Good Health and Well-Being

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 100,000 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 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 500,000 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 300,000-350,000 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.

The high cost and low quality of services indicate that other models of service delivery need to be considered.

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.

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).

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).

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.

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).

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).

The sharp decline in mortality since 1950 and a steady recent decline in fertility has contributed to the process of population aging in India.