Good Health and Well-Being

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 1,000 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).

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 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?

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.

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:

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.

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.

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.

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.

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).

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.

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.

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.

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).

The 1980s may be characterized by two demographic issues which are receiving rapidly increasing attention.

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.

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”.

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.

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.

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.

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.

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.

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.

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.

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.