieve
dizziness. gender equality.
• Once a month pill: It is a mixture of long-acting estrogen
and short-acting progesterone with a high failure rate and Need for Women Empowerment
has some harmful effects.
• Emergency contraceptive pill: It should be taken to
• To encourage decision-making power
prevent pregnancy after unprotected sexual intercourse. • To freedom of movement
With 2 pills, one should be taken within 72 hours after • To access to education
unprotected sex and second is taken 12 hours after the • To access to employment and media
first pill. • To get rid of domestic violence

Advantages Ways to Empower Women

• Easy to use • Changes in women employment
• Easily available and cost-effective • Changes in women control in decision-making abilities
• High safety rate
• Education to women
• Causes regulation of menstrual cycle
• Providing needs like nutrition, health, sanitation, housing
• Reduction of breast problems
• Encouraging women to develop in the fields they are
Disadvantages good at and make a career.
• Changes in women’s access to and control over resources
• Contra indicated in cardiac diseases
• Women’s access to laws and policies of the government
• Metabolic effects like obesity, hypertension, clotting of
• Providing social and financial security for women.
blood, and not suitable for women after 40 years.
• Breast tenderness, headache, irregularity of bleeding, liver
disease, reduced lactation and ectopic pregnancy occurs.
9. Write in brief about chemical methods of
contraception. (CCU)

8. Write a note on women empowerment. (CCU) Answer

Answer Chemical Methods of Contraception

Women Empowerment • Spermicide: Spermicide is a substance that renders

sperm inactive. Nonoxynol-9 is a substance found in the
Women empowerment can be defined as boosting women’s majority of spermicides. Spermicide can be used alone
self-esteem, ability to make their own decisions, and right to or in conjunction with all other barrier treatments, with
influence societal change for themselves and others. the exception of the sponge, which already includes a
spermicide.
Principles of Women Empowerment
• Foams: The sponge is a circular spermicide-containing
• Establish high-level corporate leadership for gender device constructed of soft foam. It is placed in the
equality. vaginal canal to cover the cervix and prevent sperm
• Treat all women and men fairly at work: respect and from accessing the uterus. Sperm is likewise rendered
support human rights and nondiscrimination. inactive by the spermicide. The sponge does not provide
• Ensure the health, safety and well-being of all women and protection against STIs such as HIV.
men workers. • Creams and jellies: Spermicides are inserted into
• Promote education, training and professional the vagina before sex and comes in a variety of forms
development for women. including as gels, creams, foams, and suppositories.
• Implement enterprise development, supply chain and • Suppositories: This spermicide suppository, is an insert
marketing practices that empower women. that dissolves after being placed in the vagina.

17
 Target High Next Nursing DECODE Final Year

Advantages of Chemical Methods of Contraception 3. Enumerate Objectives of National Health Policy

Community Health Nursing-II

(2015)
• Affordable
• Convenient Answer
• No hormonal use
• Easy to use Objectives of National Health Policy (2015)

Disadvantages of Chemical Methods of Contraception • To inform, clarify, strengthen and prioritize the role of the
government in shaping health systems in all its dimensions
• High failure rate (investment in health, organization and financing of
• May cause burning sensation, and irritation in vagina healthcare services and prevention of diseases).
• Should be used every time during sexual contact • Promotion of good health through cross-sectoral action,
access to technologies, developing human resources,
encouraging medical pluralism, building the knowledge
SHORT ANSWER QUESTIONS base required for better health, financial protection
strategies and regulation and legislation for health.

1. Differentiate between vasectomy and tubectomy. 4. Define eligible couples. List birth control methods for
a newly married couple.
Answer
Answer
Difference between Vasectomy and tubectomy
Eligible Couple
Vasectomy Tubectomy
An “eligible couple” is a married couple in which the wife is of
It is the permanent family It is the permanent family
reproductive age, which is commonly regarded to be between
planning method for men. planning method for women.
the ages of 15 and 45.
A vasectomy is a minor surgical A tubectomy is a surgical
procedure performed to surgery in which the fallopian Birth Control Method for A Newly Married Couple
prevent sperm from accessing tubes are cut, so blocking the
the semen secreted by the ovary’s released egg from • Barrier method of contraception: This method not only
penis. There is still semen, but it reaching the uterus. prevents pregnancy but also protects against sexually
is devoid of sperm. transmitted diseases such as AIDS. Spermicidal creams
and condoms are among the most effective barrier
contraceptive options. Whichever option the newly
married couple chooses, they should use it every time
2. Enumerate four causes of overpopulation. during sexual intercourse.
• Birth control pills: Both men and women can use
Answer birth control pills. There are several methods of birth
Four Causes of Overpopulation control available, including over-the-counter, natural,
prescription, permanent, and emergency.
1. Early marriage: Marriages at a young age may have
greater chances for potential childbearing.
2. Poverty: Population below the poverty line consider
5. Enlist five population control measures.
their children as economic assets and this results in rapid
population growth.
Answer
3. Polygamy: Polygamy system of marriage results in more
number of children. Population Control Measures
4. Illiteracy: Illiteracy in combination with poverty,
ignorance, and unawareness about the use of • Provide equal opportunities to females for their social
contraceptives results in rapid population growth. and economic development.
• Proper education for females helps in population control.

18
 Population and its Control

• The law related to the minimum age of marriage for • Females should be motivated for family planning.

Community Health Nursing-II

females should be strictly enforced for better outcomes. • Provide adequate social security, incentives, recreational
facilities and tax benefits to limit overpopulation.

CONCEPTUAL REVISION

Golden Points
• Population explosion refers to the rapid and dramatic rise in world population.
• Global warming refers to the long-term increase in earth’s average surface temperature due to human activities, primarily the
emission of greenhouse gases such as carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O).
• Overpopulation can strain resources, degrade ecosystems, and exacerbate environmental problems.
• The ability of women to control their fertility is fundamental to women’s empowerment and equality.
• Family planning methods are temporary and permanent.
• Hormonal methods of contraception include birth control pills, birth control patches, birth control rings, hormonal IUDs, implants
and shots.
• Non-hormonal methods of contraception include condoms, diaphragms, sponges, withdrawal methods, cervical caps, nonhormonal
IUDs and rhythm methods.
• Vasectomy is the permanent method of family planning for men.
• Tubectomy is the permanent method of family planning for women.
• Family Planning 2020 (FP 2020) is a global partnership that supports the rights of women and girls to decide on whether, when
and how many children they want to have.

MULTIPLE CHOICE QUESTIONS

1. Which of the following is a consequence of population 3. Which of the following is a barrier method of
explosion? contraception?
a. Decreased strain on natural resources a. Intrauterine device (IUD)
b. Increased economic productivity b. Contraceptive patch
c. Higher unemployment rates c. Diaphragm
d. Greater environmental sustainability d. Sterilization
Ans. c. Higher unemployment rates Ans. c. Diaphragm
2. Which family planning method involves periodic 4. Which family planning method involves the surgical
abstinence from sexual intercourse during the blocking of the fallopian tubes?
woman’s fertile window? a. Vasectomy
a. Vasectomy b. Tubal ligation
b. Tubal ligation c. Contraceptive implant
c. Natural family planning (NFP) d. Intrauterine device (IUD)
d. Emergency contraception
Ans. b. Tubal ligation
Ans. c. Natural family planning (NFP)

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 Target High Next Nursing DECODE Final Year
Community Health Nursing-II

5. Which of the following is a hormonal method of 8. In countries where it is legal, up to how many weeks
family planning? of gestation can medical termination of pregnancy
a. Tubal ligation (MTP) be legally performed?
b. Vasectomy a. 10 weeks b. 12 weeks
c. Condoms c. 20 weeks d. 24 weeks
d. Birth control pills Ans. b. 12 weeks
Ans. d. Birth control pills 9. Which of the following was a key focus area of family
6. Which of the following is a nonhormonal planning efforts in 2020?
contraceptive method? a. Promotion of traditional contraceptive methods
a. Birth control pills b. Expansion of family planning services to rural areas
b. Contraceptive injection c. Encouragement of large families
c. Contraceptive sponge d. Reduction of access to contraceptives
d. Male condom Ans. b. Expansion of family planning services to rural
Ans. d. Male condom areas
7. Which of the following is a long-acting reversible 10. Which organization is responsible for implementing
contraceptive (LARC) method? the National Family Welfare Program in India?
a. Condoms a. Ministry of Health and Family Welfare
b. Birth control pills b. Ministry of Education
c. Depo-Provera injection c. Ministry of Social Justice and Empowerment
d. Intrauterine device (IUD) d. Ministry of Rural Development
Ans. d. Intrauterine device (IUD) Ans. a. Ministry of Health and Family Welfare

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