ICMR BULLETIN VOL. 29-No.-2-FEBRUARY-1999.pdf

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February, 1999

0 Vol. 29, No. 2

INDIA’S NEEDS AND PRIORITIES IN FERTILITY REGULATION RESEARCH
India is the seventh largest country in the world
and the second most populous, after China. Its vast
area of over 3.29 million sq km is home to approxi­
mately 975 million people. More than 70% of the
population live in rural areas and about one-third live
on or below the United Nations poverty line. Accord­
ing to the 1991 census. 52% of the adult population
was literate1.

The people living in the 26 States and 6 Union
Territories of India have distinct racial, cultural, reli­
gious and linguistic identities. The perceptions of people
A about fertility regulation also vary considerably. The
socio-economic status, the level of education and the
religious beliefs have strong bearing on their decision
on the family size, spacing between children and also
the sex of the chi ldren. Moreover, a large number of
people are either quite ignorant of or cannot afford
the available technologies and services for controlling
their fertility. These factors generally perpetuate high
fertility, which has a bearing on the infant and maternal
mortality and eventually the quality of life both
for the present and the future generations.
In view of the large diversity in the perceptions
and needs of people in India, no single fertility regu­
lation research strategy will probably be effective across
the country. Why some couples in their reproductive

age do not use the available technologies for birth
control, or why are such technologies and services not
available to some of the potential users, need to be
investigated. High priority also needs to be given to
develop more effective and safer fertility regulating
technologies so that the couples could be provided with
wider contraceptive choices, and on improving the
services for ensuring their optimum utilization. Bio­
medical and operational research in the area of fertil­
ity regulation should be linked to users' needs and their
perceptions, and the ability of the delivery system to
meet those needs. It is also important to develop a
comprehensive multidisciplinary approach integrating
various components of reproductive health.

Reproductive Health Status
The population of India was 318 million in the
1940s1 and has since increased to 975 million. During
1941-51, on an average 10 million people were added
to the Indian population over 860 days, during the 1990s
this duration has decreased to 197 days (Table), and
with the present rate the population of India will double
in 36 years. This visible large built-in momentum for
continued growth of population is because 45% of
women in India today are in the reproductive age group
of 15-44 yr2. In 1996.- the population of adolescents
and youth, in the age group of 15-24 yr, was almost

Division of Publication & Information, ICMR, New Delhi - 110029

18,5% (180 million) of the total rxp
o.5 r-•..
Nearly 44% of women get married between die age
group of 15-19 yr, and almost 17% of women aged
13-19 yr start bearing children. Less than f9% x rrarriec
couples in the age group of 15-' 9 ;* r use coriracer:::r.
in any form. These alarming statistics stem rx: cr.?from an early start of reproduction, but also from the
large unmet need for contraception.
Table. Average time taken for the Indian population to grow
!>v 10 million.

Period (Year)

Days

1941-51

860

1951-61

466

1961-71

335

1971-81

266

1981-91

226

1991-2001

197

Young people, in particular, face an excessive risk
of unintended pregnancy because of their sexual
behaviour and lack of information or little-or-no ac­
cess to sexual and reproductive health services. Stud­
ies show, for instance, that women delay about one
year on an average between starting sexual activity
and using contraception. The large unmet need of
contraception, in addition to the risk taking behaviour
particularly among adolescents, increases the risk of
unwanted pregnancy and abortion. The precise esti­
mate of the incidence of induced abortions is not avail­
able. The official data indicate approximately 600.000
pregnancy terminations in the country during 199192*. However, the Shah Committee, an expert group
constituted by the Government of India to review the
situation in the late sixties, suggested that for every
73 live births there were 25 abortions including 15
induced abortions. Taking into consideration the in­
crease in population and total fertility rate since 1960s.
the Shah Committee estimated that there were 1 1.2
million abortions in 1991. of which 6.7 million were
induced and 4.5 million spontaneous*. It is expected
that there may be 10-11 illegal induced abortions for
every legal abortion. Analysis of India's 1992-93
National Family Health Survey (NFHS) data on 301.400
pregnancies collected from ever-married women from
urban and rural areas showed that 9.3% of the induced
abortions were performed on females aged 15-19 yr
18

> sr. ferrx’es
age group of 15-24 yr\
Sxi.es
shswr; :ha: lack of information on
recoi-xf - e health T,as one of the main reasons
x.' j''
pregnancies and abortions particularly

In India. I in 5" women has a chance of dying
x-rr. plications of pregnancy. child birth or unsafe
abzrrisr. d-jring her life time as compared to 1 in more
than 17.000 in seme of the des eloped countries5. At the
prev ailing maternal mortality rate (MMR) of 437 deaths
per 100.000Jive births, more than 100.000 women in
India die even year from causes related to pregnancy
and child birth-, It is estimated that 15.000-20.000 abor­
tion related deaths occur annually among married, mul­
tiparous women in India. In addition, a survey in India
found that for each maternal death there were 16.5 ill­
nesses related to pregnancy and child birth6.
fl

Similarly, the infant mortality rate (IMR) is approxi­
mately 74 per 1.000 live births, which is almost 12 times
higher than that in many developed countries7.

Sexuality and sexual behaviour may predispose women
to sexually transmitted diseases (STDs) and non-sexually transmitted reproductive tract infections (RTIs). of
which they may not be aware. An unpublished survey
conducted by the UNICEF has shown that in India 5%
of sexually active adults is infected with a STDS. An­
other survey among 2.100 urban and rural men and women
found 7.3% prevalence of STDs in the general popula­
tion*. Infection, if not treated, could lead to infertility.
The whole range of adverse pregnancy outcomes viz
miscarriage, stillbirths, prematurity, growth retardation.
have all been related to various STDs.
Another major issue of great health concern is th"
grow ing evidence that STDs act as risk factors or fa­
cilitators of HIV transmission. Within 8 years of the
detection of the first HIV positive case in 1986 in India.
the official figures as of mid-1994 stood at 15.000 HIV
positive and 559 AIDS cases’. This is most certainly
an underestimate because of under reporting. Il is es­
timated that by the year 2000. 5-7 million people in
India will be infected with HIV and 1 million persons
will have AIDS, and the country will contain one-sixth
of the world's HIV infected population’" **. The WHO
estimates that India may have more HIV infected in­
dividuals than any other country in the world by the
year 2000,:. The chance of HIV transmission during
a single act of intercourse may be increased 50 times1'.
Young people once again face an excessive risk of

STDs both because of their sexual behaviour and
because they lack information or have little or no access
to sexual and reproductive health services14. Preven­
tion and treatment of STDs is a major challenge and
there is an urgent need to integrate STD care with family
planning programmes.
regional Variations in Reproductive Healiii

The burden of reproductive ill-health is not
uniformly distributed all over the country. The five
states. Uttar Pradesh. Bihar. Rajasthan. Madhya Pradesh
and Orissa which constitute almost 44% of the country *s
population contribute maximum to the burden of
reproductive ill-health'. Fertility and mortality rates
arc lower in most of the western and southern stales.
Kerala has the least crude birth rate. I MR. and the highest
ife expectancy at birth.
According to the 1992 NFHS data, in Kerala 19.3%
of women aged 20-24 yr had married before the age
of 18 as compared to 73.3 and 69.1 % in Uttar Pradesh
and Bihar, respectively'3. Similarly, in Kerala only 5.9%
of women aged 13-19 yr had begun child-bearing which
was much less compared to Uttar Pradesh (14.1%).
Bihar (18.6%) and Madhya Pradesh (26.5%). Kerala
with the highest contraceptive prevalence rate of 63.3%
among married women, has 94.7% of boys and girls
attending schools between the age group of 6-14 yr.
54.4% of children fully immunized and IMR of 23.8
per 1000 live births. Whereas. Uttar Pradesh and Bihar
with contraceptive use of 19.8 and 23.1 %. respectively
have the least number of children attending school
between 6-14 yr. and total fertility rate and IMR above
kthc national averages. Moreover, relative risk of fe­
male to male mortality in the age group of 5-9 yr is
almost double in Uttar Pradesh and Bihar as compared
to Kerala. The female to male ratio in Kerala is 1.04
and in Uttar Pradesh it is 0.88’. These statistics are
suggestive of wide variations in the reproductive health
status of people in various parts of the country.

Kerala spends Rs 78.37 (< 2 US $) annually per
eligible couple on family welfare programmes and this
expenditure is quite comparable to that spent by Gujarat
(Rs 78.80). Rajasthan (Rs 72.30) and Orissa (Rs 72.07).
and far less than that spent by Haryana (Rs 97.28) and
Punjab (Rs 119.81)15. In spite of this, the burden of
reproductive ill health is much less in Kerala as com­
pared to other states.

Analysis of the NFHS data is suggestive of a posi­
tive correlation between contraceptive use. literacy rate
particularly that of the female child, children attend­
ing school, children fully immunized ahd even the socio­
economic status in terms o.f availability of essential
items like waler and sanitation. Statistics also sug­
gest that the success of the family planning programme
cannot be related-only to the investments in Family
Welfare Programmes but is closely linked to the health
and social needs of the population. The Programme
of Action of the International Conference on Popula­
tion and Development (ICPD) has rightly emphasized
the need for shifting the focus from population con­
trol by just increasing the contraceptive prevalence rates
to programmes that promote overall sexual and repro­
ductive health and rights16. Programmes with empha­
sis on the need of improving the quality of services:
empowering women and improving their social and
economic status: and enhancing the involvement of
men in sharing the responsibilities in parenthood will
help achieve the ICPD goals. .

Unmet Need eor Contraception
The contraceptive prevalence rate due to all methods
in India was 46.5% in 1996* ie approximately 70 million
eligible couples practice contraception either because
they do not want any more children or want to space
children17. On the other hand, there are at least 35
million people who are not using any method of con­
traception in spite of the fact that they would either
like to stop or space child-bearing. The average unmet
need for contracep'tion is 19.5%. of which 11% is for
spacing births and 8.5% for those who have reached
their desired family size and need no more children2.
Within the country, the unmet need for contraception
ranges from 10.4% in Andhra Pradesh to 30.1 % in Uttar
Pradesh'.

The reported unmet need of 19.5% in India may
be an underestimate as NFHS had covered primarily
the sexually active married women living in union.
and not the large proportion of unmarried adolescents
and youth. Unlike the developed countries, in India
only a minority of young adults engage in sexual ac­
tivities before marriage. However, there is a gradual
increase in premarital sexuality reflecting a clear need
for contraception. An Indian family planning survey
found that 13% of girls and 25% of boys approved of
premarital sexual relations”5. The high incidence of
19

abortion in the country is also suggestive of the fact
that a large proportion of women want to limit their
family size or space the children but are not using any
effective contraceptive. The projected unmet need for
contraception also does not consider the needs of men.
In addition, there may be some couples who practise
contraception but are not satisfied with their method
of choice. This implies that the actual unmet need for
contraception might be much higher than that offi­
cially projected. It also suggests that increasing the
contraceptive choices may help increase contracep­
tive prevalence and eventually reduce fertility.
Results from surveys in India show that the
knowledge about available contraceptives and the desire
to use contraception varied not only among different
states but also among different religions. For example.
in a survey carried out in three districts of Madhya
Pradesh, in spite of the fact that the mean age of marriage
was 15 yr, 92% of the adolescents knew at least one
modern contraceptive and 83% were aware of at least
one modern method of birth spacing19. They were more
familiar with female sterilization, oral contraceptives,
male sterilization, condom and the IUD. However, only
19% of the married teenagers had ever used a
contraceptive method and their unmet need was 43%.
About 25% of the adolescents did not approve of using
family planning methods19. Similar surveys from other
areas also suggest that a substantial percentage of
women know about at least one contraceptive and
wanted to stop child-bearing but were not practising
contraception. In general, knowledge about
contraceptive methods and contraceptive prevalence
rate was higher among Hindus as compared to the
Muslims20. The most common reasons cited as to why
some apparently motivated couples were not practising
contraception are: (i) lack of sufficient knowledge about
the methods and apprehensions that the available
methods are not safe; (ii) lack of easy access to
contraceptive supplies and services; and (iii) social
and family disapproval including religious beliefs.

In addition, there are couples with very low socio­
economic status living in slums or remote areas who
are not aware of existing technologies which can help
them control fertility. In a survey 88% of girls seeking
abortion did not know that sexual intercourse could
lead to pregnancy or STDs and 90% did not know about
contraception21. In general, studies have shown that
20

the unmet need was highest among women who lived
in rural areas, were illiterate or whose husbands were
illiterate, were Muslims and were not exposed to media
messages.
Priorities in Fertility Regulation Research
The Programme of Action of the ICPD has
emphasized that all countries should ensure the provision
of family planning products and services including
counselling, information and education to all individuals
no later than the year 201516. The ICPD has also
emphasized the need to develop newer methods of
fertility regulation so as to widen the contraceptive
choices. The objective of research in fertility regulation
should be to ensure that couples have control over their
fertility and are able to plan the number and spacing
of their children. Moreover, their attitude towards
sexuality and sexual behaviour should not increase the
risk for unwanted pregnancies and STDs. Fertility
regulation research should accord high priority to the
reproductive health needs of adolescents and youth who
are most vulnerable and in greater need for information.
counselling and services for fertility regulation. It
necessitates integration of technology development with
provision of services.
Research in fertility regulation should thus aim at
expanding contraceptive choices by improving the ac­
cessibility and acceptability of good quality contra­
ceptive products and services which have already been
developed. In addition, high priority needs to be given
to develop newer methods which are more effective
and safer. It would necessitate improving the quality
of care, increasing awareness about sexuality and fer­
tility regulation, empowering women, and even increas­
ing male-female partnership in sharing responsibili­
ties for family planning and parenthood.

Expanding Contraceptive Options

Studies have shown that the unmet need for con­
traception is related to the number of contraceptive
methods and services accessible to the potential user.
The greatest unmet need is among those who have the
least access to family planning programmes22. An
analysis of the demographic health survey data from
44 countries showed that for each additional method
of family planning which is made widely available in

the country, the contraceptive prevalence rate increases
by 3.3% and the unmet need is met by 1.7%23. These
figures clearly speak for expanding contraceptive
choices if the couples are to be empowerd to control
their fertility.
In India only five contraceptive choices are offered
through the National Family Welfare Programme,
namely vasectomy and condoms for men, and IUDs,
oral pills and tubectomy for women. Long-acting
injectables, or implantable devices which are quite
effective and safe for preventing pregnancy and
available in many countries are still not offered through
the Family Welfare Programme in India24. Since some
of the modern contraceptives have not been extensively
evaluated in India, the immediate challenge is to assess
their efficacy, safety and acceptability and if found
acceptable introduce those methods in the national
programme. In addition, realising that none of the
available methods is 100% effective, completely free
of side effects and fully reversible, research should
continue looking for better methods of fertility
regulation. High priority should be given to develop
methods which men can use, those which can prevent
pregnancy when used even after unprotected sex and
which have the potential to prevent both pregnancy
and transmission of STDs including HIV.
Male methods

Condom and vasectomy, in addition to the with­
drawal method, are the only options available to the
Indian male to control fertility. In a study, over 90%
of the men surveyed had heard of these two methods25.
However, less than 3% use condoms and less than 2%
use vasectomy2. Condoms have been promoted as an
easy to use, comfortable and safe method of birth control.
However, studies show that a large number of men, at
least in stable marriages do not prefer condoms for
the following reasons (i) embarrassment of buying and
disposing off the condom; (ii) the need for planning
before having sex; (iii) its use reduces the sensitivity
of the penis including sometimes loss of erection; and
(i v) female partner feels less exciting to touch the penis
with condom on. In stable marriages condom may
not be the best choice when more acceptable female
control options are available. However, realising that
the use of condom can also help reduce the chances
for transmitting STDs including HIV, it is essential to

undertake research to identify the means to improve
the acceptance of condom as a male contraceptive.
Similarly, vasectomy, a simple procedure, is not
preferred by men. Firstly, because it is not reversible
in all men and secondly, because of the apprehension
that vasectomy reduces male potency. The first con­
cern is justifiable. The IMR in India is very high and
couples would prefer to use a method which is totally
reversible. Research efforts to make vasectomy a
reversible procedure must be pursued more vigorously.
Secondly, the conventional vasectomy procedure re­
quiring incision should be replaced with the ‘no scal­
pel’ procedure. This would further motivate men to
accept vasectomy. Finally vasectomy should be per­
formed under most hygienic conditions to prevent any
sepsis, otherwise interpersonal communication will
discourage many more men to opt for this procedure.
The quality of information, better privacy and dispel­
ling myths about the harmful effects of vasectomy
should be addressed.

In addition, efforts to develop newer male
contraceptives should be given preference. The weekly
injection of testosterone enanthate has been shown in
multi-country clinical trials to render men infertile and
the method has been found to be safe and reversible.
A longer acting androgen which would either make
men azoospermic or severely oiigospermic would be
preferred. Research efforts to further pursue work on
the antifertility vaccines directed against follicle
stimulating hormone (FSH) and specific molecules on
the spermatozoa or the epididymal secretions need to
be geared up. Approaches targeting maturation of
spermatozoa in the epididymis or sperm egg interaction
without interfering with sperm production or secretion
of testosterone, may find more acceptance by men.
Post-coital contraception
The available emergency contraceptive methods
if used within 72 hours of unprotected sexual inter­
course can prevent approximately 80% of unintended
pregnancies26-27. If the providers and potential users
are made aware of these methods, and services could
be provided within 72 hours, a substantial number of
the 11 million induced abortions occurring annually
in India can be prevented. This will also help save
some women from the agony and embarrassment of
undergoing abortion, and many more from the post
21

abortion complications which generally occur in the
hands’ of unskilled providers operating under unhy­
gienic conditions.

Research needs to be directed to assess the reasons
why these methods are not readily available to or used
by the potential users. This also necessitates research
on the risk taking behaviour of people, determinants
and consequences of induced abortion including its
effect'; on subsequent fertility, reproductive and mental
health and contraceptive practices.

More biomedical research is needed to understand
me ‘window’ of endometrial receptivity. Research
should also be aimed to increase the window of effec­
tiveness of the available methods of emergency con­
traception, and to increase their contraceptive efficacy
to almost 100%. The development of better methods
of emergency contraception is a challenging task re­
quiring high priority.
STDs and contraception

It is estimated that more than 300 million people
get infected with curable STDs each year, most of them
in developing countries28. In more than 90% of the
cases the transmission of HIV is due to heterosexual
partners. About half of the HIV infections world-wide
occur among people younger than 25 yr of age and
rates of STDs and HIV are higher among adolescents
than for any other age group. Girls are the worst af­
fected. The focus of research for the prevention of
STDs must be directed to both men and women.
In this regard, it may be appropriate to focus on
the development of methods which would prevent
pregnancy and simultaneously transmission of STDs.
Research on the development of male and female
condoms, spermicides or diaphragm with or without
spermicide and cervical cap should be pursued. At
present only 12% of the contraceptive users in India
use condoms. Due to the weak socio-economic status
of women, the professional sex workers, in particular.
are not in a position to impress upon the male partner
to use a condom.

A number of safe fertility regulating methods are
available which can help couples prevent unintended
pregnancies. It is for the health care providers to en­
sure that such methods are provided with appropriate
quality of care to the potential users who differ greatly
in their needs and perceptions. A survey covering 2,500
ever married women from each of the 15 districts of
Uttar Pradesh showed that in spite of the fact that some
of the contraceptives were readily available the con­
traceptive prevalence rate in some districts was as low
as 12% and the unmet need ranged between 19 to 59%30.
Less than 15% of women had recently been contacted
by community health workers30-The quality of care in
these districts was poor. These observations suggest
that merely making the contraceptives available at the
chemists' shops or through a social marketing systen^.
is not sufficient in our society. Continuous motiva™

tion and follow up are essential for better compliance.
Improving the quality of care in the family planning
services would require: (i) broadening the potential
user’s knowledge about family planning choices;
(ii) motivating the potential user to weigh the
beneficial effects of using fertility regulating
technologies with perceived or real side-effects, religious
beliefs and other societal inhibitions of using such
technologies; (iii) increased realization by men of their
role in family planning and responsible sexual
behaviour; (iv) accessibility of a variety of good quality
affordable methods and services for fertility regulation;
(v) management of unwanted pregnancies; and
(vi.) prevention and treatment of reproductive tract .
infections and STDs, and other reproductive healtl^
issues31. Implementation of these may require
multipronged strategy focusing on improving
reproductive health care facilities rather than a narrow
focus on meeting contraceptive targets. It may
necessitate improving infrastructure support for
women’s health, mobilizing community involvement
and providing training to health care personnel. There
.is a greater need to involve non-governmental
organizations in improving the quality of care with
better coordination among different national and
international agencies.

Quality of Care

Awareness about Sexuality and Fertility Regulation

Quality of care refers to the way clients are treated
by the system, or the actual process of care giving,
with a focus on the users’ perspectives of services19.

In India more than 45% of the population is
illiterate and over 70% reside in rural areas, and
their knowledge about sexuality and awareness about

22

fertility regulation is very poor. A prospective study
of school girls about their knowledge of menstruation,
reproductive physiology and birth control methods
showed that 87.6% of the girls in rural areas and 75.1%
in urban areas lacked this knowledge21. TheNFHS data
showed that only 29 to 73% of the couples in various
states knew about the four official methods of family
planning ie vasectomy, tubal ligation, condom and oral
pill. Moreover, most of the couples did not know from
where to obtain these contraceptive services. For
example, in Madhya Pradesh only 34-39% of women
knew from where to obtain pills, condoms, and IUDs32.
In Gujarat, only 33% of persons reporting knowledge
of AIDS had correct information and 19% believed
that AIDS was curable33.
Sex education, even in the urban areas, is a sensi­
tive subject and talking about this is taboo. There are
Cultural and ethical constraints to providing contra­
ceptives to unmarried adolescents. With an increase
in the gap between menarche and marriage there is a
gradual increase in sexual intimacy among unmarried
adolescents and youth. Many of them do not know
about the fertility regulating methods and some do not
use them reliably or properly.

A survey conducted by the Family Planning As­
sociation in 1992 among school children revealed that
the primary source of information on sex and related
matters was television, magazines and not the family,
friends or the school34. However, surveys have re­
vealed that in most parts of the country only about a
quarter of the ever married women was exposed to
the mass media family planning messages3. Illiterate,
rural and scheduled tribes women were the least likely
to be exposed.
Studies have found that the mass media messages
about family planning have a positive correlation with
contraceptive use. For example, in Kerala 56% of ever
married women were exposed to the mass media family
planning messages and had a contraceptive prevalence
rate of 63%35. On the other hand, in Rajasthan 33%
of ever married women were exposed to the mass media
family planning messages and had a contraceptive
prevalence rate of 33%36. The NFHS has shown that
in Uttar Pradesh among women who were not using
contraception, those exposed to the mass media
messages about family planning were considerably more
likely to say that they intended to use contraception
than women with no exposure37.

It is essential to undertake research to assess the.
knowledge, attitude, needs and perceptions of people
about sexuality and contraception and develop
programmes to increase their awareness about sexu­
ality and fertility regulation. Sex education, in the form
of creating awareness about one’s own body, should
be introduced in schools and expanded to the mass
media for spreading awareness of the available tech­
nologies for fertility regulation, and inculcating
favourable attitudes towards contraceptive use. The
mass media should also help dispel apprehensions, of
the users about the efficacy, safety and mode of
action of the fertility regulating methods and also create
awareness of the places from where these services can
be sought.

Women’s Empowerment
The Constitution of India assures equality of sta­
tus and of opportunity ft>r all citizens. It specifically
prohibits discrimination against women. However, a
gender gap still exists in most parts of the country.
Women are biologically the stronger sex with a life
expectancy at birth greater than that of men. In spite
of this biological advantage, however, there are ap­
proximately 100 women for every 107 men, creating
an unaccountable deficiency of almost 33 million
women. A recent report estimating that 17% of fe­
male mortality in India is due to gender discrimina­
tion and gross neglect is a reflection of the weak socio­
economic status of women38. Almost 30% of HIV
infection occurs in those women who have sexual
intercourse with a single male partner28. World-wide
studies also show that from 20 to over 50% of women
have been beaten by a male partner28. Female discrimi­
nation is also reflected in primary educational oppor­
tunities, nutritional status, and income. On the other
hand, the burden of contraceptive usage, consequences
of unintended pregnancies and induced abortions, re­
sponsibilities of child bearing and rearing, and STDs
are borne more by women than by men.
Gender discrimination is primarily due to the
economic dependence of the female on the male.
Consequently, females often cannot act effectively to
realize their reproductive intentions in the face of real
or perceived objections from their husbands or others.
Studies have shown that woman’s status, education
and economic independence are positively linked not
23

only to her reproductive health but also to better health
of the entire family. Woman’s control over fertility
empowers her to complete her education, seek job
opportunities and plan the family size39. The preventable
mortality and morbidity of the infants and mothers are
less in families with more educational and financial
resources. In Kerala 23% of women work at places
other than their own farms as compared to 5-7% in
states like Uttar Pradesh and Rajasthan which have
high fertility rates and IMR3.
ICPD, the Fourth World Conference on Women
and the World Conference on Human Rights have em­
phasized40, in addition to other women-related issues,
(i) the need to enforce woman’s right to health, repro­
ductive health and family planning; (ii) the right to
decide on the number of and spacing of children; and
(iii) the right to be free from sexual assault and ex­
ploitation.

These goals can be achieved by increasing access
to education job opportunities outside the house, and
access to methods and services for fertility regulation.
This demands for an increase in investment in womenrelated programmes including reproductive health,
quality family planning services and combating STDs.

Increasing Male-female Partnership
In most families in India, and probably in many
other countries too, man is the dominant factor in
decision making in almost all spheres of life includ­
ing family planning and family size. The illiteracy
and low economic independence of woman works
against her being an equal partner with her husband in
decision making. It does not imply that most men are
not responsible in accepting their responsibilities in
family planning, sexual behaviour and parenthood. It
may be ignorance, illiteracy and poverty which inad­
vertently prevent most men from sharing responsibilities
in several matters related to reproductive health.
Studies show that a vast majority of men in urban
areas who are educated and aware of the available tech­
nologies for fertility regulation control their fertility
by choice in spite of the fact that the quality of care
in general is poor in urban areas. Even less educated
men with low economic status working in the indus­
trial sector in urban areas have started to realize the
advantages of a small family size. In many such so­
24

cieties small family size has become a status symbol.
A study on 77 male and 101 female family members
from the five generations of a south Indian family
showed a gradual decline in fertility levels with prac­
tically no female involvement in reproductive deci­
sion making41. It was primarily the men who decided
to limit the family size. Media motivation was the
major factor which had influenced men to control their
fertility rather than the choice of methods. These
observations suggest that interpersonal and mass media
communication are central to motivating men to con­
trol their family size.

The nonavailability of a choice of a variety of con­
traceptive methods which men can use is another major
reason depriving them from sharing responsibility for
contraceptive use. Vasectomy is still considered to
be a terminal method and condom use is not a prefefred method. No ‘mini pill’ or long-acting hormonal
method is yet available for men. Many men also have
apprehensions about vasectomy, its relationship to
prostate cancer and its effect on sexual potency. Men
believe that in comparison to vasectomy, tubectomy
is easier to perform, associated with fewer complica­
tions and has no effect on libido or potency.
Fertility regulation programmes for males need to
be developed with the objectives of (i) increasing aware­
ness among men about the available contraceptive
services; (ii) helping build a positive attitude to ac­
cept available family planning methods and to sup­
port his partner’s decision to use a contraceptive;
(iii) encouraging their cooperation with methods which
are under their control; (iv) disseminating information about safer sex practices to reduce the incidence

of STDs; and (v) dispelling myths or strong beliefs
not only about the technologies but also for holding
the partner responsible for the birth of a female child
and for infertility.
To formulate these programmes would require
extensive research to understand the perceptions and
needs of men about fertility regulation and sex behaviour
and to develop appropriate quality of care for
providing reproductive health services for men.
Moreover, it is important that the programme should
start addressing the needs of men early in their teens.
The new programme to increase involvement of men
in reproductive health and in making service delivery
more male friendly should in no way be at the cost of

*

the ongoing or proposed programme for women.
Moreover, women should not feel offended that their
rights and privileges were being challenged. The re­
search effort should be directed to develop and pro­
mote communication, understanding and feeling for
sharing responsibilities between partners.

Non-surgical Methods of Pregnancy Termination
Pregnancy termination is not a method to regulate
fertility. However, the 11 million abortions induced
annually in India suggest that induced abortion is the
primary means of fertility regulation. Providing abortion
services is also a necessity as no contraceptive is perfect.
A survey of women seeking abortions in the United
States found that half were using some form of contra­
ception during the month that they conceived. In
addition, in India, the incidence of abortion related
deaths, 14% of all maternal deaths, or development of
other complications such as chronic infection, en­
dometritis or infertility is very high. It suggests that
a large number of induced abortions are performed by
unqualified persons under septic conditions. These
observations suggest that mere legalization of the
abortion procedure is not sufficient. The need is to
make abortions safe, readily accessible and affordable.
Vacuum aspiration is an acceptable safe method
to terminate pregnancy42. However, in resource poor
settings where millions of pregnancies are to be ter­
minated annually, it is probably difficult to provide
matching facilities and qualified providers. Provid­
ing a safe, non-invasive medical method should be a
feasible and affordable alternative. The advent of
prostaglandins (PGs) during the early 1970s and more
recently of an antiprogestin mifepristone (R.U 486) has
completely changed the scenario of induced abortions43."'
Treatment with a single oral dose of mifepristone
followed 48 hours later with a small dose of a PG
analogue, administered either vaginally or intramus­
cularly, has been shown to terminate pregnancy in
almost 95% of the women with an amenorrhoea of up
to 63 days42’44. More recently, an orally active pros­
taglandin misoprostole, when used in combination
regimen with mifepristone, has also been shown to be
effective in terminating up to 56 day pregnancy42-45-46.
Mifepristone and misoprostole both are orally active
and stable at room temperature and can be easily made
available. Similarly, the use of PG alone or in com­
bination with mifepristone has made abortion safer in

the second trimester42. However, further research is
required to develop newer more potent antiprogestins
which can terminate early pregnancy without the need
for supplementation with PGs.
The major thrust of the family welfare programme
should be to prevent unintended pregnancies and in­
duced abortions, which can be achieved by providing
high quality contraceptive services. In addition, it should
make abortion safe. Due to social inhibitions and lack
of easy access to good pregnancy termination services
many couples are compelled to subject themselves to
high risks by going to unqualified persons.

CONCLUSIONS
The fertility regulation research programmes should
be linked to the potential users perceptions and needs.’
Increase in contraceptive options by introducing existing
methods and developing newer more effective and safer
methods backed by service delivery system with
appropriate quality of care is essential to curtail the
burden of reproductive ill health. Tailored information,
education and communication programmes promoted
through interpersonal and mass media communication
can help dispel the myths and disbeliefs about the
available fertility regulating technologies and help
increase awareness and eventually the acceptance of
the available methods and services. A multidisciplinary
comprehensive approach integrating various
components of reproductive health might be a better
option rather than an isolated focus oh fertility regulation
with an intention of improving the contraceptive
prevalence rate. Various initiatives have been taken
by the Government as well as non-governmental
agencies to confront the alarming rise in population
growth. However, there is no time for complacency.
Modern fertility regulating methods still remain
unavailable to more than 35 million couples in India.
Any further delay in controlling the high fertility rate
and meeting the large unmet need for contraception
may be too late to ensure better quality of life for the
coming generations.

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. Department of Family Welfare. Ministry of Health and Family
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2.

National Family Welfare Programme: Achievements, Challenges
andStrategies. Department of Family Welfare, Ministry of Health

25

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Khan. M.E. and Patel. B.C. Reproductive Behaviour Among
Muslims in Uttar Pradesh. Population Council. New Delhi, India.
p 20. 1997.

National Family Health Surveys 1992-1993. India. International
' Institute of Population Studies. Mumbai. India. 1995.

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Chhabra. S. A step towards helping mothers with unwanted
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Chhabra. R. Abortions in India: An overview. Demogr India
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Robey. B., Ross. J. and Bhushan. I. Meeting unmet needs: New
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Bhushan. I. Understanding Unmet Need. Johns Hopkins School
of Public Health, Centre for Communication Programs. Work­
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Puri. C.P. and Soonawala, R.P. Steroidal Contraception. The
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25.

Balaiah. D.. Ghule. M.. Naik, D.D.. Parida. R.C. and Hazari.
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survey analysis. Adv Contracep Deity Syst 13: I. 1997.

26.

Puri, C.P. and Van Look, P.F.A. Editorial In: Emergency Con­
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Societies of India. Mumbai, p 2, 1996.

and Family Welfare. Government of India. New Delhi. India.
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Reproductive Risk: .4 I ForId-wide Assessment of I Komen’s Sexual
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Washington D.C.. 1995.

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Scnanayake. P. Direct effects of family planning on adolescent
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and Children through Family Planning. Nairobi. Kenya, p 19.
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7.

Population Concern. Annual Report 1996. Population Con­
cern. London, p 20. 1996.

8.

Nataraj. S. The magnitude of neglect: Women and sexually
transmitted diseases in India. In: Private Decisibns, Public Debate:
Women, Reproduction and Population. Eds. J. Mirsky. M. Radlett,
Davies and 0. Bennett; Panos Publications. London.p 7. 1994.

27.

Puri. C.P. Emergency contraception. ICMR Bulletin 27:19. 1997.

9.

Pais, P. HIV and India: Looking into the abyss. Trop Med Int
Health 1: 295, 1996.

28.

Family and Reproductive Health. World Health Organization.
Geneva. 1996.

Dasgupta, P.R. Strategies for prevention and control of HIV
infection/AIDS in the country'. J Indian Med Assoc 92:5. 1994.

29.

Hull. V.J. Improving Quality of Care in Family Planning: How
far Have We Come? The Population Council, Jakarta, Indo­
nesia, 1996.

30.

Population Council; India: Major Survey Effort Provides Data
for Family Welfare Program Planning and Policy. Population
Council, New York. U.S.A, p 2. 1995.

31.

Singh, A.K.. Jabbi, M.K., Rajyalakshmi, C., Srikar, N.,
Balakrishnan, R., Rama Rao, S., Khan. M.E., Gupta, R.B..
Townsend, J.W. and Patel, B.C. Situation analysis of family
welfare programme in Uttar Pradesh: Agra District. Final Report.
Council for Social Development, New Delhi. India, p 1, 1995.

32.

National Family Health Survey (MCH and Family Planning).
Madhya Pradesh, 1992: Directorate of Economics and Statis­
tics. Population Research Centre, Bhopal, and International
Institute for Population Sciences. Mumbai, India, p 27. 1995.

33.

Gandotra, M.M.. Das, N.P., Mukherji. S., Kanitkar. T. and
Govindswamy. P. National Family Health Survey (MCH and
Family Planning). M.S. University of Baroda, Population: Re­
search Centre, Vadodara, India p 308, 1995.

34.

Anand. A. India: Introduction of sex education. Lancet 341:
1207. 1993

35.

National Family Health Survey (MCH and Family Planning),
Kerala, 1992-93. University of Kerala, Population Research
Centre, and International Institute for Population Sciences.
Mumbai, India p 24, 1995.

36.

National Family Health Survey (MCH and Family Planning).
Rajasthan, 1992-93. Mohanlal Sukhadia University, Popula­
tion Research Centre. Udaipur. India, p 28. 1995.

10.

11.

Lal. S. and Mertens, T.E. HIV and AIDS. Indian J Pub Health
39: 77, 1995.

12.

Mills, S. AIDS in Asia: Facing the epidemic.* AIDS Captions
1(3): 6, 1994.

13.

Bond, G. Breaking the chain: STDs and HIV. World AIDS 22:
4, 1992.

14.

Friedman, H.L. Overcoming obstacles to good adolescent health.
Network 14: 4, 1993.

15.

Ramachandran, P. Reproductive health: Methodologies for
evaluating progress. In: Reproductive Health. Eds. C.P. Puri.
J.M. Kasonde and P.F.A. Van Look, 1999, In Press.

16.

Population and Development. Programme ofAction Adopted at
the International Conference on Population and Development.
Cairo 1994. United Nations Publication, New York. 1995.

17.

Adlakha. A. Population Trends: India. Bureau of the Census.
Washington, D.C.. p 8. 1997.

18.

Bhattacharya, M. and Joshi, P.L. Teenage pregnancies: Present
trends and future prospects. In: Workshop on Strategy Formu­
lation to Reduce Teenage Fertility in Uttar Pradesh, India. Eds.
R.B. Gupta and S. Joshi. Academy of Administration, Nainital,
India, p 33. 1995.

19.

26

Rajagopal. S. and Phillip, G. Status of married adolescent girls.
A case of three districts of Madhya Pradesh. In: Workshop bn
Strategy Formulation to Reduce Teenage Fertility in Uttar
Pradesh, India. Eds. R.B. Gupta and S. Joshi. Academy of
Administration, Nainital, India, p 27, 1995.

37.

Devi. D.R.. Rastogi, S.R. and Rctherford. R.D. Unmet need
for family planning in Uttar Pradesh. In; National Family
Health Survey Studies Report No. I. International Institute of
Population Sciences. Mumbai, p 25. 1996.

38.

Sarin. A.R. Sexual discrimination: Its impact on Indian women’s
health. J Obstet. Gynaecol Family Welfare. I (6)\ 10. 1995.

43.

Puri. C.P. and Van Look. P.F.A. Newly developed competitive
progesterone antagonists for fertility control. Front Horm Res
/PH 27.1991.

44.

World Health Organization. Termination of pregnancy with
reduced doses of mifepristone. BMJ 307: 532. 1993.

45.

Winikoff. B.. Sivin. L. Coyaji KJ.. Cabezas. E.. Bilian. X.. Sujuan.
Gu. Mingkum. Du. Krishna. U.R.. Eschen. A. and Ellenson. C.
Safety, efficacy, and acceptability of medical abortion in China.
Cuba, and India: A comparative trial of mifepristone-misoprostol
versus surgical abortion. Am J Obstet Gynecol I “6:431. 1997.

Carbonell. J.L.L.. Varela. L.. Velazco. A. and Fernandez. C. The
use of misoprostol for termination of early pregnancy. Contra­
ception 55: 165. 1997.

'**9. Dixon-Mueller. R. Women’s rights and reproductive choice:
Rethinking the connections. In: Beyond the Numbers. A Reader
on Population, Consumption, and the Environment. Ed. L.A.Mazur. Island press. Washington D.C. p 227. 1994.

40.

Women s Reproductive Rights: The International Legal Foun­
dations. Centre for Reproductive Law and Policy. New York.
1996.

46.

41.

Karra. M. Stark. N. and Wolf. J. Male involvement in family
planning: A case study spanning five generations of a south Indian
family. Stud Family Plan 28: 24. 1997.

42.

World Health Organization. Medical Methods for Termination
of Pregnancy. Report of a WHO Scientific Group. WHO Tech
Rep Ser 87L 1997.

This write-up has been contributed by Dr Chander P. Puri,
Deputy Director (Sr. Grade), Institute for Research in Repro­
duction, Mumbai-400012. The views expressed by the author
do not necessarily represent those of the Indian Council of
Medical Research.

ABSTRACTS
Some Research Projects Completed Recently

Fragile sites and mutagen sensitivity in colon cancer
families.

The study was carried out to determine the presence
if any, of constitutional chromosomal markers and chro­
mosomal fragile sites in familial and non familial colon
cancer patients and their close relatives; and to see whether
any family member showed mutagen sensitivity or re­
sistance with regard to chromosomal breakage. The sub­
jects studied comprised 44 familial colon cancer patients
from 34 families (23 males and 21 females), their first/
second degree relatives (189) and 44 sporadic coion cancer
patients (no family history of colon cancer).
Cytogenetic analysis of peripheral blood lymphocytes
of colon cancer patients and their relatives showed a normal
chromosomal pattern without any constitutional or struc­
tural anomalies. No consistent fragile sites were detected
in colon cancer patients or their relatives. All familial
colon cancer patients showed bleomycin induced chro­
mosome hypersensitivity. Of the 189 relatives of famil­
ial colon cancer patients, 13(6.9%) showed hypersensi­
tivity, 33(17.4%) normal sensitivity and 143(75.7%)
hyposensitivity. Among the 44 sporadic patients, 7( 15.9%)
were hypersensitive, 31(70.5%) sensitive and 6(13.6%)
hyposensitive. Of the 13 hypersensitive relatives 2( 15.3%)
developed colon cancer. Subsequently Pedigree analy­
sis showed that familial colon cancer was inherited in an
autosomal dominant pattern.

The observations indicate that the genetic suscepti­
bility risk in familial colon cancer is transmitted from
generation to generation. There was a good correlation
between bleomycin induced chromosome hypersensitivity
and cancer susceptibility. Results of this study indicate
that the bleomycin induced chromosome sensitivity analy­
sis can be utilized as a biomarker for identification of
high risk members in cancer families.

Jyothish B.
Ravindran Ankathil
Division of Cancer Research
Regional Cancer Centre
Thiruvanantapuram.
Publication:
Jyothis. B.. Ankathil. R.. Chandini. R.. Vinod Kumar. B.. Roy. D.D..
Nayar. S.G.. Madhavan. J. and Nair. M.K. The cytogenetic identi­
fication of high risk members in colorectal cancer families. Neoplasma
44: 258. 1997.

Prevalence of Mycoplasma pneumoniae in acute lower
respiratory tract infections.

The study was carried out in 249 patients (192 chil­
dren <10 yr of age, 43 adults between 18-30 yr, and 14
elderly >60 yr) with acute lower respiratory tract infec­
tions and 55 normal healthy individuals (matched forage)
to find out the age related prevalence of Mycoplasma
27

37. Devi. D.R.. Rastogi, S.R. and Rctherford. R.D. Unmet need
for family planning in Uttar Pradesh. In; National Family
Health Survey Studies Report No. I. International Institute of
Population Sciences. Mumbai, p 25. 1996.

38. Sarin. A.R. Sexual discrimination: Its impact on Indian women’s
health. J Obstet. Gynaecol Family Welfare. I (6)\ 10. 1995.

43.

Puri. C.P. and Van Look. P.F.A. Newly developed competitive
progesterone antagonists for fertility control. Front Horm Res
/PH 27.1991.

44.

World Health Organization. Termination of pregnancy with
reduced doses of mifepristone. BMJ 307: 532. 1993.

45.

Winikoff. B.. Sivin. L. Coyaji KJ.. Cabezas. E.. Bilian. X.. Sujuan.
Gu. Mingkum. Du. Krishna. U.R.. Eschen. A. and Ellenson. C.
Safety, efficacy, and acceptability of medical abortion in China.
Cuba, and India: A comparative trial of mifepristone-misoprostol
versus surgical abortion. Am J Obstet Gynecol I “6:431. 1997.

Carbonell. J.L.L.. Varela. L.. Velazco. A. and Fernandez. C. The
use of misoprostol for termination of early pregnancy. Contra­
ception 55: 165. 1997.

'**9. Dixon-Mueller. R. Women’s rights and reproductive choice:
Rethinking the connections. In: Beyond the Numbers. A Reader
on Population, Consumption, and the Environment. Ed. L.A.Mazur. Island press. Washington D.C. p 227. 1994.

40.

Women s Reproductive Rights: The International Legal Foun­
dations. Centre for Reproductive Law and Policy. New York.
1996.

46.

41.

Karra. M. Stark. N. and Wolf. J. Male involvement in family
planning: A case study spanning five generations of a south Indian
family. Stud Family Plan 28: 24. 1997.

42.

World Health Organization. Medical Methods for Termination
of Pregnancy. Report of a WHO Scientific Group. WHO Tech
Rep Ser 87L 1997.

This write-up has been contributed by Dr Chander P. Puri,
Deputy Director (Sr. Grade), Institute for Research in Repro­
duction, Mumbai-400012. The views expressed by the author
do not necessarily represent those of the Indian Council of
Medical Research.

ABSTRACTS
Some Research Projects Completed Recently

Fragile sites and mutagen sensitivity in colon cancer
families.

The study was carried out to determine the presence
if any, of constitutional chromosomal markers and chro­
mosomal fragile sites in familial and non familial colon
cancer patients and their close relatives; and to see whether
any family member showed mutagen sensitivity or re­
sistance with regard to chromosomal breakage. The sub­
jects studied comprised 44 familial colon cancer patients
from 34 families (23 males and 21 females), their first/
second degree relatives (189) and 44 sporadic coion cancer
patients (no family history of colon cancer).
Cytogenetic analysis of peripheral blood lymphocytes
of colon cancer patients and their relatives showed a normal
chromosomal pattern without any constitutional or struc­
tural anomalies. No consistent fragile sites were detected
in colon cancer patients or their relatives. All familial
colon cancer patients showed bleomycin induced chro­
mosome hypersensitivity. Of the 189 relatives of famil­
ial colon cancer patients, 13(6.9%) showed hypersensi­
tivity, 33(17.4%) normal sensitivity and 143(75.7%)
hyposensitivity. Among the 44 sporadic patients, 7( 15.9%)
were hypersensitive, 31(70.5%) sensitive and 6(13.6%)
hyposensitive. Of the 13 hypersensitive relatives 2( 15.3%)
developed colon cancer. Subsequently Pedigree analy­
sis showed that familial colon cancer was inherited in an
autosomal dominant pattern.

The observations indicate that the genetic suscepti­
bility risk in familial colon cancer is transmitted from
generation to generation. There was a good correlation
between bleomycin induced chromosome hypersensitivity
and cancer susceptibility. Results of this study indicate
that the bleomycin induced chromosome sensitivity analy­
sis can be utilized as a biomarker for identification of
high risk members in cancer families.

Jyothish B.
Ravindran Ankathil
Division of Cancer Research
Regional Cancer Centre
Thiruvanantapuram.
Publication:
Jyothis. B.. Ankathil. R.. Chandini. R.. Vinod Kumar. B.. Roy. D.D..
Nayar. S.G.. Madhavan. J. and Nair. M.K. The cytogenetic identi­
fication of high risk members in colorectal cancer families. Neoplasma
44: 258. 1997.

Prevalence of Mycoplasma pneumoniae in acute lower
respiratory tract infections.

The study was carried out in 249 patients (192 chil­
dren <10 yr of age, 43 adults between 18-30 yr, and 14
elderly >60 yr) with acute lower respiratory tract infec­
tions and 55 normal healthy individuals (matched forage)
to find out the age related prevalence of Mycoplasma
27

pneumoniae and correlate the clinical findings with
M.pneumoniae to identify the risk factors.

M.pneumoniae was found to be an important respi­
ratory pathogen in patients of ail ages; the prevalence
being 34.89% (67/192) in children, 46.5% (20/43) in adults
and 14.28% (2/14) in the elderly. Coexistence of
M.pneumoniae with other bacterial pathogens (both Gram
positive and negative) was frequently seen in all age
groups; 17.07, 48.9 and 14.28% in children, adults and
the elderly, respectively.
A past history of parents having had upper and lower
respiratory tract infections was identified as a risk factor
in the children. M.pneumoniae infection was more preva­
lent in children whose parents had had at least 1-3 epi­
sodes of upper and lower respiratory tract infections per
year.
The high incidence of M.pneumoniae in patients of
all age groups thus emphasizes the need for examination
of specimens for this pathogen in all patients with acute

lower respiratory tract infections. For the complete
diagnosis of M.pneumoniae infection culture/antigen
detection must be supplemented with serological
examination so as to plan appropriate treatment strategies
for the management of acute lower respiratory tract
infections in these patients. Since Mycoplasma infection
was seen along with other bacterial pathogens, it is
suggested that the therapy should be directed towards
both pyogenic and atypical pathogens for a good clinical
and therapeutic response.

Nazima Nisar
Rama Chaudhry
Department of Microbiology
All India Institute of Medical Sciences
New Delhi.
Publication:
Day. A.B.. Chaudhry. R.. Nisar. N.. Goel. P.. Nagarkar. K. and Kumar.
V.P. Community acquired pneumonia due to M.pneumoniae. A pre­
liminary report. J Assoc Phys India 12: 880. 1996.

ICMR NEWS
The following meetings of various technical groups/
committees of the Council were held:

Meetings of the Scientific Advisory Committee (SAC)/
Project Review Committee (PRC)ZTask Force (TF) and
other meetings held:

PRC for Proposals in
Epidemiology and
Communicable Diseases
Meeting of the Steering
Committee and Principal
Investigators of the National
Cancer Registry Programme

February 12, 1999
(at New Delhi)

February 15, 1999
(at New Delhi)

TF on Filariasis

February 16, 1999
(at New Delhi)

Participation of ICMR Scientists in Scientific Events:

Dr. S.C. Gupte, Dy.Director, Institute of
Immunohaematology, Mumbai, participated in the II
General Assembly and International Conference of
the Third World Organization for Women in Science
at Cape Town (February 8-11, 1999).
Dr. M.A. Ansari, Dy.Director (Sr.Grade), Malaria
Research Centre, Delhi, undertook a short-term WHO
Consultancy on Integrated Vector Control in Muscat
and Oman (February 12-26, 1999).

Honours/Awards:

SAC of the Centre for
Advanced Research on
Standardization and Quality
Control and Formulation of
Selected Traditional Remedies/
Natural Products, Jammu

28

February 15, 1999
(at Jammu)

Dr. H.V. Bhat. Dy. Director, National Institute
o f Occupational Health, Ahmedabad, has been awarded
the Academy of Environmental Biology Archana Medal
for 1997 in recognition of his outstanding contribu­
tion and research in the field of neurobehavioural
toxicology.

VVorkshop/Symposium/Confcrcncc:
An Indo-German Symposium-cum-Workshop on
inflammatory Heart Diseases was organised at New
Delhi (January 28-30. 1999).

The ICMR. Consensus Conference on Interferon
Therapy in Chronic Liver Disease due to HBV and
HCV Infections was organised at New.Delhi (February
Ik 1999).

ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
Symposium/ScminarAVorkshop/
Course/Confe pence

*

Date & Place

Contact Address

1 Conference of South Asian Pacific Society of Human
Genetics and XXIV Annual Conference of Indian Society
of Human Genetics

February 1-3. 1999:
(at Mumbai)

Dr. Dipika Mohanty. Chairperson of the Con­
ference. Institute of Immunohaematology.
Mumbai-400012.

Seminar on Low Level Electromagnetic Field Phenomena
in Biological System

February 3-4. 1999:
(at New Delhi)

Dr. J. Behari. Professor of Environmental Physics.
School of Environmental Sciences. Jawaharlal
Nehru University. New Delhi-110067.

I National Conference on Hepatitis and Renal Medicine

February 13. 1999:
(at New Delhi)

Dr. Sanjay K. Agarwal. Organising Secretary of
the Conference. Department of Nephrology. All
India Institute of Medical Sciences. New
Delhi-110029.

VII Annual Meeting of Molecular Immunology Forum 1999

February 13-15. 1999:
(at Hyderabad)

Dr. Ashok Khar. Convener of the Meeting. Centre
for Cellular and Molecular Biology. Hyderabad500007.

IV International Symposium on Vectors and Vector-borne
Diseases

February 18-20. 1999:
(al Gwalior)

Dr. P.R. Malhotra. Convener of the Symposium.
Defence Research and Development Establishment.
Gwalior-474002.

XVIII Annual Convention of Indian Association for Cancer
Research and National Symposium on Molecular Biology
of Cancer

Februaiy 19-21. 1999:
(al New Delhi)

Dr. Neeta Singh. Addl. Professor. Department of
Biochemistry. All India Institute of Medical
Sciences. New* Delhi-110029.

AOCS-OTAI International Conference and Exhibition on
Oil Seeds and Vegetable Oil Processing

Februaiy 19-21. 1999:
(at New Delhi)

Sh. K.P. Sharma. Organising Secretary of the
Conference. Oil Technologists Association of
India. 1205. Nirmal Tower. Barakhambha Road.
New Delhi-110001.

Technical Training Workshop on Industrial Hygien'e
Measurements and National Seminar on Occupational
Safety and 1 lealth

March 1-6. 1999:
(at Chennai)

Dr. Kalpana Balakrishnan. Organising Secretary
of the Workshop. Sri Ramachandra Medical
College and Research Institute. Chennai-600016.

Workshop on HIV/AIDS/STDs and Healthy Life St vie

April 10-11. 1999:
(at Berhampur)

Dr. R.M. Tripathy. Organising Secretary of the
Workshop. Department of Social and Preventive
Medicine. MKCG Medical College. Berhampur760004.

29

COUNCIL’S TRAINING PROGRAMMES FOR 1999-2000
Reproductive Biology

Laboratory* Animal Technology

At the Institute for Research in Reproduction. Mumbai:

At the National Centre for Laboratory Animal Science.
National Institute of Nutrition. Hyderabad:

•
•

Training Course in Molecular Techniques in Ovarian
Function (September 27-October 2. 1999).
Training Course on Cytological Detection of Repro­
ductive Tract Infections (December 13-17. 1999).

•

Training Course for Laboratory Animal Technicians
(June 14-July 30. 1999).

•

Training Course for Laboratory Animal Supervisors
(September I-November 30. 1999).

Endocrinology

Medical Entomology:

At the National Institute of Nutrition.. Hyderabad:
At the Vector Control Research Centre. Pondicherry:
•

Annual Certificate Course on Endocrinological
Techniques and their Application (August I September 15. 1999).

•

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M.Sc. in Applied Nutrition (June 1. 1999-February 28.
2000).

•

Basic Course in Statistics for Medical Officers (July
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Nutritive Value of Indian Foods (1985) by C. Gopalan. B.V. Rama Sastri and
S.C. Balasubramanian. Revised and Updated (1989) by B.S. Narasinga Rao. Y.G. Deosthale
and K.C. Pant (Reprinted 1996)

23.00

Growth and Physical Development of Indian Infants and Children (1972. Reprinted 1989)

10.00

Studies on Weaning and Supplementary Foods (1974. Reprinted 1996)

15.00

A Manual of Nutrition (Second Edition 1974. Reprinted 1995)

6.00

Low Cost Nutritious Supplements (Second Edition 1975. Reprinted 1996)

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Menus for Low-Cost Balanced Diets and School-Lunch Programmes Suitable tor North India

4.50

(Second Edition 1977. Reprinted 1994)

30

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Some Common Indian Recipes and their Nutritive Value (Fourth Edition 1977. Reprinted 1995)

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Japanese Encephalitis in India (Revised Edition 1980)
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Nutrient Requirements and Recommended Dietary Allowances for Indians (199O.Reprinted 1995)

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Dietary Guidelines for Indians - A Manual (1998)

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Dietary Guidelines for Indians (1998)

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3TF7

3TTKTT

^7

1974,

(1997)

1990)

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