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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).