Good Health and Well-Being

During the past four decades, Sri Lanka has experienced significant changes in the level and pattern of fertility. The total fertility rate has declined from about 5 children per woman in the early 1960s to near the replacement level of 2.1 by the end of the 1990s despite the fact that the number of women in the reproductive age group more than doubled during this period.

Programme managers must be aware that language may be a substantial barrier to the diffusion of reproductive health knowledge

An entire chapter of the recently published Economic and Social Survey of Asia and the Pacific, 1993 is devoted to consideration of population issues in the region. In this regard the Survey analyses demographic changes in respect of the rates of growth, age composition and spatial distribution of populations, and brings out their implications for education, health, employment and the environment. The emerging differentiated approaches to demographic issues in different countries, reflecting varying degrees of success in managing the demographic transition in past years, are highlighted.

Social factors and family considerations play an important part in shaping migration patterns and influencing outcomes

The problem of care for the elderly is likely to be especially acute for women.

China’s birth control programme did reduce couples’ demand for children, but it did not change their attitudes about ’male superiority’

In this note we examine the ageing of the female population in the State of Kerala, India, in the light of current and future demographic trends as well as the social and economic implications of this process.

To reduce poverty, there first must be an improvement in human resources and increased investment in human capital.

The removal of the social, psychic and economic costs of contraception coupled with efforts to ’crytallize’ demand would hasten the fertility decline.

Female migrants should constitute a special target group for the delivery of contraceptive services.

Women will readily accept contraception if services are made available in a culturally appropriate manner.

The dramatic changes in fertility that occurred in China during the past few decades are well known. The 1982 One-per-Thousand Fertility Sampling Survey of China reveals that the total fertility rate fell from 5.81 at the beginning of 1950 to 2.63 in 1981.

Norplant is an acceptable method of family planning and should be made available along with other methods of contraception.

More attention should be paid to the quality of care in family planning programmes instead of focusing on quantitative aspects.

If more couples were to use effective contraception, the proportion of women receiving pregnancy terminations could be drastically reduced.

Whatever the future may bring, a pervasive familial system of support and care has persisted despite major social and economic change.

The most recent demographic data collected by India’s 1992/93 National Family Health Survey revealed marked variations in fertility by state. Fertility, measured by the total fertility rate (TFR), ranged from as high as 4.82, 4.25, 4.00, 3.99 and 3.90 children per woman in the states of Uttar Pradesh, Arunachal Pradesh, Bihar, Haryana and Madhya Pradesh, respectively, to as low as the replacement, or lower, level of fertility at 1.90, 2.00 and 2.26 in Goa, Kerala and Mizoram, respectively. The national average TFR was 3.39 children per woman; the TFRs of the remaining 16 states varied between a low of 2.48 children per woman in Tamil Nadu to a high of 3.74 children per woman in the State of Meghalaya (see accompanying figure).

The effects of the development of township and village enterprises are not yet evident, but their potential is enormous, especially with regard to the need for urban planning

Bangladesh has experienced a dramatic decline in fertility, unprecedented for a country with such poor social and economic conditions. The total fertility rate (TFR) declined from about 7.0 children per woman in the 1970s to around 3.5 per woman in the period 1993-1994 (ESCAP, 1981; Mitra and others, 1994). The Bangladesh Family Planning Programme is recognized as a success story in the contemporary third world (Cleland and others, 1994). However, the country still has a high population growth rate and needs to reach replacement-level fertility as soon as possible. The national contraceptive prevalence rate (CPR) of about 45 per cent (as of 1993) should be raised to over 70 per cent to achieve replacement-level fertility.

In view of the comparatively high suicide rates in the region, greater attention needs to be paid to the gravity of the situation.

The population programme should cater to the time constraints that women face and try to reduce their double burden caused by the inequitable division of domestic responsibilities.

There has been a substantial decline in child mortality in Bangladesh since the 1940s, particularly in the last two decades (Huq and Cleland, 1990; Cleland and Streatfield, 1992; ICDDR,B, 1984; 1994). Yet, with an infant mortality rate at about 100 deaths per thousand live births, and an under-five mortality rate of about 130 per thousand (in 1994), child mortality is still a burning problem in Bangladesh. To develop interventions to reduce infant and child mortality, it is important to know the factors responsible for mortality decline, and the factors that work as obstacles to its further decline in this country.

Bangladesh has achieved a considerable increase in contraceptive use over the past decade, resulting in an appreciable decline in fertility. The programme efforts have been largely facilitated by major changes over the past two decades, both positive and negative. Positive changes include female education, female empowerment, female mobility and access to the media. Negative changes include increasing landlessness, and rising unemployment and underemployment. Also, other changes have taken place such as change in the family size norm and a decline in infant and child mortality (Caldwell and others, 1999). In addition, fertility decline is also due to other proximate determinants besides contraceptive use.

Increasing urbanization will hasten the current trend in fertility reduction.

In recent decades, adolescent childbearing has emerged as an issue of increasing concern throughout the developing and the developed world (Jones, 1997; Shaikh, 1997; Islam and Mahmud, 1996). There is a growing awareness that early childbearing is a health risk for both the mother and the child. Also, it usually terminates a girl’s educational career, threatening her future economic prospects, earning capacity and overall well-being (United Nations, 1995). Thus, adolescent childbearing has significant ramifications at the personal, societal and global levels. At the personal level, childbearing at an early age can shape and alter the entire future life of an adolescent girl. From the perspective of societies and governments, adolescent pregnancy and childbearing have a strong and unwelcome association with low levels of educational achievement for young women, which in turn may have a negative impact on their position in and potential contribution to society. Usually, in both developed and developing countries, the rates of population growth are more rapid when women have their first child before they are in their twenties (Senderowitz and Paxman, 1985; Mazur, 1997). The period of adolescence encompasses the transition from childhood to adulthood during the second decade of life. It is one of the most crucial periods in an individual’s life, because during adolescence many key social, economic, biological and demographic events occur that set the stage for adult life.

Asia’s reproductive revolution has undoubtedly been one of the most significant and far-reaching changes ever in human behaviour

Compared with some regions of the world, adolescent fertility in the Pacific island countries is certainly not high, but unmet need for contraception among older women is significant.

In most developing country settings, pregnancy and childbirth are accepted as normal events of life and it is not surprising that problems associated with pregnancy are also accepted without much ado. A new approach to measuring maternal mortality indicates that there are about 585,000 maternal deaths annually worldwide, 99 per cent of them in developing countries (AbouZhar and others, 1996). Over 20 million babies are born in India every year. The maternal mortality ratio ranges from 400 to 550 deaths per 100,000 live births, with wide variations between different states (Bhat and others, 1992). However, mortality represents just the tip of the iceberg. It has been estimated that for every maternal death, there are over 100 acute morbid episodes indicating an overall figure of 62 million morbidities annually (Koblinsky, 1993). Though these are crude estimates, they highlight the magnitude of the problem.

Many articles in the popular press and in academic journals decry the doomed state of our planet. In one recent journalistic account, “The Ends of the Earth”, the author (Kaplan, 1997) journeyed to see for himself “the corrosive effects of overpopulation and environmental degradation in the Third World”. What he found, not surprisingly, was consistent with what he had expected, based on the oft-cited statistical indicators of development - or more accurately, of the malaise of development - decay, disorder and depression. Similar indicators suggest that the news from the Pacific is not good either. Demographic trends particularly are invoked as harbingers of doom for these island countries and territories. The well-rehearsed scenario is a future condemned by overpopulation of under-resourced towns and depopulation of the outer islands; by agricultural communities beggared by the pressure of numbers, the degradation of their environmental resources, and the loss of their most productive members; by the inability of basic education and health services to make headway against the growing numbers of potential clients; and by economic stagnation that is deepened by the emigration of talent and the absence of jobs for the remnant of a low-skilled labour force (see, for example, Cole, 1993).

Improvements in health services, education and provision of safe drinking water, all have a desirable impact on child survival

During the last decade, at least three international conferences (the World Conference on Human Rights in Vienna in 1993, the International Conference on Population and Development in Cairo in 1994 and the Fourth World Conference on Women in Beijing in 1995) sought to reshape a vision of women’s lives by placing gender equity, women’s rights, empowerment, health (including reproductive health), quality of life, equality and freedom at the centre of population and sustainable development policies and programmes. In the period since these international events, almost all States, as signatories of the action agendas of the conferences, have attempted to move closer to fulfilling many of the commitments. In this endeavour, they have also sought the help f both national and international non-governmental organizations, institutions and corporate sectors. However, certain challenges remain for many of the countries in terms of access to services for some of the marginalized groups. Perhaps more innovative approaches rather than the standard poverty alleviation approaches are needed to bring all within the fold of development.

The Lao People’s Democratic Republic is - with the exception of Singapore - the least populated country of continental South-east Asia; it also has the lowest density of population. The country’s first nationwide census as of 1 March 1985 reported a preliminary total of 3,584,803 inhabitants

The future of the support system for the Thai elderly is uncertain.

The Fourth Asian and Pacific Population Conference will be held from 19 to 27 August 1992, in Bali, Indonesia, to enable ministers and other senior representatives of ESCAP members and associate members to review the population situation in the region and plan a course of action to deal with population and sustainable development issues into the twenty-first century. They will be joined by representatives of various United Nations agencies, intergovernmental and non-governmental organizations in their discussions.

Besides living arrangements and enacted instrumental support, proper emphasis should also be given to various aspects of interpersonal exchanges and their interrelationships

The population of Fiji consisting of two major ethnic groups, the indigenous Melanesian population referred to as Fijians and the population who are of Indian origin referred to as Indians, has gone through significant demographic changes in the recent past. These were revealed in the two latest publications on Fiji (Bureau of Statistics, 1989; Gubhaju and Navunisaravi, 1989). The demographic change with which this note is mainly concerned is the decline in fertility of Fijians and Indians over the past two decades, 1966-1986.

The adoption of modern contraceptive methods appears to have more than compensated for the sharp drop in the length of post-partum amenorrhoea.

This review analyses the gender dimensions of rapid population ageing in the Asia-Pacific region, shares examples of useful practices and makes policy recommendations within the context of the 2030 Agenda for Sustainable Development and the Madrid International Plan of Action on Ageing. Population ageing is occurring along with urbanization, migration, more women in paid work, smaller families, technological advances and environmental changes. Reports from international agencies and new national policies and plans often fail to respond to the different needs of older women and men and to recognize and benefit from their different contributions. Age and sex discrimination intersect. Women live longer than men yet have higher risk of poor health and disability in old age. Although most older persons continue to live with their families, older women are more likely than men to live alone, be widowed and poor. They have had fewer opportunities to earn or make pension contributions and may lack inheritance rights. Older men are more likely to be socially isolated and miss their earlier roles. Conditions affecting quality of life are more common in older women and often neglected, including sensory impairments, arthritis and incontinence. Risk factors also differ: Women are less likely to be physically active; older men more likely to drink alcohol and smoke. Older women face greater barriers to health care. Caring for dependent older family members is usually the responsibility of women, and paid care providers are disproportionately female. Family caregivers need support, help with assistive devices and respite care. They are often unable to earn and save for their own old age. Government, civil society and the private sector all have important roles. National Governments need to invest in policies that recognize the different rights and roles of older women and men.

The keys to fertility decline would appear to lie in structural changes in the economy, the satisfaction of existing demand for family planning services and generation of additional demand

Tobacco use has been identified by the World Health Organization (WHO) as the most preventable cause of death and disability in the world. Globally, there are 1.1 billion people who smoke, over 80 per cent of whom live in low- and middle-income countries. Of all the people alive today, 500 million will die of tobacco-related causes. Although a staggering 100 million tobacco-related deaths occurred in the twentieth century, it is estimated that, by the end of the twenty-first century, 10 times that number, or 1 billion people, will have died because of tobacco use, and this burden will be borne most heavily by developing countries.

Labour shortages are brought about more by Thailand’s rapidly growing economy and lagging education than by demographic change

In India, programmes and research concerned with women’s health until very recently have focused mainly on the reproductive functions of married women. The recent paradigm shift in the Government’s primary health programme was intended to increase the attention given to gynaecological problems and other aspects of women’s health. Nonetheless, the attention given to the health problems of adolescent girls is still meagre, even though adolescence is a time when looking after health and nutrition can help to build a buffer against the heavy physical demands of the reproductive years. High rates of gynaecological morbidity have been reported in rural populations, adolescents included (Bang and others, 1989; Koenig and others, 1998). However, the health knowledge and problems of adolescents have so far received only minimal attention (Koblinsky and others, 1993).

Until recently, much of the literature concerning population issues in Bangladesh has stressed the presence of conditions that would inhibit a fertility transition — limited opportunities for women in the job market, son preference (Lindenbaum, 1975), the value of children for ameliorating risk (Cain, 1986) and providing familial labour (Caldwell, 1982), the poorly managed national family planning programme (Hartman, 1987), and high infant mortality. Bangladesh is still largely impoverished and agricultural, infant mortality is still high, education levels among women of reproductive age remain low and traditional cultural institutions strong. Yet in this unlikely setting, the total fertility rate has declined from around seven in the late 1970s to well under four in 1994. The fertility transition in Bangladesh was achieved almost exclusively through the use of birth control methods (modem and traditional), with use increasing dramatically from 8 per cent in 1975 to 45 per cent in 1994. Since that time, fertility has remained constant, while contraceptive use has increased to 53 per cent. (Razzaque and others, 2002).

Over the past decade, East Asia has halved the proportion of people living in extreme poverty on a dollar or less per day, from 28 to 14 per cent. During the same period, South Asia, where nearly half the world’s poor live, has seen a more modest drop: from 44 to 40 per cent. While part of East Asia’s success can be attributed to good economic policies, economic growth is by no means a magic potion. In fact, growth can actually increase income inequality and widen the gap between rich and poor. To reduce extreme poverty, social investment is needed to expand opportunities, capabilities and participation so that people can climb out of poverty.

The primary health care system in Sri Lanka has an international reputation for its contributions to reducing the rates of infant and maternal morbidity and mortality. These results have been achieved in part through a comprehensive system of early identification of expectant mothers, careful follow-up and monitoring, almost universal hospital deliveries, postpartum follow-up for three months after delivery, an effective immunization programme, nutrition supplements and the reporting of infectious diseases. A key to this system is the “public health midwife” (PHM) who identifies pregnant mothers, ensures their regular attendance at maternal and child health (MCH) clinics, makes monthly home visits, advises pregnant mothers on nutrition and health, facilitates hospital admission for delivery and responds to emergencies. They also provide postnatal follow-up of mother and child (Ministry of Health and Indigenous Medicine, 1998).

Population ageing has been a topic of considerable interest during the last decade (Knodel, 1999), more so in the developed regions of the world than in the less developed regions. This is so because the process of population ageing has been much slower until recent times in the less developed regions.

Asia has always been a demographic giant, but in the second half of the twentieth century it also became an economic giant. In those 50 years, real per capita income (expressed in purchasing power parity) in Asia multiplied by more than five, compared with a multiplication in Western countries of little more than threefold, and in Latin America and Africa by 2.3 and 1.6 times, respectively (Maddison, 2001). During this half century, the world GDP in fixed United States dollars multiplied six times but that of Asia did so by more than 12 times, taking the continent’s proportion of the world economy from 18 to 36 per cent. That growth was fundamental to the mortality revolution outlined here but it was also achieved by massive urbanization, producing huge cities with savage contrasts between the living conditions of the poor and the rich. Asian urban population multiplied over eightfold from under one quarter of a billion to over two billion, and will by 2020 constitute half the population. This was partly the product of hundreds of millions of poor villagers streaming into illegal shanty towns, especially around the largest cities.

Early and universal marriage has traditionally been the norm in Nepalese culture, although the practise of delayed marriage appears to be on the increase. In 1961, nearly 75 per cent of young women aged 15 to 19 years were married; this figure declined to just under 50 per cent by 1991 and to a low of 40 per cent in 2001 (Mehta 1998; Khanal 1999; NDHS 1996 and 2001). This, along with the advent of reducing age at first menarche due to improved nutritional status, has led to an increase in the window of opportunity for premarital sexual activity to occur.