Esther Budha Magar, Public health student
Fertility is the ability to conceive and produce an offspring of her own. The term fecundity and fertility comes together and most of us get confused in this term. Fecundity is the physiological maximum potential of a women to give birth whereas fertility is the actual number of offspring produced by WRA i.e. 15 to 49 years. As per Macro Trends, the fertility rate of Nepal is 1.880 births per woman in 2020 which is a 1.42% decline from 2019.
Some of the factors which affect fertility are:
a) Biological factors: Age and sex are biological factors which affects fertility. Onset of menstruation is the phase from which a girl can give birth to a child and menopause is the pause of menstruation indicating that she can no longer give birth to a child. The age at which women are most fertile is 20 to 25 years, at 38 years fecundity starts to decline slowly and at 40 to 49 years, it ceases.
b) Psychological factors: When a girl marries in an early age, the gap of cohabitation and giving birth is longer as the reproductive organ of girl is not mature enough to give birth to a child. Marital disruption, onset of permanent sterility determines the reproductive span and postpartum infecundability (condition where menstrual cycle is not resumed), natural infecundity, frequency of intercourse, use and effectiveness of contraception, still birth and induced abortion determines the rate of child bearing.
c) Social factors: Religion, caste, race, family system, education, health status of women are some of the social factors affecting fertility. In Nepal, women with high number of children were considered to be of high esteem in early days, now the concept is changing slowly and Nepal is moving to “Small family is equal to happy family”. In developed countries with high literacy rate, fertility is low. In contradiction, developing nations have high fertility rate where literacy rate is also low.
d) Economic factors: Urbanization, occupation and economic status affects fertility. As per Statistica, the unemployment rate in Nepal is 1.47% in 2020 and urbanization rate was found to be 20.15% in 2019. In urban areas of Nepal, number of children is found to be less. Employed women are found to reproduce less babies. In developed country, in order to maintain the standard life, people are found to give birth in less number whereas in developing nations, people give birth in high numbers in order to support the family.
e) Family Planning: Due to social taboos, restriction, ignorance, poverty and lack of education people in developing nations lag behind to use the contraceptive devices. As per NDHS 2016, 53% of currently married women use method of contraceptive device in Nepal. Only, 15% of married women of 15 to 19 years use a modern method of contraception. Family planning is also one of the determinant of fertility.
Above mentioned factors are associated with fertility.
Red Cycle Bracelet (The Menstrual Bracelet)
One intervention from Nepal in support of fertility awareness is Red Cycle Bracelet. Red Cycle Bracelet is innovated by SOCHAI-Youth For Nutrition. In order to learn how this red cycle bracelet works as a tool for fertility awareness, following are some of the terminologies which needs to be considered at first:
Ovarian Follicle– Ovarian follicles are small sacks filled with fluid which is found in the ovary of women.
Follicle stimulation hormone (FSH)– Follicle stimulating hormone is the gonadotrophic hormone released by the pituitary gland, it stimulates the growth of ovarian follicle in the ovary.
Estrogen– Estrogen is a hormone which develop and maintain both the reproductive system and characteristics like breasts and public hair in females. Ovaries produce estrogen before menopause and after the menopause, estrogens are produced by fat tissues.
Luteinizing Hormone (LH)– Luteinizing hormone is produced by pituitary gland and it triggers the release of an egg from the ovary which is known as ovulation.
Corpus luteum– Corpus luteum is a mass of cells that forms in an ovary. It produces a progesterone.
Progesterone– Progesterone is a steroid hormone produced by corpus luteum which helps in maintaining the early stages of pregnancy (if occurs) and it is a part of second half of the menstrual cycle.
Ovulation– In every menstrual cycle, hormone changes trigger an ovary to release an egg, this process is known as ovulation.
The Menstrual Bracelet is based on calendar method and different color of beads are arranged in order to track an average menstrual cycle of 28 days. Now, we will move on how the red cycle bracelet works with the first color i.e., red.
|1st, 2nd, 3rd, 4th, 5th
|The beads denotes the five days of menstrual cycle where blood and tissue from lining of uterus is discharged from vagina
|In clockwise direction from red beads, transparent and colorless represents the end of bleeding. In some women, bleeding may last for 7 days.
|Flowery silver bead
|Between 7th and 8th
|The window of 7 days is marked by a flowery silver bead.
|This bead indicates the pre-ovulation phase.
|Flowery silver bead and transparent beads
|10th, 11th, 12th, 13th
|The beads represent the most fertile days before ovulation. In this phase, FSH stimulates the ovaries to produce a matured egg. This maturing process produces estrogen. Estrogen thickens the lining of uterus with nutrients and blood, so in case of pregnancy, it could support the eggs. Estrogen also stimulates the release of LH. LH triggers ovulation and helps in development of corpus luteum. Corpus luteum secretes progesterone to support the early stages of pregnancy (if fertilization occurs)
|Orange bead represent the day of ovulation (usually) where a matured egg is released. During this day, bloating, discomfort or a little pain in lower belly may be felt.
|An egg can live for 24 hours after ovulation and sperm can live in the body for about 6 days after sex. So, these three days are most fertile days. 10 to 17 days are most fertile days in the cycle of 28 days.
|Flowery silver bead and transparent beads
|18th, 19th, 20th, 21th, 22nd, 23rd, 24th, 25th, 26th, 27th, 28th
|The 18th day indicate the beginning of post ovulation phase. If egg is not fertilized, level of estrogen and progesterone drops. The uterus does not need to maintain nutritious lining so, tissues starts to break down. From 20th to 28th days, women may feel stress levels, acne moodiness as the menstrual cycle is about to end. After 28th day, blood, nutrients, tissues flow out from vagina and a new cycle begins.
|Between 28th and 1st
|Indicates the strength, ease and patience to deal with cramp
I heard about Menstrual Bracelet for the first time in an international webinar. So, for you, what was the first source of information about Red Cycle Bracelet?
Esther Budha Magar,
Public Health Student,
Kantipur Academy of Health Science
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