Sustainable Cities and Communities

This review examines telemedicine practices, which are separated into teleconsultations and telemonitoring, that have applied information and communication technologies (ICT) for the delivery of health-care services to older persons in the Republic of Korea, Japan, Australia and China. The practices featured from the Republic of Korea and Japan are telemedicine pilot projects to manage chronic disease patients more efficiently and at lower cost. The projects included a health management curriculum, with emphasis on nutrition and exercise guidance. The participants in each pilot project found the services to be helpful in managing their health; the project evaluation findings also indicated several meaningful medical improvements. In Australia, a Home Monitoring of Chronic Disease for Aged Care Project was designed in 2014 to manage ageing patients with chronic diseases at home through various telemedicine devices. In China, the Ningbo Cloud Hospital was established in 2015 to control increasing health-care expenses and to resolve difficulties for individuals to see a doctor. More than 2,000 patients are now registered for online video consultations and prescriptions. The featured examples illustrate how the application of telemedicine to a health-care system not only promotes accessibility between doctors and patients but can save on construction costs for new facilities and the cost of supplying medical personnel in remote areas, which thus can help reduce national medical expenses. However, to initiate ICT-based health-care service delivery, governments in Asia and the Pacific need to first establish related policies that promote telemedicine.

Singapore is one of the first Asian countries to have adopted a vigorous population programme as part of its socio-economic development strategy. In 1966, when the Singapore Government established the Singapore Family Planning and Population Board (SFPPB) to offer family planning services and to disseminate the small family norm, the population was growing at about 2 per cent per year and the total fertility rate (TFR) stood at 4.7. Having just separated from Malaysia, Singapore was trying hard to gain a firm political and economic footing. The withdrawal of foreign military personnel based in Singapore further aggravated the unsettling economic base. The need to curb rapid population growth was obvious, and population control was viewed as critical in balancing the available economic resources with the demands of an increasing population.

With the development of its family planning programme, China has achieved great success since the 1970s in slowing the growth of its population. This is evident in the rapid decline in fertility: the total fertility rate (TFR) declined from the 1960s average of 5.68 to 4.0 in the 1970s and to only 2.46 for the first eight years of the 1980s.

The populations of most developing countries have been growing rapidly in recent decades. During the 1970s and 1980s, the number of persons of working age has often grown even faster than total populations. The struggle to provide enough employment for a burgeoning labour force often fails, resulting in high unemployment plus a large part of the working population “visibly underemployed” (working fewer hours or days than they would like) or “invisibly underemployed” (doing work of extremely low productivity for low income or underutilizing skills).

Thailand is in a relatively advantageous position compared with most other countries in the region with respect to data to document trends and patterns of breast-feeding and related infant feeding practices. Relevant questions, even if not always strictly comparable, have been included in a series of nationally representative surveys conducted during the last two decades. The information provided by these surveys makes clear that a trend towards a decline in the duration of breast-feeding was underway during the decade of the 1970s, but that during the 1980s the decline halted. In addition, the proportion initiating breastfeeding was high throughout the two-decade period and appears to have recently increased to the point where, at the national level, it is now close to universal.

Myanmar is experiencing relatively high fertility and declining mortality rates. In 1973, the population size was nearly 29 million. It increased to 35 million in 1983 with an annual intercensal growth rate of 2.02 per cent (Union of Burma, 1986a; Part 1, p. 14). Since 1948, when it became independent, Myanmar has struggled for economic development and an improved quality of life. But there have been many obstacles and socioeconomic development remains the main challenge to be met. Successive attempts have been made by means of various short- and long-term plans.

The clinical efficacy of various contraceptive methods is well known. However, relatively little is known about their use-effectiveness (which refers to both technical failure of a method and the failure to use a method properly in actual life conditions, especially in developing countries). Use-effectiveness data for programme as well as non-programme methods are necessary for assessing the impact of contraceptive use on fertility (Bongaarts and Potter, 1983).

The population of Cambodia will reach 9.0 million in 1992. It is estimated to be currently growing at a rate near 2.5 per cent per annum, or an absolute increase of about 220,000 persons a year, according to the Department of Statistics (DOS), Ministry of Planning, Government of Cambodia.

Policy measures, in their dimensions, urgency and intensity, should differ between Bangladesh’s metrocities.

Differences in a country’s fertility levels can be attributed to the differences in the length of the reproductive life of women and differences in the length of time between births when women are exposed to the risk of conception. Analysis of those factors influencing the span and those affecting the spacing of fertility has proven useful, since in many cases they appear to vary quite substantially across populations (Rodriguez and others, 1984). In recent years, policy makers and planners have focused a great deal of attention on the birth interval and its determinants. The reasons are that not only does the number of births a women may have during her reproductive span depend on the spacing between the births but also there is a significant link between birth spacing and maternal and child health (Miller and others, 1992). Thus, the spacing of births through a deliberately prolonged interval between births and a delay in child bearing following marriage could be logical alternative strategies for fertility control.

The cost-effectiveness and proven contraceptive efficacy of the TCu 380A should be considered when selecting a long-term, safe and effective, but reversible method.

Since Viet Nam’s fertility has been falling sharply recently, there will be a future decline in the number of caregivers of the elderly

Adolescents, their parents and the community should be made more aware of the negative consequences of early marriage, early pregnancy and large family size

The last decade has seen increasing interest in population ageing, especially in the more developed countries of the world (Tinker, 1989). The explosion of books, journals and articles on ageing gives an indication of this growing interest. There are plenty of reasons for this interest: the profit motive, the debate about the provision of social services and health care, the involvement of elderly people themselves, and most importantly the changing age structure of the population, which will result in increasing dependency of the elderly on society.

The Asian and Pacific region can look forward to continuing to play a key role as a leader in strategic communication for better reproductive health.

Low fertility will make it easier to bring about needed improvements in the quality of social services.

Adolescents greatly outnumber the elderly, so care must be taken to ensure that policies towards them are not neglected

In many traditional Pacific societies the strange and unknown world is the domain of males, those who were thought to have the strength and confidence to face the odds likely to be met. The female arena is the known, the less dangerous, usually domestic surroundings (Ravuvu, 1992:330).

If unmarried youth had better reproductive health information and skills, their use of pregnancy termination could be reduced.

This article focuses on the introduction and establishment of family planning in Tonga and argues that family planning has been medicalized. In the process of institutionalizing family planning through the formal medical structure, what has occurred is that women - the focus of this national policy - have had their reproductive and sexual environments medicalized. Also, family planning at the macro level, aside from its clinical and medical objectives, has taken up a regulatory function for the socio-economic and developmental aspirations of the state.

Migration patterns and selectivity will probably parallel those in other developing countries of Asia and Africa.

One aspect of the ESCAP region’s unusually steep mortality decline has been the success of its fertility transition, assisted by national family planning programmes

The population census conducted in Cambodia in March 1998 was the first since 1962. During the 36-year interval, comprehensive population data needed for social and economic planning had been lacking.

The Government of Bangladesh attempts to provide reproductive health services that emphasize maternal and child health (MCH) and family planning at different service delivery tiers through a variety of service providers. For this purpose, it has established an extensive network of reproductive health services that reaches almost every village in the country. Female field workers, known as family welfare assistants (FWAs), work at the grassroots level and provide information and counselling on various aspects of reproductive health and refer clients when necessary to clinics. They also distribute oral contraceptives and condoms at the homes of married women of reproductive age, identify pregnant women and refer them to static points of service delivery, i.e. health and family welfare centres, for ante-natal care and for obtaining clinical contraceptives.

Sexual behaviour is one of the most central, yet mysterious aspects of human life. For many people, it is virtually taboo to discuss such matters in traditional Indian settings, where attitudes remain, by and large, conservative (Bang and others, 1989). Research into sexual behaviour in India has been almost entirely confined to urban populations, particularly among groups of people thought to be at high risk of HIV infection (Pachauri, 1992; National AIDS Control Organization, 1994). Little is known about the sexual behaviour of people in rural areas, who comprise nearly 70 per cent of the country’s population. An understanding of sexuality and gender-based power relations is important to issues of reproductive health because they underlie many relevant behaviours and conditions. Family planning policies and programmes should address a broader spectrum of sexual behaviour and consider questions of sexual enjoyment and risks, and confront ideologies of male entitlement that threaten women’s sexual and reproductive rights and health (Dixon-Muller, 1993).

It is well recognized that maternal health services have a critical role to play in the improvement of women’s reproductive health in developing countries (Magadi and others, 2000; Bhatia and Cleland, 1995; Becker and others, 1993; WHO, 1989). It is also well known that the utilization of maternal health services is undoubtedly influenced by the characteristics of the health delivery system such as the availability, quality and cost of the services. However, this does not necessarily mean that where there is a good supply of services, demand is created in and of itself, which will then lead to increased utilization. Thus, there has been considerable debate in the literature recently as to whether the mere provision of health services will lead to increased utilization (Magadi and others, 2000; Obermeyer, 1993; Basu, 1990). It may be true that, even under the same condition of availability, some women are more likely to use maternal health services than others. If so, characteristics of the health delivery system may not be the only explanatory factors for the utilization of maternal health services. Other factors such as the social structure and characteristics of individuals should also be considered in promoting the utilization of maternal health services.

The 1999 population and housing census of Viet Nam estimated the population to be 76 million people (CCSC, 1999). According to the 1994 intercensal survey, the total fertility rate (TFR) was 3.1 children per woman of reproductive age in 1993 (GSO, 1995). The estimate from the 1999 census was 2.3 children per woman in 1999. These estimates suggest that fertility has been falling rapidly in Viet Nam.

“Unmet need for family planning”, which refers to the condition of wanting to avoid or postpone childbearing but not using any method of contraception, has been a core concept in international population for more than three decades (Casterline and Sinding, 2000; Freedman, 1987). The importance of the unmet need for family planning or satisfying an individual’s reproductive aspirations as a rationale for formulating population programmes was further explicitly reiterated by the Programme of Action of the International Conference on Population and Development (ICPD), which states that “Government goals for family planning should be defined in terms of unmet needs for information and services” and that “all countries should, over the next several years, assess the extent of national unmet need for good-quality family planning services (United Nations, 1994). ICPD+5 has called for a 50 per cent reduction in the unmet need for contraception by 2005 and its total reduction by 2015.

“Pregnancy is special, let’s keep it safe” was the theme for World Health Day in 1998. Even if agreement existed on the best way to ensure a safe pregnancy in a resource-poor setting, provision is only half the story; the level and nature of the demand for a “safe” pregnancy also needs evaluating. How women themselves perceive the dangers of pregnancy and how they react to those dangers are important questions to answer.

At the beginning of the twentieth century, the total population of Bangladesh was less than 30 million. The annual growth rate of the population was less than 1 per cent until 1951, when the population reached about 44 million (Bangladesh Bureau of Statistics, 1998). From the early 1950s, mortality started to decline while fertility remained high until the 1970s. Owing to the changes in fertility and mortality rates, from the 1950s the population started to grow at an unprecedented rate, reaching an all-time high (about 2.5 per cent per year) in the 1960s and 1970s. The growth rate then started to decline in the 1980s and is currently about 1.5 per cent per year (figure 1). At the close of the twentieth century, the population of Bangladesh stood at about 130 million.

It is important to recognize that ... people must be central in development.

Since 1978, economic reforms have brought about dramatic increases in temporary migration.

An important distinguishing characteristic of mammals is that the female has mammae (breasts in human beings), the function of which is to secrete milk for the nourishment of newborn offspring. The availability of artificial means (bottles and formula milk) of feeding human infants has considerably reduced the dependency of infants on breast milk; however, the newborns of all other mammalian species remain exclusively dependent on mother’s milk for survival in early life. The milk produced by each species is particularly suited to the needs of newborns of that species. It is not surprising then that breast milk is the most suitable food for the human newborn.

Comparable household-level survey data for the same population at two times are essential for many types of analysis in which age, period and cohort effects must be distinguished. Until recently, it was rare to have usable micro-level data from developing countries collected at two times, far enough apart to allow for significant demographic change in the interim (Hermalin, Entwisle and Myers, 1985). The availability of data sets from the Demographic and Health Surveys (DHS) for many of the same countries in which the World Fertility Survey was carried out has started to improve the situation greatly, enabling cross-national comparisons of changes over a decade or more for countries at different stages of the demographic transition. A growing number of countries have conducted a second DHS survey, and third surveys are planned in some countries, e.g. Indonesia.

Sri Lanka will have a rapidly ageing population, and this change will require substantial shifts in policies to cater for changing needs.

The concept "status of women" eludes precise definition and hence precise measurement. Status can be perceived in different ways: the extent of a woman’s access to social and material resources within the family, community and society (Dixon, 1978), or her authority or power within the family/community and the prestige commanded from those other members (Mukerjee, 1975), or her position in the social system distinguishable from, yet related to, other positions (Committee on the Status of Women in India, 1974), or the extent to which women have access to knowledge, economic resources and political power as well as the degree of autonomy they have in decision making and making personal choices at crucial points in their life-cycle (United Nations, 1975). The idea of status also connotes the notion of equality (Krishnaraj, 1986). There can be self-perceived status, group-perceived status or objective status (Mukerjee, 1975), a situation which can lead to status inconsistency when a person is very high in one type of status and very low in another.

Improvement of the status of women and enhancement of contraceptive supply through visits by field workers would make the family planning programme more effective and successful

There is an urgent need to plan for the transfer of necessary resources to the community in order for it to cope with the increasing burden of caring for the elderly.

The challenge will be to adopt IEC activities for minority groups, who currently express high levels of demand and the lowest levels of knowledge and use of contraception.

The Government should consider strategies to reduce poverty, expand schooling, particularly for girls, and help to strengthen women’s ability to care for their families.

The challenge before the International Conference on Population and Development, which will meet at Cairo from 5 to 13 September 1994, will be to reach agreement on a strategy for stabilizing world population growth by addressing reproductive health needs, responsibilities and choices of individuals and incorporating population considerations in efforts to achieve sustainable development.

Without a well-designed and well-financed urbanization strategy, the regional and rural development potentials of an agricultural country such as Nepal may not be fully realized.

A strategy to stabilize world population growth and achieve sustainable development by addressing reproductive health needs, rights and responsibilities of individuals was adopted by the International Conference on Population and Development (ICPD) as it concluded its nine-day meeting at Cairo on 13 September 1994.

Measures should be taken that will help to promote the practice of breast-feeding

The elderly are active participants in household activities.

The most recent Demographic and Health Survey of Viet Nam (VN-DHS II) was conducted in 1997 as a nationwide survey. Conducted by the General Statistical Office (GSO) with technical backstopping provided by Macro International, it is the country’s first such survey since the DHS conducted in 1988. The 1997 VN-DHS was among a number of activities undertaken as part of a "population and family health" project executed by the National Committee for Population and Family Planning (NCPFP).

Asia has made excellent progress over the past 30 years and we must maintain the momentum into the new millennium.

Young married women deserve special consideration because unmet need is highest among them.