Population Stabilisation and Birth Control

Population stabilisation and birth control deal with checking rapid population growth through contraception, and with the safe, legal termination of unwanted pregnancies. This page covers the population explosion and its causes, the ideal contraceptive, natural, barrier, IUD, oral, injectable, implant, emergency and surgical methods, and medical termination of pregnancy (MTP) with its Act, as in the NCERT Class 12 chapter Reproductive Health. In NEET, population stabilisation and birth control questions often ask IUD examples, how pills act, the 72-hour emergency window and the MTP week limits.

1. Population Explosion

1.1 Growth of population

• All-round development in the last century greatly improved the quality of life of people.
• Better health facilities and living conditions also had an explosive impact on the growth of population.

1.2 Causes and danger

• ★ Exam imp Probable reasons for the rise:
  (i) a rapid decline in the death rate;
  (ii) a decline in the maternal mortality rate (MMR), the rate of deaths of mothers related to pregnancy and childbirth;
  (iii) a decline in the infant mortality rate (IMR), the rate of deaths of infants in their first year;
  (iv) an increase in the number of people in the reproducible age.
• The Reproductive and Child Health Care (RCH) programme brought down the population growth rate, but only marginally.
• ★ Exam imp According to the 2011 census, the growth rate was less than 2 per cent, that is, 20/1000/year.
• Even at this rate, the population could increase rapidly.
• Such growth could cause absolute scarcity of basic needs: food, shelter and clothing, in spite of progress in these areas.
• So the government was forced to take serious measures to check the population growth rate.

2. Measures to Check Population Growth

• ★ Exam imp The most important step is to motivate smaller families by using various contraceptive methods.
• Media advertisements and posters show a happy couple with two children and the slogan Hum Do Hamare Do (we two, our two).
• Many couples, mostly young, urban and working ones, have even adopted a one child norm.
• The marriageable age was raised by law to 18 years for females and 21 years for males.
• Incentives are given to couples with small families.

3. Contraceptive Methods

3.1 The ideal contraceptive

An ideal contraceptive should be:

• user-friendly;
• easily available;
• effective;
• reversible, with no or least side-effects;
• in no way interfering with the sexual drive, desire and/or the sexual act of the user.

3.2 Types of contraceptive methods

3.3 Natural methods

• Natural methods work on the principle of avoiding chances of the ovum and sperms meeting.
• ★ Exam imp Periodic abstinence: the couple avoids coitus from day 10 to day 17 of the menstrual cycle, when ovulation is expected.
• Chances of fertilisation are very high in this period, so it is called the fertile period.
• Withdrawal or coitus interruptus: the male partner withdraws the penis from the vagina just before ejaculation, to avoid insemination.
• Lactational amenorrhea (absence of menstruation): ovulation, and so the cycle, does not occur during intense lactation after parturition (childbirth).
• As long as the mother breast-feeds the child fully, chances of conception are almost nil.
• ★ Exam imp This method is effective only up to a maximum of six months after parturition.
• No medicines or devices are used, so side effects are almost nil. However, chances of failure are high.

3.4 Barrier methods

• In barrier methods, a barrier stops the ovum and sperms from physically meeting. Such methods exist for both males and females.
• Condoms (Figure 1): barriers made of thin rubber or latex sheath.
• They cover the penis in the male, or the vagina and cervix in the female, just before coitus.
• The ejaculated semen then cannot enter the female reproductive tract, so conception is prevented.

• Nirodh is a popular brand of condom for the male.
• ★ Exam imp Condom use has increased in recent years, because condoms also protect the user from STIs and AIDS.
• Male and female condoms are disposable and can be self-inserted, which gives the user privacy.
• Diaphragms, cervical caps and vaults: barriers made of rubber, inserted into the female reproductive tract to cover the cervix during coitus.
• They prevent conception by blocking the entry of sperms through the cervix. They are reusable.
• Spermicidal creams, jellies and foams are usually used along with these barriers to increase their contraceptive efficiency.

3.5 Intra uterine devices (IUDs)

• Intra uterine devices (IUDs) are inserted by doctors or expert nurses into the uterus through the vagina.
• They are an effective and popular method of contraception. Figure 2 shows a copper releasing IUD, the Copper T; Figure 3 shows three IUDs in place inside the uterus.

How IUDs prevent pregnancy:

• ★ Exam imp All IUDs increase phagocytosis of sperms within the uterus.
• The Cu ions released by copper IUDs suppress sperm motility and the fertilising capacity of sperms.
• Hormone releasing IUDs, in addition, make the uterus unsuitable for implantation and the cervix hostile to the sperms.
• IUDs are ideal for females who want to delay pregnancy and/or space children.
• They are one of the most widely accepted methods of contraception in India.

3.6 Oral contraceptive pills

• Small doses of either progestogens or progestogen-estrogen combinations are taken by mouth by females.
• They are used as tablets, so they are popularly called pills.

How the pills are taken:

1. Start preferably within the first five days of the menstrual cycle.
2. Take one pill daily for 21 days.
3. Stop for a gap of 7 days; menstruation occurs during this gap.
4. Repeat in the same pattern for as long as the female wants to prevent conception.

• ★ Exam imp Pills inhibit ovulation and implantation, and alter the quality of cervical mucus to prevent or retard the entry of sperms.
• Pills are very effective, have fewer side effects, and are well accepted by females.
• ★ Exam imp Saheli, the new oral contraceptive for females, contains a non-steroidal preparation.
• Saheli is a once a week pill with very few side effects and high contraceptive value.

3.7 Injectables, implants and emergency contraception

• Progestogens alone, or in combination with estrogen, can also be given as injections or as implants under the skin (Figure 4).
• Their mode of action is similar to that of pills, but their effective periods are much longer.

• ★ Exam imp Emergency contraceptives: progestogens, progestogen-estrogen combinations or IUDs given within 72 hours of coitus.
• They are very effective in avoiding a possible pregnancy after rape or casual unprotected intercourse.

3.8 Surgical methods (sterilisation)

• Sterilisation: surgical methods advised for the male or female partner as a terminal method to prevent any more pregnancies.
• Surgery blocks gamete transport and so prevents conception.

• ★ Exam imp These techniques are highly effective, but their reversibility is very poor.

3.9 Using contraceptives wisely

• Choose and use a contraceptive only in consultation with qualified medical professionals.
• ★ Exam imp Contraceptives are not regular requirements for the maintenance of reproductive health.
• In fact, they are practised against a natural reproductive event, that is, conception or pregnancy.
• People use them to prevent, delay or space pregnancy for personal reasons.
• Their widespread use plays a significant role in checking uncontrolled population growth.
• Possible ill-effects: nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding or even breast cancer.
• These ill-effects are not very significant, but they should not be totally ignored.

4. Medical Termination of Pregnancy (MTP)

4.1 Meaning and scale

• Medical termination of pregnancy (MTP) or induced abortion: intentional or voluntary termination of pregnancy before full term.
• ★ Exam imp Nearly 45 to 50 million MTPs are performed in a year all over the world. This is about 1/5th of all pregnancies conceived in a year.
• Many countries debate whether to accept or legalise MTP, because of the emotional, ethical, religious and social issues involved.
• The Government of India legalised MTP in 1971, with some strict conditions to avoid its misuse.
• These restrictions help check indiscriminate and illegal female foeticides, which are reported to be high in India.

4.2 Why MTP is done

• To get rid of unwanted pregnancies caused by casual unprotected intercourse, failure of the contraceptive used during coitus, or rapes.
• MTP is also essential when continuing the pregnancy could be harmful or even fatal to the mother, the foetus, or both.

4.3 Safety and misuse

• ★ Exam imp MTPs are considered relatively safe during the first trimester, that is, up to 12 weeks of pregnancy.
• Second trimester abortions are much riskier.
• A disturbing trend: a majority of MTPs are performed illegally by unqualified quacks. These are unsafe and could even be fatal.
• Another dangerous trend: misuse of amniocentesis to find the sex of the unborn child. If the foetus is female, MTP frequently follows, which is totally illegal.
• Such practices are dangerous for both the young mother and the foetus, and should be avoided.
• Remedy: effective counselling on avoiding unprotected coitus and on the risks of illegal abortion, and more health care facilities.

4.4 The MTP Act

• The Medical Termination of Pregnancy (Amendment) Act, 2017 was enacted by the Government of India.
• Its aim: to reduce the incidence of illegal abortion and the resulting maternal mortality and morbidity.

Grounds on which a pregnancy may be terminated under the Act: