The population slide

The level of total fertility in Bangladesh has fallen from 7 in 1975 to 3 today, the sharpest fertility transition in South Asia. Fertility decline in Bangladesh and Nepal follows such transition occurring first in Sri Lanka, then in India. While in Western countries, levels of fertility began to fall once an advanced stage of development had been reached, these new declines in South Asia are not directly correlated with indicators of development such as increased literacy or the alleviation of poverty. Bangladesh has experienced major fertility decline despite being one of the world's 20 poorest countries. Fertility decline in Bangladesh may be attributed to a combination of an effective government family planning program, a general desire among Bangladesh's population to bear fewer children, reductions in mortality, the availability of microcredit, changes in women's status, and the provision of health and family planning information over the radio 6 hours per day.     

Fertility in Botswana: the recent decline and future prospects

Recent estimates of fertility in Botswana suggest a rapid decline of more than two births per woman between 1981 and 1988. This paper proposes that the baseline fertility was overestimated but that nonetheless fertility declined by about one birth per woman during the 1980s. The decline in fertility was linked to a deterioration in social and economic conditions caused by a major drought in the early 1980s and to the increased availability of family planning services in the same period. Fertility apparently began to rebound in the late 1980s in response to improved conditions, which came about as a result of a successful drought relief program. Future declines in fertility depend on the continued success of the family planning program, particularly in rural areas.     

Factors affecting choice of sterilisation among low income women in Paraíba, Brazil

Despite the absence of a family planning programme, the prevalence of sterilisation in Brazil has increased substantially, such that it is used by relatively young women in poor areas of the country. Sterilisation is influenced more by the characteristics of the health service than by socioeconomic characteristics of the population.     

Gender preference and birth spacing in Matlab, Bangladesh

Gender preference, particularly son preference, is believed to sustain high fertility in many Asian countries, but previous research shows unclear effects. We examine and compare gender-preference effects on fertility in two otherwise comparable populations in Bangladesh that differ markedly in their access to and use of contraception. We expect, and find, stronger effects of gender preference in the population that has more access to contraception and higher levels of contraceptive use. Thus gender preference may emerge as a significant barrier to further national family planning efforts in Bangladesh. We find that if a woman has at least one daughter, the risk of a subsequent birth is related negatively to the number of sons. Women with no daughters also experience a higher risk of having a subsequent birth; this finding suggests that there is also some preference for daughters. Son preference is strong in both the early and later stages of family formation, but women also want to have at least one daughter after having several sons.     

Family planning program effects on the fertility of low-income U.S. women

Under rigorous statistical controls, it has been shown that the larger the proportion of lower SES women enrolled in organized family planning programs, the lower their fertility. Program effects independent of other social, economic and cultural factors were shown for lower SES whites and blacks, and for most age groups. The potential of a fully implemented program to reduce fertility differentials between upper and lower SES groups was assessed, using 1969-1970 fertility rates and the estimates of 1969 program impact. Although we believe that the program's impact has increased in magnitude over time, even these estimates from an early point in U.S. program development provide impressive documentation that the program reduces fertility in the subpopulation served by the program, and, by implication, that there is a genuine need for organized family planning services, even in an industrialized nation like the United States. If there were no need, there could be no program effect. The family planning program was one of the major new health and social programs introduced in the mid-1960s. This study shows that, far from failing, the program was succeeding very well in attaining its objectives. The program works because it gives women of lower socioeconomic status access to modern and effective methods of contraception that they would not otherwise have. As a result, the rates of unwanted and mistimed pregnancy of patients are lower than those of comparable women who lack access to organized clinic programs.     

In search of value: an international comparison of cost, access, and outcomes

The United States spent the most resources on health care of all the twenty-nine industrialized countries in 1996 by a wide margin. Managed care and other recent initiatives have been credited with slowing the rate of increase in the U.S. health care spending in recent years. Although the rate of increase slowed, it was still more rapid than the rate in most other industrialized countries between 1990 and 1996. Among the twenty-nine industrialized countries, the United states had the lowest percentage of its population eligible for publicly mandated insurance in 1995. Since 1960 Greece, Korea, and Mexico have surpassed the United States on this measure. AMong the twenty-nine industrialized countries, only the United States had less than half of its population eligible for publicly mandated health insurance in 1995. The United States appears to be comparable to the other G7 countries in terms of access to physicians, in-patient hospital services, and pharmaceuticals. However, on outcomes indicators such as life expectancy and infant mortality, the United States is frequently in the bottom quartile among the twenty-nine industrialized countries, and its relative ranking has been declining since 1960.     

Implications of fertility patterns in the Republic of Korea: a study by computer simulation

Implications of various fertility patterns in the Republic of Korea (ROK) are studied by computer simulation. These patterns include the factors: age of marriage, sex preference, abortion (induced), contraception and sterilisation. As a result of studying a large number of combinations of these factors, the following tentative conclusions, among others, are reached. If future cohorts of women in the ROK become limiters after two live births and marry according to an observed high level marriage distribution, at least two of the methods of birth control--abortion, contraception, and sterilisation--will have to be used extensively to yield a mean number of live births (MNLB) in these cohorts of the order 2-2. However, if these women marry later than the observed high level marriage distribution and, in addition, accept effective methods of contraception more widely and use them more effectively, then the MNLB experienced by these cohorts could move below 2-5 wihtout the extensive utilisation of abortion and sterilisation.     

The role of the Family Planning Association in Hong Kong's fertility decline

The fertility decline in Hong Kong appears to be the result of 1) the economic and social development achieved during the 1960s which created an environment favorable to the development of a family planning program, and 2) the changes in the practice of and to a lesser extent the attitude toward contraception induced by the Family Planning Association (FPA). The FPA has motivated people to accept family planning services and has provided them with an inexpensive and convenient source of contraceptives. Prior to 1966, posters, pamphlets, and newspaper advertisements were the main sources of publicity with radio and television used only on a limited basis. Since 1966 the existing channels of communication have been modified and new approaches in the form of film showings, contests, and telephone inquiry services have been developed to inform and motivate couples to begin contraceptive practice. After many years of these publicity campaigns, over 95% of all married women in Hong Kong understand that contraceptives can be used for limiting births and practically all of them are familiar with the FPA. Additionally, the most important referral source, accounting for over 85% of all new acceptors, has been the person-to-person contact made by the FPA family planning workers as well as satisfied clients. In 1966 fieldwork operations were expanded and a new recruitment strategy was initiated in which activities were increasingly concentrated in maternal and child health centers. The effect of reaching young and low parity women in the mid- to late 1960s has been cumulative. Since 1969 there have been indications that fertility decline is increasing in the older age groups. Although the extent to which the FPA's activities encouraging the use of the more modern methods of contraception affected the fertility decline is difficult to determine, it is obvious that the population was receptive to the new and improved methods as evidenced by the boom of acceptors in 1965 when IUD insertions were at their peak and by the 2nd boom in 1969 when the large-scale distribution of orgal contraceptives began.     

Factors underlying unmet need for family planning in the Philippines

The prevalence of unmet need for family planning is a primary justification for family planning programs, but the causes of unmet need have not been much explored. This article investigates four explanations for unmet need: (1) as an artifact of inaccurate measurement of fertility preferences and contraceptive practice; (2) as a reflection of weakly held fertility preferences; (3) as a result of women's perceiving themselves to be at low risk of conceiving; (4) as due to excessive costs of contraception. The explanations are examined using quantitative and qualitative data collected in 1993 from currently married women and their husbands in two provinces in the Philippines. The results indicate that the preference-behavior discrepancy commonly termed "unmet need" is not an artifact of survey measurement. The most important factors accounting for this discrepancy are the strength of women's reproductive preferences, husbands' fertility preferences, and the perceived detrimental side effects of contraception. Inaccessible family planning services appear to carry little weight in this setting. Modification of services to make them more attentive to other obstacles to contraceptive use would improve their effectiveness in reducing unmet need.     

Reiteration frequency of the histone genes in the genome of the amphibian, Xenopus laevis

Although female employment and fertility are generally inversely related in already developed countries, no clear association has been found in the developing economies. The absence of a uniform relationship is related to the problems of measurement for both variable s. Consequently, it is suggested that a better understanding of the relationship between fertility and employment for women can be obtained by giving consideration to: 1) the ecological or individual level of analysis, 2) the life cycle aspects of fertility and labor force participation by means of the use of small age groups in the analysis or cohort data if available, 3) the matching of current or historical perspective on both work and fertility, 4) more complete measures of fertility that consider both the number and spacing of children, and 5) a new approach to measuring the labor force and labor force participation as outlined in the Council of Asian Manpower Studies and the Organization of Demographic Associates approaches. Although there is a need for more data, the most important need is for different data and for different combinations of fertility and work data. It is particularly the labor force data that require a new approach. Both the gainful worker and labor force approaches were designed to measure the work of men in a Western society. These approaches were not designed nor can they be expected to provide useful service for measuring the very different work of women in developing countries, much less in relating work to other variables such as fertility. Thus, it is expected that the relationship between work and fertility will remain elusive under these circumstances. Neither the labor force dimension nor the other dimensions indicated have been generally considered in studies of work and fertility in developing countries. No study has been made using all these suggested dimensions. It is believed that the use of these dimensions is necessary in order to achieve a complete understanding of the relationship between female employment and fertility.     

Mortality patterns and trends for lung cancer and other tobacco-related cancers in the Americas, 1955-1989

Mortality from cancers of the oral cavity and pharynx, oesphagus, larynx and lung between 1955 and 1989 has been analysed for USA, Canada and 14 countries in Latin America. Among males, Uruguay, Cuba, Argentina and Puerto Rico have the highest rates for all sites, and Peru, Ecuador, Dominican Republic, Mexico and Colombia have the lowest rates. Among females, Cuba, Colombia and Puerto Rico rank high for all sites, and Mexico, Paraguay, Ecuador and Peru rank low. For both sexes, lung cancer mortality rates from the US and Canada are high, whereas rates from other sites are intermediate. An increasing trend in lung cancer mortality over time is shown in all countries except Cuba (no changes), Argentina, Paraguay and Peru (decreasing trend). In Latin America, the tobacco-related lung cancer epidemic is in its early phase among males, and very early phase among females.     

Neandertal capitate-metacarpal articular morphology

The cost effectiveness of several modes of family planning service delivery based on the cost per couple-year of protection (CYP), including commodity costs, is assessed for 1991-92 using programme and project data from fourteen developing countries (five in Africa, four in Asia, three in Latin America and two in the Middle East). More than 100 million CYP were provided through these family planning services during the 12 months studied. Sterilisation services provided both the highest volume (over 60% of total) and the lowest cost per CYP ($1.85). Social marketing programmes (CSM), delivering almost 9 million CYPs, had the next lowest cost per CYP on average ($2.14). Clinic-based services excluding sterilisation had an average cost of $6.10. The highest costs were for community-based distribution projects (0.7 million CYPs), which averaged $9.93, and clinic-based services with a community-based distribution component (almost 6 million CYPs), at a cost of $14.00 per CYP. Based on a weighted average, costs were lowest in the Middle East ($3.37 per CYP for all modes of delivery combined) and highest in Africa ($11.20).     

Women's lives in transition: a qualitative analysis of the fertility decline in Bangladesh

The fertility decline that began in Bangladesh in the late 1980s and continues has prompted diverse theories to explain it. In this qualitative analysis of 21 focus-group sessions with rural women ranging in age from the teens to late 40s and living in the villages of the Matlab area, the women's perceptions of their changing society and of the influence of the family planning program are examined. The women's statements reveal their awareness of the social and economic transition they are undergoing and their interest in family-size limitation, which is bolstered by a strong family planning program. Although the shifts in economic and social circumstances are not large, in conjunction with the strong family planning program they constitute a powerful force for change in attitudes, ideas, and behavior among these women.     

Diffuse alveolar hemorrhage and systemic lupus erythematosus. Clinical presentation, histology, survival, and outcome

This article introduces the concept of men's unmet need for family planning and explains its programmatic relevance. Using data from Demographic and Health Surveys (DHS) of Ghana (1988, 1993) and Kenya (1989, 1993), married men are found to have high levels of unmet need for family planning that are comparable to, although slightly lower than, those for women. The importance of men's unmet need is demonstrated when the analysis is restricted to marital pairs in the DHS samples; trends in the joint unmet need of husbands and wives are shown to be closely associated with the nature of the fertility transitions occurring in Ghana and Kenya. Because of wide discrepancies found between husbands' and wives' unmet need statuses, family planning programs that foster spousal communication are likely to facilitate the transition to lower fertility.     

Fertility decline in Barbados: some spatial considerations

Despite its small size, Barbados exhibits some striking regional differences in fertility levels, which persisted during a period of major fertility decline in the 1960s. Regression analyses are performed for 28 subregions, using sex ratio, male occupational structure, female education, and female employment for 1960 and 1970 as the independent variables. The spatial influence of the Barbados family planning program is also considered. The author argues that a concentration of family planning programs in areas of greatest accessibility and modernization contributes to spatial variations in fertility.     

Notes on the socio-economic and cultural factors influencing the transmission of HIV in Botswana

Botswana currently has one of the highest recorded incidences of HIV infection in Africa although AIDS was only first publicly recognized in 1985. By this time other countries in the region such as Malawi, Zambia and Uganda were already showing signs of epidemic levels of HIV. The rapid transmission of HIV in Botswana has been due to three main factors; the position of women in society, particularly their lack of power in negotiating sexual relationships: cultural attitudes to fertility; and social migration patterns. These three factors along with other, arguably more minor, ones have been shaped and mediated within the specific context of Botswana's rapid socio-economic development and cultural milieu. This has resulted in a constellation of factors unique to Botswana which accounts for the current high seroprevalence rate in the country.     

Fertility and family planning in Haiti

This paper presents data on current levels and trends in fertility in Haiti and discusses some of the factors that determine the current situation. Particular attention is given to knowledge and use of contraception and the impact of the recently established national family planning program. The major source of data is the 1977 Haiti Fertility Survey, but more recent information on family planning program activities is also presented. Factors likely to influence future trends in fertility and family planning are presented in concluding.     

Some aspects of health care in rural Nigeria

1973 and 1974 surveys of Ibo women of childbearing age were undertaken in order to obtain baseline information for developing a community health program. Findings from the village of Ebendo show extremely high fertility rates and infant and maternal mortality levels as well as high desired family size. An examination of the traditional health care and family planning attitudes suggests that a health program offering family planning services in this region should consider offering subfertility counseling; providing services free or nearly free; and focusing on the younger women who are more receptive to family planning.     

The potential value of small responses and partial solutions

At the turn of the century, Taiwan's population was increasing slowly, then later grew during a period of high fertility after the end of World War II and the accordance of independence in 1946. This growth in fertility came together with increasing life expectancy and a general desire by couples to have families comprised of 5-6 children. Taiwan was therefore poised to experience a major population explosion. In this context, a family planning program was established in the country which has since evolved into one of the world's most successful such programs. By 1990, the preferred family size was 2-3 children and of couples which already had 2 children, 70% of those without any sons were nonetheless practicing contraception. While in 1965, no married women used contraception until they had some children, by 1990, 27% of married women without children used contraception. Increasing age at marriage has been an important factor in Taiwan's declining fertility, with the average age at marriage increasing from 20 years in the 1950s to approximately 27 in the 1970s. Few mothers, however, want only one child. The fertility trends observed in Taiwan have been made possible through the provision of contraception, which used to be universally free, but which is now provided free to only people of low income or the disabled. Oral contraception, condoms, and IUDs are used, although 30% of couples depend upon sterilization.     

Regulation of metabolic pathways in various groups of aboriginal populations of the European North (as exemplified by the thyroliberin test)]

Injectable progestogen-only contraceptives can be considered for the woman who is unwilling or unable to use oral contraceptives or an IUD. They have a very low failure rate. They appear to have few serious life-threatening side-effects. The woman does not have to remember to take a daily pill. The method requires little compliance from the client and is independent of patient error. Short-term uses include for partners of men undergoing vasectomy, women being immunised against rubella and for women awaiting sterilisation. Noristerat can be used immediately after an abortion or birth of a baby. Breast feeding is not inhibited. Main side-effects are menstrual irregularities and delayed return of fertility after use. It is essential that women are counselled about the method and its side-effects before injectable contraceptives are given.