Asia-Pacific Population Journal - Volume 24, Issue 2, 2009

Worldwide, stigma and discrimination have been identified as tremendous barriers to addressing the HIV/AIDS epidemic, beginning with Jonathan Mann in the 1980s (Mann, 1987), and by others (UNAIDS, 2001, 2008; Reidpath, Brijnath and Chan, 2005; APN+, 2004). Stigma was defined by Goffman (1963) nearly half a century ago as a discrediting attribute about an individual or group that serves to devalue that person or group in the eyes of the society. More recent theoretical frameworks suggest that stigmatization and discrimination are manifest in a number of contexts, including within families, communities, schools, employment, travel/ migration opportunities, health-care settings and HIV/AIDS programmes (Parker and Aggleton, 2002), and in religion and the media (Malcolm and others, 1998). A study in four countries in Asia found pervasive discrimination, with 80 per cent of respondents having experienced AIDS-related discrimination, including nearly one in five facing discrimination within their families and in their workplaces (APN+, 2004). In a review of interventions to reduce HIV/AIDS stigma, Brown, MacIntyre and Trujillo (2003) noted that stigma affects prevention behaviours, test-seeking, care-seeking, quality of care provided to positive clients, and perceptions and treatment of people living with HIV and AIDS by communities and families. Parker and others (2002) contend that HIV/AIDS-related stigma is often layered upon other stigma, for example, the one associated with engaging in illegal behaviour, such as sex work and drug use. Furthermore, families with HIV-positive members often face stigma from the community. In order to combat stigma and the associated discrimination, it is important to understand the knowledge, beliefs and attitudes and how they vary across groups within a country. Such knowledge is critical for designing interventions to reduce stigma and discrimination.

While demography is an inherently spatial science, most practicing demographers have not been encouraged to think spatially, even though demographic behaviour will differ by geographic region (Weeks, 2004). The incorporation of geocodes in large-scale demographic surveys provides new opportunities for research on geographic patterns of behaviour, including reproductive behaviour. In this paper, the authors assume that a woman’s reproductive behaviour takes place in sociocultural contexts, and specifically, authors explore whether the sociocultural context of women’s empowerment is important in shaping her behaviour. Using data on 1,594 Nepalese married women from the 1996 Nepal Living Standards Survey (NLSS), the specific issues explored are whether sociocultural context matters for a woman’s use of prenatal care and assistance during delivery. To date, no nationally representative study of Nepal had explicitly incorporated district-level contextual data, linked those data with individual-level responses, and then used multivariate hierarchical methods for analysis.

Malnutrition is a persistent problem for both children and mother throughout the world. In developing countries malnutrition is an important root of infant and young child mortality, morbidity and reduced life span. It is considered that if malnutrition cannot be reduced and prevented, it will be impossible to achieve many of the Millennium Development Goals (MDGs) including the goals on extreme poverty and hungry, primary education, child mortality, and incidence of infectious diseases. The World Summit for Children in 1990 recognized malnutrition as a contributing factor in half of all deaths occurring among young children. The nutrition goals for the decade 1990-2000 include reduction of both moderate and severe protein-energy malnutrition among children under five years of age by one half of the 1990 levels (UNICEF, 1990). However, the reduction of child malnutrition by half in a decade was one of the most ambitious goals set by the various summits convened during the 1990s. As a result, all of the nutrition goals were not successfully achieved during the period 1990-2000. As a step towards building a strong foundation for attaining the internally agreed development goals, including the MDGs, a consistent set of intermediate targets and benchmarks during the course of the decade (2000-2010) were set to help the unmet goals (UNICEF, 2003; United Nations, 2001). One of the most important goals regarding nutrition during the period 2000-2010 was the one on reducing child malnutrition among children aged under five by at least one third of the 2000 levels, with special attention paid to children under two years of age—especially reduction of stunted and underweighted children by at least one third during the period 2000-2010 (UNICEF, 2002).

At the beginning of the twentieth century, most Pacific islands were still recovering from the high death rates that followed from the introduction of new diseases into the region in the eighteenth and nineteenth century and therefore had low rates of population growth. Some countries did not recover from high mortality until the 1930s, and colonial authorities were content with increasing fertility as it signalled a return to population health. However, fertility rates accelerated for several decades until by the 1970s the total fertility rate (TFR) had reached 7 children per woman or even higher in some countries/areas. Rapid social change and increasing government support for family planning resulted in the TFR falling steadily over several decades so that by the beginning of the twenty-first century several countries had TFRs below 3.