1.3Transition (Malthus,1798) Cleland & Wilson, 1987, in

1.3Transition in Human Fertility
Fertility transitions, ie. the childbearing and fecundity among populations has been seen to follow highly unpredictable statistics. Countries with developed economies in the past years has seen a transition to such levels below replacement level of one. A few Asian countries have also seen similar results, with levels of two. Many developing countries have seen sudden decline in fertility rates. This was debated and discussed by Malthus in “Essay on the Principle of Population”, (Malthus,1798)
Cleland & Wilson, 1987, in their article has said that there are many theories which try to explain why some countries have undergone significant fertility transitions. But there has been no single comprehensive theoretical framework which explains this. In this context, Mason 1997, developed her own theoretical framework which conveys ideas and is also interactional with the public using it. Ideational so that people are able to recognize changing perceptions towards induced fertility reductions and interactive, so that existant conditions and co-existant changes are also considered.

According to this model, a country’s fertility level is determined by three proximate factors: The perceptions among reproducing people of children’s probabilities of surviving, their perceptions of the costs and benefits associated with having children, and their perceptions of the costs of postnatal versus prenatal controls on family size and composition, with costs incorporating both social, psychological, and financial aspects.This model views each household as a single unit. Hence it is also open to accepting that men and women in the house may have different points of view about fertility and reproductive health. Mason, 2001 has said that power structures within households is based on the sex who also is also the powerful partner in fertility decisions.

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(Mason, 1997)*, model adapted from Mason, K. (1997). Explaining Fertility Transitions. Demography,34(4),443-454. Retrieved from http://www.jstor.org/stable/3038299. This model was developed to understand interactions between different factors that lead to lower fertility rates and replacement levels.
1.3.1 The Case of South India*
The South India Fertility study is a baseline of trends and transitions about demographic and fertility transitions in the southern states of India. It is a geographical study about village level changes in child bearing capacities. It has been anticipated that future fertility will be based socioeconomic, socio-psychological, and cultural developments in societies. Hence, this study has a predictive nature about human fertility transitions in the southern states in comparison to the northern states. Better standards and easier access to education for women, being career oriented- at least do work in small scale industries in the villages, becoming independent- economically and emotionally and also having buying capacities to suit their needs has contributed to such an autonomy, Frejka and Calot 2001; Lesthaeghe 2001; McDonald 2000. This trend has been known as the second demographic transition. van de Kaa 1987, says that with this sense of autonomy , such transitions are accompanied by changes in attitudes and behaviors which define sexuality, contraception, marriage, divorce and in certain cases having children outside of wedlock.
1.3Pathways of Help-Seeking
The methods of seeking treatment and medical help by affected men and women are known as pathways of help-seeking. Ravi, 2017 has identified four pathways of medical help seeking by affected women .

*Guilmoto, C. Z., & Rajan, S. I. (2001). Spatial patterns of fertility transition in Indian districts. Population and development review, 27(4), 713-738. a study specifically undertaken to understand transitions in population in South India compared to rest of India.

The common types of treatment seeking patterns were identified to be :
1.Allopathic-Ayurveda-Allopathic-Ayurveda-Homoeopathy systems of medicine pathway
2.Allopathic-Ayurveda-Allopathic systems of medicine pathway
3.Allopathic-Ayurveda systems of medicine pathway
4.Allopathic-Homoeopathy systems of medicine pathway
These women had approached different systems of treatment for seeking resolution for their involuntary childlessness related difficulties. The Government of Kerala had introduced a new system especially to cater to women in need, named AARDRAM. It is an initiative to make government hospitals more people friendly and to improve the basic infrastructure of government hospitals.
Ravi,2017 has also identified certain pathways of treatment seeking which were not popular but nonetheless were sought by affected women. These were;
5.Allopathic-Siddha-Homoeopathy systems of medicine pathway
6.Allopathic-Herbal systems of medicine Medicine pathway
7.Allopathic-Allopathic systems of medicine hospital in neighbouring state pathway
Couples seek different pathways for seeking adequate help for conception. These are based on accessibility, affordability and requirement of treatment needs.

The want for children and the heartbreak from an inability have children been a part of life since the beginning of mankind, chronicled throughout history by religious accounts, myths, legends, art, and literature. Whether driven by biological drive, social necessity, or psychological longing, the pursuit of a child or children has compelled men and women to seek a variety of remedies, sometimes even extreme measures. In fact, in all cultures involuntary childlessness is recognized as a crisis that has the potential to threaten the stability of individuals, relationships, and communities.
Every society has culturally approved solutions to infertility involving, either alone or together, alterations of social relationships (e.g., divorce or adoption), spiritual intercession (e.g., prayer or pilgrimage to spiritually powerful site), or medical interventions (e.g., taking of herbs or consultation with ‘medicine man’).While spiritual and medical remedies for involuntary childlessness are common and often used early on by involuntary childless couples, social solutions demanding the alteration of relationships have been shown to be the last alternative individuals or couples usually consider.

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