Learn — Family, marriage, population & social problems

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Family and marriage — forms, functions and changing patterns

The family is the universal, primary social group formed by marriage, blood or adoption, living together in a household and cooperating to bear and rear children and to meet the material and emotional needs of its members — the basic unit of society and, in community health, the unit of care. Marriage is the socially approved union that founds it, and the forms of both, their functions, the Indian joint family and the laws that govern marriage, dowry and violence are the substance of the sociology paper's most-asked topic.

Functions of the family: biological (reproduction and the regulation of sex), physical (food, shelter, protection, care in sickness and old age), economic (production and the sharing of income), socialisation of the child (the first school of culture and conscience), emotional (affection, security, identity), status-giving, religious and recreational; the family is where health habits are learnt and illness is first treated, which is why the family folder is the community nurse's record.
Types by structure: the nuclear family (a couple and their unmarried children), the joint family (several generations or married brothers under one roof with a common kitchen, property and worship — the classical Hindu joint family) and the extended or three-generation family; by authority, patriarchal or matriarchal; by residence, patrilocal, matrilocal or neolocal; by descent, patrilineal or matrilineal (the Nairs of Kerala and the Khasis of Meghalaya); by marriage, monogamous or polygamous.
The joint family gives security, shared child care, care of the old and pooled income and demands conformity, limits privacy and the couple's autonomy and can delay a woman's decision to seek care; the nuclear family gives freedom and mobility and loses the support, so the elderly and the newly delivered mother are alone; India is moving towards the nuclear and the dual-earner family with urbanisation, while the joint family persists in rural and business families.
Marriage forms: monogamy (one spouse — the norm and the law for Hindus, Christians and Parsis), polygamy — polygyny (one man, several wives) and polyandry (one woman, several husbands — the Todas of the Nilgiris, fraternal polyandry in parts of the Himalaya) — and group marriage; endogamy (within the caste or community) and exogamy (outside the gotra or village); hypergamy (a woman marrying up) and hypogamy; levirate (a widow marrying her husband's brother) and sororate.
The law: the Hindu Marriage Act 1955 (monogamy, conditions and divorce), the Special Marriage Act 1954 (civil marriage across religions), the Prohibition of Child Marriage Act 2006 (minimum age 18 for the bride and 21 for the groom), the Dowry Prohibition Act 1961 (giving or taking dowry is an offence, with dowry death and cruelty as offences in the penal code), the Protection of Women from Domestic Violence Act 2005 (civil remedies including protection and residence orders), and the Maintenance and Welfare of Parents and Senior Citizens Act 2007.
Kinship is the web of relationships by blood (consanguineal) and by marriage (affinal), with its degrees and its terms; kin decide who lives where, who inherits, who cares for whom and who consents to a treatment, and a nurse who does not know who the decision-maker is in a family plans a discharge that will not happen.
Family problems the nurse sees as health: marital discord and desertion, domestic violence, dowry harassment, alcoholism in the earner, son preference and the missing girl child, neglect of the old, the disabled child, and the disruption of migration; the family life cycle — formation, child-bearing, child-rearing, launching, the empty nest and old age — predicts the crises, and the nurse's tools are family assessment, counselling, referral to the protection officer or the social worker, and the entitlements that keep a family fed while it recovers.

Population dynamics, urbanisation and migration in India

Population dynamics is the study of the size, composition and distribution of a population and of the three forces that change it — fertility, mortality and migration — read through the census, the Sample Registration System and the national health surveys. Urbanisation and migration are the two movements reshaping India's population, and the paper asks the census figures, the demographic cycle and the health consequences of a country whose people are moving to its cities.

Census of India 2011, the figures asked: a population of 121 crore (1,210 million), a decadal growth of 17.7 per cent (down from 21.5), a density of 382 per square kilometre, a sex ratio of 943 females per 1000 males (940 in 2001), a child sex ratio of 918 for ages 0 to 6 (the lowest since independence), a literacy rate of 74 per cent (82 in men, 65 in women), and 31 per cent of the population urban; Uttar Pradesh the most populous state, Kerala the best sex ratio and literacy.
The demographic cycle has five stages — high stationary (high birth and death rates), early expanding (deaths fall, births stay high), late expanding (births begin to fall; India is here), low stationary (both low) and declining (deaths exceed births, as in parts of Europe) — and the demographic transition is the passage through them with development, education of women and family planning.
The current vital rates: a birth rate of about 18 per 1000, a death rate of about 6, an infant mortality rate of 24 per 1000 live births (SRS 2024), a maternal mortality ratio of 87 per 100,000 live births (SRS 2022-24), and a total fertility rate of 2.0 in NFHS-6 (2023-24), unchanged from NFHS-5 and below the replacement level of 2.1 — India's population still grows because of the momentum of a young age structure.
Composition: a population pyramid still broad at the base but narrowing, with about a quarter of the population under 15 and about a tenth over 60; the dependency ratio (the young and old per 100 of working age) is falling, which is the demographic dividend if the working age population is educated, healthy and employed — and the ageing that follows is the next challenge.
Urbanisation: 31 per cent urban in 2011 and rising towards 40 per cent, with more than 50 cities of over a million people; the health of the city is the health of its slums (about 17 per cent of urban households), where overcrowding, unsafe water, open drains, pollution, road traffic, tobacco and fast food produce tuberculosis, diarrhoea, dengue, injury, hypertension and diabetes side by side, and the urban poor are often worse served than the rural poor; the National Urban Health Mission (2013) was the response.
Migration is internal (rural to urban, seasonal, for work and marriage — the largest stream) and international; its push factors are poverty, unemployment, drought, landlessness and conflict, its pull factors wages, education and services; migrants lose their entitlements, ration cards and health records, live in the worst housing, carry and acquire tuberculosis and HIV, and their women left behind carry the farm and the children — which is why the mobile migrant is the hardest patient to complete a treatment for.
Population policy: the National Population Policy 2000 aimed at replacement fertility by 2010 and a stable population by 2045 through unmet-need contraception, delayed marriage and birth, institutional delivery and child survival rather than coercion; the community nurse's part is the eligible-couple register, the spacing method, the adolescent's delayed marriage, and the girl's schooling, which is the single strongest predictor of the fertility rate.

Social problems — poverty, unemployment, dowry, child labour, substance abuse and violence

A social problem is a condition that a significant number of people regard as a deviation from the norms they value and that they believe can be changed by collective action — poverty, unemployment, illiteracy, dowry, child labour, child marriage, juvenile delinquency, substance abuse, violence against women and children, trafficking, beggary and the neglect of the old among them. Each has a law and a programme the paper asks by name and year, and each arrives on the ward as a patient whose injury, addiction or malnutrition the nurse is required by law or by duty to recognise, record and report.

Poverty and unemployment: poverty is measured multidimensionally today (health, education and living standard) and by the below-poverty-line lists that open entitlements; unemployment in India is seasonal, disguised and educated as much as open; the responses are the National Food Security Act 2013 (subsidised grain for two-thirds of the population), the Mahatma Gandhi National Rural Employment Guarantee Act 2005 (100 days of wage work a year to a rural household on demand) and the pensions and insurance of social security.
Dowry and violence against women: the Dowry Prohibition Act 1961 makes giving, taking or demanding dowry an offence, and the penal code adds dowry death and cruelty by the husband or his relatives; the Protection of Women from Domestic Violence Act 2005 gives civil protection, residence and maintenance orders through a protection officer; the Sexual Harassment of Women at Workplace Act 2013 requires an internal committee in every institution, including the hospital; female foeticide is answered by the Pre-Conception and Pre-Natal Diagnostic Techniques Act 1994, which bans sex determination.
Children: the Child Labour (Prohibition and Regulation) Act 1986, amended in 2016, bans the employment of children under 14 in any occupation and of adolescents of 14 to 18 in hazardous ones; the Prohibition of Child Marriage Act 2006 sets 18 and 21; the Right to Education Act 2009 makes schooling free and compulsory from 6 to 14; the Protection of Children from Sexual Offences Act 2012 defines the offences and makes reporting mandatory for every person, the nurse included; and Childline 1098 is the number.
Juvenile delinquency — offences by those under 18, rooted in broken homes, poverty, school failure, peer gangs and substance use — is handled under the Juvenile Justice (Care and Protection of Children) Act 2015 by Juvenile Justice Boards, observation and special homes and rehabilitation rather than prison, with the same Act covering the child in need of care and protection through Child Welfare Committees.
Substance abuse: alcohol is the commonest and the costliest (road deaths, domestic violence, cirrhosis, poverty), tobacco the biggest killer (the Cigarettes and Other Tobacco Products Act 2003 bans smoking in public places, sale to and by minors and sale within 100 yards of a school, and requires pictorial warnings), and the Narcotic Drugs and Psychotropic Substances Act 1985 governs the illicit drugs; the National Action Plan for Drug Demand Reduction and the tobacco and mental health programmes carry the treatment, and the nurse screens, counsels briefly and refers.
Trafficking, prostitution and beggary are answered by the Immoral Traffic (Prevention) Act 1956, the anti-trafficking units and the rescue-and-rehabilitation homes; elder abuse and neglect by the Maintenance and Welfare of Parents and Senior Citizens Act 2007, which obliges children to maintain their parents and provides tribunals; communal and caste violence by the penal code and the atrocities Act; and every one of these is a medico-legal case when the victim reaches the hospital.
The nurse's role is fourfold: to recognise the problem behind the presentation (the burn that is a dowry burn, the fracture in a child of different ages, the malnourished working child), to record and report as the law requires — mandatory for child sexual abuse, and as a medico-legal case for assault, burns, poisoning and rape — to refer to the protection officer, the social worker, the helpline (1098 for children, 181 for women, 14567 for the elderly) and the programme, and to prevent through health education, school health and community mobilisation.

Social security and welfare programmes for women, children and the elderly

Social security is the protection that society provides for its members, through public measures, against the economic and social distress that would otherwise be caused by the stoppage or reduction of earnings from sickness, maternity, employment injury, unemployment, invalidity, old age and death, together with medical care and subsidies for families with children (the ILO definition). It is delivered as social insurance, which the worker contributes to, and social assistance, which the state pays from taxes, and alongside it stand the welfare programmes for women, children, the elderly and the disabled that the paper asks by name and that the nurse links her patients to.

Social insurance is contributory and earned: the Employees' State Insurance scheme (begun under the ESI Act 1948) covers workers in factories and establishments (currently those earning up to the wage ceiling) and gives medical, sickness, maternity, disablement, dependants' and funeral benefits through the ESI hospitals and dispensaries, financed by the employee's and the employer's contributions; the Employees' Provident Fund 1952, the Employees' Compensation Act 1923 (compensation for injury and occupational disease), the Payment of Gratuity Act 1972 and the Maternity Benefit Act 1961 (26 weeks of paid leave since 2017) completed the worker's protection — and since 21 November 2025 all five Acts are subsumed in the Code on Social Security 2020, which now governs these benefits.
Social assistance is non-contributory: the National Social Assistance Programme (renamed the Pradhan Mantri Samajik Sahayata Yojana in October 2026) pays the old age pension (60 years and above, below the poverty line; formerly the Indira Gandhi pension, now the PM Vridhavastha Pension Yojana), the widow pension, the disability pension and a lump-sum family benefit on the death of the breadwinner; the public distribution system under the National Food Security Act 2013 gives subsidised grain; and the Pradhan Mantri Matru Vandana Yojana pays a cash benefit for the first living child to compensate wage loss in pregnancy, and since April 2022 a further ₹6,000 when the second child is a girl.
Health protection: Ayushman Bharat's Pradhan Mantri Jan Arogya Yojana (2018) gives an insurance cover of five lakh rupees a year per family for secondary and tertiary hospitalisation to the poorest 40 per cent — and, since October 2024, to every citizen aged 70 and above whatever the income — cashless and portable, and the Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram make institutional delivery free with a cash incentive; the low-cost insurance and pension schemes — Pradhan Mantri Jeevan Jyoti Bima, Suraksha Bima and the Atal Pension Yojana — cover the unorganised worker.
Women: Beti Bachao Beti Padhao (2015) against the falling child sex ratio, the One Stop Centres and the 181 helpline for women facing violence, Shakti Sadan (Swadhar Greh and Ujjwala merged under Mission Shakti from April 2022) for women in distress and rescued from trafficking, the SANKALP: Hub for Empowerment of Women, the National Commission for Women (1992), the working women's hostels and the maternity benefit; the legal protections are on the family and social-problem rows.
Children: the Integrated Child Development Services under Saksham Anganwadi and Poshan 2.0, Mission Vatsalya (the former Integrated Child Protection Scheme) with its Child Welfare Committees and homes, Rashtriya Bal Swasthya Karyakram's screening of children from birth to 18 for defects, deficiencies, diseases and disabilities, PM POSHAN (the former mid-day meal), the National Commission for Protection of Child Rights (2007) and Childline 1098.
The elderly and the disabled: the National Programme for Health Care of the Elderly (2010-11) with geriatric clinics and wards, the old age pension and the Annapurna scheme's free grain for the destitute elderly without a pension, the Maintenance and Welfare of Parents and Senior Citizens Act 2007 and the 14567 elder line; the Rights of Persons with Disabilities Act 2016 (21 recognised disabilities, reservation of 4 per cent of government posts and 5 per cent of higher-education seats, accessibility), the Unique Disability ID, the aids and appliances scheme and the National Trust for the more severe disabilities.
The nurse is the point where entitlements meet the patient: she identifies who is eligible (the labourer's ESI card, the family's health card, the widow's pension, the child's disability certificate), refers to the medical social worker and the block office, fills the forms that make a benefit real, and reports the gaps; voluntary agencies — the Indian Red Cross, HelpAge India, CRY, the Family Planning Association and the local Rotary and Lions clubs — fill what the state does not.

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