LECTURE NOTEBOOK

ON

POPULATION DYNAMIC AND FAMILY PLANNING

COMMUNITY HEALTH EXTENSION WORKER’ STUDENTS

Compiled by
MUHAMMAD YAKUBU MUNKAILA
CHE (2014), DHE (2015) AND B.SC (Ed) HED (2019), M.Sc (Ed) HED (2023).

2023/2024

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POPULATION DYNAMICS
A population describes a group of individuals of the same species occupying a specific area at a
specific time. Some characteristics of populations that are of interest to biologists include the
population density, the birthrate, and the death rate. If there is immigration into the population,
or emigration out of it, then the immigration rate and emigration rate are also of interest.
Together, these population parameters, or characteristics, describe how the population density
changes over time. The ways in which population densities fluctuate increasing - decreasing, or
both over time is the subject of population dynamics.
Population dynamics is the study of how and why populations change in size and structure over
time. Important factors in population dynamics include rates of reproduction, death and
migration
 The birthrate of a population describes the number of new individuals produced in that
population per unit time.
 The death rate, also called mortality rate, describes the number of individuals who die in
a population per unit time.
 The immigration rate is the number of individuals who move into a population from a
different area per unit time.
 The emigration rates describe the numbers of individuals who migrate out of the
population per unit time.
The global population has increased by two billion over the last 25 years, surpassing the 7 billion
mark in late 2011. It is likely to increase by at least another two billion by 2050.
Beyond the sheer numbers, the world is faced with unprecedented diversity in demographic
situations across countries and regions, as well as within countries. Such diversity is mostly
found in evolving demographic structures and the changing proportions of youth and elderly
groups, and in different rates of fertility, morbidity and mortality, population growth,
urbanization, and internal and international migration.
Good sexual and reproductive health is a state of complete physical, mental and social well-
being in all matters relating to the reproductive system. It implies that people are able to have a
satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and
how often to do so.
REPRODUCTIVE HEALTH
Reproductive health refers to the condition of male and female reproductive systems during all
life stages. These systems are made of organs and hormone-producing glands, including the
pituitary gland in the brain. Ovaries in females and testicles in males are reproductive organs, or
gonads, that maintain health of their respective systems. They also function as glands because
they produce and release hormones.
Reproductive health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity, in all matters relating to the reproductive system and to its
functions and processes (WHO). Reproductive health implies that people are able to have a

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satisfying and safe sex life and that they have the capability to reproduce and the freedom to
decide if, when and how often to do so
THE RIGHT TO REPRODUCTIVE HEALTH
Reproductive rights have been described as gender-specific human rights that are already
recognized in national laws and international human rights instruments. These rights rest on the
recognition of all individuals to decide freely and responsibly the number, spacing and timing of
their children and to have the information and means to do so, and the right to attain the highest
standard of sexual and reproductive health. They also include the rights to make decisions
concerning reproduction free of discrimination, coercion and violence.
Reproductive rights, also referred to as sexual rights, include the right to be free from sexual
violence and coercion and the right to the highest standard of sexual health. Sexual health
implies a positive approach to human sexuality and includes the freedom from sexual abuse,
coercion or harassment, protection from sexually transmitted diseases, and success in achieving
or in preventing pregnancy. Defining and exploring reproductive and sexual rights clarifies their
location within the framework of empowerment and facilitates the need for a change in gender
power relations.
These rights include:
(1) Access to population and family planning services;
(2) Safe legal abortions;
(3) Prevention and control of HIV/AIDS and other sexually transmitted infections;
(4) Legal protection from harmful traditional practices affecting reproductive health including
female genital mutilation; and
(5) Criminalization of domestic violence against women including sexual violence in the private
sphere.
In addition to the afore-mentioned inter-national instruments, Nigeria also ratified the
International Covenant on Civil and Political Rights and the International Covenant on
Economic, Social and Cultural Rights. The constitution of the Federal Republic of Nigeria
upholds basic civil, political, social and economic rights and protects women against any
discrimination based on gender. The State is therefore obliged to domesticate and implement the
provisions of these legal instruments and conventions that protect health, equity and equality.
Contraception and family planning services
In Nigeria, the National Policy on Population for Development, Unity, Progress and Self-
Reliance, adopted in 1988, seeks to make family planning services easily accessible to all
couples and individuals at an affordable cost.15 This policy provides that government family
planning clinics distribute contraceptives at low cost. However, there is often a shortage of
contraceptives at these health centres. In addition, because clinics and hospitals within the public
primary health care system are mostly located in urban areas, the availability of modern
contraceptives in rural areas is extremely limited.

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Safe abortion
The obligation to respect rights requires State parties to refrain from obstructing action by
women in pursuit of their health goals. Barriers to women's access to appropriate health care
include laws that criminalize procedures only needed by women and that punish women who
undergo those procedures. At the core of reproductive rights is the principle that a woman has
the right to decide whether and when to have a child. When faced with an unwanted pregnancy,
she has the right to choose whether to carry the pregnancy to term or not. Governments are
bound to respect this basic human right by ensuring that women can access the full range of
quality reproductive health services including safe abortion. In addition, laws and policies that
regulate abortion should guarantee safe, accessible and affordable abortion services. International
legal support for a woman's right to safe and legal abortion can be found in numerous
international treaties and other instruments.
In Nigeria, the criminal and penal laws prohibit abortion except when done to save the life of the
expectant mother. As a result of the country's restrictive laws, women undergo unsafe abortions
at the hands of quacks and unqualified medical personnel and face threats to their physical, social
and mental health. Between 10 and 50% of women who undergo unsafe abortions in Nigeria
require post-abortion medical attention due to complications arising from the procedure. The
most common complications due to unsafe abortion are incomplete abortion, infection,
hemorrhage and injury to internal organs. Where these complications do not result in death, they
may result in life-long health injuries or infertility. For a woman who is not ready to be a mother,
having a baby can also cause a severe strain on her mental and emotional health. Removing legal
and other barriers to abortion services is necessary to protect women's health and requires action
on the part of government, NGOs and international donors.
Prevention and control of HIV/AIDS and other sexually transmitted diseases
The issues of HIV/AIDS and other sexually transmitted diseases are central to the rights of
women and adolescent girls to sexual health. In Africa, where HIV is transmitted primarily
through heterosexual contact, women are being infected at higher rates than men. Recent studies
indicate that the rate of HIV/AIDS is increasing faster among young women than among men in
lower income countries including Nigeria. The impact on women of HIV/AIDS is thus one of the
most pressing reproductive health concerns of the time. Because women's subordinate role in
developing countries heightens their risk of HIV infection, governments must approach this
epidemic with a gender perspective. HIV prevention strategies that are not gender-sensitive
violate women's human right to non-discrimination in enjoyment of their rights to health and life.
While discrimination against people with HIV/AIDS affects both sexes, women with HIV/AIDS
also contend with pervasive gender discrimination, making them doubly marginalized.
Elimination of harmful traditional practices including female genital mutilation
In Nigeria, harmful customs and traditions severely jeopardize the health, wellbeing, and dignity
of women and young girls. Practices that are consistently recognized as harmful traditional
practices include female genital cutting (FGC)/female genital mutilation (FGM), very early
marriage, nutritional taboos and traditional practices associated with childbirth. In many parts of
the country, FGC/FGM is performed on girls between the ages of four and twelve, although it is
practiced in some cultures as early as a few days after birth or as late as just prior to marriage or

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after the first pregnancy. It is estimated that 130 million girls and women worldwide have
suffered FGC/FGM, and at least two million girls each year are at risk of undergoing some form
of the procedure. The practice carries a strong message about the subordinate role of women and
girls in society and is an attempt to repress the independent sexuality of women by altering their
anatomy. When performed on minors and non-consenting women, FGC/FGM violates a
recognized human right protected in international and regional instruments and re-affirmed in
international conference documents.
Legal protection from domestic violence including sexual violence in the private sphere
The term violence against women means any act of gender-based violence that results in or is
likely to result in physical sexual or psychological harm or suffering to women, including threats
of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private
life. Violence against women is one of the most physical consequences of the economic, social,
political and cultural inequalities that exist between men and women. It is perpetrated by legal
and cultural systems that have historically discriminated against women. The international
community has recognized that violence against women constitutes a violation of their human
rights and fundamental freedoms. Sexual violence such as rape and forced sex in marriage is a
violation of women's reproductive rights since it impacts their sexual and reproductive health and
autonomy. It violates women's reproductive rights, particularly their rights to bodily integrity,
sexuality and reproductive capacity. Sexual violence severely com-promises a woman's right to
health including her physical, psychological, reproductive and sexual health.
INTRODUCTION
BRIEF HISTORY OF FAMILY PLANNING IN NIGERIA
Family planning has been in existence since the creation of the world. Family planning clinics in
Nigeria started in 1950s as a result of two major problems:
i. Increasing incidence of abandoned children
ii. Increasing rate of crimanal abortions
The modern family planning clinic was established in Nigeria in the year 1958 by the Marriage
Audience Council (MAC) headed by Dr. Adeniyi Jones.
In 1964, funds were made available by the Pathfinder Funds to the National Council of Nigeria
(PFFCN). In 1965, family planning was established at UCH Ibadan. The clinic trained family
planning providers only.
In 1982, family planning was integrated into the midwifery curriculum at UCH Ibadan by Mrs.
R.O Babalola the then Principal School of Midwifery at Ibadan.
Some International Organizations like pathfinder, John Hopkins, UNFPA and USAID made
tremendous efforts to improve family planning in Nigeria. On February, 4 th 1988, the National
Policy on Population was drafted and approved by the Federal Government of Nigeria.
In 1991, the Federal Ministry of Health in collaboration with the Pathfinder International/USAID
organized family planning curriculum development workshop to upgrade the capacity of

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CHO/CHEW to enable them upgrade family planning services-management and information at
the community level (grassroot). Since then, these cadres of health practitioners have been
providing various degrees of family planning services in the communities.
Family planning now has gained community support, nearly every one knows about family
planning methods. Most people use family planning at one time, more than half of the world
married couples and even unmarried women are family planning users.
IMPORTANT HEALTH BENEFITS OF FAMILY PLANNING
Important health benefits of some family planning methods have been discovered such as:
a) Preventing of unintended pregnancies
b) Combined oral contraceptives help stop anaemia, reduce inflammatory diseases
c) Condom helps to prevent STDs and other sexual infections.
Finally, different types of people now provide family planning supplies, services and
informations. Healh professionals and not even Doctors provide most methods in clinics and
communities, sell family planning supplies and community members distribute family planning
supplies and help their even neighbours.
DEFINITION OF FAMILY PLANNING
Family planning means birth control or contraception as a deliberate prevention of pregnancy,
using any of the several approved methods. The principle is to prevent the sex cells of the female
and male partners from meeting and fertilizing.
Family planning allows individuals and couples to anticipate and attain their desired numbers of
children and spacing and timing of their birth (WHO).
Family planning can be defined as a means by which fertile couples have the method available to
control, space and limit the size of their families according to their own desire, so that any child
born to this couple is born of choice and not by chance.
Child spacing means allowing sufficient intervals or gap between births of children. This interval
has been found to be at least two (2) years or better 3 years.
METHODS OF FAMILY PLANNING
1. Traditional Method
 Abstinence-separation of wife from the husband
 Coitus Interruptus-withdrawal method
 Charms such as rings, waist beads (guru)
 Prayers
 Native medicine
 Vaginal douche-washing away the sperms immediately after sexual intercourse.
2. Modern Methods
 Condom
 Intra-uterine contraceptive device (IUCD)
 Injectables

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  Oral pills
 Diaphragm
 Foams and gellies
 Safe period-calendar method
 Implant method
 Tubal ligation
 Vasectomy
3. Natural Methods
 Lactational amenorrhoea-prolong breast feeding
 Body Basal Temperature
CONDOM
This is a very thin cover made up of rubber (sheath). It is placed on the man’s erect penis to
catch sperm and prevent it from entering into the women’s uterus.
Female condom put inside the vagina. Condom are not dangerous to use. They are safe when
used correctly. Check the expiry date before use. If expired, a condom have an increased risk of
breaking.
ADVANTAGES
 It is simple to use but effective method
 It prevents infection of veneral disease such as gonorrhoea, syphilis, HIV/AIDS.
 It prevents pregnancy when used correctly
 It can be stopped at anytime
 Easy to keep on hand in case sex occurs unexpectedly
 It can be used without consulting a health care provider.
DISADVANTAGES
 Accidental pregnancy may occur if the condom burst
 In interferes with sexual act thereby reducing feeling (sensation) for the partners.
 Latex condom may cause itching for a few people who are allergic.
 Couple must take the time to put on the erect penis before sexual intercourse.
 A man’s co-operation is needed for a woman to protect herself from pregnancy or disease
 Many people connect condom with immoral sex
 May embarrass some people to buy from shop
ORAL PILLS
These are pills in form of tablets taken on daily basis for a complete one month depending on
number of days decided by a woman. It contains hormone called progesttin only which is the
best oral contraceptive for breast feeding woman. Woman who are not breastfeeding also can use
progestin oral contraceptive. The pills must be taken everyday, whether or not a woman had sex.

FUNCTIONS

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  It thickens cervical mucus making it difficult for sperm to pass through.
 It also stops ovulation (releasse of eggs from ovaries)
ADVANTAGES
 Can be used by nursing mothers starting 6 weeks after child birth
 If taken correctly as prescribed, it is highly effective
 It prevents some diseases such as pelvic inflammatory diseases, ovarian cancer, benign
breast disease
 The oral pills may prevent menstrual irregularity/ reduce menstrual pains
 It is simple to use and no special preparation are necessary before intercourse.
DISADVANTAGES
 Spotting or bleeding between periods
 Amenorrhoea (absence of menstraution)
 Less common side effects includes headache, breast tenderness
 It should be taken on daily basis and if there is missing 2 or more pills increases the risk
of pregnancy greatly.
SIDE EFFECTS
 Weight gain or weight loss
 High blood pressure
 Nausea/vomitting
 Breast tenderness/swelling
 Headache
 Change in monthly menstrual patterns.
Additonal Information: if you missed just 1 pill, take it as soon as you remember.
Continue taking 1 pill each day at your normal time. This might mean taking 2 pills on
the same day (1 when you remember and the other at the regular time). However, if you
remember at your normal time, you need to take 2 pills at once.
Interine Uterine Contraceptive Device (I.U.C.D)
This work chiefly by preventing sperm and eggs from meeting. Perhaps the I.U.C.D makes it
hard for sperm to move through the woman’s reproductive tract and it reduces the ability of
sperm to fertilize an egg, possibly could prevent egg implanting in the uterus.
ADVANTAGES
 Effective in preventing pregnancy
 It usually remais in place
 It can be used for many years, hence it is not expensive
 A woman using this method does not have o take daily medication
 It increases sexual enjoyment because no need to worry about pregnancy
 Can be inserted immediately after induced abortion (if no evidence of infection)
DISADVANTAGES

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  Menstrual changes (common in the first 3 months but likely to lessen after)
 Longer and heavier mentrual period
 Muscle cramps or pain during period
 Does not protect against STDs
 Not a good method for women with recent STDs or with multiple sex partners
 Pain and bleeding may occur immediately after insertion
 Client cannot stop IUCD use on her own. A trained health worker must remove the IUCD
for her
 May come out of the uterus if not properly fixed
 The woman should check the position of the IUCD string from time to time. To do this,
she must put her fingers into her vagina
SIDE EFFECTS OF USING IUCD
 Pains particularly backache and abdominal pains
 Vaginal discharge
 Weight loss
 Immigration of the tube/perforation
 Urinary tract infection
INJECTABLES CONTRACEPTIVE
It is given every 3 months. It contains hormone called progestin. The hoemone is released slowly
into the blood stream. There is another injectable contraceptive also called NORISTERA which
is given every 2 months. The 3 months injectable contraceptive is called DEPO PROVERA.
ADVANTAGES
 Very effective
 Private, no one else can tell that a woman is using it
 Long term pregnancy method but reversible
 Does not interfere with sexual act
 No daily medication
 May help to prevent iron-deficiency anaemia
 Prevent ovarian cancer, uterine fibroid and ectopic pregnancy
 It can be used by nursing mothers as soon as 6 weeks after child birht
DISADVANTAGES
 Light spotting or bleeding
 Amenorrhoea (especially after 1st year of use)
 May cause weight gain
 It requires another injection every 2 or 3 months
 Does not protect against STDs/HIV/AIDS
 Delayed return of fertility (untill the hormonal levels in the body drop).

ASSINGMENT (20%)

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Write note the following
1. GENERAL BENEFITS OF FAMILY PLANNING
2. BENEFITS OF FAMILY PLANNING TO THE MOTHER/PARENTS
3. BENEFITS OF FAMILY PLANNING TO THE WHOLE FAMILY
4. BENEFITS OF FAMILY PLANNING TO THE COMMUNIY/NATION

BENEFICIERIES OF FAMILY PLANNING

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 1. Mothers of child bearing age
2. Men
3. Infertile couples
FAMILIES IN NEED OF FAMILY PLANNING
The following levels of families needs to be sensitised on the need of family planning if it
becomes necessary due to one reason or the other. They are:
1. Birth interval less than 2 years
2. Women under 18 years for fear of unexpected pregnancy
3. Mother above 35 years of age
4. Mother or father having genetic disease e.g sickle cell disease
5. Mothers having history of difficult pregnancy or delivery e.g ectopic pregnancy, constant
caesarean section
6. Mothers having chronic or severe illness e.g diabetes and hypertension
COUNSELLING
This can be defined as a method to suggest advice or convince a client to choose a satisfied
method of family planning.
PROCEDURE OF CLIENT’S COUNSELLING
1. Welcome the client and provide seat
2. Self introduction
3. Enquire client’s mission
4. Explain all the methods available
5. Physical examination
6. Help client make choice
7. Explain possible associated side effects, complications and to report back if any problem
occur
8. Review after a certain period e.g 2 weeks, 4 weeks e.t.c
9. Thank the client
GATHER
G- Greet client
A- Ask client about herself
T- Tell the client about choice
H- Help client make an informed choice
E- Explain fully how to use the chosen method
R- Return visits should be welcome
PRINCIPLES OF COUNSELLING

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 1. Treat client well- Be polite, respectful and creat a feeling of trust. Allow your client to
speak openly. Assure her of confidentiality
2. Good interaction- Listen to the client and also encourage question from her. Allow her to
talk her mind.
3. Tailor information to the client-e.g newly married woman may want to know more about
temporary methods of birth spacing. Also, old women may like to know more about
female sterilization and vasectomy. A young unmarried woman may need to know more
about avoiding STDs. The provider shpould explain properly to all these group of people
accordingly.
4. Avoid too much information- Avoid information overload, because a client may need to
know every method of family planning you have to summarize to avoid time wastage.
5. Provide the method that the client wants and its suitable- A health provider helps the
client make their own informed choices. So address the risks, advantages and
disadvantages, side effects of family planning method chosen.
6. Help the client understand and remember- Show samples of family planning materials
and encourage client to handle them and show how they are used. Explain posters,
pamphlets and give to the client to even give others.
STEPS IN THE MANAGEMENT OF FAMILY PLANNING CLINIC
1. History taking/interviewing
2. Physical examination
3. Laboratory tsets such as
 Pregnancy test
 Urine test
 HB estimation
 VDRL (Veneral Disease Research Laboratory)
 Semen analysis
PROBLEMS THAT FAMILY PLANNING ENCOUNTER IN THE SOCIETY
(DISCOURAGEMENT FACTORS)
The major problems that family planning encounters are grouped socio-cultural problems. They
are:
1. Ignorance due to poor level of education
2. Misconception as a result of non beneficial stories and beliefs
3. Religion- some doctrines preach against family planning
4. Tradition and customs- some beliefs claim that a woman must bear as many children as
are given on her by God
5. Myths and superstition- some believe that any child or children blocked from coming into
the world has a way of dealing negatively spiritually with the couple, especially the
womwn
6. Land inheritance- in families/communities where land is inherited by male children,
couples try to bear many children looking for male who will inherit lands.
7. Wars- warring communities encourages incresase in population so as to have war fighting
human resources and as well as replace war victims.

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 8. Politics- the policy management of allocating higher resources to higher populated areas
encourages population increase or manipulation and discourages family planning.
9. Polygamy- the right of men to marry as many wives as they wish in many communities is
a problem to family planning as none of those wives would wish to be childless.
10. Sex of a child- many couples has many children as a result of the search for certain sex.
COMMON RUMOURS AND MISCONCEPTIONS ABOUT FAMILY PLANNING
Rumours are general talk which may not be true. Rumour and misconceptions about family
planning methods have discouraged people from using the methods.the effect of this is that many
people end up with unplanned pregnancies and suffer the consequences.
SOME OF THE RUMOURS ARE:
1. Pills accumulate in the womb and causes infertility.
2. Pills causes cancer.
3. Women on pills give birth to many babies at the same time.
4. Condom can come off during sex and get lost inside the women’s body.
5. IUCD might travel through a woman’s body to the brain or heart.
6. Injectable contraceptive causes infertility and make a woman behave like a man.
7. IUCD makes women infertile and cause birth defect in children.
Dispelling rumours and correcting misconceptions can be done by explaining the mode of
action of methods of reproductive organs.
INFERTILITY
Introduction
Infertility can be refer to the biological inability of an individual to contribute to conception, or
to a female who cannot carry a pregnancy to full term. In many countries infertility refers to a
couple that has failed to conceive after 12 months of regular sexual intercourse without the use of
contraception.
The World Health Organization ( WHO, 2017) defined infertility as “a disease of the
reproductive system defined by the failure to achieve a pregnancy after 12 months or more of
regular unprotected sexual intercourse (and there is no other reason, such as breastfeeding or
postpartum amenorrhoea).
Infertility may result from an issue with either husband or the wife, or a combination of factors
that interfere with pregnancy. Fortunately, there are many safe and effective therapies that
significantly improve your chances of getting pregnant. (Makar RS, Toth TL, 2002)

Classification/type of infertility
Primary infertility
This is defined as the absence of a live birth for a couple who desires a child and has been in a
union for at least 12 months, during which they have not used any contraceptives. The World
Health Organization also adds that women whose pregnancy spontaneously miscarries or whose
pregnancy results in a still born child without ever having had a live birth would present with
primarily infertility,
Secondary infertility

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This is defined as the absence of a live birth for women who desire a child and have been in a
union for at least 12 months since their last live birth, during which they did not use any
contraceptives.
Thus the distinguishing feature is whether or not the couple has ever had a pregnancy which led
to a live birth.
Symptoms of infertility
The main symptom of infertility is inability to conceive by a woman and man inability to
contribute to conception by a man. There may be no other obvious symptoms sometimes, an
infertile woman may have irregular or absent menstrual P rely, and an infertile man may have
some signs of hormonal problems, such as changes in hair growth or sexual function.
When to see a doctor
Most couples will eventually conceive, with or without treatment. You probably 40m need to see
a doctor about infertility unless you have been trying regularly to concert for at least one year.
Talk with your doctor earlier, if you're a woman and:
• You're age 35 to 40 and have been trying to conceive for six months or longer
• You menstruate irregularly or not at all
• Your periods are very painful
• You have known fertility problems
• You've been diagnosed with endometriosis or pelvic inflammatory disease
• You've undergone treatment for cancer
• You've had multiple miscarriages
Talk with your doctor if you're a man and:
 You have a low sperm count or other problems with sperm
 You have a history of testicular, prostate or sexual problems
 You've undergone treatment for cancer
 You have testicles that are small in size or swelling in the scrotum or swelling in the
scrotum known as a varicocele.
 You have others in your family with infertility problems
Causes of Infertility
1. Advancing maternal age:
Historically before the latter 20th century, women were conceiving in their teens and twenties,
when age-related abnormalities with the egg were not evident. However, in our modern era,
women are delaying child birth until their thirties and forties, which has led to the discovery of
the adverse effect of advanced maternal age on egg function. In fact, female age-related
infertility is the most common cause of infertility today. For unknown reasons, as women age,
egg numbers decrease at a rapid rate. Hence the ability to conceive a normal pregnancy decreases
from when a woman is in her early 30s into her 40s.
2. Ovulation disorders:
Normal and regular ovulation or release of a mature egg, is essential for women to conceive
naturally. Ovulation often can be detected by keeping a menstrual calendar or using an ovulation
predictor kit. There are many disorders that may impact the ability for a woman to ovulate
normally such as polycystic ovary syndrome and ovarian insufficiency.
3. Tubal occlusion (blockage):
A history of sexually transmitted infections including chlamydia, gonorrhea, or pelvic
inflammatory disease can predispose a woman to having blocked fallopian tubes. Tubal

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occlusion is a cause of infertility because an ovulated egg is unable to be fertilized by sperm or to
reach the endometrial cavity.
4. Uterine fibroids:
Fibroids are very common and the mere presence alone does not necessarily cause infertility.
There are three types of fibroids: 1) subserosal, or fibroids that extend more than 50% outside of
the uterus; 2) intramural, where the majority of the fibroid is within the muscle of the uterus
without any indentation of the uterine cavity: and 3) submucosal, or fibroids project into the
uterine cavity. Submucosal fibroids are the type of fibroid that has clearly been demonstrated to
reduce pregnancy rate, roughly by 50%, and removal of which will double chance pregnancy.
(Edmund S. Sabanegh, Jr.. 2010)
5. Male factors affecting sperm function:
Male factor infertility has been a contributing factor causing infertility, this associated with:
 Low sperm count (low concentration) - the man ejaculates a lower number compared to
other men. Sperm concentration should be 20 million sperm per milliliter of semen. If the
count is under 10 million there is a low sperm concentration
 No sperm - when the man ejaculates there is no sperm in the semen.
 Low sperm mobility (motility) - the sperm cannot "swim" as well as it should.
 Abnormal sperm - perhaps the sperm has an unusual shape, making it more difficult to
move and fertilize an egg.
• Endometriosis:
Endometriosis is a condition whereby cells very similar to the ones lining the uterine cavity, or
endometrium, are found outside the uterine cavity. Endometriosis causes infertility by producing
inflammation and scarring, which can result in not only pain but also potentially detrimental
effects on egg, sperm or embryo. Your doctor will determine if you are at risk of having
endometriosis based on a careful history, physical exam, and ultrasound.
• Other causes:
Other likely causes of infertility include: Testicular infection, Testicular cancer. Testicular
surgery. Overheating the testicles, Ejaculation disorders, Undescended testicle, Genetic
abnormality, Radiotherapy. Some diseases such as linked to lower fertility in males: Anemia,
Diabetes, Thyroid disease. Illegal drugs – consumption of marijuana and cocaine can lower a
man's sperm count.
Risk factors of infertility
1. Age - a woman's fertility starts to drop after she is about 32 years old, and continues
doing so. A 50 years-old man is usually less fertile than a man in his 20s. (Male fertility
progressively drops after the age of 40).
2. Smoking - smoking significantly increases the risk of infertility in both men and women.
Smoking may also undermine the effects of fertility treatment. Even when a woman gets
pregnant, if she smokes she has a greater risk of miscarriage.
3. Alcohol consumption - a woman's pregnancy can be seriously affected by any amount of
alcohol consumption. Alcohol abuse may lower male fertility. Moderate alcohol
consumption has not been shown to lower fertility in most men, but is thought to lower
fertility in men who already have a low sperm count.
4. Being obese or overweight - in industrialized countries overweight/obesity and a
sedentary lifestyle are often found to be the principal causes of female infertility. An
overweight man has a higher risk of having abnormal sperm.

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 5. Eating disorders - women who become seriously underweight as a result of an eating
disorder may have fertility problems.
6. Over-exercising - a woman who exercises for more than seven hours each week may
have ovulation problems.
7. Not exercising - leading a sedentary lifestyle is sometimes linked to lower fertility in
both men and women.
8. Sexually transmitted infections (STIS) can damage the fallopian tubes, as well as
making the man's scrotum become inflamed. Some other STIs may also cause infertility.
9. Exposure to some chemicals - some pesticides, herbicides, metals (lead) and solvents
have been linked to fertility problems in both men and women.
10. Mental stress - studies indicate that female ovulation and sperm production may be
affected by mental stress. If at least one partner is stressed it is possible that the frequency
of sexual intercourse is less, resulting in a lower chance of conception.
Effects of infertility
• The effect of infertility is manifold and can include societal impact and personal suffering. The
medicalization of infertility has unwittingly led to a disregard for the emotional responses that
couples experience, which include distress, loss of control, stigmatization, and a disruption in the
developmental trajectory of adulthood.
• Infertility may have profound psychological effects. Partners may become more anxious to
conceive, increasing sexual dysfunction. Marital dispute often develops in infertile couples,
especially when they are under pressure to make medical decisions.
• The emotion losses created by infertility include the denial of motherhood as a rite of passage;
the loss of one's anticipated and imagined life; feeling a loss control over one's life; doubting
one's womanhood; changed and some one's religious environment as a support system
• In many cultures, inability to conceive bears a stigma. In closed social groups, a degree of
rejection (or a sense of being rejected by the coup considerable anxiety and disappointment.
Diagnosing infertility
Most people will visit their GP (general practitioner, primary care physician) if the no pregnancy
after 12 months. For anybody months. For anybody who is concerned about fertility, especially if
they are older (women over 35), it might be a good idea to see an earlier diagnosis involves
physical examinations and tests.
Infertility tests for men may include:
1. General physical exam - the doctor will ask the man about his medical history,
medications, menstruation and sexual habits. She will under a gynecology examination
2. Blood test - several things will be checked, for example, whether hormone levels are
correct and whether the woman is ovulating (progesterone test). .
3. X-ray - fluid is injected into the woman's uterus which shows up in X-ray pictures. X-
rays are taken to determine whether the fluid travels properly out of the uterus and into
the fallopian tubes. If the doctor identifies any problems, such as a blockage, surgery may
need to be performed.
4. Laparoscopy - a thin, flexible tube with a camera at the end (laparoscope) is inserted into
the abdomen and pelvis to look at the fallopian tubes, uterus and ovaries.
5. Ovarian reserve testing - this is done to find out how effective the eggs are after
ovulation.

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 6. Genetic testing - this is to find out whether a genetic abnormality is interfering with the
woman's fertility.
7. Pelvic ultrasound - high frequency sound waves create an image of an organ in the
body, which in this case is the woman's uterus, fallopian tubes, and ovaries.
8. STIs test - if the woman is found to have any STIs which can affect fertility, she will be
prescribed antibiotics to treat it.
Treatment, prevention and control and control measures of infertility
Infertility treatment depend on many factors, including the age of the patient(s), how long they
have been infertile, personal preferences, and their general state of health. These can be fully
assessed by your health care provider. Preventive measures may include:
1. Education: Educating couples about the normal process of fertility, problems that affect
fertility and treatment options will empower our people to make the best choices.
Understanding the normal reproductive process is essential in knowing when to seek for
help. (Schmidt L, Christensen U, 2005).
2. Frequency of intercourse: The couple may be advised to have sexual intercourse more
often. Sex two to three times per week may improve fertility if the frequency was less
than this. Male sperm can survive inside the female for up to 72 hours, while an egg can
be fertilized for up to 24 hours after ovulation.
3. Medications to induce egg development and ovulation: The medications that help
stimulate the ovary to develop mature eggs for ovulation are of different forms. Your
Doctor may prescribe any suitable one.
4. Insemination: Intrauterine insemination, also known as IUI, is a process by w sperm is
washed and prepared for placement into the uterine cavity, therefore bypassing the cervix
and bringing a higher concentration of motile sperm closer to me tubes and ovulated egg.
5. In Vitro Fertilization (IVF): In vitro means "outside the body.” IVF is a process
whereby eggs are collected and then fertilized by sperm outside the body, in an
embryology laboratory.
6. Surgery - After a thorough history, physical examination and ultrasound are performed,
your doctor may recommend surgery to correct the abnormality. (Makar R, Toth T,
2002).
ASSIGNMENT
1. DISCUSS THE PROBLEMS OF POPULATION IN NIGERIA
2. DISCUSS THE NATIONAL POPULATION POLICIES
3. DISCUSS THE FACTORS THAT INFLUENCE REPRODUCTIVE HEALTH RIGHTS

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