Good Health and Well-Being

Longitudinal research, which includes panel research, is the term used to differentiate the methodology and utility of prospective studies from that of cross-sectional research. It describes not a single method, but a family of methods that measure change by linking individual data across time (Zazzo, 1967, cited in Menard, 2002).

During the early phase of the demographic transition in Sri Lanka (in the 1920s), the birth rate persisted at about 40 per 1,000 population, with the death rate fluctuating at around 20 per 1,000. A slight decline in the death rate was observed from the late 1920s onward. After the 1940s, the crude death rate dropped at an unprecedented level: about 1.5 deaths per 1,000 population per year on average, before reaching the level of 12 deaths per 1,000 population by the middle of the twentieth century (Caldwell, 1986).

Low fertility has become an important area of demographic research as fertility in many countries has fallen to levels well below replacement. Advanced countries have experienced low fertility trends for decades (United Nations, 2000), and some are experiencing lowest-low fertility (i.e. TFR below 1.3) (Kohler, Billari and Ortega, 2002; Caldwell, 2006). Less developed countries, by contrast, have recently experienced low fertility levels, and there no longer seem to be any barriers to most countries reaching replacement level and subsequently falling below that level. According to the United Nations, by 2000, around 44 per cent of the world population lived in countries where fertility had fallen below the replacement level. This proportion is expected to increase to 67 per cent by the year 2015 (United Nations, 2000). According to the United Nations median variant projections, approximately 80 per cent of the world’s population is projected to live in countries with below-replacement fertility before mid-century (United Nations, 2002a). Several East and North-East, as well as North and Central Asian countries have attained below replacement in recent decades (Gubhaju and Moriki-Durand, 2003; Atoh, 2001; Hirschman, Chamratrithirong and Guest, 1994; Knodel, Chamratrithirong and Debavalya, 1987). However, countries have attained low fertility in different ways (Perelli-Harris, 2005) and thus, every country and region may have a unique experience in reaching low fertility. For instance, Hirschman, Chamratrithirong and Guest (1994) have argued that the distinctive attributes of East Asian countries such as Hong Kong, China; Singapore; the Republic of Korea; and Taiwan Province of China in terms of rapid economic growth and Confucian cultural heritage would not make them a model for fertility decline in other countries in Asia.

The Programme of Action of the International Conference on Population and Development (ICPD) held in Cairo in 1994 called for the establishment of strong linkages between sexual and reproductive health (SRH) and HIV/AIDS by enhancing the capacity of health-care providers, including all family planning providers, in the prevention and detection of, and counseling on, sexually transmitted diseases, including HIV/AIDS, especially among women and youth.

Sample surveys carried out during the last four decades have proven the existence of “unmet need”, a term coined to describe a significant gap between a woman’s sexual and contraceptive behaviour and her stated fertility preference. According to the Demographic and Health Surveys (DHS) definition, a woman has an unmet need for contraception if she is fecund, sexually active and not using any contraceptive method, and yet does not want a child for at least two years. If a woman is pregnant or amenorrhoeic after giving birth, she is also considered to have had an unmet need if she had not wanted the pregnancy or birth either when it occurred or ever (Ross and Winfrey, 2002).

The paradigm shift in population and development that occurred at the International Conference on Population and Development (ICPD) in Cairo, in 1994, from reduction in population growth for socio-economic progress to ensuring sexual and reproductive health and rights as a fundamental human right and as a means for improving the quality of life, has also become apparent in the Pacific. The Millennium Development Goals (MDGs) provide the current global framework for development efforts and were formally endorsed in 2000 by 189 countries, including Pacific island countries. The importance of sexual and reproductive health was not fully articulated during the formulation of the MDGs as an explicit goal. However, during the World Summit convened in 2005, world leaders endorsed the fundamental human right of “universal access to sexual and reproductive health services” - an additional target to the MDG 5, as a result of intense lobbying by sexual and reproductive health advocates, including the Prime Minister of Tuvalu. The full integration of the MDGs into national sustainable development strategies and plans outlining an allocation of a certain percentage of the national budgets to poverty reduction is requiring a lengthy internalization and implementation process for many Pacific island countries. Part of the challenge for many of those countries has been the relevance of the poverty definition and the prevailing perception by some country leaders that “poverty of opportunity” is the more fundamental issue.