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Good Health and Well-Being
Strategic assessment of reproductive health in the Lao People’s Democratic Republic
The status of women’s reproductive health remains a serious problem in the Lao People’s Democratic Republic. Although data on reproductive health are generally scarce the maternal mortality ratio has been estimated to be 656 per 100000 live births (Ministry of Public Health and United Nations Children’s Fund (MOPH and UNICEF) 1998). Estimates of total fertility rates vary from 4.7 children per woman for urban women to 7.8 for rural women (National Statistical Centre (NSC) and the Lao Women’s Training Centre (LWTC) 1995). Only limited data exist on the incidence of reproductive tract infections (RTIs and sexually transmitted infections (STIs) but anecdotal evidence suggests that the magnitude of these problems is likely to be great. The data from the sentinel surveillance system show generally low prevalence rates for HIV but only limited testing has been carried out and a more comprehensive sentinel surveillance system has only recently been put into place. Abortion and adolescent reproductive health remain politically sensitive issues. A report from a small-scale survey conducted by the Japanese Organization for International Cooperation in Family Planning (JOICFP) in three districts showed that the abortion rate was 101.1 per thousand pregnancies (Podhisita and others 1997). Early marriage and pregnancy in adolescence are the norm in the Lao People’s Democratic Republic The Fertility and Birth Spacing Survey (NSC and LWTC 1995) estimated that the median age at first birth for all married women was 20.5 years.
The oral contraceptive pill in Viet Nam: Situation, client perspectives and possibilities for promotion
Viet Nam has one of the highest rates of abortion in the world according to the 1997 Demographic and Health Survey. Even though official statistics and survey fieldwork are likely to have underreported the number of abortions the rate is still high at 340 per 1000 pregnancies (Henshaw and Morrow 1990; NCPFP 2000a). This can be partly attributed to unmet need for contraceptives among married women and also to the fact that unmarried women do not have access to free modern contraceptives (Nguyen Minh Thang and others 1999). To deal with this situation the Vietnamese Government’s family planning programme is expanding the contraceptive mix so that temporary methods such as condoms and oral contraceptive pills are being given more emphasis especially the pills as they are so effective in preventing pregnancy (NCPFP 2000b; Harlap Kost and Forrest 1991).
Bangladeshi migrant workers in Malaysia’s construction sector
The 1980s and 1990s were characterized by an absorption of foreign labour into the Malaysian economy that was unprecedented in terms of numbers and rapidity. From approximately 500000 foreign workers in 1984 (Ministry of Human Resources 1991) their numbers shot up beyond 1.2 million in 1991 (Pillai 1992) and 2.4 million in early 1998 (Utusan Malaysia 1998). Labour voids manifested particularly during the high-growth period of 1988-1997 were the main inducing agent. Construction was among the sectors which came to rely heavily on foreign workers owing to a confluence of factors: Malaysian youth’s aversion to low-status work an expanding manufacturing sector which was offering much better employment conditions labour attrition widening opportunities for tertiary education a lower birth rate and the emigration of Malaysian workers to high-wage countries such as Japan and Singapore (Abdul-Aziz 1995). The Construction Workers Union estimated that in 1987 about 60 per cent of the 300000-350000 workers in the industry were immigrants (Gill 1988). Pillai (1992) estimated that by 1991 70 per cent of the construction workforce comprised immigrants while the author’s own study (Abdul-Aziz 1995) conducted in 1995 found that in the major cities of Georgetown Kuala Lumpur and Johor Bahru foreign workers made up in excess of 80 per cent of site operatives. During this time the nationality of site operatives especially for the undocumented diversified in tandem with the augmentation of the labour movement. As for legal entry at the time of writing Malaysia had granted to five countries namely Bangladesh Indonesia Pakistan the Philippines and Thailand permission to export their surplus construction labour to Malaysia.
Viet Nam’s older population: The view from the census
Viet Nam as many other countries in East and South-East Asia has been successful in its policy to lower fertility in the interest of national development. According to United Nations estimates the total fertility rate fell from over six just three decades ago to close to the replacement level by the turn of the twenty-first century. Life expectancy at birth increased during the same time by almost 20 years to close to 70 (United Nations 2001a). Past high fertility combined with mortality decline is resulting in substantial growth in the numbers of the older persons and in conjunction with the subsequent fertility decline to an increasing share of the overall population who are at older ages. Recent United Nations projections indicate that the population aged 60 and over will increase by 80 per cent in size in the first two decades of this new century and grow fivefold by mid-century (United Nations 2001b). By 2050 persons aged 60 and over will constitute almost a quarter of the total Vietnamese population.
The importance of field-workers in Bangladesh’s family planning programme
The high cost and low quality of services indicate that other models of service delivery need to be considered.
Patrilines, patrilocality and fertility decline in Viet Nam
The 90 per cent or so of the Vietnamese population who belong to the Kinh ethnic group (Vietnam 1991: volume 1 table 1.4) have a patrilineal patrilocal family system. To conform to the rules of this system a couple must have at least one biological or adopted son Viet Nam’s dramatic fertility decline has however entailed a rise in the proportion of parents unable to fulfil this condition. What does this imply about the strength of Viet Nam’s patrilineal patrilocal norms now and in the future?
Sex-selective abortion: Evidence from a community-based study in Western India
Selective abortion of female foetuses has been documented in India as early as the late 1970s when amniocentesis for genetic screening became available (Ramanama and Bambawale 1980) but it was only with the increasing availability of ultrasound technology in the mid-1980s that the practice became widespread. Most of the existing evidence on sex-selective abortion comes from micro-studies in northern India. These have demonstrated a widespread acceptance of the practice and several researchers have documented indirect evidence in the form of increasing sex ratios at birth in hospitals or within communities (Booth and others 1994; Gu and Roy 1995; Khanna 1997; Sachar and others 1990 and 1993; Sahi and Sarin 1996). While abortion (also called medical termination of pregnancy or MTP) on broad social and medical grounds has been legal since 1972 sex selection is not. The state of Maharashtra where the present study was conducted banned prenatal sex selection in 1988; the Prenatal Diagnostic Techniques Bill made sex detection tests illegal throughout India in 1994.
Fertility decline in Sri Lanka: Are all ethnic groups party to the process?
Sri Lanka has played the role of a virtual laboratory in understanding the process of demographic transition in low-income countries. The advanced stages of demographic transition in any context entail irreversible population growth patterns that affect the population growth components of fertility mortality and migration. The significant demographic transitional effects are the fertility changes that these communities undergo tending towards achieving replacement or below replacement fertility levels (De Silva 1994). It would therefore be of interest to investigate the course of such changes occurring in a heterogeneous society.
The strategic approach to the introduction of DMPA as an opportunity to improve quality of care for all contraceptive methods in Viet Nam
The Government of Viet Nam has an explicit policy to regulate population growth and in 1993 established replacement level fertility as a target. It has implemented a strong family planning programme and contraceptive prevalence is high. The contraceptive method mix however remained very skewed. In 1996 the contraceptive prevalence of modern methods was 52 per cent of which the IUD accounted for 72 per cent female sterilization 10.4 per cent condom 9 per cent and oral pills 6.9 per cent. The use of injectables was negligible. In addition 16.3 per cent reported using natural methods (NCPFP 1998). One of the concerns of the national population policy is to diversify the mix through adding more methods such as the DMPA (depot medroxyprogesterone acetate) injectable and the Norplant implant. There continues to be a concern about the high rate of induced abortion in the country and the need to address unmet need for family planning has been highlighted as a means to address this issue (Be’ langer and Khuat Thu Hong 1998; Do Trong Hieu and others 1993).
Government-organized distant resettlement and Three Gorges Project, China
Resettlement of population displaced by major infrastructure projects is an important development issue with concerns about the economic social and environmental consequences being paramount (World Bank 2001; Cernea and McDowell 2000; OED 1998). Cernea and McDowell (2000:12) state that “the most widespread effect of involuntary displacement is the impoverishment of a considerable number of people”. They propose that socially responsible resettlement – that is resettlement genuinely guided by equity considerations – can not only counteract this impoverishment but also generate benefits for both the national and local economy. The World Bank (2001) has indicated that the objectives in involuntary settlement should be as follows:
An assessment of the Thai government’s health services for the aged
In 1998 Thailand’s Health Systems Research Institute a unit within the Ministry of Public Health launched a comprehensive review of health services available to elderly people in Thailand. As part of this review staff at Khon Kaen University gathered data on the provision of services by public facilities. Four methods of gathering data were used: (a) interviews with policy makers and implementors; (b) a survey of elderly people in the community; (c) exit interviews with patients at hospitals; and (d) observations in hospitals. This article summarizes results obtained through the latter three methods A more detailed account of all four methods and the results can be found in the final report (Kamnuansilpa and others 1999).
Quality characteristics of field workers and contraceptive use dynamics: Lessons from Matlab, Bangladesh
In recent years the quality of services of the family planning programme has been identified as a fundamental determinant of contraceptive use and continuation since the potential clients are more sceptical and more concerned with the quality of care than past clients (Hull 1996; Jain 1989; Koenig and others 1997; Mroz and others 1999; Simmons and Phillips 1990). However the quality of care which consists of a series of varied and interacting factors has been defined in different ways in different contexts by various experts (Adeokun 1994; Bertrand and others 1995; Brown and others 1995; Bruce 1990: Hardee and Gould. 1993). hi his classical study. Brace (1990) has identified six elements of quality of care in family planning such as choice of contraceptive methods providers’ technical competence provider-client information exchange interpersonal relations mechanisms to encourage continuity of contraceptive use and appropriate constellation of services. Jain (1989) stated that quality of care refers to the way clients are treated by the system providing sendees. Quality of care in this sense places much emphasis on the interpersonal dimension of interactions between providers and clients. In this context the role of field workers is crucial in fulfilling the demand for quality of care as they are the programme representatives working at maintaining the important link between the programme and the clients. Clients interact with the programme through outreach staff who promote the practice of contraception disseminate information and distribute supplies.
How well do desired fertility measures for wives and husbands predict subsequent fertility? evidence from Malaysia
Data on fertility preferences are often used to help predict future fertility and the demand for contraception. The quality of fertility preference data is of prime importance when examining how well stated fertility preferences predict subsequent births and completed family size and how well they predict fertility-related behaviour such as contraceptive use. Data on fertility preferences have also been used to construct measures of the unmet need for contraception and of unwanted fertility. The usefulness of these measures which have been the basis for many studies and some programmatic efforts depend on the underlying component (stated fertility preferences) being valid and reliable.
On the move: Migration, Urbanization and development in Papua New Guinea
Papua New Guinea has seen incredibly rapid social change Most of the country’s coastal population however have had a longer period of time in which to adjust to the “modern” world than many people in the highlands whose existence was unknown to the outside world until the late 1930s. Extensive areas of the highlands were connected to the rest of the country by road less than two decades ago.
Population and poverty: Some perspectives on Asia and the Pacific
The international community has committed itself to an ambitious programme of social development for the opening decades of the twenty-first century. Attacking poverty directly — as a matter of human rights to accelerate development and to reduce inequality within and among countries — has become an urgent global priority. World leaders have agreed on a variety of new initiatives including the United Nations millennium development goals (United Nations 2001).
Substance use and premarital sex among adolescents in Indonesia, Nepal, the Philippines and Thailand
Early initiation of smoking and drinking are well known to have both immediate and long-term adverse health and social consequences (CDC 1994; Gruber and others 1996; WHO 1997). Premarital sex during adolescence is often unprotected against unwanted pregnancies and sexually transmitted infections and as a consequence often results in adverse social economic and health consequences (UNICEF UNAIDS and WHO 2002; WHO 2001). For these reasons substance use and premarital sex during adolescence are regarded as risk-taking behaviour. Limited studies on substance use and premarital sex also indicate that the prevalence of these risk-taking behaviours among adolescents is increasing in Asian countries (Corraro and others 2000; Tan 1994; Issarabhakdi 2000). In order to formulate and implement effective adolescent health policies and programmes it is essential that the prevalence of adolescent risk-taking behaviousr and the factors associated with them are identified.
Influences on client loyalty to reproductive health-care clinics in the Philippines and Thailand
Studies of factors that affect client loyalty to reproductive health (RH) clinics are limited. This is the case even though the International Conference on Population and Development held at Cairo in 1994 noted among other issues the importance of understanding how client perceptions of quality and satisfaction impact continued use of RH clinics (Ashford 2001). From the client’s perspective stronger clinic loyalty enhances willingness to follow treatment recommendations and keep subsequent appointments (RamaRao and others 2003). From the clinic’s perspective stronger loyalty results in more positive word-of-mouth and repeated visits. Visit continuity in turn increases staff’s ability to deliver quality care and reduces higher costs of recruiting new clients to replace one or two-time users (Sandaram Mitra and Webster 1998).
Population policy
Between 1965 and 1970 the annual population growth rate for the Asian and Pacific region was 2.5 per cent; by the mid-1980s the growth rate had been reduced to 1.7 per cent per year.
Aging in India: Its socio-economic and health implications
The sharp decline in mortality since 1950 and a steady recent decline in fertility has contributed to the process of population aging in India.
Women’s autonomy and uptake of contraception in Pakistan
Recent years have seen increasing attention being drawn to the issue of gender equality in the demographic and reproductive health literature (Federici Mason and Sogner 1993; Jejeebhoy 1995; Dixon-Mueller 1998). While some argue for this focus in the language of reproductive rights (Sen Germain and Chen 1994) it is also frequently asserted that greater gender equality will contribute positively to fertility decline (see for example ESCAP 1987).
Towards a formulation of the Republic of Korea’s foreign worker policy: Lessons from Japan and Germany
On 15 June 2003 some 700 migrant workers in the Republic of Korea gathered in front of the National Assembly building calling for a complete overhaul of the Foreigner Industrial Training and Employment programme (oekukin sanup yonsu chwiup jedo) and demanding an employ permit system (goyonghogaje) to replace it (Chosun Ilbo 2003). After the Republic of Korea experienced a tremendous labour shortage in the late-1980s the Government implemented the industrial trainee system in 1991. Lacking the experience in managing the flow of foreign workers the Republic of Korea established the Japanese version of the immigrant labour scheme providing ostensibly transferable skills to foreigners. That programme however produced inordinate number of undocumented workers and created unacceptable conditions for foreign workers in the country. Those trainees were cheap labourers in disguise. In response the non-governmental organizations (NGOs) in the country advocated persistently for a major reform of the system focusing on the deleterious effects of the trainee system and considering various guestworker models from countries in Europe. This article examines international contract labour programmes from Japan and Germany in order to provide a desirable framework for the foreign worker policy of the Republic of Korea.
Does economic inequality matter in cases of infectious childhood diseases? An analysis for India
Although remarkable declines in infant and child mortality have been observed in developing countries during the last quarter of the twentieth century the incidence and the prevalence of infectious diseases among children under five years of age still persist at an alarmingly high level especially in sub-Saharan Africa and South Asian countries in the ESCAP region. Over two thirds of the estimated 3.7 million deaths of children in South Asia in the year 2000 were attributable to infections such as pneumonia (acute respiratory infections) diarrhoea and measles (UNICEF 2004; Black Morris and Bryce 2003). In India diarrhoea acute respiratory infections tuberculosis and chronic hepatitis continue to threaten the lives of millions of children.
Unintended pregnancies in the Islamic Republic of Iran: Levels and correlates
The first family planning programme in the Islamic Republic of Iran started in 1966 and continued until the 1979 Islamic Revolution. The programme only slightly affected fertility. During the period 1966-1976 the population of the Islamic Republic of Iran experienced a modest fertility decline but this was restricted to urban areas (Mirzaie 1998; Aghajanian and Mehryar 1999). Shortly after the Revolution the family planning programme was suspended although the provision of family planning services continued. In addition the new Government adopted a pronatalist approach encouraging earlier marriage in the society. The eight-year war with Iraq also created a pronatalist atmosphere in the Islamic Republic of Iran. A rationing system was introduced for food and basic necessities and this was helpful to large families. Two years after the revelation of the high population growth rate by the 1986 Census the government population policy was reversed and a new antinatalist programme was officially inaugurated in December 1989. The details of this fundamental policy reversal and its success in such a short period of time have been elaborated elsewhere (Aghajanian 1995; Mehryar and others 2001; Abbasi-Shavazi 2000a 2002a; Abbasi-Shavazi and others 2002; Kaveh-Firouz 2002).
Fertility transition in Bangladesh: Trends and determinants
In the late 1970s there was a consensus that pronounced fertility declines had occurred in many developing countries (Dyson and Murphy 1985; Knodel 1984). Bangladesh however was an exception and even if some changes in fertility did take place any analysis of those changes would be severely hampered owing to the poor quality and unreliability of its data. Nonetheless because of recent improvements in data quality particularly since the middle of the last decade it is possible to examine trends in fertility patterns for the period 1975 -1985. However some data from earlier periods are also used for drawing conclusions. Note should be taken of the fact that these data have specific methodological problems that raise questions about their comparability over time and cross-sectionally. Therefore caution must be exercised in interpreting the estimates.
Internal migration policies in the ESCAP region
The movement of people between various regions of a country is one of the most important processes shaping its settlement system the spatial structure of its economy and the spread of sociocultural attributes over its national territory. Because it assumes such a significant role internal migration has been the focus of long-standing attention by those involved in policy-making and public interventions.
Population and development
Efforts to integrate population and development planning are based on the recognition that population and development are interrelated: population variables influence development variables and are influenced by them.
Socio-economic development and mortality patterns and trends in Malaysia
Mortality in Peninsular Malaysia has reached a level which is quite similar to that prevailing in the low mortality countries (World Health Organization 1982: 17). As in countries such as China Japan Singapore and Sri Lanka neoplasms and cardiovascular diseases which previously had been minor causes of death in Malaysia have become important in recent years (World Health Organization 1982: 20).
Assessment of fertility behaviour change in the sociocultural context of Pakistan: Implications for the population programme
The process of change in fertility behaviour has been explained by social scientists in a variety of contexts. They give diverse interpretations of the reasons underlying these changes. A number of theories and arguments put forward on the subject contend that the level of socio-economic development on one hand and the quality of family planning services on the other are primarily responsible for reducing fertility levels in a society. The available literature however suggests that social values and cultural precepts play an important role in shaping the reproductive attitudes of couples and that this factor ultimately affects fertility outcomes. Hence it is important that in developing programme strategies the local social and cultural context of the setting being studied be taken into account (Coale 1973; Pollak and Watkins 1993; Sultan Cleland and Ali 2002 and Stephenson and Hennink 2004).
Why is funding for population activities declining?
The sexual and reproductive health community heralded the International Conference on Population and Development (ICPD) held in 1994 at Cairo as a new dawn in reproductive rights. ICPD saw a seismic shift in the way we look at reproductive health away from the narrow confines of family planning and demographic targets to the broader areas of women’s empowerment and young people’s reproductive health needs. Most importantly ICPD strengthened the concepts of “rights” and “choice” as the backbone of reproductive health. But many of the declarations hailed at the time remain just that – declarations. Many of the positive changes mooted at the Conference have not been implemented. No doubt this is partly owing to a lack of political resolve – particularly around sensitive issues of young people’s sexual rights and abortion – but also crucially a lack of financial will.
Population aging in Japan, with reference to China
The 1980s may be characterized by two demographic issues which are receiving rapidly increasing attention.
Nutritional status of children in north-east India
Undernutrition in children is the consequence of a range of factors which are often related to insufficient food intake poor food quality and severe and repeated infectious diseases. The inadequacy is relative to the food and nutrients needed to maintain good health provide for growth and allow a level of physical activity (National Nutrition Policy Government of India 1993). Widespread poverty resulting in chronic and persistent hunger is the biggest scourge of the developing world today. Poverty in turn is closely linked to the overall standard of living and whether a population can meet its basic needs such as access to food housing health care and education. This intersectoral and interrelated cause of undernutrition operates at many levels from the community at large to the household and children within households. Undernutrition is often cited as an important factor contributing to high morbidity and mortality among children in developing countries (Sommer and Loewenstein 1975; Chen Chowdury and Huffman 1980; Vella and others 1992a 1992b). Undernutrition during childhood can also affect growth potential and risk of morbidity and mortality in later years of life.
Fertility decline, family size and female discrimination: A study of reproductive management in East and South Asia
Contrary to demographic expectations and in defiance of historical experience elsewhere widespread and continuing son preference in much of Asia has not proved to be an impediment to progressive or rapid fertility decline. Indeed one of the most significant features of the twentieth century has been the dramatic decline in fertility and explicit preference for smaller families in much of East and South Asia which far from reducing has exacerbated son preference leading to increased discrimination against daughters. An examination of the masculinity rates sex ratios at birth and gender-disaggregated infant and child mortality rates all point to excess female mortality in most East and South Asian societies. A study of demographic narratives for each country suggests that region-wide there is an increasing tension or conflict between preferred family size and preferred family-sex composition which is only resolved by intensified reproductive management technological intervention and excess female mortality. Simultaneously ethnographic studies in villages and cities across the region suggest that beliefs and behaviours associated with the management of reproduction are rooted in notions of gender difference complementarity and unsubstimtability. Within the new and now preferred smaller families daughters rarely able to substitute for sons are subject to new trade-offs with daughters more than ever before “taking the place of’ or “limiting opportunities for” sons. This paper summarizes demographic trends in and patterns of female discrimination associated with fertility decline and smaller family size in East and South Asia before turning to ethnographic voices in China and India to investigate and identify the premises or rationales underlying family management of reproduction. Combined demographic and anthropological approaches suggest that there is a demographic development and gendered coherence in East and South Asia combining rapid or progressive fertility decline rising and sometimes rapid economic development and common cultures of gender which have all contributed to an intensification of daughter discrimination.
CNN vs. ABC: A debate not worth continuing!
The debate between the protagonists of the Condoms Needles and Negotiating Skills (CNN) and the Abstinence Be Faithful and Use Condoms (ABC) approaches could go on forever. It is time for the proponents on each side to put aside their differences and begin working together to address the HIV/AIDS pandemic. To claim that ei ther approach is superior to the other is to fail to rec ognize the potential benefits that each approach can have for various individuals communities and cultures. We must recognize that all individuals are different. It is therefore foolish to limit our selves by this “either-or” way of thinking.
Recent trends in international migration in Asia and the Pacific
When the twentieth century came to a close international migration had become part of the region’s economic social and political fabric. As of 2000 there were 49.9 million international migrants in Asia and 5.8 million in Oceania accounting for 29 and 3 per cent respectively of the 175 million international migrants worldwide. Excluding refugees the International Labour Organization (ILO) estimates that of the 86 million migrant workers worldwide (ILO 2004:7) some 22. million were economically active in Asia and some 2.2 million in Oceania (27 and 4 per cent respectively).2 Those numbers reflect the relentless migration that accompanied regional integration and the broader process of globalization on the move since the 1970s. By the end of the century several migration systems had become firmly established in South-East Asia East Asia South South-West Asia and North and Central Asia (Battistella 2002; ESCAP 2002). In the Pacific migration from the Pacific Islands to core countries notably Australia and New Zealand has also been a recurrent pattern in the past decades. Thus in the Asian and the Pacific region alike elsewhere in the world international migration has become a structural reality setting in motion the dynamics for further migration in the years to come. As noted by the participants of the Berne Initiative regional consultation for Asia held in Guilin China on 29-30 July 2004 “The debate in Asia of course differs from the one in other regions of the world not least of which is due to the predominant interest on the continent in the issues surrounding labour migration”.
Changing age structure
Two or three decades ago when birth rates were high in most of the countries and areas of the Asian and Pacific region the major emphasis of population policies was on reducing fertility. Government family planning programmes introduced in the 1950s and 1960s combined with sustained socio-economic development resulted in reduced birth rates. The crude birth rate for the region as a whole is estimated to have declined from 40 to 36 per thousand in the period 1970-1975 and to 27 per thousand in the period 1980-1985.
Committee on population
Human resources development and the implications of the changing age structure in the Asian and Pacific region were among the major issues covered at the fifth session of the ESCAP Committee on Population during its meeting at Bangkok from 17 to 21 August 1987.
Female autonomy and fertility: An overview of the situation in South Asia
Fertility in the Asian and Pacific region has been falling with notable uneveness over the past one and half decades and there has been considerable variability in the decline among the subregions. Fertility in the region declined 36.8 per cent from 1960-1965 to 1980-1985 and most of the decline (30.8 per cent) occurred during the period 1970-1975 to 1980-1985.
Menstrual regulation practices in Bangladesh: An unrecognized form of contraception
Menstrual regulation (MR) refers to any chemical mechanical or surgical process used to induce menstruation and thus to establish non-pregnancy either at the time of or within a few weeks of the due date of the menstruation (Population Information Programme 1973; Tietze and Murstein 1975; Dixon-Muller 1988). It involves the vacuum aspiration of the uterine lining and is usually done within few weeks (preferably eight weeks or less) following a missed menstrual period.
Tsunami versus HIV/AIDS: Perception dictates response
On 26 December 2004 a magnitude 9.0 earthquake struck off the coast of Indonesia generating a widespread tsunami. The resulting waves some up to 15 meters high reached the heavily populated shores of Indonesia Thailand Sri Lanka India and the east coast of Africa leaving a path of death and destruction in their wake. The final death toll may never be known but it is likely that at least 200000 people lost their lives on that fateful day with some estimates running as high as 280000. Along with lives lost the tsunami destroyed countless livelihoods and made millions of people homeless. Soon after the event in an interview with CNN United Nations Emergency Relief coordinator Jan Egeland summarized the situation: “This may be the worst natural disaster in recent history because it is affecting so many heavily populated coastal areas... so many vulnerable communities”.
Readiness, willingness and ability to use contraception in Bangladesh
In his frequently quoted article Coale (1973) proposes that one weakness of the demographic transition theory is that it indicates a high degree of modernization as sufficient to cause a fall of fertility without indicating the degree of modernization that is necessary. By summarizing the findings of historical studies of European communities Coale proposed three broad conditions necessary for fertility transition. He argued that modernization ultimately establishes these conditions but that they can also occur in communities that have undergone little modernization. Lesthaeghe and Vanderhoeft (1998) later described the three conditions for fertility transition under the heading “readiness” “willingness” and “ability”. Economic readiness means that fertility control must be advantageous to the actor so that fertility is within the calculus of conscious choice. Willingness means that fertility control must be legitimate and normatively acceptable. The basic question addressed by “willingness” is to what extent fertility control runs counter to established traditional beliefs and codes of conduct and to what extent there is a willingness to overcome objections and fears. Ability refers to the availability and accessibility of contraceptive techniques. Similarly Ahmed (1987: 363) applying Easterlin’s supply-demand theory of fertility observes that “studies on contraceptive use most often view three variables-motivation attitude and access-as the key determinants”. Motivation stems from having or expecting to have too many children or having them too soon. Although this has similarity with Coale’s notion of “economic readiness” it does not necessarily capture whether fertility control is economically advantageous to an individual. In this paper the authors name Easterlin’s notion of motivation as simply “readiness” to distinguish it from Coale’s broader notion of “economic readiness”. Attitude refers to broad notions of acceptability of family planning in general and feelings about specific contraceptive methods in particular and is similar to Coale’s notion of willingness. Access or the “costs of fertility regulation” as described by Easterlin (1975) pertains to the availability of contraceptives and selected services and is similar to Coale’s notion of ability.
Barriers to family planning service use among the urban poor in Pakistan
Although fertility has shown some decline in Pakistan in recent years contraceptive use remains low. Despite high knowledge of modern methods of contraception (94 per cent of married women know of a modern method of contraception) only 17 per cent of married women of reproductive age currently use a modern method of contraception (Pakistan Reproductive Health and Family Planning Survey 2001; Sathar and Casterline 1998). This is in part a product of poor physical access to family planning services. The coverage and quality of family planning services is poor with only 10 per cent of the population living within easy walking distance of government-operated family planning services (Rosen and Conly 1996). Consequently there exists a large unmet need for family planning services in Pakistan (Mahmood and Ringheim 1997). Previous research however into the barriers to family planning service use has highlighted the importance of looking beyond physical access to examine barriers that arise from the socio-economic and cultural environment in which an individual lives (Bertrand and others 1995; Foreit and others 1978). Pakistan presents an interesting context for examining the range of potential barriers to the use of family planning services with a low level of economic development and strict cultural norms that may inhibit service utilization. This paper identifies the barriers to family planning service use among women in urban slum areas. The paper also examines the characteristics of urban poor women who report different types of barriers to using family planning services. Gaining a better understanding of the types of women who are likely to experience particular barriers to family planning services is valuable for developing service promotion strategies and for informing service delivery protocols.
Adolescent reproductive health in Asia
The reproductive health of adolescents is of growing concern today. The Programme of Action adopted at the International Conference on Population and Development held at Cairo in 1994 stresses the importance of addressing adolescent sexual and reproductive health issues and promoting responsible sexual and reproductive behaviour (United Nations 1994). The reproductive health needs of adolescents have been largely ignored by the existing health services. Therefore there is a need to provide such services and to undertake research in understanding adolescent sexual behaviour and reproductive health.
The ‘Unreached’ in family planning: A case study of the Republic of Korea
The family planning programme of the Republic of Korea has been quite successful yet it has not been able to extend its services to all couples of childbearing age. For example there still exists a group of couples who want no more children and yet are not currently using any contraceptive method. The word “pong-eem “ which literally means “being neglected” i.e. untouched by the family planning programme was coined to describe this group (Park et al.).
Family transition in South Asia: Provision of social services and social protection
Family may be defined as a group of persons related to a specific degree through blood adoption or marriage. The difficulty is that comparative data on the family in the broad definition of the term are not available. The available statistics relate to households defined by location community or living arrangements. Surveys and censuses usually cover all households not merely family households. Nevertheless the latter type constitutes a major proportion enabling the characteristics of the totals to be identified as those of family households. For many demographic socio-economic and political reasons family members may disperse and consequently the size of the household could be reduced although the size of the family would remain unchanged. In Asian countries most young people live with their parents after marriage and later move to another place whenever custom imposes or the economic condition of the new couple permits. Lloyd and Duffy (1995) believe that beyond this natural ebb and flow of family members families are becoming more dispersed. Young and elderly adults spouses and other relatives who might otherwise have shared a home are now more likely to live apart from one another. In 2004 the United Nations observed the tenth anniversary of the International Year of the Family. Thus it appears timely to review some of the trends such as fertility marriage dissolution migration urbanization and ageing that affect the family in the region.
Growing old in Asia: Declining labour supply, living arrangements and active ageing
Several decades ago the discussion on population and development focused on the large size and high growth rate of the population resulting from rapidly declining mortality rates and continuing high fertility which leads to population explosion. Controlling of infectious diseases through the diffusion of public health programmes and the availability of modern antibiotics invented in Western countries were some of the key factors in declining mortality rates in developing countries including those in Asia (Hirschman 2005).
Gender, leisure and empowerment
In this paper the author looks at one important but usually sidelined aspect of gender equity and female empowerment: the access that women have to leisure. Much of the research on empowerment is about women having the resources technical material and physical to take decisions to be physically mobile and to manipulate their larger environment. In turn this empowerment is valorized because of all the good uses to which it is typically put according to the large and growing literature on female empowerment. The autonomous or empowered women is supposed to be good for society and for the family because her autonomy results in lower fertility lower infant and child mortality better household welfare higher contributions to economic development and other benefits. But there is much less concern with what autonomy and empowerment can do for women themselves with the exception of the demographic outcomes like better health.
Translating pilot project success into national policy development: Two projects in Bangladesh
Prescriptions for policy change pervade the research literature on population programmes. While the audience for such conclusions may be receptive to the wisdom imparted established bureaucracies resist systemic renewal and reform. Even if policies are modified in response to research the promulgated changes often fail to influence what public-sector programmes actually do since bureaucratic traditions outweigh reasoned responses to research outcomes.
Social issues in the management of labour migration in Asia and the Pacific
Any discussion of the mobility of labour across borders in a region as huge and complex as Asia is bound to do no more than provide a sketch of a few idiosyncrasies and peculiarities. With a combined population of 3.6 billion the Asian and Pacific region accounts for almost three fifths of the world’s total population. The region’s land mass and innumerable islands have been partitioned into over 50 independent States dividing people usually along lines of ethnicity common language religion and shared recent history. Each one is pursuing independent national policies for political and economic development with varying success creating in the process differentials in standards of living within and between States that often drive people to move. Those differentials have been magnified by the forces of globalization which have spurred the economies of the region but favouring the open and politically-stable countries more than others.
Women’s perceptions of the pill’s potential health risks in Sri Lanka
The birth control pill has been in use for three decades. By the early 1980s an estimated 50 million women worldwide were using the pill and approximately three times as many had used it at some time in their reproductive years (Kols et al.1982).
Why are population and development issues not given priority?
From the time of Adam Smith onward economists have recognized important linkages between population trends and economic development. Yet the attention given to these linkages in international conferences and other venues where policy is debated has varied enormously over time and also according to the issues being discussed: women environment poverty and sustainable development for example. Looking back over recent decades it is hard to escape two conclusions: (a) politics sometimes plays a more important role than dispassionate academic discourse at such meetings and this greatly influences the attention given to population matters; and (b) fads are almost as ubiquitous in international thinking on development issues as they are in matters of dress eating habits and youth culture.