Reducing Fertility Rate
A Challenging Task

By Khilendra Basnyat

TODAY, the world population has increased rapidly at a rate that will double human numbers within four decades.

From mid-1965 to 1975 alone, the population increase was equal to the world total of two centuries ago. Since 1900, population has risen from about one and half billion to six billion.

Problems

Advanced countries, including the United States, have population growth rates lower than those of the developing ones. However, many industrialised countries also have problems related to population growth. These problems are severe in the cities, where there is overcrowding and unemployment, inadequate health as well as education services, increasing crime rates and pollution.

No doubt, in the past, in the developing countries of Asia, Africa and Latin America, there has been some gains in total gross national product, industrialisation, agricultural production, educational facilities and health services. These are the gains through which poor nations helped services. These are the gains through which poor nations helped to relieve widespread poverty and accumulate the savings necessary for sustainable development.

However, in many developing countries, population growth has had a negative impact.

As a result of high population growth, not only will the total demand for food be greater than it has ever been, but the nature of that demand will be different. In many countries, changes have taken place in dietary habit, and in the methods of food production, processing and marketing. Apart from this, international trade in raw commodities and processed foods has also increased.

With the increased in population, the challenge is to complete the demographic transition in order to reestablish the balance between births and deaths that characterise a sustainable society.

Actually, the world’s interest in population growth intensified in the mid-1960s when a grave food shortage developed in the South Asian countries.

Since the mid-1960s, new and stronger population policies and programmes leading to high birth rate reduction have been initiated by many national governments and by the United Nations, other international organisations, and many non-governmental organisations and institutions. Consequently, by mid-1975s over two-thirds of the world’s people were living in countries with positive programmes for family planning and control of excess fertility.

Both the developing and developed countries have initiated population/family planning programmes as a means of attacking economic and social problems, stemming from some degree of excessive or poorly distributed populations. These activities are having a measurable effect on the fertility rate throughout the world.

Nepal’s demographic target of reducing the present high fertility rate poses a challenge. In order to reduce the fertility rate, the number of contraceptive users must be increased. Apart from this, the predicted cost for delivery may have to be reevaluated and realistic levels set to be consistent with the resources available.

According to a sample survey, Nepalese women want to space their children or limit the number of birth. The reasons for the non-use of family planning methods are because of the lack of information, education and communication.

Due to the mountainous terrain, it is difficult to deliver the family planning services and information to potential acceptors. What is more, there is a shortage of trained medical personnel to implement family planning activities in different parts of the country.

Despite the inception of the family planning programme in our country in 1968, the achievements of the programme in terms of acceptors have not been encouraging. Although the number of new acceptors has increased, acceptances are heavily weighted towards less effective birth control method, such as the condom.

Although Nepal has developed a policy to moderate the population growth rate, it encounters difficulties in expanding family planning activities to reduce the fertility rate.

Attitudinal changes regarding health and family size seem to be determined by the level of education and the spread of women’s education.

Change

Studies from different countries show that the number of children born to a woman declines as her educational level rises. It is because women’s education initiates changes in one’s attitude toward family size and children health within the family and in the society.

The relatively less significant women’s role in various decision-making processes and their relatively small participation of family planning activities have hindered family planning programmes. In fact, the importance of the women’s status for fertility reduction needs to be recognised in our development programmes.

Electromagnetic Fields & Public Health

IN 1996, the World Health Organisation (WHO) established the International Electromagnetic Fields (EMF) Project to address the health issues associated with exposure to EMF. The EMF Project is currently reviewing research results and conducting risk assessments of exposure to static and extremely low frequency (ELF) electric and magnetic fields. WHO plans to conduct an evaluation of all health effects from ELF field exposure in 2002-3.

Findings

Whenever electricity is conducted through transmission and distribution lines or is used in appliances, both electric and magnetic fields exist close to the lines or appliances. The power frequency used is 50 or 60 Hz. Use of electric power has become part of everyday life. However, questions have been raised as to whether these and other ELF fields are carcinogenic.

The International Agency for Research on Cancer (IARC) – a specialised cancer research agency of WHO – has recently concluded the first step in WHO’s health risk assessment process by classifying ELF fields with respect to the strength-of-the-evidence that they could caused cancer in humans.

This Fact Sheet updates findings of recent reviews on the health effects of static and ELF electric and magnetic fields conducted by IARC (June 2001), by the Health Council of the Netherlands (May 2001), and by an expert Advisory Group of the National Radiological Protection Board in the United Kingdom (AGNIR) (March 2001). This document supplements WHO Fact Sheet 205.

In June 2001, an expert scientific working group of IARC reviewed studies related to the carcinogenicity of static and ELF electric and magnetic fields. Using the standard IARC classification that weigh human, animal and laboratory evidence, ELF magnetic fields were classified as possibly carcinogenic to humans based on epidemiological studies of childhood leukaemia. Evidence for all other cancers in children and adults, as well as other types of exposures (i.e. static fields and ELF electric fields) was considered not classifiable either due to insufficient or inconsistent scientific information.

"Possibly carcinogenic to humans" is a classification used to denote an agent for which there is limited evidence of carcinogenicity in humans and less than sufficient evidence for carcinogenicity in experimental animals.

This classification is the weakest of three categories ("is carcinogenic to humans", "probably carcinogenic to humans" and "possibly carcinogenic to humans") used by IARC to classify potential carcinogens based on published scientific evidence.

ELF fields are known to interact with tissues by inducing electric fields and currents in them. This is the only established mechanism of action these fields. However, the electric currents induced by ELF fields commonly found in our environment are normally much lower than the strongest electric currents naturally occurring in the body such as those that control the beating of the heart.

Since 1979 when epidemiological studies first raised a concern about exposures to power line frequency magnetic fields and childhood cancer, a large number of studies have been conducted to determine if measured ELF exposure can influence cancer development, especially leukaemia in children.

There is no consistent evidence that exposure to ELF fields experienced in our living environment causes direct damage to biological molecules, including DNA. Since it seems unlikely that ELF fields could initiate cancer, a large number of investigations have been conducted to determine if ELF exposure can influence cancer promotion or co-promotion. Results from animal studies conducted so far suggest that ELF fields do not initiate or promote cancer.

However, two recent pooled analyses of epidemiological studies provide insight inot the epidemiological evidence that played a pivotal role in the IARC evaluation. These studies suggest that, in a population exposed to average magnetic fields in excess of 0.3 to 0.4ìT, twice as many children might develop leukaemia compared to a population with lower exposures. In spite of the large number data base, some uncertainty remains as to whether magnetic field exposure or some other factor(s) might have accounted for the increased leukaemia incidence.

Childhood leukaemia is a rare disease with 4 out of 100,000 children between the age of 0 to 14 diagnosed every year. Also average magnetic field exposures above 0.3 to 0.4ìT in residences are rare. It can be estimated from the epidemiological study results that less than 1% of populations using 240 volt power supplies are exposed to these levels, although this may be higher in countries using 120 volt supplies.

Regulatory policies for agents classified as possible carcinogens vary by country and by particular agent. The carcinogenic evaluation and classification of an agent by IARC does not automatically trigger a national regulatory response. While gasoline exhaust and coffee have been classified as possible human carcinogens, there has been a significant response by government to reduce gasoline engine exhausts, but there has not been any effort to limit intake of coffee.

In response to increasing public concern over health effects from EMF exposure, several countries have established their own scientific reviews prior to the IARC evaluation. Already in 1998, a working group examining the issue for the US National Institute of Environmental Health Sciences (NIEHS) classified ELF magnetic fields as possibly carcinogenic to humans. The US government agency has since recommended "Passive regulatory action," described as continued information and education of the public and encouraging power utilities to voluntarily reduce exposure to people where possible.

In the United Kingdom, an Advisory Group on Non-lonising Radiation recently reported to the National Radiological Protection Board (NRPB) on the topic of power frequency EMF and the risk of cancer (AGNIR, 2001). It concluded that while the evidence is currently not strong enough to justify a firm conclusion that EMF fields caused leukaemia in children, the possibility remains that intense and prolonged exposures to magnetic fields can increase the risk of leukaemia in children. Further, they provided research recommendations. The Health Council of the Netherlands, a major scientific advisory body of the Netherlands government, reached similar conclusions.

While the classification of ELF magnetic fields as possibly carcinogenic to humans has been made, it remains possible that there are other explanations for the observed association between exposure to ELF magnetic fields and childhood leukaemia. In particular, issues of selection bias in the epidemiological studies and exposure to other field types deserve to be regorously examined and will likely require new studies. WHO therefore recommends a follow-up, focused research programme to provide more definitive information. Some of these studies are currently being undertaken and results are expected over the next 2-3 years.

WHO’s EMF Project aims to help national authorities balance the benefits of electrical technology against possible health risks, and to help them decide what protective measures may be needed. It is especially difficult to suggest protective measures for ELF fields because we do not know what field characteristic might be involved in the development of childhood leukaemia and therefore need to be reduced, or even if it is the ELF magnetic fields that are responsible for this effect. One approach is to have voluntary policies that aim to cost-effectively reduce exposure to ELF fields. This has been discussed in the WHO Backgrounder issued March 2000.

Measures

Some precautionary measure are outlined below:

Government and industry should be congnisant of the latest scientific developments and should provide the public with balanced, clear and comprehensive information on potential EMF risks, as well as suggestions for safe and low cost ways to reduce exposures. They should also promote research that will lead to better information from which assessments of health risk can be made.

Members of the general public might choose to reduce their EMF exposure by minimizing the use of certain electrical appliances or by increasing distance to the sources that can produce relatively high fields.

Obviously power lines must be sited to provide power to consumers. Siting decisions are often required to take into account aesthetics and public sensibilities. However, siting decisions should also consider ways to reduce peoples’ exposure.

An effective system of health information and communication among scientists, governments, industry and the public is needed to help raise general awareness of programmes to deal with exposure to ELF fields and reduce any mistrust and fears.

The Teacher Who Worked Against Time

By Anantayatree S. Khanal

POORNA Bahadur was a teacher in J.P. High School more than six decades ago. Actually, he was a primary school teacher. As there was acute shortage of teachers at that time, he was appointed in a high school although he had not matriculated. He taught English in elementary classes, i.e. one to three grades. While teaching pronunciation of simple words like Cat, Bad and so on, he himself pronounced the word in a very loud voice. The students had to exactly follow him. He keenly watched the lip movement of all the students and also listened to their pronunciation. Whenever he found defect in some student’s accent, he rose from his table, reached the student and caned him mercilessly. Every student was scared to death when Poorna Bahadur looked at him gravely. Sometimes he asked the spelling of a word he had taught the class before. He called the students one by one before him and asked to spell a particular word. As soon as a student made a mistake in spelling, the teacher thrashed him with the cane which he never forgot to bring before entering a class. Sometimes a student took time in remembering the spelling. But the teacher took no time and hit the student before he could answer.

I was also a student of class three in J.P. High School. But I was never caned by the teacher who worked against time. I promptly answered his questions correctly. He was very pleased with me. So he always treated me with consideration. Once he caught me smoking in a shop by the school building. Before I could crush the cigarette or run away, he stood before me with legs apart and asked which brand of cigarette was I smoking. He was also smoking at that time. I showed him my burning cigarette which was of a cheap brand Extra. He loudly laughed and advised me not to smoke Extra but rather smoke Eagle which he always smoked. I gloomily told him that I could not afford the costly cigarette, Eagle. The teacher expressed surprise that the son of a renowned merchant could not afford to smoke cigarette that cost five paisa per stick. I told him I got only four paisa for tiffin and I smoked two cheap cigarettes from that meagre amount. My teacher offered his burning cigarette to me saying it was less harmful to health, and he left. I threw my cigarette away and smoked Eagle for the first time. I felt it better than my brand Extra.

On fine morning, my mother told me that a teacher of my school, Poorna Bahadur was going to tutor me at home. He had accepted the tuition at a nominal fee of rupees thirty per month. I was rather elated by the name of my tutor who had once encouraged me to smoke higher quality cigarettes. The same evening the tutor came and he taught me the pronounciation of a few two syllable words. He gave me the task of copying a text and said it was for improving my handwriting. Next evening, he came on time. My mother had placed a cane on the table as he had asked. And it frightened me as I had not been able to finish my homework. That morning, mother had sent me on an errand and the homework was left unfinished. I showed the incomplete work before he asked for it and tried to explain why I had been unable to complete it. But before I could utter a single word, the tutor picked up the rod in a split second and hit me black and blue. My mother tried to save me by explaining the cause of my failure but in vain. He beat me until the rod broke. Poorna Bahadur got up, looked severely at me hard and, in a husky whisper, told me to complete it for the next evening. Then my mother wiped up her tears, made her body rigid and announced that he was not wanted for tuition any more. The stern man just nodded and departed without a word. I wonder how many innocent students like me must have suffered from the hammerings of Poorna Bahadur, a very good teacher.