Friday, July 22, 2016

Background characteristics of “sexless” marriages,are they increasing in India?

Background characteristics of “sexless” marriages,are they increasing in India?
Specially in the IT sector?

"In 1994 the Japan Society of Sexual Science described a couple as being “sexless” “if, despite the absence of unusual circumstances, there has been no consensual intercourse or other sexual contact between them for a month or longer and it is expected that such a state will further persist over a longer period of time” (Abe 2004: 18). Likewise, we define “sexless” couples here as those who are married or cohabitating and have not had any sexual intercourse with the spouse or partner for more than 1 month. Such “sexless” couples have been reported to be more numerous in Japan than one might think, and the reasons for their sexless status have been hypothesized in various magazines and books"

It is a well know fact that Japan suffers from  an abundance of old people and few young working  people to support them.
their policy of  anti immigration ( some thing that Trump is advocating;-) )

 I am seeing  more and more couples specially among the NRI' having a "long distance marriage" which is essentially a sexless marriage by the above given definition.

Get married soon and have your first child soon is there a need for changing some of the Indian laws?

 I am not advocating child marriages like they happen even today in  rajasthan and some other remote areas of India. But I think we have some lessons to learn from  Hispanic women

  There is a big disconnect between evolutionary biology and social context as far as fertility is concerned.

 There was a hue and cry over teenage pregnancies and a drive to root out this " evil"
but somehow Hispanic women are an exception.

 If one looks at the age of menarche  there is a downward trend, there are many explanations given and  also controversy ( see the exchange of letters in NEJM given at the end ).

But allover the world specially in the two most populous countries namely China and India the number of women remaining unmarried and also childless is growing.

One of the main reasons is late marriage and late age first birth.
May be Just may be we have some lessons to learn from  the Hispanic women

"There has been a lot of progress in reducing the number of teen pregnancies over the last few decades. Rates have declined across all ethnic groups. But according to new figures from the Centers for Disease Control, the teen birthrate among Hispanics is stubbornly high."


http://www.npr.org/2014/04/14/302906835/why-do-more-latina-teens-get-pregnant

Is the age at menarche really falling ?
■ Age of Menarche Chumlea WC, Schubert CM, Roche AF, et. al. Age at menarche and racial comparisons in US girls. Pediatrics 2003; 111(1): 110-113. While there is no consensus definition of a normal age range at menarche, this study indicates that the age of menarche occurs between 11.11 and 13.75 years of age for 80% of U.S. girls. Non-Hispanic black girls reach menarche slightly earlier at 10.52 years. The median age at menarche for all U.S. girls is 12.43 years. Only 10% of all girls begin menses before 11 years, or 10 years for non-Hispanic black girls, and 90% of all girls will be menstruating by 13 years. This data was collected from questionnaires to girls (12 to 20 years) and parents or guardians of girls (8 to 11 years). Data was collected from 2,510 girls enrolled in the Third National Health and Nutrition Examination Survey. Results were compared to data collected by the National Health Examination Survey 30 years ago. This data suggests that the median age at menarche for all U.S. girls had not changed significantly in 30 years  Teen pregnancy and birth rates are at historic lows. There has also been impressive progress in all 50 states and among all racial/ethnic groups. Even so, the success has been uneven. Despite a steady decrease in the teen pregnancy and birth rates among Latina teens over the last decade, their rates remain much higher than rates for teens overall. It is also the case that the Latino population is the largest and fastest growing minority group in the United States—by 2030, it is estimated that more than one-quarter of all teens will be Latino.1 Key Facts • The birth rate was 38.0 births per 1,000 Latina teens age 15-19 in 2014 (the most recent data available).2 • The teen pregnancy rate, which factors in both those pregnancies that ended in a birth and those that did not, was 73.5 per 1,000 Latina teens age 15-19 in 2011 (the most recent pregnancy data available).3 • Roughly 1 in 3 Latina teens got pregnant at least once before age 20—one and a half times the national average.4 • Ongoing declines in both the pregnancy and birth rates for Latina teens suggest a more optimistic outlook. Both rates have fallen nearly continuously since 1
The Details: Pregnancy Data Overall The pregnancy rate for all teens declined 55% between 1990 (the peak year for teen pregnancy) and 2011.3 The pregnancy rate among Latina teens decreased 56% over this period (from 165.6 in 1991 to 73.5 pregnancies per 1,000 Latina teens in 2011), and fell by 11% just since 2010. The Latina teen pregnancy rate is somewhat lower than the rate among non-Hispanic black teen girls (73.5 compared to 92.6), and is more than double the rate for non-Hispanic white teen girls (35.3).3 By Age Group In 2009 (the most recent data available by race/ethnicity and age), the majority of pregnancies to Latina teens occurred among 18-19 year-olds, and the pregnancy rate among Latina teens age 18-19 was nearly triple that among girls age 15-17
3,5 • The teen pregnancy rate for Latina teens under age 15 was 1.9 per 1,000 in 2009. There was a 14% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 57% since 1990. There were approximately 4,000 pregnancies to Latina teens under age 15 in 2009. • The teen pregnancy rate for Latina teens age 15-17 was 61.1 per 1,000 in 2009. There was a 12% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 46% since 1990. There were approximately 79,000 pregnancies to Latina teens age 15-17 in 2009.

• The teen pregnancy rate for Latina teens age 18-19 was 158.9 per 1,000 in 2009. There was a 10% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 34% since 1990. There were approximately 136,000 pregnancies to Latina teens age 18-19 in 2009. By State • Pregnancy rates for Latina teens vary by state. In 2011 (the most recent data available by state), these rates ranged from a low of 19 per 1,000 in Vermont to a high of 95 per 1,000 in Georgia.6 • State specific pregnancy rates by race/ethnicity are available in the Data section of The National Campaign website at http://www.TheNationalCampaign.org/data/. The Details: Birth Data Overall The birth rate among all teens age 15-19 declined 61% between 1991 and 2014.2 The birth rate among Latina teens decreased 64% during this same period (from 104.6 to 38.0 births per 1,000 Latina teens respectively), and fell by 9% in the last year alone. Additional breakouts by age, parity, marital status, and state are available through 2012 or 2014, as described below. Latina teens currently have the highest birth rate among all teens—more than one and a half times higher than the overall teen birth rate.2 By Age Group In 2014, older teens (age 18-19) accounted for the majority of births to Latina teens, similar to teens overall. In fact, among Latina teens, 69% of births to girls age 15-19 were to older teens

• The birth rate for Latina teens age 10-14 was 0.4 per 1,000 in 2014. There was a decrease of 20% between 2013 and 2014, and an overall decrease of 83% since 1991. There were 1,037 births to Latinas younger than age 15 in 2014. • The birth rate for Latinas age 15-17 was 19.3 per 1,000 in 2014. There was a decrease of 12% between 2013 and 2014, and an overall decrease of 72% since 1991. There were 26,295 births to Latinas age 15-17 in 2014. • The birth rate for Latinas age 18-19 was 66.1 per 1,000 in 2014. There was a decrease of 7% between 2013 and 2014, and an overall decrease of 57% since 1991. There were 59,675 births to Latinas age 18-19 in 2014. By Parity • Most births to Latina teens are first births. In 2014, 80% of births to Latina teens age 15-19 were first births—17% were second births and the remainder were births to Latinas who had two or more previous births.2 • Among all Latina teen mothers, 20% will have at least one additional birth by the time they reach age 20.7 By State • In 2012, Latina teen birth rates varied from a low of 28.2 per 1,000 Latina teens in Florida to a high of 67.4 per 1,000 in Oklahoma.2 • State specific birth rates by race/ethnicity are available in the Data section of The National Campaign website at http://www.TheNationalCampaign.org/data/.


To the Editor: Last summer Science magazine published an article refuting the widely held idea that the age of menarche has been occurring earlier with each decade.' Now the Journal has come up with an article "confirming" the early-maturation view — that is, the change in age at which such maturity is said to occur.' How is the ordinary reader supposed to know what to believe? The article in Science claimed that the data commonly used, from studies in Norway, have been misinterpreted. The writers offered evidence that as far back as the Middle Ages menarche was occur-ring between the ages of 12 and 13. A home medical journal pub-lished in the United States in the 1830s gave the same age figures. And I recall that in the 1930s the maker of Kotex was running magazine ads headlined "Marjory May's Twelfth Birthday," which hinted at a mysterious happening in a girl's life near that time. Climate and maturity are generally believed to be linked. Girls whose ancestry lies in cold climates mature later than those whose ancestors came from warm countries. So how could it be valid, really, to use studies of Norwegian women to prove late maturity for all of the West 200 years ago? Furthermore, can we be sure that medical records of past eras are copious and precise enough to pinpoint monthly declines in the age of menarche? Gynecology is a relatively new medical specialty, after all, and it wasn't until the 19th century that doctors were even involved in treating pregnancy and childbirth.
FRANCES FRECH Kansas City, MO 64113 Population Renewal Office 1. Bullough VL. Age at menarche: a misunderstanding. Science. 1981; 213:365-6. 2. Wyshak G. Frisch RE. Evidence for a secular trend in age of menarche. N Engl J Med. 1982; 306:1033-5.
Brieger GH, ed. Theory and practice in American medicine. New York: Science History Publications, 1976:124-6. 6. Frisch RE. Influences on age of menarche. Lancet. 1973; 1:1007-8. 7. Raciborski MA. De la puberte et de !lige critique chez la femme. Paris. 1R44.4h

The above letter was referred to the authors of the article in question, who offer the following reply:
tion. In:


To the Editor: The long-term downward trend in age at menarche over the past century and a half is clear from the 218 reports on Europe that we analyzed and presented graphically in our article. The decline is estimated to be about 2.3 months per decade on the basis of a regression analysis that quantified the rate of change over the entire time period. This estimate is statistically significant —i.e., not likely to be due to chance (P<0 .001="" 1.2="" 12.0="" 12="" 13.0="" 13.2="" 13.5="" 14.4="" 14.75="" 1795="" 1802="" 1844="" 1870="" 18th="" 1930.="" 1930="" 1930s="" 1981="" 19th="" a.="" a="" about="" academy="" admirably="" adolescent="" advertisement.="" affecting="" age="" ages="" already="" also="" an="" and="" as="" asked="" asserting="" at="" average="" basis="" been="" begin="" being="" believe="" benjamin="" between="" by="" cease="" centuries.="" century="" children="" clark="" con-sidered="" conditions="" connected="" considered.2-="" decline="" declining="" delayed="" deviation="" direct="" do="" dr.="" during="" england="" environmental="" even="" example="" experiment="" explore="" factors="" fecundity="" female="" follows="" for="" france="" frech="" from="" germany="" girls="" graph="" great="" growth="" had="" half.="" has="" hastened="" have="" height="" his.="" historical="" historically="" how="" in="" included:="" incorrect="" increase="" interest="" investigators="" is="" it="" jefferson="" know="" knowledge="" kotex="" lacked="" laureate="" life="" like="" list="" long-term="" long="" m.="" marry="" mean="" medical="" medicine="" men-arche="" menarche.2="" menarche.63="" menarche="" menstruate="" meriwether="" middle="" missouri="" music="" not="" nutrition="" o:p="" occurred="" of="" on="" one="" or="" other="" our="" over="" paris="" past="" physical="" physicians="" poor="" presented="" president="" profes-sion="" psychological="" questions="" raciborski="" ranged="" reader="" recounted="" reported="" reproduction.="" results="" river.="" royal="" rush="" s="" scandinavia="" secular="" separately.="" showed="" significant="" similar="" solid="" spurt="" standard="" states="" statistically="" stress.="" subjects="" suckle="" sweet="" t="" taking="" talics="" test="" that="" the="" there="" therefore="" they="" thirds="" this="" to="" today.="" two="" undernu-trition="" undernutrition="" united="" unlikely="" very="" was="" we="" weight.="" were="" what="" when="" whether="" who="" with="" women="" would="" year="" years.="" years="">
Cambridge, MA 02138
GRACE WYSHAK, PH.D. ROSE E. FRISCH, PH.D. Harvard Center for Population Studies

1.       Tanner JM. Growth at adolescence. 2d. ed. London: Blackwell, 1962:94-143. 2. Fluhmann CF. The management of menstrual disorders. Philadelphia: WB Saunders, 1976:61-8. 3. Backman G. Die beschleunigte Entwicklund der Jugend: verfriihte menarche verspatete menopause, verlingerte Lebensdauer. Acta Anat (Basel). 1948; 4:421-80. 4. Frisch RE. Population, food intake and fertility. Science. 1978; 199:22-30. 5. Will DW. The medical and surgical practice of the Lewis and Clark expedi-tion. In: Brieger GH, ed. Theory and practice in American medicine. New York: Science History Publications, 1976:124-6. 6. Frisch RE. Influences on age of menarche. Lancet. 1973; 1:1007-8. 7. Raciborski MA. De la pubend et de Fagg critique chez la femme. Paris. 1844:46.


http://www.racgp.org.au/afp/2012/may/making-decisions-about-fertility/

Get married soon and have your first child soon is there a need for changing some of the Indian laws?

 I am not advocating child marriages like they happen even today in  rajasthan and some other remote areas of India. But I think we have some lessons to learn from  Hispanic women

  There is a big disconnect between evolutionary biology and social context as far as fertility is concerned.

 There was a hue and cry over teenage pregnancies and a drive to root out this " evil"
but somehow Hispanic women are an exception.

 If one looks at the age of menarche  there is a downward trend, there are many explanations given and  also controversy ( see the exchange of letters in NEJM given at the end ).

But allover the world specially in the two most populous countries namely China and India the number of women remaining unmarried and also childless is growing.

One of the main reasons is late marriage and late age first birth.
May be Just may be we have some lessons to learn from  the Hispanic women

"There has been a lot of progress in reducing the number of teen pregnancies over the last few decades. Rates have declined across all ethnic groups. But according to new figures from the Centers for Disease Control, the teen birthrate among Hispanics is stubbornly high."


http://www.npr.org/2014/04/14/302906835/why-do-more-latina-teens-get-pregnant

Is the age at menarche really falling ?
■ Age of Menarche Chumlea WC, Schubert CM, Roche AF, et. al. Age at menarche and racial comparisons in US girls. Pediatrics 2003; 111(1): 110-113. While there is no consensus definition of a normal age range at menarche, this study indicates that the age of menarche occurs between 11.11 and 13.75 years of age for 80% of U.S. girls. Non-Hispanic black girls reach menarche slightly earlier at 10.52 years. The median age at menarche for all U.S. girls is 12.43 years. Only 10% of all girls begin menses before 11 years, or 10 years for non-Hispanic black girls, and 90% of all girls will be menstruating by 13 years. This data was collected from questionnaires to girls (12 to 20 years) and parents or guardians of girls (8 to 11 years). Data was collected from 2,510 girls enrolled in the Third National Health and Nutrition Examination Survey. Results were compared to data collected by the National Health Examination Survey 30 years ago. This data suggests that the median age at menarche for all U.S. girls had not changed significantly in 30 years  Teen pregnancy and birth rates are at historic lows. There has also been impressive progress in all 50 states and among all racial/ethnic groups. Even so, the success has been uneven. Despite a steady decrease in the teen pregnancy and birth rates among Latina teens over the last decade, their rates remain much higher than rates for teens overall. It is also the case that the Latino population is the largest and fastest growing minority group in the United States—by 2030, it is estimated that more than one-quarter of all teens will be Latino.1 Key Facts • The birth rate was 38.0 births per 1,000 Latina teens age 15-19 in 2014 (the most recent data available).2 • The teen pregnancy rate, which factors in both those pregnancies that ended in a birth and those that did not, was 73.5 per 1,000 Latina teens age 15-19 in 2011 (the most recent pregnancy data available).3 • Roughly 1 in 3 Latina teens got pregnant at least once before age 20—one and a half times the national average.4 • Ongoing declines in both the pregnancy and birth rates for Latina teens suggest a more optimistic outlook. Both rates have fallen nearly continuously since 1
The Details: Pregnancy Data Overall The pregnancy rate for all teens declined 55% between 1990 (the peak year for teen pregnancy) and 2011.3 The pregnancy rate among Latina teens decreased 56% over this period (from 165.6 in 1991 to 73.5 pregnancies per 1,000 Latina teens in 2011), and fell by 11% just since 2010. The Latina teen pregnancy rate is somewhat lower than the rate among non-Hispanic black teen girls (73.5 compared to 92.6), and is more than double the rate for non-Hispanic white teen girls (35.3).3 By Age Group In 2009 (the most recent data available by race/ethnicity and age), the majority of pregnancies to Latina teens occurred among 18-19 year-olds, and the pregnancy rate among Latina teens age 18-19 was nearly triple that among girls age 15-17
3,5 • The teen pregnancy rate for Latina teens under age 15 was 1.9 per 1,000 in 2009. There was a 14% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 57% since 1990. There were approximately 4,000 pregnancies to Latina teens under age 15 in 2009. • The teen pregnancy rate for Latina teens age 15-17 was 61.1 per 1,000 in 2009. There was a 12% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 46% since 1990. There were approximately 79,000 pregnancies to Latina teens age 15-17 in 2009.

• The teen pregnancy rate for Latina teens age 18-19 was 158.9 per 1,000 in 2009. There was a 10% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 34% since 1990. There were approximately 136,000 pregnancies to Latina teens age 18-19 in 2009. By State • Pregnancy rates for Latina teens vary by state. In 2011 (the most recent data available by state), these rates ranged from a low of 19 per 1,000 in Vermont to a high of 95 per 1,000 in Georgia.6 • State specific pregnancy rates by race/ethnicity are available in the Data section of The National Campaign website at http://www.TheNationalCampaign.org/data/. The Details: Birth Data Overall The birth rate among all teens age 15-19 declined 61% between 1991 and 2014.2 The birth rate among Latina teens decreased 64% during this same period (from 104.6 to 38.0 births per 1,000 Latina teens respectively), and fell by 9% in the last year alone. Additional breakouts by age, parity, marital status, and state are available through 2012 or 2014, as described below. Latina teens currently have the highest birth rate among all teens—more than one and a half times higher than the overall teen birth rate.2 By Age Group In 2014, older teens (age 18-19) accounted for the majority of births to Latina teens, similar to teens overall. In fact, among Latina teens, 69% of births to girls age 15-19 were to older teens

• The birth rate for Latina teens age 10-14 was 0.4 per 1,000 in 2014. There was a decrease of 20% between 2013 and 2014, and an overall decrease of 83% since 1991. There were 1,037 births to Latinas younger than age 15 in 2014. • The birth rate for Latinas age 15-17 was 19.3 per 1,000 in 2014. There was a decrease of 12% between 2013 and 2014, and an overall decrease of 72% since 1991. There were 26,295 births to Latinas age 15-17 in 2014. • The birth rate for Latinas age 18-19 was 66.1 per 1,000 in 2014. There was a decrease of 7% between 2013 and 2014, and an overall decrease of 57% since 1991. There were 59,675 births to Latinas age 18-19 in 2014. By Parity • Most births to Latina teens are first births. In 2014, 80% of births to Latina teens age 15-19 were first births—17% were second births and the remainder were births to Latinas who had two or more previous births.2 • Among all Latina teen mothers, 20% will have at least one additional birth by the time they reach age 20.7 By State • In 2012, Latina teen birth rates varied from a low of 28.2 per 1,000 Latina teens in Florida to a high of 67.4 per 1,000 in Oklahoma.2 • State specific birth rates by race/ethnicity are available in the Data section of The National Campaign website at http://www.TheNationalCampaign.org/data/.


To the Editor: Last summer Science magazine published an article refuting the widely held idea that the age of menarche has been occurring earlier with each decade.' Now the Journal has come up with an article "confirming" the early-maturation view — that is, the change in age at which such maturity is said to occur.' How is the ordinary reader supposed to know what to believe? The article in Science claimed that the data commonly used, from studies in Norway, have been misinterpreted. The writers offered evidence that as far back as the Middle Ages menarche was occur-ring between the ages of 12 and 13. A home medical journal pub-lished in the United States in the 1830s gave the same age figures. And I recall that in the 1930s the maker of Kotex was running magazine ads headlined "Marjory May's Twelfth Birthday," which hinted at a mysterious happening in a girl's life near that time. Climate and maturity are generally believed to be linked. Girls whose ancestry lies in cold climates mature later than those whose ancestors came from warm countries. So how could it be valid, really, to use studies of Norwegian women to prove late maturity for all of the West 200 years ago? Furthermore, can we be sure that medical records of past eras are copious and precise enough to pinpoint monthly declines in the age of menarche? Gynecology is a relatively new medical specialty, after all, and it wasn't until the 19th century that doctors were even involved in treating pregnancy and childbirth.
FRANCES FRECH Kansas City, MO 64113 Population Renewal Office 1. Bullough VL. Age at menarche: a misunderstanding. Science. 1981; 213:365-6. 2. Wyshak G. Frisch RE. Evidence for a secular trend in age of menarche. N Engl J Med. 1982; 306:1033-5.
Brieger GH, ed. Theory and practice in American medicine. New York: Science History Publications, 1976:124-6. 6. Frisch RE. Influences on age of menarche. Lancet. 1973; 1:1007-8. 7. Raciborski MA. De la puberte et de !lige critique chez la femme. Paris. 1R44.4h

The above letter was referred to the authors of the article in question, who offer the following reply:
tion. In:


To the Editor: The long-term downward trend in age at menarche over the past century and a half is clear from the 218 reports on Europe that we analyzed and presented graphically in our article. The decline is estimated to be about 2.3 months per decade on the basis of a regression analysis that quantified the rate of change over the entire time period. This estimate is statistically significant —i.e., not likely to be due to chance (P<0 .001="" 1.2="" 12.0="" 12="" 13.0="" 13.2="" 13.5="" 14.4="" 14.75="" 1795="" 1802="" 1844="" 1870="" 18th="" 1930.="" 1930="" 1930s="" 1981="" 19th="" a.="" a="" about="" academy="" admirably="" adolescent="" advertisement.="" affecting="" age="" ages="" already="" also="" an="" and="" as="" asked="" asserting="" at="" average="" basis="" been="" begin="" being="" believe="" benjamin="" between="" by="" cease="" centuries.="" century="" children="" clark="" con-sidered="" conditions="" connected="" considered.2-="" decline="" declining="" delayed="" deviation="" direct="" do="" dr.="" during="" england="" environmental="" even="" example="" experiment="" explore="" factors="" fecundity="" female="" follows="" for="" france="" frech="" from="" germany="" girls="" graph="" great="" growth="" had="" half.="" has="" hastened="" have="" height="" his.="" historical="" historically="" how="" in="" included:="" incorrect="" increase="" interest="" investigators="" is="" it="" jefferson="" know="" knowledge="" kotex="" lacked="" laureate="" life="" like="" list="" long-term="" long="" m.="" marry="" mean="" medical="" medicine="" men-arche="" menarche.2="" menarche.63="" menarche="" menstruate="" meriwether="" middle="" missouri="" music="" not="" nutrition="" o:p="" occurred="" of="" on="" one="" or="" other="" our="" over="" paris="" past="" physical="" physicians="" poor="" presented="" president="" profes-sion="" psychological="" questions="" raciborski="" ranged="" reader="" recounted="" reported="" reproduction.="" results="" river.="" royal="" rush="" s="" scandinavia="" secular="" separately.="" showed="" significant="" similar="" solid="" spurt="" standard="" states="" statistically="" stress.="" subjects="" suckle="" sweet="" t="" taking="" talics="" test="" that="" the="" there="" therefore="" they="" thirds="" this="" to="" today.="" two="" undernu-trition="" undernutrition="" united="" unlikely="" very="" was="" we="" weight.="" were="" what="" when="" whether="" who="" with="" women="" would="" year="" years.="" years="">
Cambridge, MA 02138
GRACE WYSHAK, PH.D. ROSE E. FRISCH, PH.D. Harvard Center for Population Studies

1.       Tanner JM. Growth at adolescence. 2d. ed. London: Blackwell, 1962:94-143. 2. Fluhmann CF. The management of menstrual disorders. Philadelphia: WB Saunders, 1976:61-8. 3. Backman G. Die beschleunigte Entwicklund der Jugend: verfriihte menarche verspatete menopause, verlingerte Lebensdauer. Acta Anat (Basel). 1948; 4:421-80. 4. Frisch RE. Population, food intake and fertility. Science. 1978; 199:22-30. 5. Will DW. The medical and surgical practice of the Lewis and Clark expedi-tion. In: Brieger GH, ed. Theory and practice in American medicine. New York: Science History Publications, 1976:124-6. 6. Frisch RE. Influences on age of menarche. Lancet. 1973; 1:1007-8. 7. Raciborski MA. De la pubend et de Fagg critique chez la femme. Paris. 1844:46.


http://www.racgp.org.au/afp/2012/may/making-decisions-about-fertility/

Get married soon and have your first child soon is there a need for changing some of the Indian laws?

 I am not advocating child marriages like they happen even today in  rajasthan and some other remote areas of India. But I think we have some lessons to learn from  Hispanic women

  There is a big disconnect between evolutionary biology and social context as far as fertility is concerned.

 There was a hue and cry over teenage pregnancies and a drive to root out this " evil"
but somehow Hispanic women are an exception.

 If one looks at the age of menarche  there is a downward trend, there are many explanations given and  also controversy ( see the exchange of letters in NEJM given at the end ).

But allover the world specially in the two most populous countries namely China and India the number of women remaining unmarried and also childless is growing.

One of the main reasons is late marriage and late age first birth.
May be Just may be we have some lessons to learn from  the Hispanic women

"There has been a lot of progress in reducing the number of teen pregnancies over the last few decades. Rates have declined across all ethnic groups. But according to new figures from the Centers for Disease Control, the teen birthrate among Hispanics is stubbornly high."


http://www.npr.org/2014/04/14/302906835/why-do-more-latina-teens-get-pregnant

Is the age at menarche really falling ?
■ Age of Menarche Chumlea WC, Schubert CM, Roche AF, et. al. Age at menarche and racial comparisons in US girls. Pediatrics 2003; 111(1): 110-113. While there is no consensus definition of a normal age range at menarche, this study indicates that the age of menarche occurs between 11.11 and 13.75 years of age for 80% of U.S. girls. Non-Hispanic black girls reach menarche slightly earlier at 10.52 years. The median age at menarche for all U.S. girls is 12.43 years. Only 10% of all girls begin menses before 11 years, or 10 years for non-Hispanic black girls, and 90% of all girls will be menstruating by 13 years. This data was collected from questionnaires to girls (12 to 20 years) and parents or guardians of girls (8 to 11 years). Data was collected from 2,510 girls enrolled in the Third National Health and Nutrition Examination Survey. Results were compared to data collected by the National Health Examination Survey 30 years ago. This data suggests that the median age at menarche for all U.S. girls had not changed significantly in 30 years  Teen pregnancy and birth rates are at historic lows. There has also been impressive progress in all 50 states and among all racial/ethnic groups. Even so, the success has been uneven. Despite a steady decrease in the teen pregnancy and birth rates among Latina teens over the last decade, their rates remain much higher than rates for teens overall. It is also the case that the Latino population is the largest and fastest growing minority group in the United States—by 2030, it is estimated that more than one-quarter of all teens will be Latino.1 Key Facts • The birth rate was 38.0 births per 1,000 Latina teens age 15-19 in 2014 (the most recent data available).2 • The teen pregnancy rate, which factors in both those pregnancies that ended in a birth and those that did not, was 73.5 per 1,000 Latina teens age 15-19 in 2011 (the most recent pregnancy data available).3 • Roughly 1 in 3 Latina teens got pregnant at least once before age 20—one and a half times the national average.4 • Ongoing declines in both the pregnancy and birth rates for Latina teens suggest a more optimistic outlook. Both rates have fallen nearly continuously since 1
The Details: Pregnancy Data Overall The pregnancy rate for all teens declined 55% between 1990 (the peak year for teen pregnancy) and 2011.3 The pregnancy rate among Latina teens decreased 56% over this period (from 165.6 in 1991 to 73.5 pregnancies per 1,000 Latina teens in 2011), and fell by 11% just since 2010. The Latina teen pregnancy rate is somewhat lower than the rate among non-Hispanic black teen girls (73.5 compared to 92.6), and is more than double the rate for non-Hispanic white teen girls (35.3).3 By Age Group In 2009 (the most recent data available by race/ethnicity and age), the majority of pregnancies to Latina teens occurred among 18-19 year-olds, and the pregnancy rate among Latina teens age 18-19 was nearly triple that among girls age 15-17
3,5 • The teen pregnancy rate for Latina teens under age 15 was 1.9 per 1,000 in 2009. There was a 14% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 57% since 1990. There were approximately 4,000 pregnancies to Latina teens under age 15 in 2009. • The teen pregnancy rate for Latina teens age 15-17 was 61.1 per 1,000 in 2009. There was a 12% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 46% since 1990. There were approximately 79,000 pregnancies to Latina teens age 15-17 in 2009.

• The teen pregnancy rate for Latina teens age 18-19 was 158.9 per 1,000 in 2009. There was a 10% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 34% since 1990. There were approximately 136,000 pregnancies to Latina teens age 18-19 in 2009. By State • Pregnancy rates for Latina teens vary by state. In 2011 (the most recent data available by state), these rates ranged from a low of 19 per 1,000 in Vermont to a high of 95 per 1,000 in Georgia.6 • State specific pregnancy rates by race/ethnicity are available in the Data section of The National Campaign website at http://www.TheNationalCampaign.org/data/. The Details: Birth Data Overall The birth rate among all teens age 15-19 declined 61% between 1991 and 2014.2 The birth rate among Latina teens decreased 64% during this same period (from 104.6 to 38.0 births per 1,000 Latina teens respectively), and fell by 9% in the last year alone. Additional breakouts by age, parity, marital status, and state are available through 2012 or 2014, as described below. Latina teens currently have the highest birth rate among all teens—more than one and a half times higher than the overall teen birth rate.2 By Age Group In 2014, older teens (age 18-19) accounted for the majority of births to Latina teens, similar to teens overall. In fact, among Latina teens, 69% of births to girls age 15-19 were to older teens

• The birth rate for Latina teens age 10-14 was 0.4 per 1,000 in 2014. There was a decrease of 20% between 2013 and 2014, and an overall decrease of 83% since 1991. There were 1,037 births to Latinas younger than age 15 in 2014. • The birth rate for Latinas age 15-17 was 19.3 per 1,000 in 2014. There was a decrease of 12% between 2013 and 2014, and an overall decrease of 72% since 1991. There were 26,295 births to Latinas age 15-17 in 2014. • The birth rate for Latinas age 18-19 was 66.1 per 1,000 in 2014. There was a decrease of 7% between 2013 and 2014, and an overall decrease of 57% since 1991. There were 59,675 births to Latinas age 18-19 in 2014. By Parity • Most births to Latina teens are first births. In 2014, 80% of births to Latina teens age 15-19 were first births—17% were second births and the remainder were births to Latinas who had two or more previous births.2 • Among all Latina teen mothers, 20% will have at least one additional birth by the time they reach age 20.7 By State • In 2012, Latina teen birth rates varied from a low of 28.2 per 1,000 Latina teens in Florida to a high of 67.4 per 1,000 in Oklahoma.2 • State specific birth rates by race/ethnicity are available in the Data section of The National Campaign website at http://www.TheNationalCampaign.org/data/.


To the Editor: Last summer Science magazine published an article refuting the widely held idea that the age of menarche has been occurring earlier with each decade.' Now the Journal has come up with an article "confirming" the early-maturation view — that is, the change in age at which such maturity is said to occur.' How is the ordinary reader supposed to know what to believe? The article in Science claimed that the data commonly used, from studies in Norway, have been misinterpreted. The writers offered evidence that as far back as the Middle Ages menarche was occur-ring between the ages of 12 and 13. A home medical journal pub-lished in the United States in the 1830s gave the same age figures. And I recall that in the 1930s the maker of Kotex was running magazine ads headlined "Marjory May's Twelfth Birthday," which hinted at a mysterious happening in a girl's life near that time. Climate and maturity are generally believed to be linked. Girls whose ancestry lies in cold climates mature later than those whose ancestors came from warm countries. So how could it be valid, really, to use studies of Norwegian women to prove late maturity for all of the West 200 years ago? Furthermore, can we be sure that medical records of past eras are copious and precise enough to pinpoint monthly declines in the age of menarche? Gynecology is a relatively new medical specialty, after all, and it wasn't until the 19th century that doctors were even involved in treating pregnancy and childbirth.
FRANCES FRECH Kansas City, MO 64113 Population Renewal Office 1. Bullough VL. Age at menarche: a misunderstanding. Science. 1981; 213:365-6. 2. Wyshak G. Frisch RE. Evidence for a secular trend in age of menarche. N Engl J Med. 1982; 306:1033-5.
Brieger GH, ed. Theory and practice in American medicine. New York: Science History Publications, 1976:124-6. 6. Frisch RE. Influences on age of menarche. Lancet. 1973; 1:1007-8. 7. Raciborski MA. De la puberte et de !lige critique chez la femme. Paris. 1R44.4h

The above letter was referred to the authors of the article in question, who offer the following reply:
tion. In:


To the Editor: The long-term downward trend in age at menarche over the past century and a half is clear from the 218 reports on Europe that we analyzed and presented graphically in our article. The decline is estimated to be about 2.3 months per decade on the basis of a regression analysis that quantified the rate of change over the entire time period. This estimate is statistically significant —i.e., not likely to be due to chance (P<0 .001="" 1.2="" 12.0="" 12="" 13.0="" 13.2="" 13.5="" 14.4="" 14.75="" 1795="" 1802="" 1844="" 1870="" 18th="" 1930.="" 1930="" 1930s="" 1981="" 19th="" a.="" a="" about="" academy="" admirably="" adolescent="" advertisement.="" affecting="" age="" ages="" already="" also="" an="" and="" as="" asked="" asserting="" at="" average="" basis="" been="" begin="" being="" believe="" benjamin="" between="" by="" cease="" centuries.="" century="" children="" clark="" con-sidered="" conditions="" connected="" considered.2-="" decline="" declining="" delayed="" deviation="" direct="" do="" dr.="" during="" england="" environmental="" even="" example="" experiment="" explore="" factors="" fecundity="" female="" follows="" for="" france="" frech="" from="" germany="" girls="" graph="" great="" growth="" had="" half.="" has="" hastened="" have="" height="" his.="" historical="" historically="" how="" in="" included:="" incorrect="" increase="" interest="" investigators="" is="" it="" jefferson="" know="" knowledge="" kotex="" lacked="" laureate="" life="" like="" list="" long-term="" long="" m.="" marry="" mean="" medical="" medicine="" men-arche="" menarche.2="" menarche.63="" menarche="" menstruate="" meriwether="" middle="" missouri="" music="" not="" nutrition="" o:p="" occurred="" of="" on="" one="" or="" other="" our="" over="" paris="" past="" physical="" physicians="" poor="" presented="" president="" profes-sion="" psychological="" questions="" raciborski="" ranged="" reader="" recounted="" reported="" reproduction.="" results="" river.="" royal="" rush="" s="" scandinavia="" secular="" separately.="" showed="" significant="" similar="" solid="" spurt="" standard="" states="" statistically="" stress.="" subjects="" suckle="" sweet="" t="" taking="" talics="" test="" that="" the="" there="" therefore="" they="" thirds="" this="" to="" today.="" two="" undernu-trition="" undernutrition="" united="" unlikely="" very="" was="" we="" weight.="" were="" what="" when="" whether="" who="" with="" women="" would="" year="" years.="" years="">
Cambridge, MA 02138
GRACE WYSHAK, PH.D. ROSE E. FRISCH, PH.D. Harvard Center for Population Studies

1.       Tanner JM. Growth at adolescence. 2d. ed. London: Blackwell, 1962:94-143. 2. Fluhmann CF. The management of menstrual disorders. Philadelphia: WB Saunders, 1976:61-8. 3. Backman G. Die beschleunigte Entwicklund der Jugend: verfriihte menarche verspatete menopause, verlingerte Lebensdauer. Acta Anat (Basel). 1948; 4:421-80. 4. Frisch RE. Population, food intake and fertility. Science. 1978; 199:22-30. 5. Will DW. The medical and surgical practice of the Lewis and Clark expedi-tion. In: Brieger GH, ed. Theory and practice in American medicine. New York: Science History Publications, 1976:124-6. 6. Frisch RE. Influences on age of menarche. Lancet. 1973; 1:1007-8. 7. Raciborski MA. De la pubend et de Fagg critique chez la femme. Paris. 1844:46.


http://www.racgp.org.au/afp/2012/may/making-decisions-about-fertility/

Get married soon and have your first child soon is there a need for changing some of the Indian laws?

 I am not advocating child marriages like they happen even today in  rajasthan and some other remote areas of India. But I think we have some lessons to learn from  Hispanic women

  There is a big disconnect between evolutionary biology and social context as far as fertility is concerned.

 There was a hue and cry over teenage pregnancies and a drive to root out this " evil"
but somehow Hispanic women are an exception.

 If one looks at the age of menarche  there is a downward trend, there are many explanations given and  also controversy ( see the exchange of letters in NEJM given at the end ).

But allover the world specially in the two most populous countries namely China and India the number of women remaining unmarried and also childless is growing.

One of the main reasons is late marriage and late age first birth.
May be Just may be we have some lessons to learn from  the Hispanic women

"There has been a lot of progress in reducing the number of teen pregnancies over the last few decades. Rates have declined across all ethnic groups. But according to new figures from the Centers for Disease Control, the teen birthrate among Hispanics is stubbornly high."


http://www.npr.org/2014/04/14/302906835/why-do-more-latina-teens-get-pregnant

Is the age at menarche really falling ?
■ Age of Menarche Chumlea WC, Schubert CM, Roche AF, et. al. Age at menarche and racial comparisons in US girls. Pediatrics 2003; 111(1): 110-113. While there is no consensus definition of a normal age range at menarche, this study indicates that the age of menarche occurs between 11.11 and 13.75 years of age for 80% of U.S. girls. Non-Hispanic black girls reach menarche slightly earlier at 10.52 years. The median age at menarche for all U.S. girls is 12.43 years. Only 10% of all girls begin menses before 11 years, or 10 years for non-Hispanic black girls, and 90% of all girls will be menstruating by 13 years. This data was collected from questionnaires to girls (12 to 20 years) and parents or guardians of girls (8 to 11 years). Data was collected from 2,510 girls enrolled in the Third National Health and Nutrition Examination Survey. Results were compared to data collected by the National Health Examination Survey 30 years ago. This data suggests that the median age at menarche for all U.S. girls had not changed significantly in 30 years  Teen pregnancy and birth rates are at historic lows. There has also been impressive progress in all 50 states and among all racial/ethnic groups. Even so, the success has been uneven. Despite a steady decrease in the teen pregnancy and birth rates among Latina teens over the last decade, their rates remain much higher than rates for teens overall. It is also the case that the Latino population is the largest and fastest growing minority group in the United States—by 2030, it is estimated that more than one-quarter of all teens will be Latino.1 Key Facts • The birth rate was 38.0 births per 1,000 Latina teens age 15-19 in 2014 (the most recent data available).2 • The teen pregnancy rate, which factors in both those pregnancies that ended in a birth and those that did not, was 73.5 per 1,000 Latina teens age 15-19 in 2011 (the most recent pregnancy data available).3 • Roughly 1 in 3 Latina teens got pregnant at least once before age 20—one and a half times the national average.4 • Ongoing declines in both the pregnancy and birth rates for Latina teens suggest a more optimistic outlook. Both rates have fallen nearly continuously since 1
The Details: Pregnancy Data Overall The pregnancy rate for all teens declined 55% between 1990 (the peak year for teen pregnancy) and 2011.3 The pregnancy rate among Latina teens decreased 56% over this period (from 165.6 in 1991 to 73.5 pregnancies per 1,000 Latina teens in 2011), and fell by 11% just since 2010. The Latina teen pregnancy rate is somewhat lower than the rate among non-Hispanic black teen girls (73.5 compared to 92.6), and is more than double the rate for non-Hispanic white teen girls (35.3).3 By Age Group In 2009 (the most recent data available by race/ethnicity and age), the majority of pregnancies to Latina teens occurred among 18-19 year-olds, and the pregnancy rate among Latina teens age 18-19 was nearly triple that among girls age 15-17
3,5 • The teen pregnancy rate for Latina teens under age 15 was 1.9 per 1,000 in 2009. There was a 14% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 57% since 1990. There were approximately 4,000 pregnancies to Latina teens under age 15 in 2009. • The teen pregnancy rate for Latina teens age 15-17 was 61.1 per 1,000 in 2009. There was a 12% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 46% since 1990. There were approximately 79,000 pregnancies to Latina teens age 15-17 in 2009.

• The teen pregnancy rate for Latina teens age 18-19 was 158.9 per 1,000 in 2009. There was a 10% decrease in the rate between 2008 and 2009, and there has been an overall decrease of 34% since 1990. There were approximately 136,000 pregnancies to Latina teens age 18-19 in 2009. By State • Pregnancy rates for Latina teens vary by state. In 2011 (the most recent data available by state), these rates ranged from a low of 19 per 1,000 in Vermont to a high of 95 per 1,000 in Georgia.6 • State specific pregnancy rates by race/ethnicity are available in the Data section of The National Campaign website at http://www.TheNationalCampaign.org/data/. The Details: Birth Data Overall The birth rate among all teens age 15-19 declined 61% between 1991 and 2014.2 The birth rate among Latina teens decreased 64% during this same period (from 104.6 to 38.0 births per 1,000 Latina teens respectively), and fell by 9% in the last year alone. Additional breakouts by age, parity, marital status, and state are available through 2012 or 2014, as described below. Latina teens currently have the highest birth rate among all teens—more than one and a half times higher than the overall teen birth rate.2 By Age Group In 2014, older teens (age 18-19) accounted for the majority of births to Latina teens, similar to teens overall. In fact, among Latina teens, 69% of births to girls age 15-19 were to older teens

• The birth rate for Latina teens age 10-14 was 0.4 per 1,000 in 2014. There was a decrease of 20% between 2013 and 2014, and an overall decrease of 83% since 1991. There were 1,037 births to Latinas younger than age 15 in 2014. • The birth rate for Latinas age 15-17 was 19.3 per 1,000 in 2014. There was a decrease of 12% between 2013 and 2014, and an overall decrease of 72% since 1991. There were 26,295 births to Latinas age 15-17 in 2014. • The birth rate for Latinas age 18-19 was 66.1 per 1,000 in 2014. There was a decrease of 7% between 2013 and 2014, and an overall decrease of 57% since 1991. There were 59,675 births to Latinas age 18-19 in 2014. By Parity • Most births to Latina teens are first births. In 2014, 80% of births to Latina teens age 15-19 were first births—17% were second births and the remainder were births to Latinas who had two or more previous births.2 • Among all Latina teen mothers, 20% will have at least one additional birth by the time they reach age 20.7 By State • In 2012, Latina teen birth rates varied from a low of 28.2 per 1,000 Latina teens in Florida to a high of 67.4 per 1,000 in Oklahoma.2 • State specific birth rates by race/ethnicity are available in the Data section of The National Campaign website at http://www.TheNationalCampaign.org/data/.


To the Editor: Last summer Science magazine published an article refuting the widely held idea that the age of menarche has been occurring earlier with each decade.' Now the Journal has come up with an article "confirming" the early-maturation view — that is, the change in age at which such maturity is said to occur.' How is the ordinary reader supposed to know what to believe? The article in Science claimed that the data commonly used, from studies in Norway, have been misinterpreted. The writers offered evidence that as far back as the Middle Ages menarche was occur-ring between the ages of 12 and 13. A home medical journal pub-lished in the United States in the 1830s gave the same age figures. And I recall that in the 1930s the maker of Kotex was running magazine ads headlined "Marjory May's Twelfth Birthday," which hinted at a mysterious happening in a girl's life near that time. Climate and maturity are generally believed to be linked. Girls whose ancestry lies in cold climates mature later than those whose ancestors came from warm countries. So how could it be valid, really, to use studies of Norwegian women to prove late maturity for all of the West 200 years ago? Furthermore, can we be sure that medical records of past eras are copious and precise enough to pinpoint monthly declines in the age of menarche? Gynecology is a relatively new medical specialty, after all, and it wasn't until the 19th century that doctors were even involved in treating pregnancy and childbirth.
FRANCES FRECH Kansas City, MO 64113 Population Renewal Office 1. Bullough VL. Age at menarche: a misunderstanding. Science. 1981; 213:365-6. 2. Wyshak G. Frisch RE. Evidence for a secular trend in age of menarche. N Engl J Med. 1982; 306:1033-5.
Brieger GH, ed. Theory and practice in American medicine. New York: Science History Publications, 1976:124-6. 6. Frisch RE. Influences on age of menarche. Lancet. 1973; 1:1007-8. 7. Raciborski MA. De la puberte et de !lige critique chez la femme. Paris. 1R44.4h

The above letter was referred to the authors of the article in question, who offer the following reply:
tion. In:


To the Editor: The long-term downward trend in age at menarche over the past century and a half is clear from the 218 reports on Europe that we analyzed and presented graphically in our article. The decline is estimated to be about 2.3 months per decade on the basis of a regression analysis that quantified the rate of change over the entire time period. This estimate is statistically significant —i.e., not likely to be due to chance (P<0 .001="" 1.2="" 12.0="" 12="" 13.0="" 13.2="" 13.5="" 14.4="" 14.75="" 1795="" 1802="" 1844="" 1870="" 18th="" 1930.="" 1930="" 1930s="" 1981="" 19th="" a.="" a="" about="" academy="" admirably="" adolescent="" advertisement.="" affecting="" age="" ages="" already="" also="" an="" and="" as="" asked="" asserting="" at="" average="" basis="" been="" begin="" being="" believe="" benjamin="" between="" by="" cease="" centuries.="" century="" children="" clark="" con-sidered="" conditions="" connected="" considered.2-="" decline="" declining="" delayed="" deviation="" direct="" do="" dr.="" during="" england="" environmental="" even="" example="" experiment="" explore="" factors="" fecundity="" female="" follows="" for="" france="" frech="" from="" germany="" girls="" graph="" great="" growth="" had="" half.="" has="" hastened="" have="" height="" his.="" historical="" historically="" how="" in="" included:="" incorrect="" increase="" interest="" investigators="" is="" it="" jefferson="" know="" knowledge="" kotex="" lacked="" laureate="" life="" like="" list="" long-term="" long="" m.="" marry="" mean="" medical="" medicine="" men-arche="" menarche.2="" menarche.63="" menarche="" menstruate="" meriwether="" middle="" missouri="" music="" not="" nutrition="" o:p="" occurred="" of="" on="" one="" or="" other="" our="" over="" paris="" past="" physical="" physicians="" poor="" presented="" president="" profes-sion="" psychological="" questions="" raciborski="" ranged="" reader="" recounted="" reported="" reproduction.="" results="" river.="" royal="" rush="" s="" scandinavia="" secular="" separately.="" showed="" significant="" similar="" solid="" spurt="" standard="" states="" statistically="" stress.="" subjects="" suckle="" sweet="" t="" taking="" talics="" test="" that="" the="" there="" therefore="" they="" thirds="" this="" to="" today.="" two="" undernu-trition="" undernutrition="" united="" unlikely="" very="" was="" we="" weight.="" were="" what="" when="" whether="" who="" with="" women="" would="" year="" years.="" years="">
Cambridge, MA 02138
GRACE WYSHAK, PH.D. ROSE E. FRISCH, PH.D. Harvard Center for Population Studies

1.       Tanner JM. Growth at adolescence. 2d. ed. London: Blackwell, 1962:94-143. 2. Fluhmann CF. The management of menstrual disorders. Philadelphia: WB Saunders, 1976:61-8. 3. Backman G. Die beschleunigte Entwicklund der Jugend: verfriihte menarche verspatete menopause, verlingerte Lebensdauer. Acta Anat (Basel). 1948; 4:421-80. 4. Frisch RE. Population, food intake and fertility. Science. 1978; 199:22-30. 5. Will DW. The medical and surgical practice of the Lewis and Clark expedi-tion. In: Brieger GH, ed. Theory and practice in American medicine. New York: Science History Publications, 1976:124-6. 6. Frisch RE. Influences on age of menarche. Lancet. 1973; 1:1007-8. 7. Raciborski MA. De la pubend et de Fagg critique chez la femme. Paris. 1844:46.

Low Cost fertility treatment

According to the American Pregnancy Association, the cost for a single IVF cycle can range from at least $12,000-$17,000, and the success rate for each IVF cycle in the U.S. is as follows:
41-43% for women under age 35
33-36% for women ages 35 to 37
23-27% for women ages 38 to 40
13-18% for women ages over 40.

Out-of-pocket Costs/fee-for-service

The cost of undergoing IVF and intracytoplasmic sperm injection is highest in the United States, compared with other developed countries (30). The estimated cost for one cycle of IVF (approximately $12,500) represents 44% of annual disposable US income (30). The cost of undergoing intracytoplasmic sperm injection is usually $3,000 to $5,000 higher. The average cost per delivery using IVF is estimated to be more than $56,000 31 and 32.
These costs, combined with limited health insurance coverage, mean that out-of-pocket expenses for couples seeking infertility care are substantial. Wu et al. (33) analyzed cost diaries from 332 couples receiving care at eight different community and academic reproductive endocrinology clinics. Couples were treated with either medical therapy for ovulation induction medication, medical therapy for ovulation induction combined with IUI, or with IVF. Median out-of-pocket expenses ranged from $912 for couples using medication only to $19,234 for couples pursing IVF (33).
Men undergoing surgery for azoospermia may face costs in addition to the costs of ART. For those with nonobstructive azoospermia, outpatient testicular or epididymal biopsies alone, whether diagnostic or therapeutic, cost more than $500, with microsurgical epididymal or testicular sperm extraction costing upward of $5,000. Vasal reconstructive surgery or vasectomy reversal, for those with obstructive azoospermia, can cost up to $10,000. Out-of-pocket expenses are likely to be an important factor in the willingness and ability of couples to pursue evaluation and treatment for male factor infertility. These costs place significant financial strain on a family, even for couples with higher income and better insurance coverage, compared with the national average (Elliot et al. unpublished data). In one study of men seeking care for infertility, 64% spent more than $15,000 in out-of-pocket infertility-related expenses, which represented 16%–20% of their annual income. Forty-seven percent experienced financial strain, and 46% had treatment options limited by cost (Elliot et al. unpublished data).

As the  percentage  of  people  coming  for  IVF  showed  a downward trend in the last few years  mainly due to the cost involved  there is  rethinking  in reproductive medicine circles  about  Lowering the cost of  fertility treatments.

I think  this  has a great  relevance to a country like  India
  

USUAL Double speak about advanced Nurse practitioners

"ANPs are not supplanting doctors but complementing them and enhancing multidisciplinary teams' capabilities. This will need our active contribution to developing appropriate local roles and job descriptions for ANPs—they will be most successful in a mutually supportive multiprofessional team where there is good understanding of and ‘buy-in’ to their roles. The roles will need local tailoring and specification. Are there existing pathways or protocols that ANPS can support to provide less variable and higher quality care for frail older people?"


Advanced nurse practitioners in the care of frail older people: a challenge for geriatricians?

  1. E. C. Pulford
+Author Affiliations
  1. Department of GeratologyOxford University Hospitals NHS Foundation Trust, John Radcliffe HospitalOxford OX3 9PU, UK
  1. Address correspondence to: E. C. Pulford. Tel: (+44) 01865234176. Email:Claire.Pulford@ouh.nhs.uk

""ANPs are not supplanting doctors but complementing them and enhancing multidisciplinary teams' capabilities."


I can understand ANP's doing  primary care or helping a specialist but the idea of sending  a patient to see a specialist and then having the patient see an ANP is really dumb in my opinion.It may be  better  that  i treat the  patient  to the best of my ability.
what really irks me is in some hospitals privileges are given  to  the  ANP or PA based on the  power of the specialist.At the same  time   they refuse the  same  privileges to  a board certified internist.

However, there is a constant danger of staying alive:

However, there is a constant danger of staying alive: becoming older. Although all stages of the life course have their own consumer profile, they are not equally respected. The idealization of youthfulness promotes the image of an eternally young adult for whom age and generational differences don’t seem to exist. But this image is meant to satisfy the aged, not the young, who will still think that all these people are “old” and that aging should be avoided.
Typically, children want to become older, and older people want to stay young. In between, we fi nd young adults who don’t bother because age has not yet become an issue and those who are becoming aware that their ages are going up. Here, the anti-aging industry comes to the rescue, reconstructing the life course again by depicting aging as an avoidable decay and offering remedies that can never be consumed too soon. It makes young adults aware of the imminent dangers of staying alive and of what they could do about these dangers, building a billion-dollar industry involving cosmetic surgery, diets, nutritional supplements, resorts, and training regimes.

what does it actually mean to say that “60 is the new 30”?
“Take Years Off Your Looks and Add Them to Your Life”

Even when somebody feels fi ne, there is a widespread “gerontophobic shame”: the old person hides her hands, dyes her hair, tries to get rid of wrinkles, and feels she is in the way of all those young hurrying persons even if she evades rush hour

 A solution is offered for all parts of the body that suffer from Exclusion, Activism, and Eternal Youth 71 Newtonian gravity.

In the obsessive self preoccupation of the anti-aging culture, any diminishing sexual interest is made into something problematic for which all kinds of commercial solutions are offered, presented in a terminology of empowerment and emancipation (King and Calasanti 2006).

Whatever the problem—fear of failure, stress, depression—there is help in the form of the most advanced science,

A new sexual revolution is taking place. The first revolution separated sexuality from reproduction. This time, the revolution is aimed at the infinite continuation of sexual preoccupations: “forever functional” (Katz and Mar- 72 Aging and the Art of Living shall 2003; Marshall and Katz 2002).

 it is not surprising that according to recent surveys the pharmaceutical industry is much more interested in the development of “lifestyle drugs” than in developing medicines for rare and thus less lucrative diseases or for diseases that are predominant in poor countries
The desire not only to live better and improve living conditions for everyone but to escape senescing and death has a long and interesting history. The Greek mythological tales of the Argonauts tell us of the sorceress Medea, who transformed her father-in-law, Aeson, into a young man by cutting him into pieces and boiling him in fragrant spices, tomato, cypress, and, of course, magic herbs. Those herbs did the trick, for when the malicious Medea showed the daughters of Pelias the splendidly rejuvenated Aeson and seduced them into trying to do the same for their old father, things came to a bad end. They didn’t have the necessary magic herbs, and nothing remained of Pelias but the pieces.

 Even the famous Francis Bacon was engaged in scientific  research on the prolongation of life. In 1632 he published a manual in Latin that was translated into English as The Historie of Life and Death, with Observations Natural and Experimental for the Prolongation of Life. In it he advised using tobacco, opiates, betel nuts, and sex to stay young, since all these had a “fi ring” effect and thus fought senescing, which according to traditional Galenic insights consisted of “dehydration” and “chilling.” This belief brought him an early death. He caught a cold when carrying out an experiment in which he tried to prove that meat can be kept fresh by frosty air and then insisted that he should be nursed in a damp bed in order to prevent the feared “dehydration.” He died of pneumonia.

In such a world, where aging humans are portrayed as configurations of badly functioning parts, living longer will become a matter of maintenance, transplantation, or implantation of technical equipment or organs that are specially cultivated for such purposes.

As soon as aging is medicalized, death tends to be seen as the result of an illness that can not be fought effectively. According to the most prestigious classification of death causes, the “International Statistical Classification of Diseases and Related Health Problems,” “old age” cannot be a cause of death (Hayflick and Moody 2003).
'

Since this classification is used in the completion of legal death certificates, it might, according to Leonard Hayflick, even be illegal to declare that someone died of old age. There is no room for natural causes of death, although there is a category of unnatural causes (i.e., accidents and crimes). 

And may you stay forever young. BOB DYLAN, 1965

"dheerGAyushmAnbhava"

there are a number of mythological stories in India about ageing and the fear with which it is  looked upon.

There once lived a King named Yayaati who lived for a full one thousand years of enjoying all the pleasures a King of his position could command. Guru Shukracharya's daughter Devayani was his wife. Guru Shukracharya cursed him to become old because he had intimate relations with a maid servant named Sarmistha. He asked for forgiveness. Shukracharya took pity on him and favourably modified his curse, so that Yayaati could regain his youth if anyone of his sons is ready to get his old age in return. He had still a great desire to enjoy all royal pleasures for some more years, he asked each of his sons (Yadu, Turvasu, Druhyu and Anu), one by one, to take upon himself this old age and give him his youth in return, assuring that after one thousand years he would return the youth and take back his decrepitude. Not one of them was willing to accept the offer except his youngest son named Puru.
Puru gave his youth to his father and got in return old age and its consequent weakness. Yayaati, being exceedingly delighted with his new youth, began to indulge again in sensual pleasures. He enjoyed himself to the full limit of his powers and as much as he desired without violating the precepts of religion. He was very happy, but only one thought troubled him. And that was the thought that the one thousand years would come to an end. He was not satisfied even when the fixed time came to an end. He came to his son Puru and addressed him thus: "0 son, I have enjoyed with your youth to the full limit of my powers and all pleasures, according to their seasons.

“ But desires never die. They are never satiated by indulgence. By indulgence they flame up like the sacrificial fire with ghee poured into it."
जातु कामः कामानुपभोगेन शाम्यति
हविषा कृष्णवत्मैर्व भुय एवाभिवर्धते
जैसे अग्नि में घी डालने से वह अधिक प्रज्वलित होती है, वैसे भोग भोगने से कामना शांत नहीं होती, उल्टे प्रज्वलित होती है

He said, "If one becomes the sole lord of all the earth, with its paddy, oats, gems, beasts and women, still it will not be considered by him enough. Therefore, the thirst for enjoyment should be abandoned. The thirst for enjoyment which is difficult to cast off by the wicked, which does not fail even with failing life, is truly a fatal disease in man. To get rid of this thirst is real happiness.

Yayaati's experience is very useful to mankind. He continued, "My mind was attached to the pleasures of life for full one thousand years. My thirst for them, however, without being abated, is daily being increased."

Thursday, July 21, 2016

Ageing and the Art of living

 Today I started reading this book online

 Quite interesting, specially at my present situation.

I have reproduces some excerpts which I liked a lot 

"My sympathy and support went out to those few older persons who dared to raise their voices: yes, they were in a wheelchair and had to live in a nursing home; but no, they did not need anybody to think or decide for them—just somebody to communicate with them as they would with any normal person and to push the chair, thank you. Or it went to those who admitted that they were eighty or more years old but didn’t need care, at least not more than other adults, and would like to be taken seriously. Even when the tone of the general debate changed to a new emphasis on the alleged selfishness of the aged—those “greedy geezers” who would all live so long with their high pensions, radiant health, and sun tans—it appeared that age-related generalizations with their supposedly scientific prestige could offer a solid ground for any collective character they were supposed to have. Aging appears to evoke ambivalent cultural conflicts with deep roots in many layers of our late modern existence. On the one hand, it appears that negative generalizations about aging are a way to exorcise human vulnerability from young and adult life (supposed normalcy) and reserve it for those who have reached a higher age, so that life would seem safe. Thus, getting to a higher age is identified with pathological senescing. On the other hand, the overburdened “normal” adults tend to see aging as an indefinite extension of the short vacation they are longing for. Here, aging becomes identified with distorted, consumerist forms of a good life and defined as staying young, a denial of aging as living infinite time. Both tendencies not only deny the vulnerability of human life in general but also restrict the potential richness and fulfillment of later life. As a result, the continuity of life, or the interconnection between “normal” and older adults, is undermined, with detrimental consequences for both sides"

"What still strikes me is a widespread tendency to see the aged almost as another human species, demented or wise but not in a perspective of one’s own possible future with all its uncertainties and promises. Such a perception of aging persons blocks the possibilities of really communicating with them and impairs not just the developmental opportunities of older persons but also of the young, since they are constructing their own future aging process as an utterly problematic and estranged one. "

"Measuring the time that people have lived has become part of a culture in which the age of a wide variety of objects—cars, clothes, expensive consumer items—is considered important. When persons reach a greater age, this is usually a cause for celebration, but otherwise awareness of age usually develops into a wish for replacement that has already been programmed into the production of objects."
" The predominance of chronometric perspectives leads in late modernity to a one-sided focus on living longer, but since aging has scarcely been integrated as an important and dignified phase of life, aging well tends to be equated with staying young. This leads to a broad culture of anti-aging,"

" One of them is the paradox of the “younger older”: on the 16 Aging and the Art of Living one hand, the rising life expectancies can be interpreted as a slowing down of processes of senescing; while on the other hand, a general cultural acceleration results in a progressive societal senescing, where people are seen as old at a younger age. This paradox however, also has another side that has emerged as an anti-aging counterculture of getting older while staying young,"

" Weber conveys the merciless character of the doctrines of Richard Baxter or Benjamin Franklin: “Waste of time is thus the first and in principle the deadliest of sins. The span of human life is infinitely short and precious to make sure of one’s own election. Loss of time through sociability, idle talk, luxury, even more sleep than is necessary for health, six to at most eight hours, is worthy of absolute moral damnation” (Weber 1976, 157ff.)."
\
" In earlier times one celebrated the day of one’s patron saint and derived one’s place in the family, for instance, from the order of birth. Definitions of who is “old” and when “old age” has arrived have long been more dependent on the appearance and physical capacities of individuals than on chronological age (Thane 2005, 266)"

" Engels recounts that after the introduction of mills in the industrial town of Carlisle more than 47 percent of the children died before reaching the age of 5, and more than 12.5 percent of adults died before age 39."

" The new civil legal system was accompanied by the overall and continuous registration of the entire population, something far more ambitious than the occasional censuses carried out in the Roman Empire. The goal, however, was basically the same: the formation and fi nancing of Napoleon’s armies by means of conscription and taxes."

" Typical problems were child labor, disability, unemployment, poverty, and illness."

" the basic idea regarding the life course was that children should be protected, adults might be helped for some period of time but should take care of themselves, and “old people” should be supported for the short time they would remain alive."

" In the Netherlands a child labor act of 1874 prohibited children under 12 years of age to work in factories, a rule that was, however, only implemented by the Act on Compulsory Education of 1901. In England the 1847 Factory Act aimed at restricting working hours of women and children between the ages of 13 and 18 years to ten hours per day. The 1883 Factory Act stipulated that children aged 9 to 13 were not allowed to work longer than nine hours a day. Basically, these regulations could already be found in the 1833 Factory Act, demonstrating that the proclamation of new laws did not imply that situations would directly be changed but that such new regulations needed to be embedded in their social contexts. In the United States “oppressive child labor” was only declared illegal by the 1938 Fair Labor Standards Act."

" In the Netherlands a child labor act of 1874 prohibited children under 12 years of age to work in factories, a rule that was, however, only implemented by the Act on Compulsory Education of 1901. In England the 1847 Factory Act aimed at restricting working hours of women and children between the ages of 13 and 18 years to ten hours per day. The 1883 Factory Act stipulated that children aged 9 to 13 were not allowed to work longer than nine hours a day. Basically, these regulations could already be found in the 1833 Factory Act, demonstrating that the proclamation of new laws did not imply that situations would directly be changed but that such new regulations needed to be embedded in their social contexts. In the United States “oppressive child labor” was only declared illegal by the 1938 Fair Labor Standards Act."


" In 1889 the first state pension, introduced by Bismarck, was granted at the age of 70 years (Kohli 1985), and other Western countries gradually followed with their pension acts."

"The major part of this programmed route consisted of forty to fifty years of labor, preferably for the same employer. Finally, there might be the reward of retirement, the worker’s equivalent of a carefree old age, the Ciceronean otium cum dignitate (idleness with dignity), that was previously the privilege of the elite, in particular the feudal elite."

"Most workers of the nineteenth and early twentieth centuries looked forward to this period of inactivity in vain and died before they could reap their pensions. This ideal, of entering a “carefree old age,” usually at between 60 and 65 years of age, has only become a reality for the majority of people since the 1950s and 1960s."

" often we are recognized as a mere number in a databank."

" Historical studies tell us that many children and old people lived in horrible situations and that there is no reason to mourn the loss of a golden age of spontaneous, selfless care (Cole and Edwards 2005; Hareven 1996; 2001; Laslett 1984)."
"Howard Chudacoff’s How Old Are You? (1989), which showed how consciousness of age had developed since the late nineteenth century, resulting in relatively strong and broadly shared ideas about one’s position along the life course according to age and in the age-segregating pressure to “act your age.”"

" the standardization of life course appears to have been fully developed during the 1960s as retirement became a reality for a majority of people (Kohli 2007)."

"e. In some poor minority subcultures a standardized life course has developed in which it would be normal for women to have their first child when they are 13 years old and become grandmothers when they are not yet 30 (Burton 1996; Dannefer 2003a). Also it appears to be normal, in some street gangs, for members to go through a compressed life course, proceeding from being a Homeboy to becoming a Tiny Gangster and later an Original Gangster, and ending up as a Veterano in their thirties. Around this age they will also have reached their maximum life expectancy (Bing 1992)."
" but retirees also move to other states or even to other countries, like the North European pensionados who live in Spain or Portugal (Uhlenberg and Mueller 2004; Vincent 1995, 2006)."

" Even in the United States, where mandatory retirement has been abolished, the preferred retirement age (60 to 65 years) has remained unchanged between 1965 and 1996 (Settersten and Hagestad 1996a, 1996b)."

"Some authors, such as Anthony Giddens (1990, 1991), Zygmunt Bauman 28 Aging and the Art of Living (1997), or Ulrich Beck (1992), have highlighted the fl uid character of late modern society, emphasizing that individuals are overburdened with choices rather than being confronted with a regulated life course. There is little doubt that late modern individuals have to constantly choose, over the course of their lives, about everything from education to primary relationships, from types of work to places to live. This is where theorists such as Giddens, Beck, and Bauman are partly right: individuals have to choose from their options, and if they don’t choose, others will choose for them. Moreover, they must assume the consequences of their choices and cannot hold others responsible for them'


"The debate about the (de)standardization of the life course has a sharp edge, since it touches governmental concerns over the viability of the material arrangements that were developed in connection with some major age-related regulations, especially the laws that would guarantee income for citizens who have reached retirement age."
"Louis Dublin calculated in 1927 that the maximum life expectancy would lie around the age of 65 years (Oeppen and Vaupel 2000"

" In France, the normal age for defi nitively leaving the labor market has become 55, and workers in their 40s are seen as “nearly old,” which puts them at a disadvantage if they become unemployed (Guillemard and Argoud 2004)."
"Even in the United States, however, where mandatory retirement does not exist, persons over 40 are referred to as “older workers” (Henretta 2001), and they have the lowest rates of re-employment, typically in part-time positions or jobs with low skill and training requirements, resulting in large wage losses (Chan and Stevens 1999; Hirsch, MacPherson, and Hardy 2000)."


" some retirees will only fi nd employment bagging groceries or greeting customers; others will be able to take up a new enterprise while they collect a solid pension from an earlier job."

"Given the tendency to exclude older workers from the labor market (unless they are absolutely needed) and yet the importance of work for income, housing, health, social contacts, and the articulation of personal identities, these aspects of life may become increasingly at risk as people reach higher ages."

"In the late modern life course, old age may be twice as long as “normal” adulthood, which may not last much longer than 20 or 25 years. It does not take more than a few moments to realize the absurdity of this situation"

"Taking care of others is not highly respected in current society: giving everyday care, doing household chores, raising children, and taking care of ill relatives bring little status and are often seen as lost work time. Although care activities are of crucial importance for everybody and not just for those in need of care, within a systemic culture of instrumentality, such activities can only obtain a marginal position, even when they have been professionalized and organized in institutions."

" The more a person is removed from direct bodily care, the more he or she appears to be valued, with the managers of large care institutions at the top of the pyramid."

" The base of the typical institutional care pyramid consists nearly exclusively of female caregivers who increasingly come from poorer countries. At the top are mostly persons who have been trained in instrumental approaches and managerial models that are supposed to work well everywhere and who, consequently, often have diffi culty seeing and understanding the specifi c nature of caregiving."

"In spite of their unpleasant effects, the pressures of time limits are broadly accepted and even seem to have a certain appeal because they are associated with popular macro-narratives that connect acceleration with progress (as if this cannot have a destructive side), youthfulness (as if this commercial image would be the only way to live well), dynamic life (as if serenity, contemplation, and time for each other have lost their meaning) and the “newest new.” The flip side is waste, in which meaningful cultural heritages will be debunked as old-fashioned things of the past and replaced together with yesterday’s newest gadget. It may take some aging, at least some deepening of life experience, to see that much of what is presented as new amounts to “more of the same” and to make meaningful distinctions accordingly."
" In such a chronometric culture, it comes as no surprise to encounter proposals to limit access to health care for people in their seventies, because at such ages humans would have led a “full life” and all that “unnecessary care” would get far too expensive in comparison with what may be needed for people with lower ages (Callahan 1987).'
" Similar fundamental questions arise in the debates about the acceptable costs of QUALYs or Quality Adjusted Life Years (years gained by medical interventions) in which existential issues are not faced but are calculated away (Hirth et al. 2000)."

" Think, for instance, of 60-year-olds. One would expect enormous differences in terms of empirical data and personal experiences between, let us say, a poor African woman, a Japanese man, or a homeless American of that age—not to mention 60-year-olds in prehistoric times, in the Roman Empire, in classical China, or among nineteenth-century factory workers. One has only to look around to notice major differences between people with the same age."

" The many faces of aging between the extremes of a teenager suffering from progeria (premature aging syndrome) and a vibrantly alive centenarian are mirrors in which prejudiced citizens, scientists, or bureaucrats who count the ages should be able to see their own distorted views."

"If we want to develop more insight into human aging, we need a broader and deeper understanding of different temporal perspectives so that we can understand more about aging as living in time. From a measurement perspective, it might seem that the longest life would be the best life, but this is no more true than is the claim that the largest painting is the best or that the highest building the most beautiful."
"One of the macro-narratives behind chronometric practices is a technologically inspired idealization of acceleration that speeds up the obsolescence of technological generations and creates a general climate of intolerance toward slowness or “taking your time.” In response to these developments, there has sometimes been an idealization of slowness, but the problem is that some forms of acceleration, such as giving help in case of emergencies, are meaningful."

"The first paradox of the “younger older”—living longer but being regarded as old at an earlier age—has been an excellent breeding ground for the commercial development of new ways of aging that are actually ways to present yourself as “still young.” This leads to the second paradox of the younger older: growing older while staying young"
J Bar  oxford university press