HPE Book 9_2076 Edition

The reduction measures can be summarized in the following points: Using jute/ fabric bag while going to the market for shopping. By not cooking food more than our requirement. Reusing and recycling the inorganic waste. Making compost from the organic waste. Using our own pots/utensils while buying milk and milk products from dairies. b. Reuse The reusable waste materials should be used time and again in order to reduce the generation of wastes. In this method, the same thing can be used time and again in its original form. Without processing glass, beverage bottles, cans, horlicks bottles can be reused time and again. Rubber rings can be made from discarded cycle tubes and this reduces waste generation during manufacture of rubber bands. Similarly, the articles like iron rods, buckets, spades, water pipes, etc are kept for sale in the market as reusable articles (Kawadi Saman). Those articles also can be used for domestic purposes. It helps to save our resources and helps for the management of solid wastes. c. Recycle Recycling is the reprocessing of discarded materials into new useful products. Old aluminum cans and glass bottles are melted and recast into new cans and bottles. In another word, recycle refers to the reuse of things time and again after certain measures of recycling process. The already used papers, torn out plastics, polythene, broken metal pots and utensils etc can be collected and recycled in the factories or at home. This method brings the wastes in use frequently. In this way, it helps to reduce the use of raw materials in one hand and the cost of the material is cheaper in other hand. Ultimately, it helps to keep the environment clean and save the resources for the future generation. The difference between reuse and recycle of the waste materials can be depicted by the following table: Reuse Recycle • Reuse is the use of the waste • Recycle is the use of the waste materials time and again without materials time and again after processing. processing. • There is no change or alteration in • There is some changes or alteration the physical and chemical properties in the physical and chemical of the materials while using properties of the materials before repeatedly. using them time and again. 201

• The previous shape and size is not • The previous shape and size may or altered. may not be altered. • It is an easy process. • It is a little bit lengthy and complicated process. • It is easy for application. • It is a little bit difficult for application. Activity Prepare different types of articles like envelop, greeting cards and photo frame by recycling the waste paper and show them in the class. 7.3.1 Management of Drainage and Human Excreta A. Management of Drainage The water which is thrown after use is called waste water. Waste water comes out from house, market, hospitals, hotels, restaurants, clinics, laboratories etc. Such water is resulted from cooking, cleaning, washing, bathing, cleaning toilets and kitchens. The waste water, not mixed up with the human excreta is called sullage. Such waste water can be drained through drainage system. Such water can be used again for different purposes other than drinking if it is treated scientifically. On the other hand, the waste water after mixing up with the human excreta is called sewage. Drainage of sewage is done through sewer system. Proper management of waste water helps to keep environment clean and safe for living beings. Waste water is discharged from different sources like house, hospitals, laboratories, industries etc. It is harmful to living beings. So proper management of drainage is a serious challenge of the present situation. If there is combine efforts of individuals, community and the governments proper management of drainage is not impossible. Some measures for the proper management of drainage is mentioned below: e Drainage pipes should be paved in all the required places especially in the towns and cities e Drainage system should be built in residential, industrial and hospital areas to manage waste water from house, hotels, industries, labs, etc. e Proper care and timely maintenance of drainage pipe is essential e There should be effective participation of the community people for the management of drainage system e Adequate manpower should be mobilized for this purpose e Government should facilitate the industries to set up drainage system and treatment of waste water 202

B. Management of Human Excreta Improper and unscientific disposal of human excreta (urine, faeces) is one of the environmental pollution problems of our local communities. It spreads various kinds of faecal borne diseases, foul smells and spoil the natural quality of water, soil and air. It also increases the rate of morbidity and illness among the population. Open defecation is observed to be common in rural villages. Hand washing before and other critical time is rare, and only few public and private eating places provide hand washing facilities. Though even hygiene messages are delivered at schools, they are rarely found in practice, indicating a resistance to behaviour change. Recent surveys show that 59% of public and community schools across the country do not have adequate toilet facilities. It is a factor which contributes to the high rates of girls dropping out each year. Girls who reach puberty often do not attend school during menstruation as schools lack toilet facilities. Some of the problems resulted by improper disposal of human excreta are mentioned below: 1. Pollution of Surrounding The surrounding environment gets polluted if human excreta is disposed in the open places. Now, in Nepal majority of the people (62% of the total population) defecate in the latrine; however, they may not keep the latrine clean. As a result, it pollutes the surrounding environment. 2. Pollution of Air, Water and Land There are not adequate latrines to each and every houses in the rural areas. According to the Census Report of 2011 AD, 39% of total households do not have toilet facilities. So, many people in the rural areas use open places like field, bank of river and ponds, forest, pasture land etc for defecation. Defecation in such open places eventually pollutes air, water and land resources of the environment. 3. Spread of Diseases Human excreta itself is a source of causative agents for many gastrointestinal faecal borne diseases such as diarrhea, cholera, typhoid, Jaundice (Hepatitis E), Worm infestation etc. These causative agents spread through excreta to our drinking water, food materials which cause sickness to the people. The sickness becomes fatal to many diseased persons. Types of Latrine Improper disposal of human excreta has many ill effects on our life. The disposal of excreta requires a special place which is called latrine. A proper use of latrine plays a significant role in keeping the environment healthy. It helps us to keep away from various kinds of faecal borne diseases. According to the place and budget, we can choose the types of the latrine. But, unfortunately 38.17 percent people of the total 203

population of our country are living without any kind of toilet facility. In rural areas, a latrine are found to be constructed outside the house but in the towns and cities it is constructed inside the house. Hence, the place especially made for the purpose of defecation and urination is called latrine. There are different types of latrines in rural and urban. Some of them are mentioned below: 1. Trench Latrine These consists rows of parallel trenches. The trenches are 3 feet long one foot wide and 1-2 feet deep. They are dug at a distance of 2 feet away from each other. The faeces, urine and ablution water directly fall into the trench. The trench after use should be filled up by excavated earth, heaped above the ground level, and suppressed. This type of latrine is suitable as a temporary measure during fairs, Trench Latrine festivals, and temporary market (haatbazar). A fly proof wooden superstructure with a hinged lid opening is placed in position over the top. The person using the trench latrine should place one foot on each side of the trench. He/she should squat in such a way that the feaces and urine fall directly into the trench. 2. Borehole Latrine It is an improved form of simple pit latrine. It was first introduced by the Rockefeller Foundation during 1930 AD, while campaigning for the control of hook-worm disease. In this type of latrine, a 18-20 feet deep with 14-16 inches diameter circular hole is dug with the help of borehole machine called Auger; until the surface of subsoil water is reached. This type of latrine is rarely found in Nepal. A lining of split-up bamboo (chitra) is put inside the wall of the latrine hole to prevent earth from collapsing or falling in. The opening of the hole is covered at the top with a concrete slab of 25 inches diameter with the facility for defecation and urination. And a small superstructure is constructed above it. It should be constructed 15-50 meter away from the source of water. Advantages of Borehole Latrine It is an improved form of latrine over the simple pit latrine It is more durable than simple pit latrine 204

Less skilled and experience manpower can construct this type of latrine It can be constructed in low cost It can be constructed without iron, rods, bricks and sophisticated materials It prevents from spread of faecal borne diseases and environmental pollution Disadvantages of Borehole Latrine It is more expensive than simple pit latrine Auger (borehole machine) is required to dig hole Cement slab is required to cover the top of the borehole Spit-up bamboo (chitra) is required to cover the wall of the borehole It is not of permanent type of latrine 3. Simple Pit Latrine (Dug Well Latrine) Bore Hole Latrine Simple pit latrine is constructed by digging a pit in the Earth. The size of the pit depends upon the size of the family. This types of latrine is generally constructed in the rural areas where there is lack of provision of adequate budget, iron, rods, cement, bricks and other materials. Generally, a pit with 75 cm diameter and 3 to 3.5 depth is dug for a small family. At the top of the pit, a wooden slab with a small hole for the facility of urination and defecation is provided. It is a temporary and simplest type of latrine. In Nepal about 8% of the total population are using this type of latrine. Site Selection Pit 5 -8 Feet The site for a Pit Latrine should be selected very carefully. The soil structure of the site should be Simple Pit Latrine hard for its durability. The following points should be considered while selecting the site: The site for latrine should be at least 30 feet away from the house and water resource (i.e. Well, Tube well, Pond, etc) 205

It should be constructed below the water sources It should not be constructed on the soft soil The door and ventilation should not be faced towards the house It also should not be too far away from the house otherwise it would be difficult for the children and old people to go to latrine Advantages of Simple Pit Latrine Such types of latrine can be constructed even in a place where there is no provision of water, bricks, rods, cement, etc It can be constructed at least cost and by less skilled manpower too It helps to keep the surrounding environment clean to some extent It helps to reduce the growth and spread of germs and disease It helps people for healthy life Disadvantages of Simple Pit Latrine It is less durable compared to other types of latrines If proper attention is not given while constructing the pit, it may be filled from sliding the soft soil around the pit The leakage of waste water through underground pollutes the surface and ground water if constructed just above the water sources It may pollute the surrounding and may spread faecal borne diseases especially during rainy season It spreads foul smell in the surrounding since there is no provision of water seal system 4. Improved Pit Latrine Squatting This type of latrine is improved form Plate of simple pit and borehole latrine. It is permanent latrine. The material like cement Concrete rings, concrete slab attached with water seal Rings pan and squatting plate, drain pipe etc are used up to construct this type of latrine. Two Improved Pit Latrine pits are necessary for this type of latrine. Concrete rings are kept in the pits. Site is selected as per the criteria for the simple pit latrine. When one pit is full, the next pit is used. About 13 percent of the total population of the country are living with this type of latrine facility. 206

Advantages of Improved Pit Latrine Less skilled and experienced manpower also can construct this type of latrine It can be constructed in low cost compared to modern latrine It can be constructed even in the absence of iron, rods, bricks and sophisticated materials It helps to produce compost manure at every two to three years interval It controls environmental pollution and spread of faecal borne diseases It can be used permanently Disadvantages of Improved Pit Latrine It is more expensive compared to simple pit and borehole latrine It cannot be constructed inside the house so unfit in city areas Foul odour can spread and environmental pollution may occur in the case of improper management 5. Water-seal Modern Latrine Modern concrete latrine is the best type of sanitary latrine. It can be constructed inside or outside the house. It is the most expensive and sophisticated type of latrine. It is the most durable and hygienic latrine. This type of latrine prevents from spread of odour and foul gases as well as transmission of faecal borne disease. But it needs adequate supply of water. The sophisticated materials like : squatting plates of China wear, smooth pan of China wear, Cistern (flush tank), Modern Flush System Latrine China tile on the wall and surface are required for the construction of flush system modern latrine. This type of latrine is basically available in the towns and cities. Of the total population of our country 42 percent people are using flush system latrines, in which 8.27 percent of those latrines are directly drained in public sewer system. Advantages of Modern Latrine It prevents the breeding of flies and foul smell due to the provision of water seal in the pan It lasts for many years even though cost is high at the beginning It can be constructed inside the house also 207

It is safe for the people of all age groups This type of latrine is best for hygiene and sanitation Disadvantages of Modern Latrine It is very expensive so it is beyond the reach of the poor families Less skilled and experienced manpower cannot construct this type of latrine It takes long time for construction It creates cleaning problem during inadequate supply of water It cannot be constructed if there is no provision of cement, water seal trap, Cistern, China wear, etc. Difference between Improved pit and Modern flush System Latrine Improved Pit Latrine Modern Flush System Latrine • This type of latrine is the improved • This type of latrine is the most form of simple pit and borehole advanced form of sanitary latrine. latrine. • The materials like cement rings, • The materials like cistern, commode concrete slab, water seal, pan, water seal, and tile made from and drainpipe are required for the ceramics or china wear and construction of this kind of latrine. drainpipes as well are required for the construction of this kind of latrine. • In this type of latrine, two pits need • In this type of latrine, a septic tank to be constructed for the collection needs to be constructed for the of sewage. collection of sewage. • It cannot be constructed inside the • It can be constructed inside the house. house. • It can be constructed in low cost • It is more expensive compared to compared to modern flush system other type of latrines. latrine. • This type of latrine is commonly • This type of latrine is commonly found in the rural area. found in the urban area. • This type of latrine is not as good as • This type of latrine is very good from the modern flush system latrine from sanitation point of view. sanitation point of view. 208

Summary M Environmental health refers to those aspects of human health and disease that are determined by the factors in the environment. M Environmental sanitation refers to the control of all those factors in man’s physical environment, which exercise or may exercise for adverse effect on his health and survival. M Pollution is an undesirable change in the physical, chemical, or biological characteristics of air, water, and soil that may pose to various forms of health hazards. M Air pollution is an undesirable change in the physical, chemical, and biological properties of air due to the mixing of pollutants like harmful gases, smoke, dust particles, and pathogens. M An undesirable change in the physical, biological, and chemical properties of water due to intrusion of harmful pollutants is called water pollution. M The degradation of bio-chemical quality of soil due to the accumulation of pollutants in the land is called land pollution. M An unwanted and unpleasant sound that is harmful to health and productivity of health is called sound pollution. M Solid waste management refers to the handling process of solid waste materials from the source of its generation to disposal. M The solid waste can be classified as organic waste, inorganic waste, and land fill (Disposable waste). M The non-biodegradable solid waste, which do not contain carbon compound, are called inorganic solid waste. M Reduction, Reuse and Recycling is known as the “3R principle” of the solid waste management. M The use of the waste materials repeatedly without further processing is called reuse. M The use of the waste materials repeatedly after processing is called recycle. M The composting method in which compost manure is prepared with the help of aeration (function of aerobic bacteria) facility is called aerobic composting method. M The composting method in which compost manure is prepared without aeration (function of anaerobic bacteria) facility is called an aerobic composting method. M The preparation process of compost manure with the help of earthworm is called vermi-composting method. M The landfill site, which is scientifically prepared for the safe disposal of the solid waste, is called sanitary landfill. 209

Exercise A. Very short answer questions. 1. What is pollution? 2. What are the sources of pollution? 3. What is environmental health? 4. Define environmental sanitation. 5. Write any two sources of methane. 6. What is inorganic waste? 7. Show any two efforts for pollution management. B. Short answer questions. 1. What is land pollution? Explain its causes and control measures. 2. What is noise pollution? What are the effects and control measures of noise pollution? 3. What is solid waste? Explain the ‘3R’ principle of solid waste management. 4. Explain the natural causes and anthropogenic causes of environmental pollution. 5. Mention any five measures that can be applied for the proper management of drainage system. 6. “Reuse of materials helps in conserving environment”. Clarify the statement. C. Write short notes on: 1. Borehole latrine 2. Vermi-composting method 3. Control of pollutants D. Write difference between: 1. Aerobic and Anaerobic method of compost preparation 2. Simple pit and improved pit latrine E. Long answer questions. 1. Describe water-seal latrine. Explain the advantages and disadvantages of water- seal latrine. 2. Elucidate improved pit latrine with a diagram. Write the difference between simple pit and borehole latrine. 3. Explain the different disposal methods of solid waste. Project Work Prepare a report on sanitation situation of your community by taking any ten sample households on the basis of access to the following sanitation services: i. Improved pit or modern flush system latrine ii. Safe drinking water iii. Separate bathroom iv. Electricity v. Alternative fuel for cooking 210

Unit ADOLESCENCE, SEXUAL AND REPRODUCTIVE HEALTH EDUCATION 8 Learning Objective After completing this unit, students will be able to: • Define adolescence, describe changes and problems during the adolescence period. • Tell measures to solve adolescent’s problems. • Explain Sex Education, tell its importance. • Discuss about Reproductive Health, reproductive rights and reproductive system. 8.1 Adolescence Adolescence is the most important stage of human life. Adolescence is a period of life in which boys and girls move from childhood to adulthood mentally, physically, emotionally, spiritually and socially. Simply, speaking adolescence is ‘to grow to maturity’. It is a time of psychological maturation; becoming “adult-like” in behaviour. During this period, adolescents are expected to become capable of adult behaviour and response. This period is a transitional period of human life, when a boy or girl is no more a child nor is considered as an adult by others. Indeed, it is the most crucial stage of the total life span of human life. In this period, great changes occur in all developmental dimensions of the individuals. According to WHO, “adolescence is the age between 10 to 19 years”. It is called a transitional period of life since rapid change in physical, social, mental, emotional and spiritual aspects takes place during this period. So, this period of life is also called as the period of storm and stress. Adolescence period can be classified into three stages e Early adolescence stage (age between 10 to 13 years) e Middle adolescence stage (age between 14 to 16 years) e Late adolescence stage (age between 17 to 19 years) From the onset of this period human reproductive system becomes active and eventually enters into maturity in terms of its functions. The first stage of adolescence is also considered as puberty. Puberty is the time at which the onset of sexual maturity occurs and the reproductive organs become functional. This can be observed in both sexes by the appearance of secondary sexual characteristics like; deepening of voice in boys and 211

growth of breasts in girls and in girls by the start of menstruation. These changes are brought about by the increase in sex hormone activity due to stimulation of the Ovaries and Testes by pituitary hormone. Generally, in girls: puberty falls around 11 to 13 years of age and in boys around 13 to 15 years. Rapid changes in physical, mental, emotional and social aspects is observed during the puberty period. Before having the first menstrual period, the pubescent girl will normally experience: Rapid growth, especially in increase in height e Breast enlargement e Pubic, armpit and leg hair growth e Clear or whitish vaginal secretion e Increase hip width Unlike girls, there is no visible signs that tells a boy that he has entered puberty. However, the pubescent boy will normally experience: e Accelerated growth, especially height e Increase shoulder width e Growth of the penis and testicles e Voice changes e Pubic and armpit hair growth e Night time ejaculation (nocturnal emissions: “wet dreams”) 8.1.1 Characteristics of Adolescence A. Adolescence is the stage of change Change in the physical, social and emotional aspects among the adolescents can be observed during this period. So this phase of life is also known as the stage of storm and stress. They become more sentimental, sexually mature and show independent behavior. At the same time, interest in social activities increases during this period. Moreover, they become more conscious about the positive and negative implication of social norms, values, and beliefs. B. Adolescence is the Stage of Dilemma This stage of life is also called the stage of dilemma since they are in the middle of the road. Indeed, they cannot leave their childhood characteristics completely in one hand. On the other hand, they have not fully adopted the characteristics of adulthood. In this stage, they are confused themselves whether they are merely the children or adult. C. Adolescence is an Important Stage There is rapid development in the physical, social and psychological aspects during this stage of life. Moreover, there is rapid development in sexuality also. 212

The characteristics of this stage remains for long period. In other words, this stage creates foundation for shaping personality in adulthood. So, this stage is considered as an important stage of life. D. Adolescence is the Stage of Searching Identity It is truly said that it is the stage of identity. Adolescents are highly ambitious compared to the people of other age group. They are in search of dignity and identity in this period. They want that others should recognize their work and personality. Therefore, this stage is called the stage of identity. E. Adolescence is the Stage of Pre-adulthood It is true that it is the stage of pre-adulthood. In this stage, they feel that they are now no more children. They show adult’s personality and choices. Hence, it is better to say that it is the pre- adulthood stage. F. Adolescence is the Stage of Daydream In this stage, adolescents feel happy in daydream. They are very often busy in abstract thoughts, which may not be possible in real life. They dream about of being doctor, engineer, heroes and so on. They enjoy living a fantasy life. Therefore, this stage is called the stage of daydream. G. Adolescence is the Stage of Frustration Adolescents are aggressive and over ambitious during this stage. Sometimes, they also happen to commit unsocial activities. As a result, frustration and agony may give tension to them. H. Adolescence is the Problem Creating Stage The adolescents of this stage are of experimental nature. Therefore, they want to experiment every new thing. They are curious to commit even unsocial activities, which may create problem later on. Sometimes, their wrong doings are not acceptable to the society. So it create problem to themselves and to the family also. In some condition, it may create misunderstanding and dispute between the adolescents and adults. 8.1.2 Changes in Adolescence It is obvious that adolescence period is the transitional period of human life. During this period, physical, psychological and social changes are taking place. Some changes are occurring rapidly whereas some other changes take place gradually. After all, these changes are very crucial for a complete human life. The changes in different aspects during this period are mentioned below: 213

A. Physical Changes During the adolescence period, marked external and internal physical changes take place. For instance, height, weight, body proportion, secondary sex characteristics and sex organs are developed externally. At the same time, digestive system, endocrine system, respiratory system, circulatory system and body tissues are developed internally. The change in girls occur a little bit earlier than their boy counterpart. The girls usually obtain their mature height at the age of eighteen whereas in boys it can be observed few years later. The development process of adolescents is influenced by various factors such as heredity, nutrition, climate, immunization, exercise and life style. Some physical changes observed in boys and girls in the adolescence period is shown in the table given below: Physical Changes Adolescent Boys Adolescent Girls Growth in height and weight Growth in height and weight Production of sperm begins Enlargement of breasts Onset of wet dream Ovulation cycle begins Growth of pubic hair Onset of menstruation Enlargement of sex organs Growth of pubic hair Growth of armpit hair Enlargement of sex organs Widening of chest Growth of armpit hair Hoarseness of voice Widening of hip Deepening of voice Fig: 8.1 Physical Changes in boys and girls B. Mental Change In addition to physical changes, mental change also takes place in the adolescence period. In this period, memory and imagination power as well as thinking and concentration power are developed. Analytical skills and greater awareness of behavioural consequences gradually developed among the adolescents. At the same time, they begin to sink in abstract thoughts and develop concern with own image. During this stage, some adolescents develop negativism in their behaviour which creates problems of adjustment in the family, group and the society. There is a great chance of misunderstanding and they may be out of control from parents and teachers because they have over confidence in their decision. It may ruin their life. Hence, they need to be provided life management education and skills for their responsible and better life on time. 214

C. Emotional Change Emotions like anger, fear, jealously, curiosity, grief, joy, affection etc are developed in adolescence period. Adolescence period is marked by heightened level of emotions. So, this period has been considered as a period of “storm and stress”. In this stage, they love to laugh, cry, sit in isolation, read love story books, see movies and so on. They are little bit aggressive in nature. They can be involved in different activities like games and sports, music, paintings group works etc. Besides this, involvement in school SCOUT, Local Clubs, Junior Red Cross Circle, Eco Club etc will be beneficial for the management of their emotional traits. D. Social Change We can observe different social changes in the period of adolescence. Some of the social traits such as to accept leadership, friendship, peer group, feeling of responsibility, group activities are developed in this stage. They are involved in different activities like games, sports, competitions, cleanliness campaign, parties, fairs and celebrations. In this period, they remain most of the time with peers. Achievements in social activities bring personal satisfaction in the adolescents. On the other hand, if members of the peer group experiment with alcohol, drugs, tobacco, pick pocketing, theft etc adolescents may be driven towards the wrong track of life. Hence, parental role is very crucial to shape social development of the adolescents. 8.1.3 Needs and Demands of Adolescents We know that adolescence period is an important stage of life. It is a transitional period of life from childhood to adulthood. During this period, parents and guardians cannot accept them as adult members where as adolescents cannot adjust with the children. This situation may lead them towards frustration. Furthermore, that situation creates problem for them and they feel hard to adjust themselves at home, school and community. In some situation, they are likely to involve themselves in bad behaviour like smoking, alcoholism, drug addiction, unsafe sexual experiment and violence. Most of the adolescents have a feeling that they are not safe and secure in this world. They also have a feeling that they are in isolation and nobody is there to take care of them. Hence, proper settlement of this period is the matter of concern of parents, guardians, community and adolescents themselves. For this, parents and teachers should create favourable environment for adolescents’ personality development. In addition to this, rational demands and needs of adolescents must be addressed on time to ensure their better future. 215

Some of the demands and needs of adolescents are mentioned below: Adolescents want their identity They expect that parents and teachers should understand their problems and needs They demand adequate time and attention from their parents They want their involvement to make necessary decision regarding their own problems They do not like any kind of undue pressure They expect suggestions and explanation from their parents and teachers at private level They do not expect any kind of discrimination from parents and teachers They need participation in all developmental activities at home, school, community and nation They need openness and encouragement to pressure and threats from their parents and elders They want collaborative efforts to solve any kind of problems The above mentioned needs and feelings of adolescents need to be realized by all. Parents, teachers and community people have to accept the fact that adolescents have their own distinct needs and feelings. Hence, it is the prime duty of the parents and guardians to address the needs and demands of adolescents for their better future. 8.1.4 Problems of Adolescents Adolescence is a sensitive period of human life. As a result of rapid change in physical, mental, emotional and social aspects; adolescents encounter many problems during this period. Some of the problems of adolescents are mentioned below: A. Peer Pressure Here, a simple meaning of peer is: ‘a person with same age, status and social group’. In this stage, adolescents have strong faith and trust on their peer mates rather than their parents and guardians. So, they enjoy with their peers. They are very loyal to their peer mates. If parents and guardians do not behave according to their expectation, adolescents feel humiliated and they can even leave their home and ready to stay with their peers. In this period, adolescents may indulge in unsocial activities like: drug addition, tobacco and alcohol consumption and unsafe and other anti-social activities. B. Imitation Imitation is also one of the significant characteristics of adolescents. In this age, adolescents easily imitate action, dressing, walking style and the like from their 216

ideal personalities (actors, singers, players, models, artists, etc). During this period, adolescents can not distinguish the right and wrong things because of their emotional instability. It is not bad if they imitate the good things but if they start smoking, alcohol consumption, drug abuse and so on as their ideals persons doing it; it ruins their life. So, blind fold imitation eventually produces bad consequences. C. Sexual Abuse At this stage, physiological and biological changes in the body increase their sexual desire. Due to this, they are attracted to opposite sex. Using dirty words, ragging, physical contact, demonstrating bad sign, telephone bluff calls, rape, etc. are common problems performed by some adolescents during this period. Some people are sexually abused basically in greed of job, promotion, extra earning, etc. It may occur both outside and inside the house. Females are more vulnerable to this kind of abuse. D. Unsafe Sex In this stage, there is adequate secretion of sex hormones among the adolescents. They develop tendency of practice in unsafe sexual activities due to the secretion of sex hormones in their body. They may misuse the relationship of girlfriend and boyfriend into unsafe sexual intercourse. This may result unwanted pregnancy, transmission of STIs, HIV & AIDS, Hepatitis ‘B’ etc. Furthermore, it may cause social boycott, health in jeopardy, disturbance in academic performance and mental tension. E. Early Marriage Early marriage refers to the marriage before completing adolescence period. In our context, our social beliefs and values are partly responsible for early marriage. On the other hand, adolescents are sexually more active but they lack proper guidance and counseling. So, they do not hesitate to get into early marriage. This situation adversely affects the girls’ health, education and over all development process. In this age, they are not physically mature to beget the children. Hence, early marriage is dangerous to the mother and the child too. 8.1.5 Management of Adolescent Problems There is no argument that the adolescents are facing different problems. But unfortunately, most of them do not share their problems with parents, teachers and elders. If these problems are not addressed in time, it may aggravate the situation. Hence, school authority, parents, community leaders and the policy makers should focus their attention on these issues. Some measures to manage the adolescents’ problems are mentioned below: 217

A. Counselling and Service Undoubtedly, adolescents are facing many problems and queries on sexual and reproductive health issues. Our social norms and values also somehow discourage them to be open to sexual and reproductive health issues. In the absence of proper counselling and service, the problems become worse and unmanageable. In this situation, counselling and service make them clear about the issues and problems like wet dream, unsafe sex, sexual abuse, unwanted pregnancy, STIs, HIV/AIDS, early marriage, peer pressure, contraception, menarche, menopause, etc. These services can be provided by parents and teachers at home and school respectively. Similarly, except the counselling outstanding services can be received from reproductive health clinics. For this, guidance and counselling should be made easily accessible to all adolescents and services should be made confidential for their efficiency. Adolescents can be provided counseling and service in the following area: e Physiological process of wet dream e Consequences of unsafe sex e Sexual abuse and its control measures e Consequences of unwanted pregnancy and its management measures e Sexually Transmitted Infections (STIs) and their preventive measures e Early marriage and its consequences e Peer pressure and its management measures e Effective use of contraception for spacing and control of birth e Physiology of menstruation process and hygiene e Physiology of menopause and its management B. Advice for Safe Sexual Behaviour Safer sexual behaviour encompasses masturbation, abstinence, sexual relationship between husband and wife only, proper use of condom and marriage at appropriate age. But unfortunately, adolescents have strong sexual desires in this stage of life. So, they may involve in unsafe sexual activities which results into different problems and complexities like unwanted pregnancy, STIs, HIV and AIDS, etc. As a precautionary purpose, it is essential to have information on safer sexual behaviour. They are mentioned below: 1. Masturbation Masturbation is the self-stimulation of one’s genitals with one’s hand for sexual pleasure. Due to the lack of proper education about masturbation, adolescents feel 218

guilty and develops the doubt of sickness of such activity. But masturbation does not harm an individual physically or mentally and does not reduce sexual potency. Actually, masturbation gives sexual pleasure without harming anybody and it serves to fill up the gaps in the absence of sexual intercourse. 2. Abstinence Abstinence is a practice of not involving oneself in sexual intercourse. Abstinence is the solution to keep adolescents safe from sexually transmitted infections (STIs) and unwanted pregnancy. There is no doubt that abstinence is safe but in practice it is hard to follow. For this, adolescents should develop strong determination and self- control over abstinence before marriage. 3. Faithful With Sexual Partner Sexual relation with only one partner is also considered as an important approach of safer sexual behaviour. The multiple sexual relationship may spread STIs & HIV/AIDS and also decrease trust and faith between partners and leads conflict and mental tension. Therefore, the sexual relation must be limited only between husband and wife. 4. Use of Condom Effective use of condom prevents from unwanted pregnancy, STIs, including HIV and AIDS. So, the couples should be encouraged for consistent use of condoms if necessary. C. Mutual Understanding The irresponsible behaviour of adolescents towards parents, teachers and elders and failure to understand adolescents’ needs and feelings sometimes leads to misunderstanding. In this situation, adolescents should be given ample opportunities to express their feelings and voice especially on those issues which are related with them. At the same time, we should have regular interaction with them and we should respect their feelings, voices and identity so that they demonstrate positive attitude and behaviour to the elders, parents, teachers and community. Eventually, they can show their talents and potency and prove their importance and recognition. D. Participation in Creative Activities We should remember that the adolescents are the most active group of people. So, there should be provision of different activities like music, dance, games and sports, drawing, painting, singing and other different creative activities to engage adolescents themselves. Such creative activities help to manage their uncontrolled 219

emotions explicitly. Similarly, they do not have time to think about misconduct and bad activities as per say that “empty mind is devil’s workshop”. Furthermore, the involvement in such creative activities gives them relief from mental tension and help to utilize the leisure time in a proper manner. Similarly, participation in creative activities eventually develops the feeling of responsibility, maturity, self-fulfillment and help to develop personality. In addition, this condition avoids the possibility of their involvement in unproductive activities such as playing cards, watching dirty movies, drug abuse, alcohol consumption, smoking and so on. Activity Collect information related to adolescence from any 10 adolescent boys and girls of your locality. Prepare a report with the help of the collected data and discuss their management measures in the class. 8.2 Sex Education Even now, open discussion on sex related issues are not allowed in our society. Sexuality has been taken as a secret issue to be discussed only between a married couple. Hence, people have negative attitude on reading, discussing and interacting about sexual matters. Most of the people have misconception that sex education teaches learners about sexual activities. But, it is not sexology. In fact, sex education deals with different queries on sex and reproductive issues which ultimately help them to maintain abstinence, proper age at marriage, proper birth spacing, responsible sexual behaviour, etc. Sex education provides knowledge, attitude and skill for safer sexual behaviour. Realizing this fact, many countries in the world including Nepal have included sex education in school and university education programme. Sex Education deals with various aspects of issues related to sexuality. It is synonymously used as Family life education. Sex education can be defined as; an educational programme designed to provide the learners with adequate and accurate knowledge of biological, socio-cultural and moral dimensions of human sexuality. It helps to bring positive change in knowledge, attitude and practice of youth on sexuality and sexual behaviour. It also helps to develop healthy interpersonal relationship and feeling of responsibility between partners to marry their children at appropriate age. Besides this, sex education is essential to control unhappy marriage, illegitimate births, STIs, heightened divorce rate etc. 8.2.1 Objectives of Sex Education Sex Education helps to clarify misconception regarding physical, biological, mental and social changes of adolescents 220

It provides correct information about human sexuality and promotes sexual hygiene It helps to understand the role of family and community for shaping sexual behaviour It helps to protect adolescents from the infection of STIs, including HIV and AIDS It helps to avoid high risk sexual behaviours It helps adolescents to demonstrate responsible sexual behaviour at home, school and community It encourages adolescents to consult appropriate health personnel to get service on sexual health To live a quality of life by controlling high level of fertility rate 8.3 Reproductive Health The concept of reproductive health as an integral part of total health was introduced in 1994 AD at Cairo Conference (International Conference on Population and Development- ICPD, 1994). After the Cairo Conference, reproductive health has been recognized as the most important aspect of health of the people. WHO has defined reproductive health as, “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and process.” The definition implies that if an individual is free from disease and physical, mental and social well being, s/he is not said to be healthy from reproductive health perspective. For a healthy life s/he must have well being on reproductive system, its functions and process. When we perceive reproductive health as an educational process. It can be defined as: an educational experience aimed for developing capacity of adolescents to understand their sexuality in the context of biological, psychological, socio-cultural and reproductive dimensions and to acquire skills in making responsible decision and action with regard to sexual and reproductive health behaviour. 8.3.1 Aspects of Reproductive Health Reproductive Health is an education regarding the human reproductive organs and about their structural and functional system. There are various determining factors of reproductive and sexual health of the people. Without identifying and realizing these factors or areas in our day to day life, we cannot obtain good reproductive health. So, their study is felt essential for our healthy life. Some areas of reproductive and sexual health are mentioned below: A. Planning of the Family Family planning is a very important area of Reproductive Health. It helps to maintain 221

healthy, prosperous and productive life. Family planning includes planning on size of family, number and spacing of children, use of contraception, job, education, marriage, etc. B. Safe Motherhood Safe motherhood is another important aspect of Reproductive Health. Here, safe motherhood refers to protect the health and well-being of mother during antenal, natal and postnatal period. But unfortunately, due to lack of safe motherhood initiatives, maternal mortality rate of our country is still more than 228 compared to other countries in the SAARC Region except Afghanistan. Lack of antenatal, natal and postnatal care, ignorance, unsafe sexual behaviour, short birth spacing, malnutrition are some risk factors of safe motherhood. So, people should be positive and government should have strong commitment to launch safe motherhood activities for healthy and safe life of mother and child. C. Neonatal and Child Health Care It is also an important area of Reproductive Health. Infant and child health care makes a great difference in infant and child morbidity and mortality rate and their health condition too. Infant and child health care includes providing nutritious and balanced diet, good hygiene and sanitation, timely and regular health check up, proper breast feeding and emotional care. The status of infant and child health care determines the reproductive health condition. D. Safe Abortion Abortion is a process of terminating pregnancy. A conditional abortion has come in practice in Nepal since 2060 BS. According to this legal provision, pregnancy of below 12 weeks can be aborted by the couples to maintain the size of the family. If anybody is found doing abortion or forcing for abortion on the basis of gender, s/ he has to go to jail for one year. Similarly, in the case of pregnancy by rape, incest relation or abnormal fetus in the uterus, abortion up to 18 weeks of pregnancy period is legally allowed. Besides this, if doctor recommends, in case of maternal health problem; abortion is allowed at any time. If necessary, abortion has to be done at authorized hospitals and abortion centers and by the authorized doctors. It reduces the complication and maternal deaths. In this way, safe abortion by the trained doctors at authorized abortion centre can save life and health of the women. E. Reproductive Tract Infection (RTIs) A large number of adolescents are victimized by reproductive tract infections (RTIs), sexually transmitted infections (STIs) and HIV & AIDS every year. It is a global problem. Most of those diseases are transmitted through unsafe sexual behaviour. 222

Women are more vulnerable to Structure of Retro virus transmission of such diseases from the infected sex partners. If we do not pay attention to these diseases, there is a chance of sterility, cervical cancer, prostate cancer etc. In some conditions, it may be fatal too. Therefore, people should be given education and information to prevent these diseases. Reproductive Health Education could be the best instrument to educate and aware the people from these problems. F. Infertility Infertility refers to some kind of disturbance in the process of reproduction, that causes failure in the birth of the baby. There may be various reasons of infertility between the couples. Basically, the defects and improper functioning of reproductive organs related with husband and wife is responsible for infertility. In this condition, many sub-fertility problems can be solved if they consult the fertility experts in time. So, instead of being discouraged to go for the treatment by the experts is beneficial to the couples. G. Adolescent’s Reproductive Health It is an important aspect of reproductive health. Adolescents refers to the group of individuals aged between 10 to 19 years. During this period, their physical, mental social and emotional change is occurring rapidly. As a result, they may demonstrate unsafe sexual behaviours like premarital sex, unsafe sex, early pregnancy and so on. Hence, sexual and reproductive health for adolescents should be in priority. H. Reproductive Health of Adult Women Menopause in adult women after the age of 45 years indicates that they are no more fertile. It causes psychological problem among the adult women. Besides this, chances of cervical cancer, breast cancer, arthritis, osteoporosis, high blood pressure is very high in this age. They also suffer from psychological problem such as empty nest syndrome. Regular health examination including reproductive health is required to identify early symptoms of these problems in time. At the same time, special counselling is needed to the women of that age group to prevent them from adult age health problems and other associated complications. 8.3.2 Reproductive System Reproduction is the characteristics of all living beings. Single celled living beings 223

produce another cell from the cell division process. On the other hand, some animals lay eggs and hatch them. In human beings, this process occurs through sexual reproduction. The combination of various organs and tissues which are associated with the process of reproduction is called reproductive system (i.e. in male: Testes, Vas deferens, Prostate gland, Seminal vesicles, Penis etc; in female: ovaries, fallopian tubes, uterus, vaginal canal etc).The reproductive system controls the development of structural and functional differences between males and females and it influences human behaviour. The male reproductive system produces sperm cells and can transfer them to the female. The female reproductive system produces ova and can receive sperm cells, one of which may unite with an ovum. The female reproductive system is then intimately involved with nurturing the development of a new individual unit until birth and usually for some considerable time after birth. To understand the process of reproduction we should know the male and female reproductive system distinctly. A. Female Reproductive Organs and their Functions The female reproductive organs are divided into external and internal organs. However, internal organs play the main role in reproductive system. They are mentioned below: External Female Reproductive Organs Pubic hair • Mons Pubis Urethra Clitoris • Labia Majora mLaabjoiara • Labia Minora oVpaegnininagl mLainboiara • Clitoris Perineum • Vestibules • Hymen • Greater Vestibular Glands Internal Female Reproductive Organs Fig: 8.2 External Female Reproductive System • Vaginal Canal • Uterus • Fallopian Tubes • Ovaries 1. Vaginal Canal The vaginal canal is a fibro-elastic muscular tube that extends from the Uterine Cervix to the Vulva. It is about 10 cm long. It is formed by fibro-elastic muscular connective tissues. It is the female organ of copulation functioning to receive the Penis during sexual intercourse and it allows menstrual flow and child birth. The wall of the vagina consists of an outer muscular layer and inner mucous membrane. The 224

muscular layer is smooth muscle that allows the vaginal canal to increase in size to accommodate the Penis during intercourse and to stretch greatly during child birth. Fundus Ampulla Fimbriae Body Uterine cavity Ovary Cervix Endometrium Vaginal Canal Cervix Fig: 8.3 Internal Female Reproductive System Structure and Function ^ It is a fibro-muscular tube extends from cervix to vulva ^ It is about 10 cm long ^ It is formed by fibro-elastic muscular elastic connective tissues ^ It is the female reproductive organ for copulation function ^ t It allows menstrual flow during the manse period ^ It also allows baby out from the uterus during labour 2. Uterus The Uterus is a muscular hollow reproductive organ with the shape of a medium sized Pear and is about 7.5 cm long and 5 cm wide. It is located between the Urinary Bladder and Rectum. It is formed by the fibro-elastic muscular connective tissues. It is the place where the fertilized ovum becomes implanted, receives nourishment and develops into a fetus during the pregnancy period. Uterus is divided into three sections like Fundus, Body and Cervix. In which the Fundus is the dome shaped part of the Uterus lying above the opening of the Fallopian Tubes. The Body is the middle part of Uterus. The lower narrow neck is called Cervix. The uterine wall is composed of three layers: Perimetrium, Myometrium and Endometrium. Of which, the outermost layer is called Perimetrium. The next layer just deep to the Perimetrium is the Myometrium and the innermost layer of the Uterus is the Endometrium or 225

Mucous Membrane. The Endometrium consists of a simple Columnar Tissues. After puberty, the Uterus goes through regular menstrual cycles. Structure and Function ^ It is a pear shaped hollow muscular reproductive organ ^ It is formed by fibroelastic muscular elastic connective tissues ^ It is about 7.5 cm long and 5 cm wide ^ It is located between the urinary bladder and rectum ^ It is divided into sections like fundus, body and cervix ^ Its wall is formed by the three layers called perimetrium, myometrium and endometrial ^ It is the place where the fertilized zygote implants and develops into a foetus ^ After menarche, the uterus goes through regular menstrual cycle till menopause 3. Fallopian Tube Two Fallopian Tubes, also called Uterine Tubes are present in the Uterus. They are extended from either sides of the dome shaped upper part of the Uterus. They are about 10 cm long. The end of each Fallopian Tube has finger structured projections called Fimbriae. Generally, fertilization occurs in the Fallopian Tube. The Fallopian Tube receives Ovum from the Ovary and passes to the Uterus. The mucosa of the Fallopian Tubes provides nutrients for the Ovum, if fertilization has occurred. Structure and Function ^ There are two fallopian tubes present in the Uterus ^ They are about 10 cm long ^ They are extended from the either sides of the fundus ^ There is presence of fimbriae (finger like structure) at the end part ^ It receives ovum from the ovary and passes to the uterus ^ Fertilization of the zygotes take place here 4. Ovaries Like Testes in the male reproductive system, the Ovaries are the female gonads. They are oval in shape and are about 4 cm long and 2 cm wide. They are formed by connective tissues. There are large number of Graafian Follicles (Immature Ova) inside the Ovaries. After puberty, a Follicle gets matured in every month. In the process of ovulation, an Ovum comes out from the Follicle; travels through Fallopian Tube and reaches the Uterus. This process continues every month until the woman becomes pregnant or she reaches menopause. Ovaries also secrete the female sex hormones called oestrogen and Progesterone. 226

Structure and Function ^ There are two female gonads called ovaries in the female reproductive system ^ They are about 4 cm long and 2 cm wide ^ They are formed by fibroelastic muscular elastic connective tissues ^ There are a large number of graafian follicles (immature ova) in them ^ Generally, a follicle develops into an ovum every month after the onset of menarche ^ During ovulation, the ovum leaves ovary and moves towards the fallopian tube ^ Ovaries also produce female sex hormones called progesterone and oestrogen B. Male Reproductive Organs and their Functions Urinary Bladder Seminal Vesicle Prostate Urethra Gland Vasdeferens Epididymis Penis Testis Lobules Prepuce Glans Fig: 8.4 Male Reproductive System 1. Testes The Testes are the male reproductive gonads. They are oval shaped and whitish in colour. Each Testis contains about 300 - 400 cone shaped sections called lobules. In each lobule, there are 2-4 thin coiled up tiny muscular tubes called semniferous Tubules in which spermatozoa are produced. They are about 5 cm long and 2 cm wide lying in an external pouch called Scrotum. The interstitial cells called leydig cells are present between the seminiferous tubules which secrete Testosterone hormone. 227

Structure and Function ^ Enclosed by Scrotum ^ Oval shaped and whitish in colour ^ 5 cm long and 2 cm wide ^ 300-400 sections called lobules ^ Tiny muscular ducts called somniferous tubules are present in the lobules ^ Somniferous tubules produce spermatozoa ^ The interstitial leydig cells produce Testosterone hormone 2. Epididymis On the posterior side of each Testis, the Seminiferous Tubules get convoluted and formed a coma shaped structure which is called Epididymis. It is a very long narrow tube which is extensively coiled up. This tubule alone if unravelled would extend for several meters. The final maturation of the sperm cells occur in the Epididymis. It stores and passes those sperm cells from the Testis to Vasdeferens. Structure and Function ^ It is the coiled up semniferous tubules convoluted outside the testis ^ It is a long narrow tiny muscular duct of several meters ^ Maturation of the spermatozoa occur at the epididymis ^ It stores and passes spermatozoa from testis to vasdeferens 3. Vasdeferens The Vasdeferens begins from the tail of the Epididymis and ends to ejaculatory duct. There are two Vasdeferenses in the male reproductive system. They are about 45 cm long. At the time of orgasm, the spermatozoa passes through different ducts to the ejaculatory ducts. Structure and Function ^ They are the muscular ductsar ducts ^ They are about 45 cm long ^ They join the tail of epididymis and ejaculatory ducts ^ They pass spermatozoa from epididymis to the ejaculatory ducts 4. Ejaculatory Ducts A short duct from the Seminal Vesicle joins the Vasdeferens to form the ejaculatory duct. There are two Ejaculatory ducts in male reproductive system. They emerge from seminal vesicles, project into the Prostate Gland and end by opening into the Urethra. They are approximately 2.5 cm long. They carry seminal fluid and sperms from the seminal vesicles towards the Urethra. 228

Structure and Function ^ They are the short muscular ducts of 2.5 cm length ^ They start from the seminal vesicles and open in to the urethra ^ They pass seminal fluid and spermatozoa from the seminal vesicles towards urethra 5. Seminal Vesicles There are two small fibro-muscular sac-shaped glands called seminal vesicles located next to the ampulla of the Vasdeferenses, on the posterior part of the Urinary bladder. They are about 5 cm long and 3 cm wide. They produce sticky viscous fluid called Seminal Fluid and store sperms. This fluid supply food for sperms and helps in motility. Structure and Function ^ There are two fibro-muscular sac shaped gland called seminal vesicles ^ They are located next to the Ampulla of the Vasdeferens ^ They are about 5 cm long and 3 cm wide ^ They produce viscous fluid called seminal fluid ^ They also store sperms before ejaculation throughout the urethra ^ The seminal fluid supplies nutrient to the sperms and help in their motility 6. Prostate Glands Prostate gland lies just below the urinary bladder. It surrounds the starting portion of Urethra (i.e. Prostatic Urethra) and two ejaculatory ducts. It produces a thin slippery fluid called Prostatic Fluid. It is about the shape and size of walnut and measures 4 cm length and 2 cm width. The prostate gland facilitates the sexual function by neutralizing the acid suspension of Urethra by releasing Prostatic Fluid and blocking urination during ejaculation of semen. Structure and Function ^ Prostate is located just below the urinary bladder ^ It is about 4 cm long and 2 cm wide ^ It is of walnut shape and size ^ It surrounds the starting part of the urethra ^ It blocks urination during ejaculation ^ It also neutralizes acid suspension of the urethra 7. Penis Penis is an external male reproductive organ of copulation through which sperm cells are transferred from the male to the female. It is cylindrical in shape and is 229

formed by soft fibro-elastic tissues. It is divided into three parts such as root, body and glans. The tip of the Penis (glans) is triangular in shape which is covered by the double folded skin called prepuce or foreskin. The Urethra is surrounded by the penis. And the Urethra opens at the tip of the glans penis from where semen and urine are ejaculated outside. C. Menstruation Discharge of blood, uterine mucus membrane, and dead endometrial cells from the uterus throughout the vagina for 4- 6 days at the interval of one month is called menstruation. Menstruation is the discharge of blood, elements of the uterine mucous membrane, dead endometrial cells and dead Ovum from the Vagina at the interval of about one month in females of child bearing age. However; in some females, it may vary from as short as 18 days to as long as 40 days also. It is a series of events which occurs in every female from menarche to menopause. It is observed among the females from the age of 11-13 years to 45-49 years. The menstruation cycle completes in the following three phases. 29 30 P M2Pens3trPua4tiPon Ph 1 28 4-6 days aseP 27 5 Iuteal phase) P 6 24 25 26 7 14 days Menstrual Cycle Proliferative Phase ( of 30 days 8 9 10 22 23 10 Phase Secretory 2 14 15 13 11 12 0 21 days 19 cular(foli 18 17 16 phase) Ovulation Occurs P= Menstrual Period Fig: 8.5 Menstruation Cycle 1. The Menstrual Phase (4 to 6 days) When the Ovum is not fertilized, the high level of Progesterone hormone in the blood inhibits the secretion of Luteinizing hormone from the Pituitary gland. As a result, the secretion of Progesterone hormone from the Ovary is also reduced. Then gradually, the Endometrial lining of the Uterus degenerates and breaks down and menses (menstrual bleeding) occurs for 4 to 6 days. The menstrual bleeding consists of dead Endometrial cells, blood from the broken capillaries and the unfertilized 230

ovum. It is the first phase of menstrual cycle. Slightly decrease in the size of breasts, hips and body weight is observed during this period. Functions During the Menstruation Phase ^ The Pituitary gland inhibits the secretion of the Luteinizing hormone ^ Secretion of Progesterone hormone is also reduced at the same time ^ The Endometrial cells die out and the endometrial layer degenerates ^ As a result, menstrual bleeding(menses) occurs for 4- 6 days ^ Menstrual bleeding consists of dead endometrial cells, blood from the broken capillaries and unfertilized or dead ovum ^ Slight decrease in body weight is observed during the menstrual period 2. Proliferative Phase (about 10 days) This phase is also called as follicular phase. In this phase, the anterior lobe of Pituitary gland secretes follicle stimulating hormone (FSH) which eventually stimulates the ovarian follicles for maturity. The growing Follicles then produce oestrogen hormone and consequently it enlarges breasts size, develops endometrial layer on the Uterine wall and slightly increase body weight and hip size too. The endometrial layer becomes thicker through rapid cell multiplication accompanied by an increase in mucus secreting glands and blood capillaries. This phase ends after the ovulation. Functions During the Proliferative Phase ^ The anterior lobe of Pituitary gland produces follicle stimulating hormone(FSH) ^ The FSH eventually stimulates ovarian follicles for maturity ^ The growing follicle then produces Oestrogen hormone The secretion of the oestrogen hormone develops endometrium layer and increases body weight slightly ^ This phase ends just after the ovulation 3. Secretory Phase (about 14 days) This phase is also called luteal phase because of the existence of Corpus Luteum. In this phase, the anterior lobe of Pituitary gland secrets Luteinizing Hormone (LH) which eventually produces Corpus Luteum in the empty Follicle. Then Corpus Luteum consequently secretes Progesterone hormone. With the help of Progesterone hormone, the endometrial layer becomes thicker and the secretary glands of the endometrial layer secrete watery mucus for the protection of the endometrium. If fertilization does not take place, secretion of watery mucus is reduced and so does the Progesterone hormone. This results next menstruation cycle. 231

Functions During the Secretary Phase ^ The anterior lobe of Pituitary gland produces Luteinizing Hormone(LH) ^ The LH eventually produces corpus luteum in the empty follicle ^ The corpus luteum then produces Progesterone hormone ^ Progesterone hormone thickens the endrometrium layer ^ At the same time, secretary glands produce watery mucus and protect the endometrial layer ^ If fertilization does not occur, the secretion of progesterone hormone and watery mucus are reduced and menstruation happens. D. Factors to be Considered During Menstruation Menstruation is a normal process that occurs in every female. But it is sometimes problematic to some women and girls. These problems may be manifested by the symptoms of severe pain at lower abdomen, heavy bleeding, physical pain etc. Due to such painful experience, the fear and mental tension may arise that may have negative consequences. Therefore, the following measures are suggested to overcome those menstrual problems. e Menstruation is a natural process. If someone has her first menstruation she must discuss the problems with friends and seniors to get right information and advice e In case of physical pain during the period, it is good to drink more liquid and use hot rubber bag. Bed rest may be harmful, hence simple body movement and walking is beneficial e It is better to use disposable sanitary pad. If the sanitary pad is not available, clean and soft cotton cloth can be used e Regular bathing is good for health during this period. Vagina must be clean after each urination e Heavy work and distant travel may be harmful in this period. More rest is recommended during this period e Balanced diet is required for good health in this period e Pay more attention to personal hygiene e Keeping the menstrual woman in isolation or in cowshed (chhaupadi pratha) is the violation of human rights Activity Divide your class into different groups and discuss about the different phases of menstruation. 232

8.4 Reproductive Rights The international conference on human rights held in Tehran in 1968 AD had raised the issues that any couple should have right to have the number of children and their spacing. It was probably the first time where reproductive rights was recognized as per the human rights. Again, the ICPD 1994 AD and Beijing conference, 1995 AD had strengthened the issues of reproductive rights. The rights discussed in those international conferences are mentioned below: • The rights to life: Every woman’s life should be protected from the risks caused by pregnancy. • The right to liberty and security: Every person is free to control and satisfy the sexual and reproductive matters. • The right to equality and free from all forms of discrimination: Everybody is free to receive services on sexual and reproductive health without any kind of discrimination. • The right to privacy: All person’s rights to secrecy for any sexual and reproductive services and free decision making should be respected. Service renders should maintain privacy. • The right to freedom of thought: All persons’ rights to express sexual and reproductive health issues should not be narrowed from any religious values, beliefs, philosophy and custom. • The right to information and education: Every person has right to get information and education on sexual and reproductive health to maintain family welfare. • The right to choose whether or not to marry: Everybody has right to decide whether or not to marry. • The right to decide whether or when to have children: Everybody has right to decide whether or not to have children. • Everybody has right to receive available sexual and health services. • Everybody has right to influence, pressurize, assemble and participate in politics to establish sexual and reproductive health rights and their implementation. • Everybody has right to be free from sexual and reproductive health related abuse, violence and sex trade. • Everybody has right to selection and use of contraceptive methods to maintain desired family size. Activity Visit any 10 married women having more than one child. Prepare a report by asking them about Age at marriage, Age at first conception, number of children and birth spacing. 233

Summary M Puberty is the first stage of adolescence period at which the onset of sexual maturity and the reproductive organs become functional. M Adolescence is the period of human life in which boys and girls move from childhood to adulthood physically, mentally and socially as well. According to the WHO, adolescence period falls between the ages of 10 to 19 years. M Generally; in girls, puberty falls around the age of 11 to 13 years and in boys around the age of 13 to 15 years. M Growth and development of height, weight, sexual organs and internal development of the endocrine system, respiratory system, digestive system and circulatory system come under the physical changes of adolescence period. M Development of memory and imagination power as well as development of thinking and analytical skill falls under the mental change in adolescence period. M The heightened levels of emotions like anger, fear, jealousy, grief, joy, affection are marked during the adolescence period. M Adolescents are likely to encounter some problems like peer pressure, imitation, sexual abuse, early marriage and unsafe sexual relationship due to the rapid change in physical, mental, emotional and social changes. M Adolescents’ problems can be managed through counselling. M Parents, teachers, community leaders, and policy makers should focus their attention to address and manage the problems faced by adolescents. M Sex education is an educational program which provides knowledge of biological, socio-cultural and moral dimension of human sexuality that ultimately help individuals to maintain proper age at marriage, birth spacing and perform safer sexual behaviour. M Family planning refers to the planning of age at marriage, size of family, number, and spacing of children, use of contraception, job and education for the attainment of quality of life. M Menstruation is a physiological process in which there is discharge of dead endometrial cells, unfertilized ovum, blood from the broken capillaries and mucous membrane from the Uterus every month. 234

Exercise A. Very short answer questions. 1. Define puberty. 2. Mention any two reproductive rights. 3. What is reproductive health? 4. Mention any two functions of a male gonad. 5. Mention any two functions of seminal vesicles. 6. What is adolescence? B. Short answer questions. 1. Discuss the importance of reproductive and sexual health. 2. In which conditions the pregnancy is dangerous? Explain. 3. What social and emotional changes we can observe in adolescences? 4. Mention the needs and demands of adolescents. 5. Draw male and female reproductive system and label them. 6. How is sex of an unborn baby determined? 7. Explain the management measures of adolescents’ problems. C. Write short notes on: 1. Rational of Sex Education 2. Areas of Reproductive Health 3. Uterus 4. Seminal Vesicles D. Write differences: 1. Physical changes in adolescent boys and girls 2. Structure and functions of Ovaries and Testis 3. Fallopian Tube and Vasdeferens E. Long answer questions. 1. Explain the different stages of a menstruation cycle with the help of a suitable diagram. 2. Mention the reproductive rights guaranteed by the international conferences. How do you relate these reproductive rights in our national context? 3. Critically examine the various aspects of reproductive health. Project Work Prepare a report conducting a sample survey on “Problems faced by school going adolescents” by collecting data from 10 adolescent boys or girls randomly from any one school of your community. 235

Unit CONSUMER HEALTH 9 Learning Objective After completing this unit, students will be able to: • Define and tell the importance of Consumers Health. • Explain the ways of protecting consumers health. • Explain the provisions of Consumer Protection Act, 2054 BS. 9.1 Consumer and Consumer Health Consumer Health is a new concept in our context. Since “better late than never is okay”, the first and foremost consumer legislation everywhere in the world was enacted on 15th March 1963 AD in the USA. During the same year, an international organization of consumer union was also set up with its head office in Hague, the Netherlands. Realizing the importance of consumer health, the international consumer day is being celebrated on 15th March every year since 1963 AD. 9.1.1 Introduction to Consumer Health Before discussing the consumer health we should know who the consumer is. In general term, consumer refers to the individual or group of individuals who purchase goods and services from the market for consumption but not for sale. According to the Consumer Protection Act, (2054 BS), “the consumers are the individuals and or institutions who use goods and services from the market.” In other words, the users of the goods and services of factories, industries or institutions are considered as consumers. As a consumer, we should be aware about the quality of goods and services available in the market. If consumers are not conscious they are not able to choose and consume quality goods and services. In this situation, conscious consumerism protects health and wellbeing of the consumers. Generally speaking, consumer health is a condition of health of the consumers which is affected by the standard or quality of those consuming goods and services in the market. Consumer Health teaches the people about consumer’s rights and protects them from food adulteration, quackery, duplicate goods and low quality services. It also encourages individuals to be organized and raise collective voice for consumer health. The government and its agencies are supposed to protect the consumers’ health. Moreover, we all are responsible to control the antisocial activities that weaken 236

consumers’ health. In the context of Nepal, different legal provisions such as Nepal Standard Act 2037 BS, Drug Act 2035 BS, Drug Abuse Control Act 2033, Black Marketing and Social Crime Punishment Act 2032, and Standard Measurement Act 2025, Food Act 2023 have been made to protect the health and wellbeing of the consumer. Legal provisions of some consumer laws of Nepal are mentioned below: Food Act, 2023 BS Provisions • Proper hygiene of food products as well as medicine • Production and distribution of safe, clean, and quality food products and medicine • Confiscate and forbid the production and distribution of low quality food products and medicine Standard Measurement Act, 2025 BS Provisions • Maintains uniform measurement system all over the country • Provision of using the weighing scales which the Department of Mint (Nepal Rastra Bank) approves • Provision of the measurement of the goods in the metric system • Punishment to the shopkeepers using uncertified weighing scales Black Marketing and Social Offence Punishment Act, 2032 BS Provisions • Punishment to the persons involved in black marketing • Punishment to the persons involved in illegal profit making • Punishment to the persons involved in artificial scarcity • Punishment to the persons involved in social offence Drug Abuse Control Act, 2033 BS Provisions • Control of production, distribution, storage and consumption of illicit drugs • Control of export and import of illicit drugs • Make known to users about the use of the drugs • Responsibility of prescribing doctor Drug Act, 2035 BS Provisions • Criteria for the manufacturing and distribution of therapeutic drugs • Regulation of production, import, export, storage and sale of quality drugs • Punishment to the quacks for their quackery 237

Nepal Standard Act, 2037 BS Provisions • Examination of the product quality • Providing quality mark to the quality products • Control of low quality products Activity Conduct an essay writing competition in the class about the “need of the knowledge of consumer health in relation to quality of life”. 9.1.2 Consumer Health Rights The goods and services consumed by the consumers are called consumer goods. All of the articles such as ingredients, colour, additives, preservatives, flavor and chemicals, which are used in manufacturing the products are known as consumer goods. Similarly, any kind of service, counseling or facilities rendered by taking fee or benefit is called consumer service. The Essential Commodities Control Act (2017 BS) has defined the following articles as the essential commodities and made provision to display the price list of those essential commodities at the shop by the retailers and wholesalers in the visible place. The Essential Commodities Control Act (2017 BS) defines that unless the subject or context otherwise requires, “Essential Commodity” means any of the following commodities: 1. Paddy, Rice 2. Corn/Maize 3. Beaten rice 4. Wheat flour and 5. Lentils/Pulses 6. Salt Maida 8. Tea products 9. Oilseed and oil 7. Molasses and sugar 11. Medicines 12. Vegetables 10. Meat/Fish 14. Fruits 15. Spices 13. Soap 17. Cotton or woollen 18. Milk and milk 16. Raw jute and goods clothing’s products prepared out of it 20. Fertilizer 21. Firewood/Coal 19. Petroleum products 23. News print 24. Zinc sheet and lubricants 26. GI pipe/Polythene pipe 27. Bricks 22. Cement 29. Printing and stationery 30. Means of 25. Wood 28. Iron rods and goods materials transportation made from the iron Source: Department of Trade and Supply, 2071 BS 238

In this Act, provisions were made to select essential goods for one’s daily life and to store such goods for the future use. This Act also made provision of price list of the goods at the shop and punishment for the manufactures, dealers and retailers involved in artificial scarcity and black marketing. Provisions • Right to select essential goods, • Right to store essential goods for future use, • Displaying price list of the goods at the shop, • Punishment to the fraudulent involved in artificial scarcity and black marketing. Those goods, which are listed in the above table as the essential commodities should have provision of regular supply to the consumers. Being the consumers, it is our right to get those goods on regular basis. It is the responsibility of the government to guarantee the regular supply of those essential commodities to the consumers. Realizing this fact, the government has provided the following rights to the consumers through the Consumer Protection Act, 2054 (Section-6) such that: for protecting the rights and interests of the consumers, every consumer shall have the following rights: i. Right to be protected from the sale and supply of consumer goods and services which may harm life, body, health and property. ii. Right to be informed about the prices, attributes, quantity, purity and quality of consumer goods and services so as to be safe from unfair trade practices. iii. Right to be assured of an opportunity to choose consumer goods and services at competitive prices as far as possible. iv. Right to be assured that an appropriate agency will hear matters concerning the protection of the rights and interests of consumers. v. Right to be heard and compensated against exploitation and grievances resulting from unfair trade practices. vi. Right to consumer education. The government agencies, civil society, and consumers themselves need to play important role to translate those legal rights of the consumers into the day-to- day life. In addition to the rights as mentioned above, the Consumer Protection Act (2054) has made some important provisions that need to be considered by the consumers. Consumers are supposed to minutely observe and analyze the following things while using goods and services: See the name and address of the producer or manufacturer. Examine the description of raw materials used and composition of the product especially in foods and medicines. 239

Observe the classification of the standard of foods according to the government regulation. See the price, batch number, manufacturing date and expiry date of the goods. Get proper information and direction for using poisonous and inflammable goods. Examine the quality of consumer goods whose quality has been determined, if any. In the case of consumer goods such as food and medicines, their ingredients as well as their quantity and weight need to be examined thoroughly. Be informed about the method of consuming consumer goods and possible impact of such consumption. Get warranty and or guarantee card in the case of electronic gadgets. Not to buy the expired goods and articles. It is the duty of a seller to provide receipt and right to get it after buying the goods; so deserve your right by getting receipt while buying goods from the market. 9.1.3 Importance of Consumer Health Education The production and selling of low quality, adulterated and harmful goods, and products causes severe public health problems. When consumers are not aware of consumer right, they are compelled to use harmful and low quality products. Consumer health is an indispensable part of human right. Consumers get cheated everyday in several ways if they are not conscious about consumer rights. People are involved in producing and selling low quality and duplicate goods and low quality services due to selfish motive. Therefore, the health and well-being of the consumers is always in risk. In this condition, there is a great importance of Consumer health education at the present context. Importance of consumer health education are mentioned below: It provides right information about goods and services available in the market. It awares people about the right, duty and obligation of the consumers. It awares people about the demand, supply and price of the goods. It awares the people about the essential commodities and services. It provides information about the organizations working for consumer’s rights. It awares the consumers about the consumer rights. It organizes and unites the consumers together so that they can fight for their rights against the low quality, fake and duplicate goods and services. It discourages and controls the production and distribution of low quality goods and services. It protects the consumers from ill effects of harmful products. 240

It protects people from food adulteration, duplicate medicines, quackery, etc. It awares the consumers of the unnecessary advertisement of low quality products and fads. It encourages people to complain to the authorities against quackery, black marketing, curtailing, food adulteration, and other social offences. It encourages the concerned authorities and institutions to implement legal provisions and policies in favour of consumers’ health and wellbeing. Activity Conduct a debate competition programme on the topic “Consumer health is essential for the enrichment of quality of life”. 9.1.4 Measures to Protection of Consumer Health The Act regarding the protection of consumer rights was enforced on 15th March 1963 AD in U.S.A for the first time in the world. Since then we are celebrating international consumer day on 15th March every year. By realizing the necessity of legal provisions for the protection of consumers’ health and well-being, the government of Nepal has executed various consumer laws in different time periods. In the context of Nepal, Consumer Protection Act (2054 BS) was enacted by law no. 20 of 2054 BS. This Act has been passed to protect the consumers’ rights for quality goods and services, compensation, security and so on. According to this Act, if there is a threat to life by producing, selling or supplying any of the consumer goods or services which cause harm to the health of the consumers; the maximum punishment is imprisonment for a term up to 14 years, or with a fine not exceeding Rs. 500,000, or with both. Besides this, the punishment and legal actions are explained on the level and degree of crime. This Act is also considered as an umbrella Act since it has accommodated the provisions of other previous consumer related Acts. Hence, the government, consumer organizations and public can play important role to implement the provisions of this Act. Objectives of Consumer Protection Act (2054) BS: i. To maintain health, facility and economic benefit of the consumer. ii. To protect the consumer from the uncertainty of quality, quantity and the price of the consumer goods. iii. Not giving permission to reduce quality and utility of the consumer goods and services. iv. To control the syndicating, curtailing, and monopoly practices. v. Controlling the unnecessary advertisement about the use and utility of consumer goods and services. 241

vi. To make provision of export, import and storage of the quality goods. vii. To protect the right of the consumer by establishing concerned authorities to guarantee their right to redress. The Scope of Consumer Protection Act, 2054: i. Formation of Consumer Protection Council including functions, duties, and powers of the council ii. Protection and promotion of consumer rights iii. Prohibition to Influence demand, supply, or price iv. Power to systematize and control supply of consumer goods and services v. Particulars to be mentioned in consumer goods vi. Prohibited actions regarding consumer goods or services vii. Standard of consumer goods or services viii. Price lists to be kept by the every shopkeeper ix. Power of government of Nepal to conduct inquiry and inspections x. Power to appoint or designate inspection officer xi. Powers of inspection officers to inspect, inquiry or search xii. Testing of consumer goods xiii. Sub-standard consumer goods to be confiscated xiv. Penalties xv. Government of Nepal to be the plaintiff xvi. Investigation and filing of lawsuits xvii. Summary trial procedure to be adopted xviii. Compensation committee and claims for compensation may be made xix. Provision of appeal Activity Prepare a chart paper mentioning the various legal provisions for the protection of consumers health and wellbeing executed by the government of Nepal in different time periods along with their objectives. 242

Summary M The first and foremost consumer legislation everywhere in the world was enacted on 15th March 1963 AD in the USA. M Realizing the importance of consumer health, the international consumer day is being celebrated on 15th March every year since 1963 AD. M According to the Consumer Protection Act (2054 BS), the consumers are the individuals and or institutions who use goods and services from the market. M Consumer Health teaches the people about consumer’s rights and protects them from food adulteration, quackery, duplicate goods and low quality services. It also encourages individuals to be organized and raise collective voice for consumer health. M All of the articles such as ingredients, colour, food additives, preservatives, flavor and chemicals, which are used in manufacturing the goods, are known as consumer goods. Similarly, any kind of service, counselling or facilities rendered by taking fee or benefit is called consumer service. M When consumers are not aware of consumer right, they are compelled to use harmful and low quality products. Consumer Health is an indispensable part of human right. M The Consumer Protection Act (2054 BS), if there is a threat to life by producing, selling or supplying any of the consumer goods or services which cause harm to the health of the consumers; the maximum punishment is imprisonment for a term up to 14 years, or with a fine not exceeding Rs. 500,000, or with both. M Those goods, which is listed in the above table as the essential commodities should have provision of regular supply to the consumers. Being the consumers, it is our right to get those goods on regular basis. M The government, consumer organizations and public can play important role to implement the provisions of consumer related laws. 243

Exercise A. Very short answer questions. 1. What is consumer health? 2. Who is a consumer? 3. Which day is celebrated as an international consumer day? 4. Mention any two essential goods according to the Essential Commodities Control Act, 2017 BS. B. Short answer questions. 1. Why should we study Consumer Health? 2. Mention any four importance of consumer health education. 3. Prepare a list of essential commodities according to the provision made by the Essential Commodities Control Act, 2017 BS. 4. Write down any four objectives of Consumer Protection Act, 2054 BS. 5. Mention the provisions of the Essential Commodities Control Act, 2017 BS. C. Write short notes on: 1. Quality of goods 2. Food Act, 2023 BS 3. Black Marketing and Social Offence Control Act, 2032 BS D. Write differences: 1. Standard measurement Act, 2025 BS and the Nepal Standard Act, 2037 BS 2. Drug Abuse Control Act, 2033 BS and Drug Act, 2035 BS 3. Consumer rights and consumer education E. Long answer questions. 1. Critically analyze the rational of the rights provided by the Consumer Protection Act, 2054 BS on behalf of the consumers in the context of Nepal. 2. Mention the provisions of consumer rights provided by Consumer Protection Act, 2054 BS. Are the existing consumer laws strong enough to control the artificial scarcity and black marketing in the country? Give your opinion. Project Work Visit any ten groceries nearby your locality. Collect the sample of any 10 different items manufactured from different factories. Write a report observing the following points. • Manufactured Date • Ingredients • Batch Number • Expiry Date • Price • Quantity • Certification Mark • Impact on health 244

9.2 Food and Nutrition Nutrition is the total process of breaking down of food or food substances taken in by the mouth to use for energy in the body. According to Lusk Graham, “Nutrition is the sum process concerned with growth maintenance and repair of the living body as a whole or of its constituent parts”. According to Bedi, “Nutrition is the scientific term of food which deals with food values, food processing, its digestion, absorption and metabolism in the body.” Adequate nutrition is important for maintaining healthy bodily function. Good nutrition combined with regular physical activity is a necessary for good health. Here, good nutrition means getting the right amount of nutrients from healthy foods in the right combination. Nutrition education is essential whereby people get knowledge about the need of proper nutrition and for the maintenance of health as well. Basic objectives of consumption of food e To supply energy to the body e To carry out physical activities e To keep body healthy and free from disease e To carry out mental activities e To carry out social and cultural activities e Proper growth and development of the body Classification of Food 1. On the Basis of Source of Origin: i. Animal Sources Milk and milk products: ghee, curd, cheese, butter, etc. Meat, fish, egg, etc. ii. Plant Sources Cereal and Cereal Products Rice, wheat, corn, millet, buckwheat, etc. Pulses and Legumes Gram, cow pea, peas, mung dal, bean, rajmah, etc. Oil Ghee, oil, almond, coconut, mustard, etc. Root and tuber vegetables Potato , sweet potato, carrot, turnip, yam, radish, etc. Green leafy vegetables Spinach, kurilo, cabbage, lettuce, mustard leaves, etc. Fruits Mango, grapes, papaya, apple, banana, guava, etc. 2. On the Basis of Functional Characteristics: Group a: Energy giving food Heat and energy giving foods including rice, maize, wheat, barley, millet, buckwheat, potato, honey, sugarcane, oil, ghee, etc. 245

Group b: Body Building Food Body building food including fish, meat, eggs, milk, beans, groundnut, etc. Group c: Body Protecting Food Body Protecting foods including vegetable and fruits, etc. In order to have a balanced diet, we must eat at least one foodstuff in required quantity from the above-mentioned groups. At the same time, we also should have knowledge of how many calories we need to consume every day. 9.2.1 Essential Nutrients for a Healthy Life We need to have all essential nutrients in our everyday diet for healthy life. Such kind of diet is called a balanced diet. A balanced diet contains about (60%) carbohydrates, (15%) fats and (17%) proteins, (1.5%) minerals with sufficient quantity of vitamins and water. Table 9.1: Composition of Nutrients in a Balanced Diet Nutrients Percent Carbohydrate 61.6 Fat 13.8 Protein 17 Minerals 1.5 Vitamins -- Water 6.1 A. Carbohydrates Carbohydrate is a macromolecule consisting of carbon, hydrogen and oxygen atoms. It supplies fuel for energy to our body. It can be found in various food substances. The major sources of carbohydrates are rice, Sources of Carbohydrates wheat, maize, barley, turnip, potato, sweet potato, yam, sugarcane, fruits, etc. In a Nepalese’s diet, (70 to 80 %) portion is occupied by carbohydrates. Carbohydrate is converted into glucose, fructose and lactose before it can be absorbed by the intestine. Extra carbohydrate is converted into fat and stored in the liver and muscle. One gram of carbohydrate supplies 4.1 calorie of energy. 246

Functions It supplies energy for all the cells in the body. Lactose enhances the absorption of calcium. It keeps the body warm. Glucose is essential for central nervous system. It is essential to remove poisonous substances from the liver. Carbohydrate prevents protein from being used as energy. B. Proteins Proteins are large complex molecules containing carbon, hydrogen, oxygen and nitrogen. Proteins are needed for the growth of our body as well as for repairing and building up of the worn out tissues in the body. In other Sources of Proteins words, proteins are required for the structure, function and regulation of the body’s tissues and organs. Fish, meat, egg, milk, beans, pulses and green leafy vegetables are the sources of proteins. One gram of protein supplies 4.1 calorie of energy. Functions It supplies energy It builds up tissues Protein helps in the growth of children It forms antibodies that help prevent infection, illness and disease Protein stimulates metabolism It helps repair and maintenance of body tissue It helps in the synthesis of antibodies, enzymes and hormones C. Fats Fats are the complex macromolecules that constitute carbon, hydrogen and oxygen. They are classified as unsaturated fat (good fat) and saturated or trans fat (bad fat). In which, saturated fat remains in the solid form at a room temperature whereas unsaturated fat remains in the liquid form at a normal room temperature. Generally, fat from animal source like ghee, butter, animal fat are called saturated fat and the vegetable oils are known to be unsaturated fat. They provide fuel for energy to the body. They supply more energy to the body than other nutrients. Fats can be 247

classified as simple fat, Sources of Fats compound fat, waxes and derived fats. Fats supply fuel for energy to the body. One gram of fat produces 9.3 calorie of energy. Fish oil, butter, cheese, ghee, adipose tissue, peanut, soya-bean, coconut oil, olive oil, sunflower and mustard oil are some sources of fats. Functions It provides energy to the body It helps in absorption of vitamins It diminishes protein metabolism Fat spares the need for thiamine Fat under the skin provides insulation against cold Fat provides support to vital organs like heart, kidney, intestine, etc. D. Vitamins Vitamins are organic compounds required by an organism as vital nutrients in limited amounts. They are the enzymes that regulate the chemical reactions in the body. They also help to protect our body from diseases. Sources of Vitamins They are found in different varieties of foods. There are thirteen types of vitamins essential for human beings. Vitamins are found in fruits, vegetables, fish, meat, eggs, etc. They are classified into two groups on the basis of their solubility. They are: e Fat soluble vitamins: Vitamin ‘A’, ‘D’, ‘E’, and ‘K’. e Water soluble vitamins: Vitamin ‘B’ complex and ‘C’. Functions Vitamins regulate chemical change in the body It is required for metabolic process in the body 248

It is required for maintenance of vision and norm Absorption of calcium and phosphorus. It stimulates normal materialization and growth of bone and teeth Vitamins protect the body from diseases Name Functions and Sources Vitamin A • Function: needed for new cell growth, healthy skin, Vitamin D hair, and tissues, and vision in dim light. Vitamin E Vitamins • Sources: dark green and yellow vegetables and Vitamin K yellow fruits, such as broccoli, spinach, turnip carrots, pumpkin, and apricots, and in animal sources such as Vitamin C liver, milk, butter, cheese, and whole eggs. (Ascorbic • Function: promotes absorption and use of calcium acid) and phosphate for healthy bones and teeth. Thiamin • Sources: milk (fortified), cheese, whole eggs, liver, and (B1) salmon. The skin can synthesize vitamin D if exposed to enough sunlight on a regular basis. • Function: protects red blood cells and helps prevent destruction of vitamin A and C. • Sources: Vegetable oil (soybean, corn, safflower, and cottonseed), wheat germ, green leafy vegetables. • Function: necessary for normal blood clotting and synthesis of proteins found in plasma, bone, and kidneys. • Sources: spinach, lettuce, cabbage, cauliflower, wheat bran, organ meats, cereals, some fruits, meats, dairy products, eggs. • Function: an antioxidant vitamin needed for the formation of collagen to hold the cells together and for healthy teeth, gums and blood vessels; improves iron absorption and resistance to infection. • Sources: many fresh vegetables and fruits, such as broccoli, green and red peppers, cauliflower, lemon, cabbage, pineapples, strawberries, citrus fruits, etc. • Function: needed for energy metabolism and the proper function of the nervous system. • Sources: whole grains, soybeans, peas, liver, kidney, legumes, seeds and nuts. 249

Riboflavin • Function: needed for energy metabolism, building (B2) tissue, and helps maintain good vision. Vitamins • Sources: dairy products, poultry, fish, grains, broccoli, turnip greens, asparagus, spinach, and enriched food products. Niacin • Function: needed for energy metabolism, proper digestion, and healthy nervous system. • Sources: liver, poultry, milk, leafy green vegetables. Vitamin B6 • Function: needed for cell growth. (Pyridoxine) • Sources: chicken, fish, pork, liver, kidney, whole grains, nuts and legumes. Folate (Folic Acid) • Function: promotes normal digestion; essential for development of red blood cells. • Sources: liver, yeast, dark green leafy vegetables, legumes, and some fruits. Vitamin B12 • Function: needed for building proteins in the body, red blood cells, and normal function of nervous tissue. • Sources: liver, kidney, yogurt, dairy products, fish, non- fat dry milk, etc. • Function: needed for healthy bones and teeth, normal Calcium blood clotting, and nervous system functioning. • Sources: dairy products, broccoli, cabbage, etc. • Function: needed for the formation of haemoglobin, which carries oxygen from the lungs to the body cells. Iron • Sources: meats, eggs, dark green leafy vegetables, legumes, whole grains, etc. • Function: needed for healthy bones and teeth, energy Phosphorus metabolism, and acid-base balance in the body. Minerals • Sources: milk, grains, etc. • Function: needed for healthy bones and teeth, proper nervous system functioning, and energy metabolism. Magnesium • Sources: dairy products, meat, fish, poultry, green vegetables, legumes, etc. • Function: needed for cell reproduction, tissue growth and repair. Zinc • Sources: meat, seafood, liver, eggs, milk, whole-grain products, etc. 250