In 1980, dilation and evacuation (D and E) in a free-standing facility was approved by the North Carolina Medical Care Commission as a method of management of 2nd-trimester pregnancy terminations. This paper reports the experience of the 1st 100 such terminations performed at the Crist Clinic, Jacksonville, and compares them with 100 2nd-trimester saline infusion abortions managed at the same clinic in 1979-80. Patients in both groups were comparable in terms of age, gravidity, race, and marital status. Women undergoing D and E were judged to be 13-16 weeks pregnant; however, 5 were noted to be <13 weeks and 12 were >16 weeks gestation. Among the saline patients, who were judged to be at least 16 weeks pregnant, 2 were found to be <16 weeks and 20 were >18 weeks gestation. The range of clinical error was comparable in both groups. An average of 2.12 hours of recovery time before discharge was required by the D and E patients. Among saline patients, the average time from instillation to evacuation was 37.7 hours with 2 days of hospitalization. Overall, 3 complications were noted in the D and E group and 16 in the saline group. Only 1 complication in the D and E group was judged to be major (hemorrhage requiring transfusion), while there were 6 major complications in the saline group (1 grand mal seizure, 5 transfusions). 8 women in the saline group required curettage for retained placenta and there were 2 failed abortions. 2 women required hospitalization after D and E, and 3 saline patients were hospitalized beyond the expected 3-day period. The total cost of the saline procedure was set at $550, compared with $340 for D and E. The low incidence of complications among D and E patients is notable in light of 2 factors: 1) most complications occur early in the experience with a new surgical technique; and 2) the direct dilation of the cervix utilized in this series is more likely to lead to cervical tearing than laminaria use. It is concluded that the reduced financial costs achieved by use of the D and E procedure are not at the expense of increased medical risks.
Cervical dilatation by Lamicel--studies on the mechanism of action.
Lamicel is a synthetic hydrophilic polymer tent which produces cervical softening and dilatation when inserted into the endocervical canal. To investigate the mechanism of action of Lamicel, the intrauterine pressure and levels of 6-keto-prostaglandin F2alpha (PGF2alpha), 13-14-dihydro-15-keto-PGF2alpha, estradiol, and progesterone in plasma and amniotic fluid were measured in patients undergoing 2nd trimester abortion. There was no significant change in any of the measured hormones during a 2 hour treatment with Lamicel, but uterine activity increased significantly for 10 minutes after insertion, then settled spontaneously to below pretreatment levels. Peripheral plasma levels of magnesium sulphate measured in patients undergoing 1st trimester abortion were not significantly raised after Lamicel insertion. Light microscopic examination of cervical specimens, obtained at hysterectomy from pretreated patients with Lamicel for 24 hours, revealed minimum increases in vascularity, mast cell population, and ground substance mucopolysaccharides. (author's modified)
Induction of 2nd trimester abortion was studied by administration of the acridine derivative Rivanol in combination with an intravenous (iv) drip infusion of oxytocin or prostaglandin (PGF2alpha), alone or in combination. It was found that an early onset of the iv infusion was of major importance for the outcome. Administration of oxytocin in immediate connection with the Rivanol instillation proved more favorable than PGF2alpha administration or a combined oxytocin/PGF2alpha drip, taking into consideration the induction-abortion time as related to side effects. A lag phase between Rivanol instillation and the start of the iv infusion such as has earlier been frequently recommended seemed to be of no specific advantage, but caused both a prolonged induction-abortion time and an increased incidence of infection. (author's modified)
[Birth control in overseas countries]
Conditions of medical practice in some developing countries, particularly in Francophone Africa, are not favorable for contraceptive prescription or patient surveillance. However, regular practice of family planning would facilitate screening and early treatment of such conditions as infertility and genital cancers. Paramedical teams should be instructed in the indications and use of methods suitable to their cultural contexts. Variations in the female life cycle in tropical Africa which may have a bearing on contraceptive use include the early and permissive sexual experience that may favor spread of sexually transmitted diseases (STDs), the development of infertility due to STDs, or more generally attributable to poor hygiene, multiple pregnancies, heavy workloads, and parasite infestations that may occur in the years from adolescence to age 35; the increased incidence of luteal insufficiency after age 35; the premenopause, in which hormonal therapy may be more appropriate than contraception; and the postabortal and postpartum state, which require special measures to guard against infection and too early pregnancy. Contraceptive methods relevant to Africa include natural family planning methods, which may be helpful in diagnosing infertility; barrier and spermicide methods, which may be suitable for adolescents and persons with a satisfactory level of hygiene; chemical and hormonal methods including oral contraceptives (OCs), which should be limited to women who can use them correctly, micro pills, which may be unacceptable because of their effects on menstruation; the "morning after pill" of high estrogen doses which should only be used in exceptional circumstances; the trimonthly injection of slow-acting progestagens, which are appropriate for postpartum use, and IUDs, which are useful if contraindications are carefully respected. Indications for choice of method depend on a physical examination and careful patient history including a search for risk factors and genital infection. Spermicides and condoms are preferable for adolescents, and pills should not be prescribed until several menstrual cycles have been observed. All methods are good for women under 35 except long-acting progesterone injections. After 35, IUDs aggravate the normal physiological changes and should be avoided unless a hormonal correction is given in the 2nd part of the cycle. Injectable progesterone is perferable for postpartum and postabortal use.
Population and development in Asia and the Pacific: a demographic analysis.
Close examinations of population trends shows that the new trends reflect demographic changes that have occurred in many developing countries in Asia and the Pacific. In East Asia the population growth rate has declined rather rapidly from 1.94% in 1960-65 to 1.38% in 1975-80 and 1.24% in 1980-85. Since nearly 85% of this region's population is accounted for by China, demographic trends there virtually dictate the trends for the region as a whole. The available data suggest that the growth rate in China declined from 2.02% in 1970-75 to 1.4% in 1975-80 and is expected to reach 1.27% during 1980-85. The sharp decline in China's population growth rate is expected to continue. It is anticipated that the population of East Asia will increase to 1.4 billion by the year 2000. In addition, the growth rate has declined significantly in Japan and the Republic of Korea. The growth rate is declining in Eastern South and Middle South Asia as well. Longterm declines have brought growth rates down in Sri Lanka and Singapore. More recently, the rate of growth also has begun to fall in India, Indonesia, Malaysia, the Philippines, and Thailand, while it remains generally at high levels in Bangladesh, Nepal, and Pakistan. In the Oceania region, 79% of which is made up of Australia and New Zealand, the growth rate is also steadily decreasing. Despite the decrease in the growth rate of Asia and the Pacific, especially during 1980-2000, in absolute terms its growth will be the largest in the world during these 29 years; 908 million out of 1687 million of the total growth. Asia and the Pacific will contribute more than 45 million people a year during the final 20 years of this century. For the world as a whole, the new estimates and projections indicate a slow but steady decline of the crude birthrate from 36.3/1000 in 1950-55 to 28.5 in 1975-80, then to 23.9 in 1995-2000, and finally to 17.9 in 2020-2025. China had a birthrate estimated at about 21 in 1975-80; and India and Indonesia had estimated rates in the range of 33-35. Japan, Australia, and New Zealand had estimated birthrates in the range of 15-18 in 1975-80. As was the case with fertility, the largest gains in mortality reduction have accrued among the less developed regions. In Asia mortality declines have slowed during recent years. Some substantial shifts in patterns of international migration have occurred in the flow of workers into the oil rich countries of Middle and Western South Asia. Migrants come closely from countries within the region, and there are growing numbers from India, Pakistan, the Philippines, Thailand, and elsewhere. The number of people living in urban centers in Asia is increasing very rapidly. Meeting basic needs requires a dual target for each less developed country--an increase in gross national product per capita and a redistribution of income.
Afghanistan [population education in countries of the region].
In Afghanistan population education began as an organized program in the nonformal education sector with the initiation of a Unesco/UN Fund for Population Activities (UNFPA) supported project--Family Health and Adult Education. The project, which aimed to integrate family health and family life education, was carried out over a 30-month period in 26 experimental classes in the province of Kohdaman, Shakardara, and the neighboring subdistricts of Kabul. The total enrollment was 479 women. In 1978 a new project was proposed for UNFPA funding, Family Health and Family Life Education through Mass Education Program. It was planned to integrate population education in all 6 education programs of the General Agency for Literacy Campaign (GALC). These programs are: general literacy program; women's program; agriculture and cooperative program; complementary education program; out-of-school children program; and follow-up materials program. The 1st national seminar on population education was organized in September 1979. 17 government and semigovernment agencies involved in population related activities participated. The seminar arrived at a definition and goal of population education. Population education is defined as an educational program which provides for study of the population situation affecting the way of life of the individual, the family, community, and the country. The seminar identified the following as the goal of population education: to provide young people and adults with a knowledge and understanding of population dynamics, causes and consequences of population growth, and the impact of population change/growth on aspects of quality of life. There are now about 26 key personnel in the Ministry of Education who have participated in regional seminars, workshops, and training programs organized by the Unesco Regional Office for Education in Asia and the Pacific. Key personnel involved in population education in Afghanistan went on study tours in India, Cuba, Somalia, and the Socialist Republic of Viet Nam. Nearly 200 teachers, supervisors, and curriculum designers recieved intensive on-the-job training through the projects. The 1982 Population Education Workshop provided intensive training on the methodology of integrating the population education content in the 6 programs of GALC.
Indonesia [Population education in countries of the region].
Indonesia currently faces 5 population problems: 1) large total population, estimated by 1980 census data at 147,383,075; 2) rapid population growth, increasing at the rate of 2.8 million annually by 1980; 3) a young population distribution, with 44% of the population under age 15; 4) uneven population distribution; and 5) rapid urbanization. The National Family Planning Coordinating Board (NFPCB), established in 1970 to plan and control family planning and population education, has set the goal of reducing the 1971 fertility rate by 50% by 1990. Population education is aimed at achieving voluntary acceptance of the small family idea. This is to be attained through awareness of the factors causing rapid population growth and the close interaction between such growth and development programs to enhance the standard of living. The population education program, which is administered by the Department of Education and Culture in cooperation with the NFPCB, underwent an orientation stage in 1970-72 and a pilot project stage in 1973-75. In the latter stage, teaching materials were developed and tested in 30 junior high schools. During the institutionalization stage, 1976-79, the program was systematically integrated into the educational system. Population topics are integrated with relevant subject areas from the 4th grade of elementary school to the 3rd grade of senior high school. A cell system is used to train teachers, who in turn train teachers in their respective schools. Population education has also been introduced into Indonesia's subsidiary schools under religious and Armed Forces jurisdiction. Current population education activities include the training of an additional 50,000 teachers and provision of teaching kits, slide projectors, and textbooks to all of the 160 nonformal learning centers. In addition, a number of government agencies, including the Ministries of Sports and Culture, Education, Health, Transmigration, Information, Religious Affairs, Home Affairs, and Defense, are involved in education programs aimed at those ages 10-45 who are outside of the educational system.
Malaysia [Population education in countries of the region].
Although Malaysia has the potential to support a population of 50-70 million, its 1980 population size was only 13.4 million. If the current 2.6% annual growth rate persists, 50 million population will be attained by 2030. Population policy is aimed at lowering the rate of natural increase to 2% by 1985. Natural population growth is to be linked with national economic development to continue to improve the quality of life in Malaysia. An in-school population education project was established by the Ministry of Education in 1973 and will be implemented in 1982. The relationship between population growth and individual aspirations and national well-being will be stressed. Population education at the university level provides for both in-depth studies of population issues in development and planning and the training of community leaders in population communication and community development services. Nonformal education is also carried out in the rural areas where 75% of Malaysia's population lives. Population education for the out-of-school sector stresses the relationships between family size and family welfare. Resource personnel at national, district, and local levels are selected from those already involved in community development programs and are given an orientation not exceeding 1 week. School teachers are provided with self-learning materials to enable them to assimilate curriculum material at their own pace. The various population education programs are linked at the national level through the National Family Planning Board. When population education was 1st introduced, it was misinterpreted as aimed only at limiting family size. Acceptance increased when program aims were clarified, as indicated by the increasing numbers of community and social development agencies that incorporate population education into their programs.
Philippines [Population education in countries of the region].
Despite a decline in the annual population growth rate from 3.1% in 1948-70 to 2.8% in 1970-75 and a corresponding decrease in average family size from 5.6 to 6 children/family, the Philippines is among the fastest growing countries in the world. The Population Education Program (PEP) was established in 1972 by the Ministry of Education and Culture. The objectives of the PEP are 1) to develop curriculum materials in population education for elementary, secondary, and tertiary levels, including a teacher education course and a prototype population course in the arts and sciences; and 2) to provide population education instruction to students of the 3 target levels by training 187,000 elementary teachers, 15,600 secondary teachers, and 360 teacher-training instructors. Population education has 5 major contents areas: demography, determinants of population growth, consequences of population growth, human sexuality and reproduction, and planning for the future. A combination of the infusion and unit methods is used in school curricula. The original training scheme, which used district supervisors as trainers of the teachers, principals, and supervisors within each district, has been restructured. District supervisors, principals, and department heads now train classroom teachers in their respective elementary and secondary schools. PEP has widened its network of target groups to include vocational students, out-of-school youth, and people ages 15-35 in the rural areas. Research studies have been conducted to assist curriculum writers develop materials for teachers and pupils suited to local needs and cultures. Surveys of teachers and parents have revealed strong support for the population education curriculum, with about 90% favoring inclusion of sexual terminology and information about contraceptive devices. Achievement tests administered to a sample of elementary and secondary students reflected significant gains in knowledge of population issues and changed attitudes. However, continued development of the program has been hampered by a shortage of instructional materials. Additional financial assistance is currently being sought to overcome this problem.
Nepal [Population education in countries of the region].
In 1979 the Ministry of Education and Culture in Nepal, in collaboration with Unesco and the UN Fund for Population Activities (UNFPA), organized a National Planning and Development Meeting in Population Education. The objectives were to understand the concept and nature of population education and population education programs in Asia, to review the existing programs of population education initiated by various agencies in Nepal, and to develop guidelines for the formulation of a national population education program, both in school and out of school. All of these objectives were realized. Subsequently, a population education project was formulated for UNFPA funding, with the help of the Unesco Regional Team on Population Education. The primary goal of the project is to gear the entire system--formal and nonformal--to the realization of the potential role of education in the development efforts of the country and the interrelationships between the population situation and different aspects of quality of life at the micro and macro levels. The long range objectives of the program are as follows: develop in the target audience an insight into the interrelationships between population growth and the process of social and economic development at the individual, family, society, national, and international levels; develop desirable attitudes and behavior in the teachers, students, and the community at large towards population issues so that they may make rational decisions about their family size and the quality of life that they would like to have; and institutionalize population education in the formal education system, including university, and the nonformal education program of the Ministry of Education. In a 1981 population education curriculum development workshop, 2 further objectives were added: develop in learners a knowledge and understanding of basic concepts, processes, and measures; and develop among learners an awareness of the attitudes, beliefs, and values affecting decision making on population issues and problems. The key personnel identified to staff the different units implementing population education had no prior training and experience in population education. 3 modalities of training were deemed necessary: an intensive training program for the project staff; orientation for key administrators; and an intercountry study visit. Population education is beginning to take root in the formal and nonformal education system and is regarded as a crucial complementary program to family planning and other population programs in Nepal.
Population, agriculture and food.
Data published by the UN Statistical Office and the Food and Agriculture Organization (FAO) indicates that food production in the world grew at an average annual rate of 2.5% during the period 1961-65 to 1980 whereas during the same period the population growth rate was 1.9% per annum, declining further to 1.8 toward the late 1970s. Yet, the food production growth trend has been most uneven. The situation in Asia has been more or less similar to the global trend. During 1962-72 the rate of population growth increased to 2.5% whereas the annual increase in food production dropped from 3.1 to 2.7%. Throughout the remainder of the 1970s, food production barely managed to keep pace with population growth. Closer analysis reveals that in about the mid 1960s food production fell behind population growth, and near famine situations developed in certain drought affected areas of India, Indonesia, and Pakistan. These countries had to import food to meet the situation at the cost of their economic development programs. According to the UN projections, the region's population will continue to grow at an average of 1.7% per annum up to 2000 despite the declining fertility trend. To cope with the population growth rate and the changing pattern of food consumption even at the present level of nutrition, Asian nations will have to increase food production annually at a 3% compound rate. An increase in food production basically means increasing the inputs of different factors of production such as land and water, labor, materials, and various types of capital and technological know how. The application of these factors in the developing countries largely depends on the infrastructure and services provided by the governments. 2 approaches are generally made in an effort to achieve the objective of increasing food production: horizontal expansion approach, used to bring new land under cultivation so as to produce more food; and the vertical expansion approach, used to increase the productivity of land through the adoption of scientific methods of farming. These include the use of high yielding crop varieties, the application of fertilizers, the use of insecticides and pesticides, weeding, farm mechanization, provision of irrigation, double cropping, mixed cropping, and the provision of widespread extension education and training facilities. Some of these inputs are examined with special reference to the degree of contribution which they can make in increasing food production, distribution, and supply.
Population change and some aspects of socio-economic development.
Some of the major dimensions of the interrelationship of population dynamics and socioeconomic development are examined in the context of Asia and the Pacific. Most of the countries in the region are developing, and population growth is viewed more as an obstacle to development rather than as a stimulant to economic progress. There are at least 10 countries in the region whose per capita income is less than US$300, namely: Afghanistan, Bangladesh, Bhutan, Burma, China, India, Maldives, Nepal, Pakistan, and Sri Lanka. In 1979 these countries had an estimated combined population of 1,867,103,000 or about 77% of the population of the region. Per capita gross national product (GNP) masks the real economic condition of the people as it fails to show the actual distribution of income and wealth. In most nonsocialist countries there is maldistribution of income and wealth. The International Labor Organization (ILO) report points out that during 1963-73 in Bangladesh, India, Malaysia, Pakistan, the Philippines, and Sri Lanka, the richest 20% of households receive about half the income. In contrast, the poorest 40% receive between 12-18% of total income. In short, there could be economic development but not social development, such as equitable distribution of wealth and income. Studies have shown that equitable income distribution exerts a far greater influence on fertility than the GNP. In many countries of the region poverty is reality. The World Bank estimates that half of the people in absolute poverty live in South Asia, mainly India and Bangladesh. It is most unfortunate that among the very poor, poverty is frequently regarded as the cause rather than the effect of high fertility. Among the very poor, mortality, particularly infant mortality, tends to be high. China is among the countries which have recognized that rapid population growth is not beneficial to the accelerated speed of capital accumulation. It has been observed that in most countries as the GNP per capita increases the birthrate decreases. This is the case in the developed countries of the region, i.e., Australia, Japan, New Zealand, and Singapore. It appears to be that wealth begets wealth, and that development is one of the better contraceptives. The processes and conditions which lead to and result from an increase in per capita income usually cause a number of social and attitudinal changes which in turn bring about an eventual decrease in the birthrate. In sum, population growth and economic development are complementary, interdependent, and act as constraints on each other.
Population change and socio-cultural values.
The developing countries of the world in general, and those of Asia and the Pacific in particular, recognize that unplanned population growth is a stumbling block to socioeconomic development. Discussion here focuses on population growth and social, economic, and institutional forces, which are referred to as sociocultural values. Generally, sociocultural values change sluggishly over time. The rate at which a country's sociocultural values change depends on several factors such as the stage of economic development and modernization and whether a country has an open or closed door policy. "The Value of Children Study: A Crossnational Study" by Fred Arnold et al. shows that there are positive and negative values attributed to children in the Asian countries. These are: positive general values--emotional benefits, economic benefits and security, self enrichment and development, identification with children, and family cohesiveness and continuity; negative general values--emotional costs, economic costs, restrictions on opportunity costs, physical demands, and family costs; large family values--sibling relationships, sex preferences, child survival; and small family values--maternal health and societal costs. Possibly the most formidable obstacle to the success of antinatalist population policies is that of religious values. It appears that the Muslim world is divided on the issue of fertility control. Conflicting views regarding fertility control is perhaps aggravated by the fact that there is no central international religious official hierarchy that issues out edicts. Despite the presence of a centralized religious hierarchy and a network of churches from the Vatican to the village levels among the Catholics, and a clearer elucidation of the Humanae Vitae, a liberal attitude to population regulation and family planning has emerged, largely because of the declining quality of life of the people resulting from unplanned births. Economic benefits of children include benefits from children's help in the house, business, or farm, from care of siblings, and from sharing of income; and old age security for the parents, including economic support, physical care, and psychological security. People in some countries of the region have a number of prenatalist values and beliefs, including a preference for sons. Changing attitudes and social realities have resulted in value changes, value crises, value conflicts, and confusion. Value clarification has much potential in terms of a couple's decision making. Values clarification involves at least 7 steps: choosing freely; choosing from alternatives; choosing after thoughtful consideration of consequences; prizing and cherishing; publicly affirming; acting; and acting with some pattern.
The Symposium on Population and Human Rights was held in Vienna in the summer of 1981 to review developments in the formulation and implementation of human rights as they relate to population trends and policies in the context of changing economic and social conditions. The Symposium focused on the developments that had occurred since 1974, when the first Symposium on Population and Human Rights was held in Amsterdam. Also, the Symposium intended to provide an up to date report on the topic that could be used by the International Conference on Population, scheduled to take place in Mexico City in 1984. The Symposium covered all aspects of the subject but devoted special attention to the status of women and the aged. These proceedings focus on the following: fertility; mortality and morbidity; status of women; population, human rights, and aging; internal migration; international migration; and new institutional functions in the area of human rights and population. Background papers cover the identified specific subject areas. The Symposium affirmed that policies concerned with fertility, as with all other population policies, must be integrated into the country's overall strategy for development since they were aimed at improving the well being of the population. The Symposium reaffirmed the right of each individual to enjoy the highest attainable level of physical and mental health. The Symposium agreed that the status of women in a society was a matter of central concern for both human rights and population. It further agreed that while a broad range of principles had been fully established as a part of the body of accepted human rights, their actual implementation was too often far from satisfactory. Thus, the Symposium gave most of its attention to the gap between existing formal rights and their effectiveness in practice, rather than to the need to formulate special new rights pertaining to women. The Symposium proposed that in the body of human rights a guarantee should be included of the rights necessary to assure older individuals of the living conditions and status within society that were legitimately theirs. With reference to its impact on the achievement of human rights, it was suggested that internal migration was too complex and variegated a phenomenon for anyone to be able to claim that there were universal patterns whereby human rights were preserved or violated by internal migration. The human rights pertaining to international migrants which had been enunciated at Amsterdam in 1974 were reaffirmed as being essential.
This document presents summaries of 80 projects in Indonesia, Malaysia, the Philippines, Singapore, and Thailand in which population issues are integrated into development programs. The report was prepared by the Clearinghouse and Information Section of the Population Division of the Economics and Social Commission for Asia and the Pacific (ESCAP). The volume is intended as a reference tool for the exchange of information and sharing of national experiences among the countries of the ESCAP region. It will also serve as a documentation support for the 3rd Asian and Pacific Population Conference to be held in Sri Lanka September 20-29, 1982. The 80 projects documented include 9 from Indonesia, 7 from Malaysia, 41 from the Philippines, 8 from Singapore, and 15 from Thailand. Projects are grouped by country, but are indexed according to 8 broad subject areas: population and agriculture, population and education, population and health, population and labor, population and social/community development, population and women's development, population research and development planning, and total integrated development (including integrated rural development schemes). Among the information provided in the individual reports is the funding source, project director, duration of project, objectives, participating groups, geographic area covered, program content, evaluation instrument, project recommendations and implications, and reports available on the project.
Ghana fertility survey 1979-1980. First report. Volume II: statistical tables.
The Ghana Fertility Survey (GFS) is the most comprehensive statistical enquiry to date into the fertility levels and patterns of Ghanaian women. The survey was conducted in 1979-80 by the Central Bureau of Statistics with the collaboration of the Ghana National Family Planning Secretariat and under the auspices of the World Fertility Survey (WFS) program. The survey, covering all 9 regions of Ghana, had a 2-stage self-weighting sample design with 300 primary sampling units, each containing an average of 25 households. The questionnaire included a household schedule and individual interview. This volume, comprised solely of statistical tables, presents detailed tabulation in 7 subject areas: 1) respondent's background; 2) nuptiality and exposure to childbearing; 3) fertility; 4) preferences for number and sex of children; 5) knowledge and use of contraception; 6) use of contraception as related to fertility preference; and 7) factors other than contraception affecting fertility, including breastfeeding, amenorrhea, postpartum abstinence, marital stability and temporary separations. ALthough the statistical report follows WFS specifications, some country-specific tables are added. These additions include data on the prevalence of polygamous marriages, age differences between couples, premarital births, age at 1st birth, knowledge of sources of contraception, and visits to sources of contraceptive supplies.
The determinants of Brazil's recent rapid decline in fertility.
The objectives of this report were to examine the accelerated fertility decline which began in Brazil in the 1970s in light of changes of the proximate determinants of fertility, and to relate these changes to socioeconomic changes that might account for the accelerated decline. Major sources of information were national level data collected by the Brazilian census bureau, the state contraceptive prevalence surveys conducted during the late 1970s, and local level in-depth fertility studies of 9 diverse communities. The report is divided into 2 parts which 1) use national and state data to examine hypotheses about the influence of socioeconomic changes on reproductive behavior during the early 1970s, and 2) examine the local level data in detail for consistency with national level findings. Despite some data shortcomings, available evidence strongly supports the hypotheses that declining marital fertility was the main demographic component of the accelerated fertility decline, that the principal proximate determinant of the decline was increased fertility control within marriage, that the decline in marital fertility was attributable mostly to the spread of fertility control to lower-income regions and groups that had not participated in previous fertility declines, and that these groups experienced socioeconomic changes such as increased educational attainment, ownership of consumer durable goods, and female labor force participation that were conducive to smaller family norms. Data indicate that neither changes in the distribution of women by marital status nor changes in breastfeeding patterns played a major role in the fertility decline. The major unanswered question concerning increased control of marital fertility relates to the mix of means involved; use of pills and surgical sterilization incresed greatly, but the role of abortion is less clear.
Domestic production, labour mobility and population change in West Africa, 1900-80
This essay reviews the changing forms and processes of labor allocation in West Africa in 1900-80 and their implications for labor mobility and population growth. West African agriculture is labor intensive, based on domestic production units which may acquire additonal labor either by hiring outside help or through reciprocal arrangements within the community. Thus, small-scale labor migration has become an integral part of the agricultural system. The abolition of slavery had a major effect on the organization of agricultural production and associated labor mobility. The dispersal of former slaves led to the emergence of many more domestic production units and new settlements. This in turn stimulated the demand for nonfamily labor and increased inter- and intravillage mobility. There is lively debate among historic demographers as to whether colonial intervention slowed or escalated population growth in tropical Africa. Regional variations and the difficulties involved in distinguishing between the effects of natural population increase and migration confound this question. Generally, population increases observed after the abolition of slavery are attributed to declining mortality resulting from European medicine, public health measures, and reduction of the devastating effects of crop failure. An alternate approach is to attribute population increases to fertility increases facilitated by the abolition of slavery. Abolition was followed by a shift toward earlier age at marriage and childbearing. To understand developments in West African agriculture in the 20th century, more attention must be given to the social history of the family unit and its productive and reproductive strategies. Information must be collected on the size and structure of families following abolition, age at marriage and childbirth, and the extent of polygany. Computer models could also be utilized to simulate growth and change in settlements and populations.
Ethnography of fertility and birth
This compilation of case studies examining fertility and childbirth from anthropological, medical, and demographic perspectives in a wide variety of sociocultural and developmental settings is unified by an introductory chapter which synthesizes the findings of the case studies and of the available literature. The social groups studied include the Batticaloa Tamils and Moors of Sri Lanka; the Enga of the New Guinea highlands; the Sande society of Mende and Sherbro women in Moyamba District, Sierra Leone; the Aowin peoples of southwest Ghana; the Yoruba of Nigeria; peasant women in Jamaica; Indian women in Guatemala; and native and immigrant women in Britain. The introductory chapter on biological, cultural, and social adaptation in human fertility and birth examines the interplay of biological and cultural aspects of birth, cultural definitions of body and fertility, the role of nutrition in menarche and menopause, factors influencing birth intervals, infertility and child survival, the role of midwives in different sociocultural milieus, indigenous practices of labor and birth, disposition of the umbilical cord and neonatal tetanus, the transition to motherhood, and delivery practices in developed countries. The case studies examine a wide variety of topics related to fertility and birth, such as sexuality, marriage, residence, diet, breastfeeding, indigenous or modern prenatal care, and others, but most also include descriptions of customs and procedures during labor and delivery.
Measuring sex preferences and their effects on fertility
This chapter presents a decision-making model for considering the effects of sex preferences on fertility and evaluates currently available methods for measuring sex preferences. A decision-making model can indicate the variety and direction of forces that influence fertility decisions. It conceptualizes such decisions as a complex function of the couple's size and sex preferences as well as their assessment of the subjective probabilities for the sex of the next child. This model of fertility decision making suggests 3 criteria for evaluating measures of sex preferences: sensitivity to the multiple determinants of fertility decisions; sensitivity to individual differences in values, beliefs, and preferences; and ability to discriminate between decisions that are influenced by sex preferences and those that are not. These can be behavioral, attitudinal, or behavioral intention measures. Behavioral measures have the advantage of being based on real behavior and can often be calculated from aggregate data sets compiled for other purposes. However, they misrepresent the true effects of sex preferences on fertility whenever either size or sex preferences are heterogeneous in a population or misbeliefs about the probabilities of the sex of the next birth are common. Both index and representational attitudinal measures can determine whether sex preferences exist and can identify the pattern of these preferences; however, they cannot indicate if sex preferences affect fertility. Behavioral intention measures assess both the existence and pattern of sex preferences. Although such measures cannot determine if sex preferences influence fertility, they can indicate whether preferences affect fertility intentions. The measure currently provides no information about the circumstances under which sex selection would be used or about who would use it, but it could be extended to obtain such information by including more complex conditions. An unresolved problem concerns the inability of all 3 measures to provide a quantitative estimate of the effect of sex selection on birth order ratios, fertility rates, or the sex ratio. It is concluded that behavioral intention measures are most viable for assessing sex preferences and their effects on fertility. If based on theoretical models of fertility decision making such measures can be tested and validated.
The economics of sex preference and sex selection
This study reviews the economist's approach to the study of sex preference and sex selection and presents an economic analysis of the subject. In the past economists focused primarily on: 1) the existence and significance of sex preferences, 2) interfamily differences in the intrinsic probability of having a boy, 3) differences in the costs and benefits of boy and girl children, and 4) the effect of prior uncertainty associated with the sex of a child. The existing state of knowledge seems to be that sex preferences are prevalent in many parts of the world although the extent to which preferences carry through to behavior has been weakly demonstrated at best, especially for developing countries. Also it is well established that there is interfamily variation in the intrinsic probability of having a boy child, implying that sex preferences can affect aggregate sex ratios. To the extent that major advances in sex selection technology and wider acceptability of such technology are in the foreseeable future, the potential for sex preferences to affect aggregate sex rates and household fertility behavior will be substantially increased. An economic model of household fertility is presented focusing on sex and risk preferences and its sequential nature. Even under fairly nonrestrictive assumptions about household behavior, the probability of having an additional child is negatively related to the strength of the household's sex preferences, the degree of the household's aversion to risk, the probability of occurrence of the non-preferred outcome, the degree of balance in the sex composition of existing children, and the magnitude of the difference in the price of boy and girl children. Some areas of research might be: 1) to specify the stochastic elements in an economic model of fertility, 2) to investigate the sex preference effect on interbirth intervals, 3) to study interfamily differences in the intrinsic probability of having a boy, 4) more careful models of household sex preferences, and 5) work on the extent to which sex preferences are reflected in actual fertility behavior.
Parental sex preferences and sex selection
Sex selection research from both developed and developing countries suggests that the effects of such technology would include smaller family size for some and possibly larger families for others, more security for women who could be sure of producing desired sons, more acceptability of children born, and more control over the family's fate. However, since sex selection in developing countries would be limited by availability and in the developed countries would be used mainly by a small elite of more affluent urban couples with strong and agreed upon sex preferences, the net societal impact of these techniques would be small. US research indicates that the most popular combinations are 1 boy and 1 girl, at least 1 of each sex, and more boys than girls. Men are more likely than women to prefer sons. Social characteristics such as education, race, and religion have little effect on preference patterns. Number preferences tend to dominate over sex preferences for most American couples, except for those with 2 of the same sex who go on for more children. Sex preferences vary widely in developing countries. Parents having large families tend to be less concerned with sex composition; however, those in the better-off developing countries or parents wanting small or moderate size families express a greater interest in sex selection. Whether sex preferences affect fertility depends on the extent to which preferences differ from the natural sex ratio, the strength of the preferences, the total number of children desired, and the availaiblity of effective birth control when the desired sex composition is attained. Modernization brings some reduction in the dependence on sons. Approval of sex selection seems to be increasing over time. The techniques showing highest rates of approval are the pill, barrier methods, or timing of intercourse. Availability is considered a more serious obstacle to sex selection than acceptability, especially in developing countries where sex preferences are strongest. Were such techniques refined, their availability would be limited mainly to the better educated, more affluent urban elites in countries with a strong private health system.
Legal aspects of prenatal sex selection
The debate about prenatal sex selection has become part of the serious public discussion about the use of emerging medical technology to influence the size, structure, and quality of the population. The issue has come to the point where one needs to consider the legal aspects of sex selection techniques. Legal issues could arise in 2 contexts, in that sex selection could be seen as a factor in achieving quantitative or qualitative control over the population. Qualitative control might minimize the incidence of negative sex-linked traits and enrich the age-sex structure of the population for social, economic, or political purposes. Applying economic principles to the question, it is concluded that child quality versus quantity tradeoffs are natural parts of the decision process involving childbearing and should be factored into every public and private consideration regarding fertility, including sex selection. The legal issues attached to the use of selective fertilization technology can involve the use of the Shettles regime or some form of artificial insemination. Some questions that might arise in using the Shettles regime might concern guaranteeing results and breaches of contractual relationship, follow-up to help patients follow the regime, and the possibility of the physician being found guilty of negligence. Another problem regards the child who might have a right to redress should the offspring have preferred to not have been born at all rather than be born the sex which he or she is. In the use of artificial insemination the doctor-patient issues are similar to those involved in the Shettles regime but because artificial insemination involves both doctor-patient counseling and some complicated procedures on the part of the physician, the possibility of malpractice suits on grounds of negligence is increased. Issues involving informed consent would be intermingled with those involved negligence, if the fetus is damaged by the procedure or if the wrong sex is produced, these issues involving the extent to which the physician provided the patient with sufficient knowledge to make an intelligent choice. Also since this method involves the cooperation of more than 1 person legislation to cover each party is needed. Sex selection through selective implantation involves fertilization in vitro so different legal issues are involved. Current US contract, tort, and consitutional law are presented and the issues addressed are: 1) overall legal environment which is gender neutral, 2) decision makers will vary in each situation, and 3) breach of contract possibility. Laws in the USSR, China, India, and Indonesia are discussed.
Toward a moral policy for sex choice
1 reason for the sluggish pace of serious discussion about sex choice is the inability of those interested to translate their immediate, usually negative reaction to the idea of sex choice into sensible arguments and policy choices that are not in conflict with other important social principles and policies. Sex choice could extend the goal of "every child a wanted child" by providing the particular type of child that parents want. Yet these parents would inevitably have higher than usual expectations based on sex and therefore the child might be even more unwanted if he or she did not fulfill these ideals. It is also argued that satisfying parental requests for sex choice would not necessarily satisfy their desires because those desires are really not for a girl or boy but for a child that will carry out certain acts its parents believe will make them content. Providing sex choice in order to better balance the male/female ratio in the world is also not appropriate since the imbalance that exists is there due to sociological differences such as making the boy's health more important than the girl's in a family, thus raising female/child mortality. Regarding the argument that the rate of population increase in developing countries could be slowed more rapidly and effectively if people could be guaranteed the sex of their children, it is thought that social arrangements resulting from an alteration in the sex ratio in favor of men would be unpleasant for women. Other researchers foresee more crime and male homosexuality and less culture and church going, resulting from a world where male sex preference is available. If sex choice is used widely in developing countries to achieve a family of 2 children, first a boy and then a girl, then the pattern already present of anxious overachieving men and passive, accomodating women, might be substantially reinforced because those personality patterns also tend to be characteristic of, respectively, 1st and 2nd borns. The worst consequence might be a subtle one, the perpetuation of stereotypes. The author advocates an embargo of sex choice because it abrogates the principle that people should be regarded as equally valuable. Society should seek no legal restrictions on reproductive freedom. Also, no more preference studies should be funded, rather studies on the technology of sex choice and how it might be used.
Ethics and public policy: should sex choice be discouraged?
This study is aimed at policymakers in the health sciences and groups in which decisions are made about whether to encourage research that may lead to sex choice. The argument is based on a rule-utilitarian approach and ethical conflicts which claim that this ethos provides a common-ground moral policy in relation to which several diverse moral traditions can contend and coexist. The predominant ethos is guided by moral principles of freedom and fairness. An overarching moral policy has developed in the US that protects the freedom of parents and physicians to apply knowledge gained from research and technology to intervene to avoid or achieve reproduction, even while treating with fairness those who would not themselves, on moral grounds, use such freedom. Thus persons who want to practice contraception may do so and those who do not are not punished. Persons at risk for genetic disease are counseled but not prohibited from reproduction and abortion decisions are the choice of the woman. Rule utilitarianism is based on a concept of unity in diversity in that one wills to act in a way that will best serve to harmonize the interests of all others who will be affected by the action proposed. This theory estimates the value of actions by reference to their consequences while not being divorced from an obligation to follow moral rules. Writers on the issue of performing amniocentesis for sex choice point to these negative consequences: 1) an excessive drain on an important medical resource at the expense of patients medically at risk, 2) precedent setting for wider use of sex choice will increase sexual discrimination, and 3) if the numbers of people using abortion for sex choice rose sharply this would be a strengthening of the antiabortion position leading to the overturn of legal abortion. The author counters these arguments and states that the moral justification for providing amniocentesis for sex choice lies in the obligation to relieve severe emotional suffering, saving the fetus, providing information to the parents within the legal boundaries of abortion policy and preventing harm to society's respect for the privacy of the woman in the abortion decision. Policymakers and citizens should prepare for a series of conflicts in reordering the rules applying to the interactions of science, medicine, and the family/individual.
Concepts of self and morality: women's reasoning about abortion.
The position taken in this volume devoted to concepts of self and morality--women's reasoning about abortion--is that thinking, reflection, and decision making are all central elements in social functioning. The data presented in this volume were gathered using an interview procedure that is systematic, guided by specific hypotheses, and designed to provide sufficiently rich information to enable descriptions of processes of judgment. The 6 chapters cover the following: psychological reasoning on abortion and reasoning in a developmental perspective; domains of social cognitive development (moral reasoning, social/conventional reasoning, personal reasoning, and domain distinctions and confusions; modes of reasonings about abortion (research procedures, qualitative descriptions of reasoning about abortion, and classification task); women's decision making about abortion (qualitative descriptions of decision making, relationships between reasoning and choice, hypothetical and actual judgments, and correlates of reasoning); stability, change, and development in women's reasoning (research procedures, descriptions of stability and change in reasoning, and analyses of stability and change in reasoning); and adolescent reasoning about abortion (descriptions of reasoning, statistical analyses of reasoning, and correlates of reasoning about abortion). The studies reported illustrate the continuity between the way adolescents and young adults conceptualize the social world and their reasoning about abortion. Moral, social/conventional, and personal concepts are each distinct and irreducible modes of thought that usually pertain to different aspects of the social world. As the studies reported indicate, they can be distinguished and individuals use the same modes of thinking to structure abortion and other issues within each domain. The findings suggest that proponents of the so-called pro-life versus the pro-choice positions are arguing fundamentally different issues that have their source in different systems of social knowledge. If there is to be compromise, it must be over issues that are more resolvable than whether or not the unborn fetus is a human life. The findings also have theoretical and methodological implications for the study of moral judgment and moral action. When morality is more narrowly defined as justice, as was done in the studies reported in this volume, general modes of responding to moral problems become evident. The findings indicate that individuals share common criteria for interpreting social events, but as is illustrated with abortion, the interpretation of particular actions or events as contents for the domains may vary.
This volume includes the proceedings of a workshop on adolescent sexuality held in Denmark during September 1982. The presentations, contained in this report, cover the following: highlights on changes in adolescent behavior as observed by the Europe regional social science group, 1980; sexual life in childhood; psychological and emotional development during adolescence; development of the male reproductive system from conception to adulthood; development and function of the female reproductive systems during puberty; psychological changes in puberty induced by hormones of cerebral origin; variants of the normal puberty development; teenage communication and developing sexual contacts; contraception and teenagers; complications of contraception; conceptions, outcome of pregnancies, births, abortions; young people's evolution towards patterns of stabilized partnership or unbound promiscuity; teenage prostitution, facts and fates; teenage mothers addicted to drugs; other forms of commercialized sex; incidence of juvenile venereal morbidity and expected late effects; and sex education with 2nd grade, 7-8 year old children. Mikolaj Kozakiewicz, in discussing changes in adolescent behavior as observed by the Europe regional social science group, reports that research on adolescent sexuality and varieties of sex education showed highly differing views on the subject. These differences appear in the field of attitudes and views and in the field of the practical behavior of young people in the sexual sphere. At this time, states Kozakiewicz, when all of Europe lives wtih the burden of a deep economic depression and a political, moral, and ideological crisis that accompanies the economic depression, it is possible to anticipate that within the range of sexual problems there are significant changes which will continue to occur. Kozakiewicz concludes that adolescent sexuality cannot be analyzed apart from the wider socioeconomic and cultural context and goes on to say that the efficiency of sex education depends on the efficiency of shaping the whole personality of a young person.
The abortion dispute and the American system.
At this time the US is far from any consensus on the theological issues involved in abortion, yet since the Supreme Court's 1973 decision in Row v. Wade, national abortion policy has been explicit as have efforts to change it on the part of several states and localities. This volume evaluates how the battle over abortion policy affects the government system, beginning with 4 essays that appraise the influence on governmental and political institutions of the means employed to realize either pro-life or pro-choice policy ends. The monograph then summarizes the reactions to those appraisals by public affairs experts and activist leaders on both sides of the abortion dispute who accepted the invitation of the Brookings Institution to participate in the day long symposium on the subject. Gilbert Y. Steiner addresses the issue of abortion policy and is potential for mischief. Conflict over constitutional legitimacy is the topic of Lawrence M. Friedman. Roger H. Davidson examines procedures and politics in Congress, covering attempts to prohibit abortion and curb abortion funding. In his presentation, G. Calvin Mackenzie deals with the question of what constitutes fitness for office. He reports that the historical record implies clearly that personal policy views are widely accepted as an appropriate test of fitness for appointment to high office and that nothing in the recent appointment controversies where abortion was an issue suggests that a change is at hand. John E. Jackson and Maris A. Vinovskis discuss public opinion, elections, and the "single issue" issue. Finally, Gilbert Y. Steiner sums up the reactions of the symposium. In response to Friedman's assertions that in the long view of constitutional interpretation there is neither "something illegitimate" about the Roe v. Wade decision nor about overturning it, participants did not attack it directly but rather picked at the proposition. Symposium participants who supported continued legislative consideration of abortion insisted on the value of legislative decision making in a democracy. Participants agreed that an ideological position is an insufficient condition to merit either presidential appointment or confirmation.
Reproductive behavior: Central and Eastern European experience
The authors attempt to clarify the reproductive decision-making process and to assess the factors influencing reproductive behavior in the Socialist countries of Central and Eastern Europe. Particular attention is paid to the effects of government policies. In Part 1, the authors present overviews of demographic trends, the role of women, the historical development of population policies, abortion policies and private behavior, and pro-natalist incentives. Part 2 consists of country reports on the Soviet Union, Poland, Yugoslavia, Romania, the German Democratic Republic, Czechoslovakia, Hungary, Bulgaria, and Albania. Each country report includes information on demographic trends: abortion and population policies; fertility planning, including family research, women's roles, and family size intentions and actualities; fertility regulating behavior, including contraceptive practice, abortion trends, and pro-natalist incentives; and sex and society, including marriage, sex education, and adolescent sexuality. The final part of the book is a bibliography containing over 1,000 references.
The politics of abortion: a study of community conflict in public policy making
The author describes the various stages in the abortion policy making process. Since the 1960s the abortion issue has been put on the public agenda, a major accomplishment considering the religious opposition to even discussing the issue publicly. Since the case of Roe v. Wade community conflict has been the dominant factor of the abortion issue; a community conflict involves all social classes and persists for a long period of time. The success of political activity in bringing the issue to a head lies partly in the ability to cultivate public approval and claim a degree of legitimacy for change. The goals of the 1960s movements were limited and met with some success; by the 1970s the goals were more encompassing and pro-life groups gained some sympathy as well. In the 1970s arguments about the meaning of human life and the integrity of civil rights were common and the issue became intertwined with that of women's rights. As an emotional issue abortion has brought more people into the debate than other political problems, especially among the lower socioeconomic classes. In considering turning the consensus into public policy one must consider the great degree of controversy surrounding abortion and the tendency of lawmakers to adhere to grass roots opinions when dealing with highly emotional matters. Actual provision of services, involving medical professionals, is another problem which may vary in degree from region to region. Further research should involve the following problems: 1) what other types of issues seem comparable to abortion, 2) what specific variables impinge upon all of these issues, and 3) can any paradigm be used to explain this policy.
And the poor get children: radical perspectives on population dynamics
The contributors to this volume, devoted to radical perspectives on population dynamics, cover the following subject areas: the ideology of population control; reproductive choice in the contemporary US--a social analysis of female sterilization; rural family size and economic change in Turkey; rural family size and economic change; population policy, family size, and the reproduction of the labor force in India; cross national labor migrants; population dynamics and migrant labor in South Africa; the effects of plantation economy on a Polynesian population; neo-Malthusian ideology and colonial capitalism--population dynamics in the southwestern Puerto Rico; and the political economy of wage labor migration in an eastern Kentucky community. The issue of birth control needs to be distinquished, both conceptually and historically, from that of population control, which is the action of more powerful groups to control the reproduction of others. In the US the birth control movement was initially part of a radical movement in which women struggled to gain control of their reproductive processes. In this volume Rosalind Petchesky makes the point that those concerned about population control coopted the use of the term "birth control" to soften their image. When Sanger turned to the wealthy to support her cause, she ultimately joined forces with persons who sought to limit population growth among the poor on racially motivated grounds. The cause of eugenicists was also stimulated by the influx of immigrants between 1920-30, which provided cheap labor for US factories but which also represented a potential source of social and political unrest. The population control movement prospered during the Depression. In 1942 the Birth Control Federation was established, becoming the International Planned Parenthood Federation in 1948. Tied closely to the eugenicists in the 1940s, this group subsequently developed close alliance with population policymaking organs at both a national and an international level. Following World War 2, the focus of those concerned about controlling population moved overseas, where unrest in some developing nations threatened US access to resources and markets. Population control and the ideology of "overpopulation" fit neatly within the imperialist scheme of effecting a greater rate of exploitation in industrial development. There is little question that Western bourgeois "development" theorists perceive population growth as the major block to economic progress.
Labour reservoirs and population: French colonial strategies in Koudougou, Upper Volta, 1914-1939
This study analyzes 4 themes of conflict: 1) between the French colonial administration and the people of Upper Volta, 2) competition between private capital and public administrators to capture labor, 3) competition between French and British capital, and 4) generalized intra-class contention. Part of the study focuses on Koudougou, an administrative district which was the most densely populated unit (density of 24.5/sq km) in Upper Volta, between 1914-39. Various types of colonial labor policies were used, including forced day labor in its form of annual "prestations" and longer term, large scale recruiting for major public works, as well as military conscription and the use of the secondary portion of the public and private sectors. Changes in the size of the labor force and the impact of the forced extraction of labor on the African populations are traced. The cumulative effect of these policies was enormous; over 30,000 people/year were probably called upon to perform some kind of labor outside the domestic economy. The average population of the area for the period was 342,000 indicating an adult male population of less than 100,000 and emigration makes the number even lower. Added to this are the taxes imposed on the people and the imposition of cash cropping. The domestic economy suffered because the capitalist alternative was underdeveloped and provided only a fraction of the production necessary to reproduce the Koudougou labor force. The labor that was extracted by capital was therefore captured at a wage far below its real value. It is also probable that food crop productivity declined and surpluses of earlier years were rapidly depleted; provoking a realignment in the division of labor by sex and age groups. The great pressure on village chiefs probably widened class differences and increased class antagonism in the non-capitalist sphere.
This volume describes the reaction of the population towards the introduction of family planning and analyzes the results of family planning activities in terms of their demographic impact on the decrease of the fertility rate. The sociocultural, socioeconomic, and demographic environment forming the basis for the various reactions of the population towards family planning in the countries of Japan, Egypt, Puerto Rico, Bangladesh, and Kenya are highlighted. In Japan it was not until after World War 2 that family planning on the modern contraceptive basis was introduced on a large scale. It was not until induced abortion was being practiced as a means of birth control that contraception began to successfully advance. The motivation of and the communication with the population are considered as well as the psychosocial factors that might affect fertility. After a discussion of the abortion problem and some demographic data a forecast for family planning on the basis of contraception in Japan is made. The government of Egypt has been trying to motivate the nation to practice family planning since the 1950s. The efforts resulted from the still heavy population pressure in Egypt. At the same time the government tackled the problems of polygamy and divorce and modernized the legislation in this field by removing it from the realm of the religious jurisdiction. The government initiated a family planning program in the 1960s. Family planning centers were established, but, although birth control is finding growing acceptance, the tempo is slow. Puerto Rico, with a predominantly Catholic population (85%), recognized that at an early stage it had a population problems. Private enterprise has been introducing and promoting contraception for almost 50 years. Within the last 15 years the practice of birth control has accelerated. Since 1973 the government of Puerto Rico has been taking an active part in the promotion of birth control. In Bangladesh the birthrate was 49.9/1000 for the 1955-60 period; it was 47.0/1000 for the 1975-80 period. Whether this moderate decline is a result of the activities in the framework of the various family planning programs or to other causes it is not possible to determine. From 1965-75 there was a special family planning program in Kenya with an organization and facilities of its own. Because of the traditional desire on the part of the population to have large families the authorites have been paying less attention to family planning since 1975. It would be desirable for the Kenya government to begin immediately a nationwide campaign to get the people to accept smaller families.
The relationship of breastfeeding to human fertility.
This discussion of the relationship of breastfeeding to human fertility covers the following: the physiological mechanisms by which human lactation influence ovulation and menstruation; the relationship between lactation and length of postpartum amenorrhea; lactation and anovulation; and lactation and pregnancy. A neglected advantage of breastfeeding is the likelihood that it will result in a wider interval between children, because lactation has some effect on fertility. In the absence of positive family planning methods, it is clear that other things being equal, mothers who breastfeed will on the average get pregnant less soon than those who do not. It appears that frequency, intensity, and duration of suckling are probably the most important determinants of the length of postpartum amenorrhea and of the time when ovulation returns in mothers, following an infant's birth. In women exposed to sexual intercourse, all other things being equal, the most important physiological factor influencing the spacing of births appears to be breastfeeding, and particularly its frequency, intensity, and duration. The data, reviewed here, show that the mean length of lactational amenorrhea varies widely around the world, but the evidence suggests that the differences are probably not mainly (if at all) due to ethnic physical or physiological differences. They are more a factor of infant feeding practices, including the frequency, intensity, and duration of breastfeeding. There are important cultural, social, and environmental factors which play a role in the length of lactational amenorrhea. These include infant feeding practices, the use of dummies or pacifiers, and the age, parity, health, previous lactational history, and possibly the nutritional status of the mother. The data from the studies relating lactation to pregnancy intervals provide strong evidence that the intensity of lactation is a factor. It appears that a mother who is breastfeeding her baby frequently, who is having her breasts fully emptied, and who is subjected to a considerable amount of nipple stimulation through sucking, is likely to have a longer postpartum interval of anovulation than is the woman who breastfeeds her child irregularly and for shorter time periods. Future research needs to divide women according to intensity as well as duration of lactation. Although the research on the effects of malnutrition and poor diets on ability of mothers to breastfeed and on menstruation and ovulation was not fully reviewed, there are data from famine areas to show that starvation causes an interruption in menstruation. There is also much evidence that moderately undernourished women conceive and give birth to infants, albeit of less than desirable weight. In sum, the studies discussed provide excellent evidence that breastfeeding has an effect in delaying the onset of menses and of ovulation postpartum.
In this chapter, devoted to a review of the complicated, controversial, and highly emotional issue of abortion in adolescence, attention is directed to the legal rights of minors, the available abortion methods (menstrual extraction, vacuum aspiration, dilatation and curettage or evacuation, intraamniotic instillation procedure, and other techniques, i.e., prostaglandins, hysterotomy, or hysterectomy); and the psychological effect of abortion. Recent statistics indicate that there are over 400,000 adolescent abortions each year in the US, and abortions are more common than deliveries for persons under age 15. Of the 1.3 million abortions occurring each year in the US, approximately 1/3 are in those under age 20. A disturbing fact is that teenagers account for many of the 2nd trimester abortions performed in the US. There are many reasons for this, including a delay in the diagnosis or ambivalence about the pregnancy and possible abortion. Abortion has been performed and discussed for centuries, but the concept of the legal rights of minors is only a recent phenomenon. The Supreme Court decision of 1976 held that a pregnant minor could have an abortion in the 1st trimester of pregnancy if a physician agreed, even if parents disagree. This seemed to be the culmination of changes in the law allowing abortions with minimal restrictions for youth. However, due to the passage of the Hyde Amendment, since 1977 the federal government has restricted the use of federal funds for legal abortions. Thus, an adolescent can still legally obtain an abortion, but she often cannot use federal money to pay for it. Legal battles continue between various groups about the legal rights of women (including teenagers) to an abortion. Methods of choice during the 1st trimester (gestation under 12 weeks) include menstrual extraction, suction curettage, or dilatation and curettage. There is controversy about the best abortion method during the 2nd trimester. Dilatation and evacuation is a popular method up to approximately 18 weeks of gestation, and intraamniotic saline instillation procedures are also common between 16-20 weeks. Considerable disagreement exists regarding which method(s) to use during 20-24+ weeks. A concern shared by all those involved with the health care of teenagers is that abortion in this age group might prove to be psychologically detrimental to those undergoing the procedure. Isolated or anecdotal reports of behavioral or psychiatric problems arising postabortion can be found, but careful review of existing literature indicates that such adverse reactions usually do not occur. Most teenagers do well psychologically after the abortion. Much of the literature makes the point that abortion can be a positive step in the lives of many women who are adequately prepared to take this step.
Abortion: an annotated indexed bibliography
3397 citations relating to the issue of abortion are included in this bibliography. Sources include English-language newspaper articles, books and monographs, journal articles, and laws, the majority of which are from the years 1968-1976. Although some international sources are included, most references are to US publications. Entries are listed alphabetically by author under 7 general topics: 1) bibliographies on abortion, 2) ethical and theological aspects of abortion, 3) medical and social aspects of abortion, 4) legal aspects of abortion, 5) abortion studies in the US, 6) abortion studies in other countries, and 7) collected articles and symposia proceedings. Approximately 10% of the entries are annotated. An index to the bibliography containing 353 headings is included.
Reasons why some women repeatedly resort to abortion are examined. The author suggests that the refusal to practice the alternative of contraception on a regular basis indicates uncertainty over choices in sexual life rather than irrational or pathological behavior. The primary focus of this article is on France. (summary in ENG, GER, SPA) (ANNOTATION)
The essays included in this volume were prepared for the National Conference on Abortion convened in October 1979 at the University of Notre Dame. The conference goal was to enlarge people's ethical perspective--not so much by provoking them to reconsider their overall judgment that abortion is right or wrong as by reminding tham that alongside this issue are many questions that also deserve serious moral inquiry, questions about family and childbearing and adoption and public welfare and political freedom. About 75 persons in all, plus interested faculty and students from Notre Dame and St. Mary's College, participated in the conference. The purpose was not a debate but an earnest conversation. The specific subject areas of the 12 essays are as follows: time for reassessment of abortion policy; predicting polar attitudes toward abortion in the US; national and international perspectives on the abortion decision; science and its use; unwanted pregnancy--a psychological profile of women at risk; an emotional history of the abortions of 3 women; a report on a program for pregnant women in distress; abortion in the US; public funding of abortions; political discourse and public policy on funding abortion; foreign aid for abortion--politics, ethics; and practice; and why abortion arguments fail. The US presently has a permissive abortion policy as a result of the Supreme Court's January 22, 1973 decision. From 1973 throught 1978, approximately 5.3 million American women had 6.6 million legal abortions. Even though the permissive policy has been in effect for over 7 years, it operates with little general consensus. As it has developed in the courts and legislatures, abortion policy has legal implications for the family and family relationships which reach far beyond the question of abortion itself. In several areas it is questionable that the current policy is functioning as it was intended to work. Some evidence suggests that in the effort to change past public policy, the medical benefits and safety of legal abortion were emphasized while the disadvantages and dangers were soft pedaled. Due to recent experience with oral contraception, a reassessment of abortion policy seems called for to ensure a more balanced view.
Fertility, biology, and behavior: an analysis of the proximate determinants
The proximate determinants of fertility are the biological and behavioral factors through which social, economic, and environmental variables affect fertility. Proximate determinants have direct influence on fertility. In studying natural fertility, it is seen that the duration of postpartum amenorrhea varies widely among regions, from a few months to 2 years with the waiting time to conception varying within a narrower range. Spontaneous intrauterine mortality and the prevalence of natural permanent sterility are relatively constant and not directly influenced by behavior. A comparison of the changes in natural fertility induced by the different proximate determinants yields a ranking of their importance in causing variations in natural fertility. A study of 8 populations with varying levels of fertility shows a general trend toward lower fertility, later marriage, and higher contraceptive prevalence, a close correlation between fertility levels and contraceptive prevalence, a negative effect of urban residence and higher education on the level of contraceptive use, and many exceptions to the general pattern of lower marital fertility among higher socioeconomic status groups. Marriage, contraception, induced abortion, and postpartum infecundability are considered the principal determinants of fertility while natural fecundability, spontaneous intrauterine mortality, and permanent sterility are less important. The conditions necessary for specified degrees of fertility control are considered: 1) family size control, 2) birth spacing, and 3) sex preselection.
Sex selection through amniocentesis and selective abortion.
An attempt is made to estimate how many medical procedures, including amniocenteses and second-trimester abortions, would be required to achieve a sex-tailored family. Two strategies of sex preference are examined, one involving a given sex composition and the other a specific order of births by sex. The authors conclude that the number of medical procedures involved in implementing specific sex preferences precludes the widespread adoption of this approach to sex selection. (ANNOTATION)
Alternatives to adolescent pregnancy: review of contraceptive literature.
Specific topics covered in this review of contraceptive literature pertaining to alternatives to adolescent pregnancy include: combination oral contraceptives (OCs) (cardiovascular side effects, cardiopulmonary conditions, hypertension, migraine headaches, epilepsy, oligomenorrhea, diabetes mellitus, sickle cell disease, hepatic disorders, cancer, and miscellaneous effects); the use of combined OCs by the teenager; low estrogen OCs; triphasic OCs; minipill; IUDs; barrier methods (diaphragm and condom); barrier methods and use by the teenager; postcoital contraceptives, injectable contraceptives; the rhythm method; and the miscellaneous methods of coitus interruptus, postcoital douche, and lactation. The issues of adolescent growth and development are critical, and a psychological profile must be developed for an individual youth who is seeking health care. Also important is the development of a pubertal assessment and its application to the psychosocial evaluation. Providing contraception for some sexually active teenagers is a difficult task because of the particular conscious or unconscious factors contributing to pregnancy in adolescents. Reasons for failure to use contraception include: developmentally unprepared to understand the concept of pregnancy; failure to acknowledge the consequences of sexual activity; and domination by an older teenage or adult male, rape, incest, and other factors; and "magical" thinking, i.e., the feeling that they, the couple, are special, and will be protected from pregnancy despite coital activity. It is critical that health care providers who deal with teenagers be capable of providing counseling on sexual matters and specific contraception to those who want it. Adequate motivation and training of these health care providers is very important, for the physician can actually impede the interested adolescent's contraceptive use by not offering contraception with assurance of adequate confidentiality and with sufficient expertise. Concern over the side effects of various contraceptive methods must be carefully discussed, but it should be remembered that the mortality rate from pregnancy and childbirth far exceeds the mortality rate for any contraceptive method. Many sexually active adolescents want to and can use contraceptive methods to avoid pregnancy. A careful history and physical examination should precede prescription or recommendation of a method which the patient can choose. Often a patient can be placed on OCs for a brief time, until she is psychologically mature enough to accept another alternative such as a barrier method. Barrier methods should be the 1st methods recommended by clinicians when their teenage patients want contraception.
Abortion, politics, and the courts: Roe v. Wade and its aftermath.
Although inspired partly by successful civil rights campaigns in the 1950s and 1960s the abortion rights campaign had less central organization and planning and more reliance on the generation of cases by physicians, women's groups, and state prosecutors. The sheer volume of cases brought within the period 1969-73 turned out to be an important factor in getting a Supreme Court hearing. In some respects the national organization of women's rights groups became stronger after the Roe v. Wade decision; after 1973 the decision caused antiabortion groups to become strong and pro choice activists strengthened as well. With the strengthening of the organizations, the struggle changed from that of movement politics, ruled by enthusiasm, to that of an organized effort necessary to resist a rollback of the gains of the legalization campaign. The author in his analysis of the aftermath or the Roe v. Wade abortion legalization decision sees the Supreme Court as the instrument of social change as well as its cause and recognizes that in many cases the Court's actions reflect what is going on in society. In different situations the Supreme Court can be an instrument or a cause of change. After Roe v. Wade the removal of state prohibitions on early abortions allowed some changes to take place, putting the burden on rolling back the new rules upon the antiabortionists. The author describes the legislative campaigns that were a cause of later abortion movements and gives an account of the abortion controversy through the election of President Reagan in 1980. The author notes the Helms/Hyde amendments allowing Congress to take action against abortion by majority vote and the apointment of the 1st woman justice of the Supreme Court who is also an antiabortionist, as major developments in 1981.
Socialist Republic of Viet Nam [Population education in the countries of the region].
The government of the Socialist Republic of Viet Nam has recognized the importance of and the need for population education. This is a totally new area in Viet Nam, although in some isolated instances it has been included in subjects in the school curriculum. There are adequate infrastructural facilities from the national to the village level for all categories of general education, vocational education, and complementary education as well as for preservice and inservice training for educational personnel. In June 1981 the UN Fund for Population Activities Needs Assessment Mission made the following recommendations for the effective implementation of a population education program: a National Committee on Population Education should be established with the Minister or Vice Minister of Education as the chairperson; a separate Department or Unit of Population Education, with full time personnel, should be created in the Ministry of Education and should be responsible for project implementation; population education should be integrated with relevant subjects in general education, complementary education, and vocational education; external assistance should be provided for the development and production of different instructional materials in population education; population education should be integrated in the preserve training of primary, junior, and senior secondary teachers; population education should be developed as an area of specialization at the post university level in Teacher Training University No. 1 at Hanoi; the launching of the population education project should be preceded by training of high level officials from the Ministry of Education and the training of key personnel at the national and provincial levels through a national training course of about 10 days; selected project personnel and teacher educators should be given specialized training in population education; all the inspectors, administrators, and heads of primary, junior, senior, and complementary schools should be given orientation in population education; all the teachers in general schools and complementary schools who would teach population education should be trained; and external assistance is recommended for seminars, study forums, specialized training and fellowships.
Innovative experiences in population education: a synthesis.
Discussion highlights some of the innovative experiences in population education in the region of Asia and the Pacific. Most of the countries implementing or planning population education programs view their projects as an integral part of their national development plans. Each population education program derives its mandate from the country's population policy, which is an integral part of the total development plan. The population education program is also consistent with and supports the national educational goals. Many countries in the region have taken the position that the content and methodology of their school curricula at the primary, secondary, and tertiary levels could be renovated using population education. Population education should be taught with an interdisciplinary approach and integrated with population education with existing disciplines in formal and nonformal education programs. Many educators in the region believe that population education can only be as good as the teachers and key personnel responsible for its implementation. Since population education is a relatively new course, a need exists for massive inservice and preservice training of school officials, particularly teachers. With such large numbers requiring training, many innovative alternative schemes have evolved. There are at least 6 models for training teachers in population education that have evolved in countries in Asia and the Pacific: phased face-to-face training conducted by the Ministry of Education; phased face-to-face training by universities and teaching training colleges; self learning modules; distance teaching; intercountry or state visits; and mobile training. Possibly the weakest link in population education is that of research and evaluation. The main objectives of baseline research are to determine what population content already exists in curricular materials and textbooks; and to better understand the targets of population education. Other types of studies include those related to curriculum and materials, the teaching process, and other evaluative research.
Dysmenorrhoea and premenstrual tension: gynaecological aspects.
A method of dysmenorrhea treatment based on anesthetizing the local site of pain referral (distribution of the 1st lumbar dermatome) was evaluated in a double blind placebo study. A local anesthetic aerosal spray, Fomocaine, was self-administered for 6 months in a group of 26 volunteers. 100 controls were given a placebo. 40% of the patients and 37% of their cycles were relieved with the spray. No pain relief was reported by controls. However, the pain threshold was greater among those obtaining relief than among nonresponders or controls. Since the spray has not shown deep penetration of the dermis, its relief action is more likely due to its action as a counterirritant than any direct anesthetic effect. Future research should focus on the roles played by hormones and prostaglandins, (PGs), opiate receptors, and neuropeptides in the mechanisms of pain. The role of psychological factors in different phases of reproductive life and in menstruation itself needs investigation. Controlled investigations of nondrug therapies such as psychotherapy and hypnosis should be considered. Primary dysmenorrhea is generally treated with either estrogen/progestogen oral contraceptives or with PG synthetase inhibitors, depending largely on whether birth control is also desired. Therapy for secondary dysmenorrhea is directed at the underlying cause of the pain and surgery is often indicated.
Increased decidual prostaglandin E concentration in human abortion.
Prostaglandin E (PGE) concentration was measured in decidual tissue after spontaneous and missed abortion and compared with that obtained from induced abortion. Tissues were obtained by curettage from groups of 10 patients each and PGE was estimated by radioimmunoassay. After spontaneous and missed abortions, decidual tissue contained significantly higher mean concentrations of PGE (486.3 and 66.7 ng/gm wet tissue respectively) than after induced abortion (18.6 ng PGE/gm wet tissue). It is suggested that an increased rate of PGE biosynthesis or reduced breakdown, or both, may play a role in the mechanism of human abortion. (author's)
[Therapeutic trend in acne associated with the menstrual cycle]
After examing the possible correlations between menstrual disorders and acne, the authors describe a trial performed on 40 subjects, of whom 20 had normal cycles and 20 had menstrual disorders. It was discovered that androgen antagonists are more effective in managing acne in those subjects with menstrual abnormalities compared to those with normal cycles and normal endocrinological conditions. (author's modified) (summary in ENG)
[Epidural anesthesia and prostaglandin-induced abortion]
Epidural analgesia combined with anxiolytics were used while terminating 2nd trimester pregnancies in 120 patients. These cases are here reviewed retrospectively. In 9 patients (7.5%; 95% confidence limits, 3.5-13.8), full relief from pain was not obtained with this form of analgesia alone. In 6 patients, complications connected with the epidural analgesia occurred. These included accidental dural puncture (2), transient headache and bilateral paraesthesia in the legs (1), and fall in blood pressure (3). The average induction-abortion interval was 17.4 hours. In 15 patients, postabortion complications necessitated prolonged hospitalization. Epidural analgesia combined with anxiolytics seem to be well suited for this intervention. (author's modified) (summary in ENG)
Fundamentals of obstetrics and gynaecology. Vol. 2. Gynaecology.
This volume deals with matters which are considered conventionally to constitute gynecology and is intended for undergraduates and for those graduates who spend a 6-month residency in obstetrics and gynecology; surgical techniques are not discussed. The following topics are covered: gynecological examination, anatomy and malformations of the female genital tract, intersex, the menstrual cycle, amenorrhea, oligomenorrhea, problems of sexual behavior, abortion, genital tract infections, the endometrium, trophoblastic disease, uterine displacement and uterovaginal prolapse, ectopic gestation and non-infective diseases of the oviduct, the ovary, accidents and injuries, pediatric gynecology, adolescence, and sex hormones. Methods of contraception discussed include the rhythm method, coitus interruptus, barrier methods, oral contraceptives and their side effects, the IUD, and sterilization. Septic and induced abortion as well as endotoxin shock are covered.
Medical and health-related, religious, feminist, population control, and legal organized groups helped to bring about the downfall of anti-abortion laws in the US. The US Supreme Court responded to the wishes of these groups, which represent the most educated and affluent strata of the US population, instead of the general public, and pro-abortion movement itself succeeded because of the sexual revolution, secularization, feminism, and political liberalism of the late 1960s. The Supreme Court used the structuring and language of the Wade and Bolton decisions to get its position across. The author discusses the weakness of the legal and constitutional case for abortion rights and the Supreme Court's perogatives in the fashioning of new rights, and concludes that privacy has been afforded protection by American law and that traditionally it did not protect contraception, abortion, and other aspects of "reproductive freedom." The illegal abortion problem has not been solved by legalization and it does not appear that the problem of unwanted children will be either. It is stated that abortion, whether legal or illegal, may bring health and fertility complications for the women, and that its wide availability has possibly increased these. The author concludes that the unborn child has a rational soul. A complete prohibition of abortion in accord with the religiously pluralistic and liberal democratic nature of the US is needed. It is also shown that the religious aspects of our fundamental political principles can be appealed to by statesmen as a way of encouraging acceptance of new anti-abortion laws. In making its decisions the Supreme Court chose not to fully weigh the evidence about the justifications for abortion or its likely consequences. The author states that abortion poses a threat to cherished traditions of western civilization and to principles of US political order and is thus a political question.
In the late 1960s and early 1970s, abortion legislation became less restrictive allowing greater numbers of women the option of abortion. Health professionals have had few guidelines and limited training in providing services for these women. Nursing faculty have had to deal with significant social change on both a personal and professional basis. Though legislation has become more restrictive in the 1980s, there are still at least 1 million abortions annually in the US. Certainly the nursing care of these women needs to be addressed in the schools of nursing. This research study was designed to identify, delineate, and develop content for baccalaureate nursing students on the care of the abortion patient. In order to identify the essential content needed in this curriculum model, this author developed a questionnaire outlining important topics. The instrument was developed upon the following sequence: literature search, the author's experience, pilot test, and final revision. In the spring of 1982, the instrument was mailed to 20 obstetric-gynecologic health professionals with abortion experience in services. The purpose of this questionnaire was to find agreement within these health professionals regarding the importance of topics in abortion education. Respondents dealt with a 7-category Likert scale and addressed whether content was essential to not-at-all essential. The process of collecting data included approval by the University of Houston Human Rights Committee, a cover letter, consent implied by the individual's reponse, and follow-up procedures. Based upon the review of the literature and results of the questionnaire, a model curriculum was developed which addressed the following areas: 1) impact of legislation on abortion services; 2) stressors contributing to problem pregnancies; 3) nurses' psychosocial problems while on abortion services and some solutions; 4) professional organizations' statements for nurses on abortion services; 5) nurse administrators' concerns regarding the care of the patient, 6) data-based research in abortion services, health professionals' attitudes and their influence on care; 7) nursing care of the abortion patient pertinent to the varying procedures utilized; 8) the unique problems of the teenager seeking an abortion, the married patient, and the patient who repeatedly seeks abortion as a primary means of birth control; 9) trends, issues, and research in abortion education; and 10) suggestions for teaching strategies and resources. Student objectives and an evaluation plan were included. (author's modified)
This study compared personality factors, self-concept, and family backgrounds of 3 groups of adolescents: unwed girls seeking a legal abortion for the 1st time; unwed girls seeking a repeat abortion, and unwed girls who had never been pregnant. The purpose of the study was to show significant differences between these groups, predicting the greatest differences and higher pathology would occur in repeat-abortion adolescents. Subjects were 96 white, middle or upper-middle class adolescents between 13 and 19, from Fairfax County, Virginia. 34 were 1st-time abortion seekers; 31 were repeat abortion-seekers, and 31 were never-pregnant controls. Subjects were voluntary and given anonymity. The research design was descriptive and correlational. Data were collected from 3 instruments: 1) a 73-item questionnaire developed by the researcher, 2) the Tennessee Self Concept Scale (TSCS), and 3) the Kinetic Family Drawings (K-F-D). A discriminant analysis yielded the optimal combination of variables that best distinguished the groups, and were, in order of their magnitude: birth control frequency; father's warmth and support to mother; size of self-figure in K-F-D; father-figure involved with mother-figure in K-F-D; marital conflict; Identity subcale of TSCS, and knowledge of contraception. Results were significant at the .05 level. Using Chi-Square analyses and/or t-test comparisons, the following hypotheses were supported (P<.05): 1) 1st-time aborters report more loss (death) and transitional events than controls; 2) repeat aborters manifest more clinical signs of instability and personality conflict than controls; 3) controls manifest higher self-esteem than repeat aborters and higher social-self and total positive scores than 1st-time aborters; and 4) abortion-seekers, particularly repeat, indicate more uninvolved fathers, marital conflict, poor family communication, and family disengagements or enmeshments than controls. An hypothesis predicting higher sex guilt scores in repeaters was not significant (P>.05). Results of this study provided a profile of the adolescent most at risk to become a multiple-aborter. Personality/family dynamics correlating with repeat abortions were: parent's marital conflict; peripheral father; family either isolated or overly-close; poor communication; tense home atmosphere; death and/or losses; low self-concept, and psychological instability, with knowledge of sex and contraception but with a poor record of usage. (author's)
[Studies on the chemical constituents from plants for fertility regulation]
Using plants for fertility regulation has had a long history and wide clinical practice in Chinese traditional and folk medicine. This report presents some Chinese plants which are described in "Pen-Tsao-Kan-Mu" as emmenagogues, abortifacients, or contraindications to pregnancy for selection in priority to the screening test. This report also reviews chemical work done on antifertility plants in recent years. Trichosanthin has been obtained from the juice of Trichosanthes kililowii and proved to be an active protein principle for inducing abortion during midgestation. The partial N-terminal 30 amino acids sequence of trichosanthin was determined by automatic Edman degradation. Yuanhuacine (I) an active principle of the Chinese herb Yaun-Hua, has been isolated and its structure proved to be a kind of diterpene orthoester. 6 other analogues of yaunhuacine were also isolated from Wiskstroemia chamaedaphne, Daphne giraldii, and D. langutica. Recently, the novel diterpenoid, pseudolaric acid B isolated from the root bark of Pseudolarix kaempferi, was found to possess the effect of terminating early pregnancy in animals. The structure of pseudolaric acid B was assigned as (II) by spectral and chemical evidences. In another Chinese folk medicine, Gardenia jasminoides, a phenolic acid, named gardenic acid which possesses some antifertility effects in preliminary animal tests, has been isolated. Its structure was suggested as (III) by spectral analysis and chemical degradation. It is interesting that a plant peptide TPII has been proven to inhibit humandecidual cell in vitro. The amino acids composition and partial N-terminal sequence of peptide TPII were determined. Its N-terminal residue is ornithine. d1-Gossypol was 1st found as a male antifertility agent in China. The d-gossypol has been obtained from Thespesia populnca but has not shown any antifertility activity in rats. Through the screening tests of some other plants (Malvaceae family), the phenolic part of Hibicus schizopelates showed some significant effects. The authors believe that the prospect of discovery of active principles from plants for fertility regulation is sure to be bright. (author's modified) (summary in ENG)
In a randomized, double-blind study, 30 healthy, nulliparous women of similar gestational age were given intracervical applications of 0.5 mg prostaglandin E2 (PGE2), 0.05 mg Suplrostone, or 0.1 mg Sulprostone gel in order to soften the cervix prior to curettage for 1st trimester termination of pregnancy. Preparations were administered 8 hours before curettage. The number of complete and incomplete abortions, ease of passage through the cervical canal, as measured by a tonometer before and 8 hours after the administration of PG, the degree of pain experienced, and the quantity of analgesics required, plus the frequency of systemic side effects were all assessed by 1 trialist. With regard to the rate of abortion and cervical softening, the administration of 0.1 mg Sulprostone gel proved the most effective method. However, in comparison with the others, it also caused the greatest degree of pain and necessitated the greatest use of analgesics. The softening effect of the PGE2 gel was significantly less and in this group, there were 2 cases of cervical lesion due to tenaculum laceration. The intracervical application of 0.05 mg Sulprostone gel is to be recommended for preoperative ripening of the cervix before termination of pregnancy in the 1st trimester, as it effectively dilates the cervix and does not cause systemic side effects or pain in the lower abdomen, enough to make treatment necessary. (author')
Authors report on data gathered as a result of an investigation aimed at evaluating the presence of psychosomatic causes or contributing factors in the onset of amenorrhea after a voluntary interruption of pregnancy (VPI). The investigation, carried out at the Little Obstetrics and Gynaecologic Surgery Dept. at the University of Rome, where law 194 concerning VPI is implemented, has provided data that, for the most part, corroborates this assumption. However, there exists a pool of patients on whom further causes will require investigation in order to completely eradicate post-VPI amenorrhea. (author's modified) (summary in ENG)
Attitudes of French adolescents toward sexuality.
386 French adolescents between the ages of 16-18 (145 boys and 241 girls) were questioned about sexuality. The 5 questions used covered their opinions on abortion, masturbation, sexual intercourse during adolescence, homosexuality, and marriage. The comparison of their responses to the 5 questions was expected to bring out the differences in reactions in these areas. In fact, results revealed that the subjects were not concerned to the same degree by the 5 questions. It was also observed that few adolescents were completely liberal and even fewer completely conservative. The importance of sociocultural factors, especially religion, associated with the attitudes of the subjects appeared undeniable. Some interesting differences in attitudes expressed by the 2 sexes were emphasized. (author's modified)
A single vaginal suppository containing 1 mg of 15-methyl prostaglandin F2 alpha (PGF2alpha) methyl ester induced cervical dilatation in 60 patients requesting surgical termination of pregnancy. 42% of the patients required no further dilatation. Even when further dilatation was required, it was performed with considerable ease due to the softening effects of the PG on the cervix. The use of this agent may be of value in preventing complications resulting from mechanical dilatation of the cervix. (author's)
[The levels of serum lipids during abortion induced by a hypertonic saline solution]
Studies were carried out on serum lipid levels in 30 women in good health who were pregnant for the 1st time with a pregnancy of between 15-20 weeks duration who had their pregnancies terminated by use of a hypertonic saline solution. They displayed a rise in cholesterol level only (5.83 mmol/l +or- 0.17) in the phase of actively aborting (a period of maximum stress) as compared with a level of cholesterol in th preabortion phase (4.93 mmol/l +or- 0.17). Between 12-15 hours after termination, the cholesterol level dropped sharply as did the levels of phospholipids and triglycerides. The levels became of the order of 4.1 mmol/l +or- 0.25, 2.73 mmol/l +or- 0.097, and 1.03 mmol/l +or- 0.06 respectively according to the phase of termination. Levels of serum lipids after termination were surprisingly almost identical to those of nonpregnant women. The poor rise in serum lipids during termination induced by hypertonic saline solution indicates that labor was probably of low intensity. (author's modified) (summary in ENG)
[Dyserythropoiesis in the fetal liver as an indicator of the intensity of stress caused by abortion]
The degree of dyserythropoiesis was measured in liver smears and the following values were obtained: 1.6% in fetuses removed during the 1st trimester, 5.9% for those fetuses removed during the 2nd trimester by abortion; 13.5% and 10% in fetuses spontaneously expelled or by induced abortion, respectively; and 30.8% and 22.2% in those fetuses aborted already dead. The degree of hepatic dyserythropoiesis developed in utero increased hypoxia, while it decreased under oxygenized conditions. In babies who died during the neonatal period, significant dyserythropoiesis occurred. All resutls suggest that contractions of the uterus leading to abortion--probably due to uteroplacental hypoxia--cause dyserythropoiesis. Its degree refers to the intensity of the stress. (author's modified) (summary in ENG)
Infertility in women exposed to diethylstilbestrol in utero.
To evaluate the reproductive consequences of prenatal diethylstilbestrol (DES) exposure, 33 infertile couples were studied in whom the female had been exposed to DES in utero. Infertility was attributed to uterotubal junction obstruction in 3 couples, anovulation in 7, endometriosis in 11, cervical obstruction in 2, adnexal adhesions in 2, oligospermia in 1, and luteal insufficiency in 3; in 4 couples no cause of infertility could be identified. No unique intraabdominal abnormalities attributable to DES exposure were observed. 4 tubal pregnancies occurred in women with grossly normal oviducts. 9 of 11 women who had previously undergone surgical manipulation of the cervix (cryosurgery, cautery, or conization) developed cervical stenosis, and 8 were found to have endometriosis. Despite our not having an appropriate referral infertility population for comparison, these findings are consistent with these hypotheses regarding women prenatally exposed to DES: 1) surgical manipulation of the cervix more frequently leads to cervical stenosis and ultimately pelvic endometriosis; 2) tubal pregnancies may occur by a mechanism unrelated to salpingitis; and 3) the spectrum of problems causing infertility is similar to that in the non-DES-exposed population. (author's modified)
[Psychodiagnostic findings in anorexia nervosa and post-pill amenorrhea]
Anorexia nervosa originates from disturbances at various points of the cortico-hypothalamo-hypophyseal axis. 65 patients suffering from this syndrome or postpill amenorrhea were classified by cluster analysis with 174 marks of social, psychodynamic, and biological levels. The different psychodiagnostic characteristics (470 F-Test, Hamiltion Depression Scale, Beck Depression Scale, Giessen test) are discussed according to these 3 clusters. (author's) (summaries in ENG, RUS, GER)
25 mg prostaglandin F2alpha was administered intraamnially every 8-12 hours in order to interrupt pregnancy of between 14-28 weeks gestation in 53 cases. Abortion occurred within 24 hours in 51% of the cases, within 35 hours in 78%, and within 48 hours in 96%. In 10 cases, induction was strengthened by intravenous oxytocin infusion in hours 18-41 partly due to the rupture of fetal membranes, and partly to the dysfunction of the uterus. In these cases, abortion took place within 2.5-8 hours following oxytocin administration. Side effects occurred in 31.5%, affecting mainly the gastrointestinal and cardiovascular systems. (author's modified) (summary in ENG)
Changes in attitudes toward contraceptives concomitant with instructional activities in physiology.
Expatriate science teachers are being asked with increasing frequency to participate in science classroom instructional activities in a large number of developing nations. The peculiar nature of social problems in many of these countries calls for a broader definition of curricular activities in the science classroom. This report is based on a study that assessed the influence of subsidiary learning activities in a physiology class on attitudes towards contraceptives. Students enrolled in a physiology course were exposed to various subsidiary learning activities through reading assignments, group projects, and group discussion sessions. A pre- and posttest evaluation of changes in attitude towards contraceptives was found to be statistically significant. A significantly larger proportion of students possessed positive attitudes toward contraceptives at the end of the semester's learning activities than at the beginning. (author's)
[Principles of the management of patients with juvenile uterine hemorrhage]
A total of 1685 pubertal patients with dysfunctional uterine bleeding were investigated using the conventional tests of ovarian function and measurements of gonadotropic and sex hormones, as well as the assessment of some hemostatic parameters and hysteroscopically controlled diagnostic and endometrial curettage. The patients were investigated before and after hormonal treatment aimed at restoring normal hemostasis and the control of menstrual function. On the basis of results achieved, symptomatic therapy is recommended as the 1st stage of treatment for juvenile uterine bleeding, followed by hormonal therapy and subsequent substitution therapy for hormonal deficiencies. For recurrent bleeding which does not respond to conservative treatment, diagnostic curettage is indicated, preferably under hysteroscopic control. Treatment for hemostatic disorders should be added to the complex management of girls with dysfunctional uterine bleeding. (author's modified) (summary in ENG)
Comparison of laparoscopic sterilization falope ring versus cauterisation.
A study was made of 475 cases of laparoscopic sterilizations using falope rings during 1979 at Kasturba Hospital, Delhi, India. It was compared with previous data on 10,642 cases done during 1977 using unipolar cautery at the same place. Maternal age and parity are compared--49.4% in both groups were less than 30 years of age. About 3% more women who had laparoscopy had 3 or less children. There is a remarkable increase in medical termination of pregnancy (MTP) cases in the laparoscopy study--50.1% had MTP as compared to 15.8% in the cautery study. Very few cases were done after delivery--0.4% of the laparoscopy cases, as compared with 0.9% in the cautery group. Complications were minimal. There was some bleeding--1.9% in the falope ring procedure and 0.9% in the cautery group. There were torn tubes in 1.9% of the laparoscopic group. The uterus was perforated in 1.9% of the laparoscopic group; 0.9% of the cautery group. The falope ring method has gradually replaced the cautery method in Kasturba Hospital. It is safer, has less complications, and reversibility is better. It is more expensive, however.
Intramuscular administration of 15 (S) methyl prostaglandins F2 alpha for midtrimester abortion.
The efficacy and safety of intramuscularly administered 15 methyl prostaglandin F2 alpha (15MPF2A) has been studied in a clinical trial conducted at the Family Welfare Department, Government Raja Mirasdar Hospital, Thanjavur Medical College, Thanjavur, Tamil Nadu, India. There were 3760 admissions from January to June, 1980. Of these, 438 medical terminations of pregnancy (MTP) were done--an incidence of 4.76%. Of these 438 cases, 214 (48.8%) were from the 2nd trimester; 25 cases were taken for the clinical trial. Indications for the abortion were socioeconomic in 48%; birth spacing, 28%; 16% following rape, and 8%, divorce. 58% were educated; 24% were in the high-income group, 36%, the middle-income group, and 40%, the low-income group. 84% were married. Most were 21-25 years old. Parity is given. In 40% of the cases, the interval between the last childbirth and MTP was 1-2 years, in 60%, 2-4 years. Most were sterilized because their family was complete. Lomotil (diphenoxylate hydrochloride and atropine sulphate) was given 2 hours before 15MPF2A. Required dosages of 15MPF2A are given. Mean dose required is 2.3 milligrams (2300 micrograms). Induction-abortion time is given. Complete abortions were induced in 92%--incomplete in 8%. Where Lomotil tablets were given, major side effects such as diarrhea and vomiting are less. Other side effects--such as nausea, cough, rise of temperature--were found. Severity of side effects is mild and well-tolerated. Comparison is made with other studies.
Endangered plants used in traditional medicine.
In the face of initiatives from various quarters towards the production of traditional herbal medicine, the world's forests are being depleted at an alarming rate. This article discusses plants that are presently in danger of extinction. 4 such plants are Caranthus coriaceous, a highly restricted plant of Madagascar which could potentially be used for the treatment of cancer; acorus calamus, a Eurasian aroid known as "vacha" in India, which contains an essential oil that possesses insecticidal and sedative properties; Rauvolfia serpentina, used by ancient medicine men in the orient for the treatment of insanity, and Ginseng, including a North American (Parax quinquefolius) and an Asiatic (P. Ginseng) species. Scientific analysis has failed to isolate physiologically active constituents from Ginseng. India occupies the top most position in the use of herbal drugs, utilizing nearly 540 plant species in different formulations. A table of endangered plants of actual or potential use in traditional medicine is given. The diagram includes species, common name, family , threatened range by country, and use of each plant.
The NAPRALERT data base an an information source for application to traditional medicine.
It has been estimated that from 25 to 75 thousand species of higher (flowering) plants exist on earth. Of these only about 1% are acknowledged through scientific studies to have real therapeutic value when used in extract form by humans. A computerized data base on the chemistry and pharmacology of natural products is available. The data base is maintained in the Department of Pharmacognosy and Pharmacology, College of Pharmacy, University of Illinois, at the Medical Center, and has been given the acronym NAPRALERT (Natural Products ALERT). A systematic surveillance of the world literature on the chemistry and pharmacology of natural products has been in progress since 1975. In addition, a substantial amount of retrospective information has been acquired and computerized on selected genera of plants and on the pharmacological activities of natural products. These retrospective searches extend back into the mid 1700s. The major fields covered in the NAPRALERT system are 1) the organism record; 2) work types; 3) compound record; 4) pharmacology record; and 5) demographic record. There are 2 major areas in which traditional medicine can be served through the use of NAPRALERT: data retrieval and problem solving. Since most problems in traditional medicine are regional ones, it is possible to program the NAPRALERT data base to respond primarily to questions concerning plants of a specific country, or within a given continent. Recently the NAPRALERT base has been made available to individuals, industrial firms, academic institutions and government agencies with a modest fee calculated on the basis of actual computer time required to generate data output, the cost of copying the material and the mailing costs. In the near future, NAPRALERT will be approaching international funding agencies to enlist their cooperation in financing a 10 year program that will allow them to computerize all of the world literature on natural products as far back as 1900. This will be an enormous effort, which cannot be effectively accomplished without direct cooperation from interested scientists and institutions in developing countries. A plan for obtaining that objective is outlined.
Phytopharmacology and phytotherapy.
There is a genuine interest now being taken in phytotherapy and medicinal plants throughout the world. In industrialized countries there is a trend of going back to nature or wanting to combat the chemical pollution of the body provoked by inopportune chemotherapy or by the misuse of convenience drugs of chemical origin; third world countries are primarily concerned with providing their peoples with adequate coverage of their essential drug needs. A new type phytotherapy is proposed, to produce phytotherapeutic preparations for use in modern medical practice from the resources of traditional medication. In view of difficulties experienced by developing countries in meeting their needs for essential drugs, 4 measures might be taken to encourage utilization for primary health care of their vast local resources: 1) a real health policy option at national and regional level; 2) determination of priorities regarding health problems and definition of possible solutions; 3) goal-oriented applied scientific research on medicinal plants, incorporating properly planned programs; 4) effective implementation of these programs with regard to technical and financial resources and appropriate personnel. Cooperation among developing countries, with the industrialized countries and with organizations of the United Nations system is recommended. A table illustrates integrated overall organization.
Many therapeutic practices in Europe are not really traditional; the traditional elements have been diluted over the centuries by what used to be official medicine. The term "folk medicine" is therefore more appropriate. The survivals of true folk medicine in Europe are part of the culture of a pre-industrialized society and no longer belong to a genuine medical system. Independent manifestations can be found in individual households all over Europe, mostly in rural areas. The more popular therapeutic practices include herbalism, balneotherapy, use of mud and clay, cupping, and bleeding. Hydrotherapy is widely applied in alternative medicine and at the same time it is a complementary part of official medicine in some countries. Popular medicine in Europe does not specifically include esoteric thoughts, but in folk medicine the spiritual aspect is still strong. Magic can be involved occasionally in therapeutic practices. Not all the traditional therapeutic methods practiced in Europe are of European origin. Imported therapeutic methods include acupuncture and Unani medicine. Some of the most frequently met practitioners and therapies of alternative medicine including Heilpraktiker herbalism, balneotherapy, cupping and bleeding, osteopathy and chiropractic, homeopathy, Anthroposophical medicine, hand healing, special cases of unorthodox medicine relating to specific drugs, and self-care are discussed. Therapeutic practices and curing theories are listed.
The role of traditional medicine in primary health care.
Primary health care is concerned with the main health problems in the communtiy; services reflect the political and socioeconomic patterns in the country. There is widespread disenchantment with health care in many of the developing countries for reasons common to all of them. Health resources tend to be concentrated in urban areas, which accommodate only about 20% of the population. These facilities are so expensive that only the elite and opulent citizens can afford the services. In several of the developing countries, while about 5% of the national budget is allocated to health services, some 30% of that amount is absorbed by the drug bill alone. It should be noted that all the drugs for such relatively poor countries are imported against payment in hard currency. A number of these countries are therefore exploring the possibility of developing their well known and tested herbal medicines for use in primary health services. The categories of traditional practitioners and the problems involved in integrating them into official health services are discussed. 90% of all traditional practitioners work in rural areas while the remaining 10% cater mainly to disadvantaged populations in urban areas. Traditional midwives are responsible for over 90% of the births. It is recommended that they be trained by health professionals of greater age and experience. Both national and international training and research projects regarding traditional medicine have focused mainly on birth attendants and very few have concentrated on traditional healers. A project recently developed in Ghana for the training of healers is described in detail. The results of follow-up surveys after 6 months of training were very encouraging in terms of acquired skills, knowledge, and terminal behavior. Supporting services such as family education and utilization of the media, and the integration of traditional pharmacopoeias with modern pharmaceutical practices are discussed.
Induced abortion in Xian City, China.
Induced abortion is widely practiced in China, yet little information on its incidence is available. A household survey of married women under 50 in Xian City reveals that nearly 1/2 have had at least 1 induced abortion. Women in their 30s and those who have been married for 5-19 years have had more abortions, on the average, than others. However, it is the youngest women, and those married most recently, who are most likely to terminate a pregnancy by abortion. For the middle 3, 5-year age groups (women 25-39), the average number of pregnancies declined 22% between 1971-81, and the average number of abortions was 74% higher in 1981 than in 1971. Among women with no children, an average of 8% of pregnancies ended in abortion between 1977-81. However, once a woman has had a child, the proportion of pregnancies ending in abortion for this group rose from 39% in 1977 to 88% in 1981. Of women with 2 or more children who became pregnant, 96% had an abortion. At the rates prevailing in 1981, women in Xian City can expect to average 3.6 pregnancies in their reproductive lives--1.5 births and 2.0 abortions. Induced abortion has become a very important fertility control method in China; by 1981, the number of abortions in Xian City had exceeded the number of births. Overall fertility appears to be below replacement level, a sign that the government's policies are having some success there. However, improved contraceptive use is desirable as an alternative to reliance on induced abortion, both for health reasons and to relieve pressure on needed medical facilities. (author's modified) (summaries in SPA, FRE, ENG)
Training community health workers.
The objective of this report is to help persons who are not training specialists to decide policy and planning questions and to oversee the implementation of training. The report is written as a series of issues that must be faced and resolved. The issues discussed concern effective program design, the kind of training efforts that should be supported, the design and implementation of the training, what should be taught, who should be trained, trainee and trainer selection, the nature of training curricula and materials, the location and duration of training sessions and training evaluation. For some issues, such as defining the Community Health Worker's (CHW) role, skills and activities, or the need for institutional development, there are specific recommendations; for others, like location planning, only pro and con arguments are given. Planners are urged to decide how training fits into their program, and how much effort to invest, given competing priorities. The report is intended to stimulate discussion by raising questions and suggesting considerations relevant to answering them. Reviews and examples of existing efforts in a number of countries are used in the appendices as illustrations of the ways in which various projects sought to tailor training needs and skills to local requirements and constraints. Appendix B presents synopses of CHW training in selected projects following a set of characteristics--scale of project, trainees' previous education, duration and schedule of training, trainers' preparation, production of training methods and materials, methods of evaluation and community participation. These are followed by a descriptive summary of the projects. Lists of resource institutions and organizations for CHW training, and of recommended readings are provided.
Sexuality and social order: the debate over the fertility of women and workers in France, 1770-1920
This monograph traces the history of the birth control controversy in France from 1770 to 1920, when France enacted legislation restricting abortion and prohibiting the dissemination of information on contraception. A major participant in this debate was Paul Robin, a neo-Malthusian libertarian who launched the French birth control movement. A unique feature of this movement was its critique of both sexual and political power. Robin's efforts were countered by powereful elements of the church and military. The passage of the 1920 legislation is generally attributed to depopulation fears induced by World War I. However, it is suggested here that the loss of social control implied in fertility control was of more concern to legislators than the loss of births. Through use of a sociopolitical analysis, this monograph traces the relationship of the forces in the 18th century birth control debate to the issues of sexuality and social order. The discussion is placed in the context of the demographic transition occurring in France during this period. In addition, the reactions of workers and feminists to this debate are described. The 1920 legislation's lack of substantial impact on the decline in the birth rate that was already under way in France is also discussed.
[Abortion, contraception, and fertility in Quebec and Canada]
Because the legality of abortion in Canada is determined by national law but the availability of abortion facilities is influenced by provincial regulations, there is a wide disparity in the availability of abortion in different provinces of Canada. In 1978, 11.3 abortions were performed in Canadian hospitals per 1000 women aged 15-45, but rates varied from under 5/1000 in Newfoundland, New Brunswick, and Prince Edward Island to 21.3 in British Columbia. Quebec had a rate of 5/1000, but many women from Quebec obtained abortions in the US. The abortion rate and ratio respectively for Canada were 7.9 and 10.4 in 1971 and 11.6 and 17.9 in 1978. 61% of the women were single. 31% were under 20 and 31% were 20-24 years old. 60% were in their 1st pregnancy. 85% of procedures were aspiration. Contraception is also regulated by the federal criminal code, but public facilities are made available by the provinces. Until 1969, the criminal code prohibited the sale or spread of knowledge of contraception, but was seldom invoked. Little is known of the evolution of contraceptive use in Canada, but total fertility rates for women born since 1860 indicate considerable fertility control within marriage. Women born in Canada, Ontario, and Quebec respectively between 1860-76 had 4.8, 3.9, and 6.4 children on average, while those born in 1911-16 had 3.1, 2.6, and 3.8. A survey of 1737 married women aged 15-65 years in Quebec in 1971 showed that 80% approved the use of contraception, despite the overwhelming Catholic majority of the population. 35-45% of women aged 35-65 approved of contraception with reservations, but almost 75% of those under 35 had no reservations. Fewer than 10% of married women had no knowledge of contraception. The average respondent was able to name 3.6 mthods, but more educated women, those with urban backgrounds, and anglophones knew more methods. In 1971, 28.7% of women married 20 years or more reported ever having used contraception, while 85% married between 1966-71 had used it or planned to use it. About 60% of those married before 1960 who used contraception used periodic abstinence, while those married later primarily used pills followed by periodic abstinence. In 1971, 70% of all contraceptive users chose either pills or abstinence. A resurvey in 1976 of some of the women who were aged under 35 in the 1971 survey indicated that ever users of contraception had increased from 80% to 90% of the total, that the proportion of couples undergoing sterilization increased from 6.7% in 1971 to 41.19% in 1976, the proportions using pills had declined from 39.6% to 24.8%, the proportion using periodic abstinence had declined from 32.2% to 13.3%, and the proportion using the IUD did not increase beyond 7.3%.
Migration flows in Punjab's green revolution belt.
This paper presents some results of a field survey of migrants into and out of the rural areas of Ludhiana district of Punjab which is the heart of the green revolution belt in northern India. Three streams of migrants are studied: out-migrants, in-migrants and return-migrants. The analysis suggests that all three flows are on the rise in Punjab's green revolution areas. Out-migration from the rural areas is dominated by the poorest and the richest and information on the reasons for migration confirms the link between migration and economic factors. The rate of out-migration from the rural areas is higher than the combined rate of in-migration and return-migration, suggesting that some of the shortage of labour reported from the region may be due to migration and not to new methods of agriculture. The data suggest that, in terms of human capital, rural areas of the region are getting depleted of their more resourceful elements. Against this, there is a compensatory inflow into the rural areas of remittances which supplements capital formation and investment in productive activities. The proportion of scheduled and low caste people in the rural population of Ludhiana district is gradually increasing as a result of migration. Ludhiana district, because of its achievement in agriculture, is attracting people from other districts of Punjab and also from the other states. These flows are not considerable at present, but are portending to become more marked with the passage of time. (author's)
The 1986 Australian census of population and housing.
The preparations for the 1986 census of Australia are described. Consideration is given to the development of the census schedule, field operations, input processing, and output processing. (ANNOTATION)
New Zealanders in Australia--a census profile.
A profile of persons born in New Zealand who were counted in the 1981 census of Australia is presented. Consideration is given to spatial distribution, occupation, industry, income, and citizenship. (ANNOTATION)
[Population estimates as of October 1, 1982]
Population estimates for Japan for 1982 are presented by age and sex, by prefecture and sex, and by prefecture, five-year age group, and sex. (summary in ENG) (ANNOTATION)
[The effect of migration on population development]
Long-term migration patterns in the USSR are analyzed by Union Republic using data from the 1979 census. The impact on the population of rural and urban areas is considered. (ANNOTATION)
A selective bibliography on abortion is presented. The bibliography is unannotated and consists primarily of French-language citations. (ANNOTATION)
Final data from the 1980 census of Switzerland are presented. Data are included on sex, nationality, religion, mother tongue, age, marital status, place of birth, residence in 1975, and the number and size of households. Some comparative data from previous censuses are also included. (ANNOTATION)
Routine tables of vital statistics are presented, followed by brief summary articles illustrated with tabular and graphic material. In this issue, data are included on population change in Czechoslovakia, 1975-1981; live birth rate, mortality, and abortion rate, 1976-1981, and 12-month sliding averages; population change, 1980; and class and social structure, population by ethnic group, age structure, and families and households in 1980. (ANNOTATION)
Routine tables of vital statistics are presented, followed by brief summary articles illustrated with tabular and graphic material. In this issue, data are included on population change in Czechoslovakia, 1975-1981; live birth rate, mortality, and abortion rate, 1976-1981, and 12-month sliding averages; and life tables for Czechoslovakia and the Czech and Slovak Socialist Republics, 1970-1979. (ANNOTATION)
Routine tables of vital statistics are presented, followed by brief summary articles illustrated with tabular and graphic material. In this issue, data are included on population change in Czechoslovakia, 1975-1981; live birth rate, mortality, and abortion rate, 1976-1981, and 12-month sliding averages; nationality structure of the population of the USSR; the first population census in Afghanistan; and demographic aspects of the population of Nigeria. (ANNOTATION)
Routine tables of vital statistics are presented, followed by brief summary articles illustrated with tabular and graphic material. In this issue, data are included on population change in Czechoslovakia, 1975-1981; live birth rate, mortality, and abortion rate, 1976-1981, and 12-month sliding averages; population change by region and district, 1980; population change in Czechoslovak cities, 1980; population distribution by nationality, 1950-1980; and estimates and projections of world population by region, 1950-2000. (ANNOTATION)
Written by a member of the All-Indian Manufacturers' Organization, this article attempts to discuss relevant issues concerning population and family planning problems in India. Indian population growth is analyzed from 1891 to 1971, followed by a review of the main events that have occurred from 1951-1971 regarding the Family Planning Program. Statistical data are presented in regard to present family planning achievements. The importance for workers is stressed as well as economic factors related to the labor force, trade unions, and organized sector. Also emphasized is the role of management in family planning programs in industry, assuming that better standards of living will yield higher production. A series of recommendations are proposed by the ILO-CBWE Workshop for Trade Union Officials for Welfare Tasks and Family Planning, all of which refer to motivation of employers by management, governmental aid in the design of family planning policies in the private sector, and availability of information on programs in the industrial enterprises as well as in the semi-organized sector. Finally, The Asian Employers' Seminar makes several suggestions concerning facilities, time, education, incentives and cooperation for family planning at work.
Demographic aspects of the supply and demand for teachers
The demographic factors affecting the changing U.S. job market for teachers are examined. The authors describe the change in the number of teachers over the baby boom and baby bust periods, analyze some of the social and demographic trends affecting the supply of and demand for teachers, and consider the changing characteristics of teachers and the teacher labor market. (ANNOTATION)
[Concerning family planning in Madagascar]
A review of the development of family planning in Madagascar is first presented, and the voluntary organizations currently providing services are described. The extent of current contraceptive practice and the methods used are then considered, together with the situation concerning abortion. Extensive statistical data on contraception are provided in the appendix. (ANNOTATION)
The Supreme Court and Congress on abortion: an analysis of comparative institutional capacity.
The focus of this research is on the institutional capacity of courts for policymaking. I argue that judicial capacity has been underestimated by previous research because courts have been analyzed in isolation from other policymaking institutions. Donald Horowitz (1977) argues that courts lack such capacity because of the inherent characteristics of adjudication. This work goes beyond Horowitz by introducing a more explicit definition of capacity, by developing measures of institutional capacity, and by comparing the capacity of a specific court-the US Supreme Court-with that of Congress. The policy area used in the analysis is abortion policy from 1973-80. The data come from Supreme Court opinions, litigant and amicus briefs, Congressional hearings, floor debates, and proposed legislation. The capacity of both Congress and the Court is analyzed on the basis of alternatives considered, consequences considered, information available, groups with access to the process, and awareness of the policymaking context. The analysis concludes that both institutions perform much the same on these input variables. However, there are some important institutional process differences which affect capacity, for example, decentralized decisionmaking in Congress, and the rule of precedent in the Court. These differences cannot be clearly labelled as capacity enhancing or detracting. Each difference has its costs as well as benefits, and capacity is most enhanced when the 2 institutions make policy interdependently since the weaknesses of each can be offset by the strengths of the other. I conclude that abortion policymaking does not support the notion that the Court inherently lacks the capacity to make social policy. (author's)
Cytologic findings in oral contraceptive users among Israeli Jewish women.
A group of 3317 Jewish Israeli women were studied to evaluate a possible correlation between previous and recent oral contraceptive (OC) usage and cervical cytopathologic findings in Papanicolaou smears. A positive correlation was established between OC usage and the occurrence of inflammatory findings; the rate of inflammatory changes depended on the length of usage, with a time lapse of at least 1 year preceding the appearance of such inflammatory changes. The cessation of OC usage was associated with a decrease in the rate of inflammatory findings. No cases of cervical intraepithelial neoplasia or malignancy were found. (author's)
Presents information on fertility and family planning in the southern region of Thailand, based on the Second Contraceptive Prevalence Survey, conducted in 1981. Comparisons are made between the rural south and Thailand as a whole, and between Moslems and Buddhists within the south. Findings show that, within the rural south, Moslem women marry earlier, have higher current fertility, have more limited knowledge of most contraceptive methods, practice contraception less, rely more on non-modern methods, and appear to have a larger unmet need for family planning services, compared with their Buddhist counterparts. Attitudes are generally favorable towards family planning among the large majority of both Moslems and Buddhists in the rural south. Considerable interest in spacing births is evident for both religious groups, although more so among Moslems than Buddhists. Findings also show that southern Buddhist women differ from women in the rest of the country in many of the same ways that Moslems differ from Buddhists within the rural south. Compared with the national average, rural southern Buddhist women have higher fertility preferences, more interest in birth spacing, experience higher current fertility, practice family planning less, and have a larger unmet need for contraceptive methods. However, they do not differ significantly in age at marriage or knowledge of contraception. Like Moslems, southern Buddhists rely more heavily on traditional methods of birth control, especially withdrawal, than couples in the rest of the country. Any effort to raise contraceptive prevalence in the south to the national level should focus on both Buddhists and Moslems. It is recommended that Thailand's National Family Planning Program put more emphasis on the contribution of family planning to facilitating birth spacing, rather than for merely limiting family size, since Moslems and southern Buddhists are more in need of this.
"These are modern times": infant feeding practices in Peninsular Malaysia.
Traditionally, Malaysian women (Malay, Indian and Chinese) breastfed their infants as a matter of course and for an extended period of time; only elite Chinese women might have resorted to a wet-nurse. But the introduction of condensed and dehydrated milk in colonial Malaya from the late 19th century, and the later marketing also of commercially manufactured baby foods, led to some variation in traditional practice. Structural changes, industrialization and urbanization affected social as well as economic life, and again these broad changes had an impact on infant feeding. Today, few women remain unfamiliar with the wide range of infant food products sold in the most isolated provision shops. This paper focuses on key sociological factors, such as women's age, the state of residence (town, urban setting, remote villages and areas), ethnic origin (Malay, Cantonese, Tamil), kinship ties, income level, education and husband's occupation, that might predict the frequency and duration of breastfeeding and weaning patterns. The data analysed, collected during semi-structured interviews with 278 women presenting at Maternal and Child Health Clinics in Peninsular Malaysia, are in part confusing. They suggest that the women most likely to bottle feed only or to breastfeed for a short period, and to use commercial baby foods, are young, with 1 child only, reside in urban or peri-urban areas and have a reasonable household income. Higher educated women, and those whose husbands are in non-traditioanl occupations, are also less likely to breastfeed or to do so for an extended period. But the profile of infant feeding practices is by no means clear. One of the shortcomings of the study relates to the method of data collection and highlights the need for detailed ethnographic studies to better explore the variability and complexity of the patterns of infant feeding. (author's modified)
Culture and fertility: the case of Singapore.
This monograph studies the relationships between the ethnic diversity of Singapore and other social and behavioral dimensions. Singapore's population was 107,000 in 1824 (with an annual growth rate of 7.7%), 3,033,000 in 1911 (3.3% growth), and 2,074,500 in 1970. The 3 major ethnic groups in Singapore are the Chinese, 76.2%; Malays, 15%; and Indians, 7%. Whereas intergroup relations were minimal in the colonial period, up until World War 2, the groups experienced increasing political activity in the period after World War 2 to 1960. In Singapore a government policy on fertility control was first introduced in 1941 with the establishment of the Singapore Family Planning Association. In addition abortion and voluntary sterilization were legalized in 1969-70. Some social policies related to fertility control are increases in delivery charges in hospitals with the birth order, no priority to large families in housing, lower priority for choice of primary school for the children of 4th order or above, and tax relief only for the 1st 3 children. The Family Planning and Population Board has helped in achieving a level of 98% of women aged 15-44 who had heard of at least 1 contraceptive method (96% heard of oral contraceptives, 88% condoms, and 62% IUDs.) In 1973 55% of married women aged 15-44 knew that induced abortion was legal. Singapore's family planning efforts have resulted in a crude birth rate drop from 30 in 1965 to 21.8 in 1969 and 16.6 in 1977. Total fertility rate has dropped from 6.5/woman in 1957 to 3.0 in 1970. As for the ethnic groups: 1) there were substantial increases in the percentage remaining single and below 30 years of age, 2) proportion widowed was consistently lower for males than for females, 3) proportion divorced was small, 4) Chinese families had more labor force participation than Malays and Indians, 5) mortality levels have declined, 6) child marriage customs among Malays and Indians are vanishing, 7) contraception is more widely accepted and practiced among Chinese (63.6%) than among Indians (51.9%) and Malays (48.7%), and 8) of methods used, the largest majority of Chinese (32.8%) and Malays (58.2%) used oral contraceptives, but the majority of Indians (35.4%) used condoms. It is found that differences in fertility among the 3 ethnic groups are not due to their social and economic differences but to other factors, probably ethnic or cultural.
The author notes that "established lifecourse mobility patterns played an independent role in the selective suburbanization of [U.S.] metropolitan populations that took place in the immediate post-World War II decades. Adhering to the traditional family life cycle, the members of several successive white population cohorts chose suburban destinations for the 'childbearing' and 'child rearing' life cycle stages, and tended to remain in suburban locations for the remainder of the lifecourse. Black movers, who were effectively barred from suburban locations during this period, chose primarily city destinations at all lifecourse stages." In the present study, it is hypothesized that recent "population factor"-generated changes in family formation, living arrangements, and race relations are causing lifecourse mobility patterns to change in ways that might allow cities to retain more whites and suburbs to accept more blacks. The hypothesis is tested by applying the cohort component projection model to data for six large SMSAs. "It is found that post-1970 lifecourse mobility changes for blacks are far more pronounced than those for whites. However, in neither case do the recent lifecourse mobility patterns imply an eventual metropolitan-wide integration of the races." (EXCERPT)
Planning priorities and health care delivery in Nigeria.
Economic development has grave as well as beneficial effects on the health of a nation. While it might enhance health standards through better prevention, diagnosis and treatment of diseases, it could endanger health via new eating habits and a tempo of life not conducive to healthy living. These effects of development necessitate rational health planning, the main ingredients of which are manpower planning, physical planning to ensure an even and equitable distribution of medical facilities between urban and rural localities, measures to integrate traditionaal and orthodox medical practices and financial planning to ensure an adequate allocation of funds to the health sector. In spite of official declarations of intentions to effect a comprehensive health coverage for Nigeria, financial allocation and planning priorities have failed to reflect this. Planned capital expenditures for the health sector has consistently hovered around the 2% mark, only attaining 4.6% in the second development plan, 1970-1974. This low priority accorded to the health sector manifests itself in inadequate medical manpower, facilities and coverage of the population by modern medical services. Meeting the health needs of the Nigerian population requires a substantial financial allocation, the integration of modern and traditional medical practices and the reorganization and improved management of medical facilities. (author's modified)
Pituitary adenomas and oral contraceptives: a multicenter case-control study.
A case-control study was conducted to determine whether use of oral contraceptives (OCs) is associated with an increased risk of prolactin-secreting pituitary adenomas. 212 women with such adenomas (140 of which were surgically confirmed) were recruited from 4 clinical centers and interviewed and matched by age and race to neighborhood control subjects. In addition, 119 hyperprolactinemic patients with amenorrhea and/or galactorrhea (A/G) who had normal or equivocal tomograms and 205 normoprolactinemic women with A/G were also interviewed and matched to neighborhood control subjects. No increase in relative odds (RO) for any of these groups was found for OC use (pituitary adenomas cases vs controls RO=1.33, 95% confidence intervals [CI]=0.81-2.22; equivocal case vs controls RO=1.35, 95% CI=0.69-2.70; secondary A/G cases vs controls RO=0.67, 95% CI=0.37-1.18). History of infertility (RO=25.5, 95% CI=8.49-76.6) of menstrual problems or A/G (RO=4.47, 95% CI=2.21-9.05), and of nulliparity (RO=4.36, 95% CI=2.10-9.04) were each associated with a significantly increased risk of pituitary adenomas. The results of this study do not indicate any increase in pituitary adenoma risk as a result of using OCs. (author's modified)
[Postcoital contraception or abortion] [letter]
Diana Brahams (May 7, p. 1039) suggests restoring the laws instituted in 1837. However, vast changes have occurred in our knowledge of the unborn since then, and this restoration would certainly be contrary to modern knowledge of the fetus. Similarly, 28 weeks is certainly a much outdated time of viability since in some hospitals 50% of babies born at 24 weeks are being discharged in good condition if the baby is born to the mother in that hospital. Also the fact that 50% of fertilized eggs are not implanted certainly does not logically allow for destruction of fertilized eggs which are in many ways the beginning of human life. (full text)
Aspirotomy for outpatient termination of pregnancy in the second trimester.
Focus in this chapter is on the question of whether aspirotomy can be regarded as a safe and convenient procedure for outpatient termination of pregnancy in the early part of the 2nd trimester. Attention is also directed to some details of the procedure and its application that are important to those who intend to practice this technique. Each of the steps in this procedure are examined while drawing attention to their possible implications and results. A brief outline of the procedure is included. For an outpatient procedure local rather than general anesthesia is essential. Due to the fact that aspirotomy cannot be performed in as short a time as a simple vacuum aspiration, anesthesia must be of slightly longer duration to compensate for an operation time of 10-30 minutes. The local anesthetic used is a 1% solution of lidocaine to which epinephrine is added. The degree of cervical dilatation that is needed depends on both the size of the products of conception that must be delivered and the diameter of the instruments used to achieve that evacuation. At the lower gestational ages cervical resistance is far greater in nulliparous than in multiparous women. If due attention is given to these changes and differences in cervical resistance, they will have several implications for the degree of mechanical dilatation. In early terminations, dilatation will generally need to be less in nulliparous than in multiparous women, a difference which is most marked in the period of 12-13 weeks before cervical compliance further increases. At the onset of the procedure, 0.15 mg ergometrin maleate is given intravenously to reduce loss of blood due to uterine atony. The evacuation is started by the introduction of an 8 or 10 mm plastic suction cannula that was specially designed with an extra opening at the top and that is longer than the usual vacuum aspiration cannula. The amniotic fluid is thus aspirated at a negative pressure of 685 mm HG. Dependent on the degree of cervical dilatation an 8, 9, or 10 mm aspirotomy forceps is then introduced into the dry and contracted uterine cavity. In general, an aspirotomy forceps of 8 mm will be adequate up to 15 weeks of gestation, whereas the 9 and 10 mm sizes are appropriate up to approximately 17 weeks. In the years 1977-79 immediate major complications were encountered in 16 of the 3370 aspirotomies performed at gestational ages of 14 weeks or more. This incidence of 0.47% can be compared with the 0.6-0.7% major complication rate described by Tietze for terminations at 13-16 weeks gestation in the US during 1971-75, but when the complication rate of Beekhuizen et al. is analyzed in relation to gestational age it appears that there is a much lower incidence of complications at gestational ages of up to 16 weeks (0.28%). At gestational ages of 17 weeks or more both the incidence (1.55%) and the severity of complications increased markedly and their management often requires hospitalization. Thus far data on the incidence of delayed complications is limited. In sum, aspirotomy carries the recognized advantages of 1st trimester abortions well into the 2nd trimester of pregnancy.
A global review of training of community health workers.
Community Health Workers (CHWs) are often the most important deliverers of health care services. This review brings together relevant information on CHWs and their training. These materials concern themselves with training techniques as they have been developed in various programs in various countries around the world. Because of the relative newness of the field, the bulk of the materials have been written only in the last 10 years. Four phases in training CHWs to undertake primary health care work are reviewed. These are: assessing the community's health needs and priorities and specifying the CHWs tasks, adapting CHW training to the community, selecting CHWs and providing the CHWs with training and support. Issues of concern relating to these phases are: who is the trainer, what training strategies are to be followed, how is the training to be monitored and evaluated, and, finally, what is the cost. A guide to 22 manuals that have been developed in various countries for use in training CHWs is included. (author's modified)
Computer analysis of etiology and pregnancy rate in 636 cases of primary infertility.
Since the rate of pregnancy is a function of time, conventional pregnancy rates (number of patients achieving pregnancy/number of patients treated) are inadequate for counseling unless the follow-up period is specified. To overcome this problem, the expectancy of pregnancy for 636 cases of primary infertility was calculated with the assumption that the patients were followed up indefinitely. The overall conventional pregnancy rate was 38%, whereas the overall expectancy of pregnancy was 64%. Endometriosis was found to be the most common factor, comprising 25% of the cases, with a pregnancy rate of 31% and an expectancy of 52%. The expectancy of future pregnancy in a patient who has not achieved pregnancy by a given time is presented for each etiologic factor. This paper also presents a comparison of expectancies of pregnancy by different treatments, which may be helpful in selecting appropriate therapy. (author's)
[Technical research on termination of early pregnancy]
The research on contraceptives for embryogenesis and pregnancy termination by applying prostaglandins and Chinese medicinal herbs has now achieved great acclaim both at home and abroad. However, these achievements cannot be considered satisfactory as of yet because the time necessary for abortion is great, and the embryo cannot be evacuated so completely. In particular, during the early stages of pregnancy, menstrual induction and pregnancy termination with drugs cannot be considered ideal. However, when utilizing a capillary mechanical method, a simple sweeping and absorbing operation is performed in the uterine cavity 2-10 days after menstruation. The uterus internal membrane can be peeled off, thus physiologically interrupting the pregnancy. The embryo can thus be eliminated at the earliest stage and the induction of menstruation and cessation of pregnancy can be brought about quickly. From the clinical observations made on 200 cases selected at random out of 1400 cases and controls, it is shown that abortion time is shortened, and that the embryo is eliminated thorougly. This occurs faster, results in less bleeding, and less discomfort, and without side effects. Therefore, it may be regarded as a safe, reliable new technology for the earliest pregnancy termination. (author's modified) (summary in ENG)
The results of pregnancy termination with ONO 802 as a vaginal suppository in 182 cases are presented. The drug was tested during the different phases of pregnancy, as well as in abnormal pregnancies (intrauterine fetal death and hydatidiform mole) and normal pregnancy. 1 suppository containing 1 mg of the drug was inserted in the posterior vaginal fornix every 3 hours, with 1 full course consisting of 5 suppositories. Cases which did not terminate spontaneously were administered the same treatment the next day. A success rate of 90.5% was obtained; 91.6% for the 1st trimester, 88.8% for the 2nd, 94.7% for intrauterine fetal death, and 100% for hydatidiform mole and 3rd trimester cases. A dosage of between 1-5 mg was successful in 83.9%. 75% terminated within 24 hours. In the 34 patients who were given 2 suppositories and whose surgical termination followed 6 hours later, the cervix was so soft and dilated that a No. 8 Hegar dilator was easily inserted and blood loss was reduced to an average of 12.5 ml. After termination, vaginal bleeding ceased within 2 weeks and menses resumed in 6 weeks. Few complications and side effects occurred. Of the 8 cases which later became pregnant, 2 have delivered normal fetuses spontaneously. In light of these results, the use of ONO 802 vaginal suppository is 1 of the better methods of pregnancy termiantion. (author's modified) (summary in ENG)
Training leaders for primary health care: a formula for success.
Since 1980, CPFH (Center for Population and Family Health) of Columbia University has offered an intensive workshop in "Family Planning, Nutrition, and Evaluation." Initially, this was a New York-based, English language course, open to participants on a world-wide basis. 117 participants (in teams of at least 2 per country) from 31 countries attended the first 3 annual workshops. Evaluation of these programs and participant follow-up were highly positive. Knowledge gain was high and participants were able to implement concepts and skills learned upon return to their own programs. This paper reports on the lessons learned in this experience and on the evolution of this training program including: a geographic focus on Africa (34 African trainees from 12 countries participated in the 4th annual program held 1983); a bilingual French-English format; and an in-country follow-up component using participants who attended the New York course as faculty for in-country training. (Workshops have been completed in the Sudan, Kenya, and Tanzania and others are planned for Senegal and Togo.) Lessons learned to date include: documentation of the continuing need for this type of training; the need for supporting in-country programs; the role of evaluation in training; the value of the training context for early dissemination of findings from the field; and, approaches to simultaneous translation which facilitate full participation and exchange between Anglophone and Francophone trainees. The changes that have taken place in the 4 year history of this training activity have led to important improvements in needs assessment and training program design for national and local community-based programs, and training and participant evaluation. The lessons learned may have important implications for training programs worldwide. (author's)
Sections 54-325.9-.12 define the conditions under which sexual sterilization is authorized for various categories of persons in Virginia. Section 54-325.9 allows sterilization procedures for persons 18 years or older capable of informed consent; however, a 30-day waiting period is required of those who have not previously been a natural or adoptive parent. The physician is required to explain the meaning and consequences of the procedure and offer information on alternate methods of contraception. Section 54-325.10 allows sterilization for persons ages 14 to 18 if a petition has been filed by the child's parents, guardian, spouse, or next friend; a full medical explanation of the procedure has been provided by the physician to the child and child's caretaker or spouse; there is evidence that the child's mental abilities are sufficiently impaired to rule out an informed judgment about sterilization; the views of the child concerning sterilization have been weighed to the extent possible; and a 30-day waiting period has elapsed. Section 54-325.11 authorizes sterilization for certain adults incapable of informed consent when a petition has been filed by the person's parent, guardian, committee, spouse, or next friend; a medical explanation has been provided; the views of the individual concerning the procedure have been considered to the extent feasible; and there has been a 30-day waiting period. Section 54-325.12 sets the standards for court-authorized sterilization. It must be proven in each case that there is a need for contraception; there is no reasonable alternative method of contraception; the proposed method of sterilization can be carried out without unreasonable risk to the health of the person; and the person's mental disability renders him or her permanently incapable of caring for and raising a child. Evaluation of these factors is to be based on independent evaluation of medical, social, and psychological factors. These standards must be complied within cases of both adults and children judged incapable of informed consent.
The integrated program of the Philippines.
The integrated program in the Philippines started in October of 1976 in 4 pilot areas. The 1st step was to inform people about the project through community assemblies, and to conduct workshop/seminars for all teachers and community leaders on parasitic infections and control. Because of initial difficulty in collecting stool specimens from school children, a law was passed that required submission of specimens; the construction of sanitary latrines was also enforced. Mothers' Clubs were organized for a 12-day course on primary health care, family planning, parasite control, and nutrition. Training was given to traditional birth attendants. Fund raising was conducted in many different ways and community volunteers were recruited. Research on the vermicidal plant Niog-Niogan has begun and its cultivation encouraged to replace dependence on commercial medicines. Campaigns for food production have been instituted to help in solving the malnutrition problem. The project has proven that deworming is a very good partner of family planning; during home visits, motivation for family planning can be interjected. At the beginning of the program only 11% of the married couples of reproductive age were practicing contraception; to date 45% are continuing acceptors. Another benefit of the integrated program is that villagers, particularly mothers, have become much more social-minded, and community participation has increased along with its support of each activity.
[Family planning in Mexico 1982 (antecedents; present situation, future; perspectives]
This work examines national family planning programs in Mexico from 1970-82 and discusses preceding and future family planning activities. A positive relationship between governmental attitudes towards population growth and demography through Mexican history is established. The programs are described with attention to demographic background; reproductive behaviors, e.g., knowledge and use of contraceptive methods; conceptual basis for family planning; population politics; health services, and administration; planning and coordination. Support activities in the programs included education which resulted in attitudinal and behavioral changes in family planning Biomedical research is also considered. Although the effects of family planning programs in Mexico are difficult to measure, the index of population growth diminished from 3.4% in 1970 to 2.4% in 1982. Fertility reduction was greater in women older than 35 years who lived in areas of high socioeconomic development, had at least secondary school education and a skilled occupation. Since the use of effective contraceptive methods contributes significantly to fertility reduction, the following groups are recommended as priority targets for future informational service, and educational family planning activities: 1) inhabitants of rural zones, 2) residents in regions of low socioeconomic development; 3) illiterates and those with low education, 4) adolescents, and 5) the male population. A number of tables give selected statistics on mortality, birthrate, abortion, and selected characteristics of program users, including age and residence.
In response to a United Nations resolution, the Mobile Training Scheme (MTS) was set up to provide training to the trainers of national cadres engaged in frontline and supervisory tasks in social welfare and rural development. The training is innovative in its being based on an analysis of field realities. The MTS team consisted of a leader, an expert on teaching methods and materials, and an expert on action research and evaluation. The country's trainers from different departments were sent to villages to work for a short period and to report their problems in fulfilling their roles. From these grass roots experiences, they made an analysis of the job, determining what knowledge, attitude and skills it required. Analysis of daily incidents and problems were used to produce indigenous teaching materials drawn from actual field practice. How to consider the problems encountered through government structures for policy making and decisions was also learned. Tasks of the students were to identify the skills needed for role performance by job analysis, daily diaries and project histories; to analyze the particular community by village profiles; to produce indigenous teaching materials; and to practice the role skills by actual role performance. The MTS scheme was tried in Nepal in 1974-75; 3 training programs trained 25 trainers and 51 frontline workers; indigenous teaching materials were created; technical papers written; and consultations were provided. In Afghanistan the scheme was used in 1975-76; 45 participants completed the training; seminars were held; and an ongoing Council was created. It is hoped that the training program will be expanded to other countries.
Maternal Mortality (analysis of 122 cases).
The purpose of this study is to assess causes of maternal mortality. A study of the deaths at Medical College Hospital, Aurangabad, India from 1975 to May 1980 was undertaken. Antenatal admissions were 34,465; deliveries--22,624; spontaneous abortions--2700; and induced abortions--4285. There were 122 maternal deaths with a maternal mortality rate of 5.4/1000 live and still births. The rate has gradually decreased in the last 10 years (8.8/1000). 105 cases are from rural areas of poor socioeconomic status, and have never attended prenatal clinics. Maternal deaths were most common between 21-30 years (52 cases--42.6%). Most occurred in primigravidas (38 cases--31.2%). Direct causes of maternal deaths include sepsis, hemorrhage, medical termination of pregnancy, ruptured uterus, obstructed labor, eclampsia, and anesthetic deaths. Direct causes accounted for 93 (70.2%) of deaths. 29 (23.8%) were due to indirect causes. They include: anemia (23.8%--7 cases), heart disease, infective hepatitis, cerebrovascular accident, pulmonary tuberculosis, acute pulmonary edema, hyperemesis gravidarum, second abdominal pregnancy, choriocarcinoma, cancer of the cervix--stage III, acute laryngitis, otitis media, and sickle cell anemia. To prevent maternal deaths, proper prenatal care is advised, hospital admission should be arranged, and proper obstetrical management undertaken.
The toxic principles in cow's urine concoction (CUC).
Cow's urine concoction (CUC) is a herbal preparation commonly administered to convulsing children by the Yoruba-speaking people of Nigeria. It is prepared by soaking varying quantities of tobacco leaves, basil leaves, garlic leaves, onions, kaun (trona) and lemon juice in cow's urine for varying lengths of time. The use of this concoction is usually complicated by severe poisoning. The features of the poisoning include hypoglycemia, respiratory depression, central nervous system stimulation and depression and occasionally, diarrhea and vomiting. These lead to death or neurological deficits in severe cases of poisoning. A thorough chemical analysis of the concoction has not been carried out. As a first step in identifying the active principles it contains, phytochemical screening tests of the individual plant-derived constituents were carried out. The results showed the presence of alkaloids, tannins and saponins in some of the constituents. The possibility of interactions between the various active principles is raised. They include: 1) transformation, 2) synergism, and 3) formation of entirely new compounds. Sulphonylureas may possibly be formed (from the sulphur compounds of onions and the urea from cow's urine) which might contribute to the significant hypoglycemia commonly induced by CUC. (author's modified)
[Twelfth report on the demographic situation in France]
This report on recent population trends in France is in two parts. The first part concentrates on the most recent official demographic statistics and includes data on marriages to foreigners, illegitimacy, and fertility. Statistics on abortions for the years 1979, 1980, and 1981 are provided by department. Data are also included on causes of death and age distribution. The second part concentrates on nuptiality and cohabitation among the young. (ANNOTATION)
Septic abortions--7 years review.
The reduction in maternal deaths in India caused by hemorrhage, infection, and pre-eclamptic toxemia has brought out septic abortion as a leading cause of obstetric deaths. The Government therefore decided to liberalize the Abortion Act in 1972 in the hope of reducing deaths due to criminal abortion. Surprisingly, the subsequent countrywide surveys have failed to show any appreciable change in this pattern of maternal mortality. The present study was undertaken to review the incidence of deaths due to septic abortion from 1973-79, and to compare the results with those obtained during the years prior to liberalization of the Abortion Act. Table 1 shows the number of deliveries, spontaneous, induced and septic abortions. Other tables present: 1) clinical features; 2) clinical findings, treatment, and number of deaths; and 3) deaths due to septic abortion. Measures to avoid such deaths include: 1) family planning education and pubicity about the free abortion services available at all major institutions; 2) publicity about the safety and advantages of contraceptives over abortions; 3) improvement and extension of abortion services; 4) training of doctors to perform abortions; and 5) education regarding the advisability of inducing abortions in the 1st trimester.
Abortion in Bangladesh: estimated mortality and physicians attitudes.
Hospital studies in Dacca have documented high rates of admission and high mortality from the complications of induced abortion. In addition, articles in the press have highlighted the tragedy associated with abortion and suggested that it is very common. However, little is known about the practice of induced abortion in rural Bangladesh, or the incidence of complications ahd death. 1 rural study indicates that 7% of maternal mortality resulted from abortion, while another informal study suggests that these deaths were numerous and largely unreported. The study being reported here attempts to estimate the incidence of death from induced abortion for the whole of Bangladesh and ascertain the attitudes of physicians toward abortion. These preliminary findings will be elaborated in later reports. (author's modified)
Reports on the 4-day Latin American Workshop on Management of Maternal and Child Health and Family Planning Programs organized by the International Committee on the Management of Population Programs (ICOMP). Workshop objectives for maternal child health and family planning (MCH-FP) programs included: development of practical analytical frameworks for solving management problems; strengthening management capabilities; studying community participation; encouraging interaction among managers and faculty; setting the agenda for future action; and reviewing objectives and methodologies of the programs. There were 47 participants present in the workshop from Bangladesh, Brazil, Columbia, Ecuador, Mexico, Nicaragua, Peru, the U.S. and Venezuela. 1 of the major objectives of the workshop and of ICOMP is to bring together population program managers and management institute faculty. This objective was achieved on a broad international scale. It was determined that the design of health programs for the rural poor should take into consideration the basic causes of health problems as well as the cure of specific diseases. Programming of health activities should be based on resources which are currently available and should begin at the local level. Because family planning is a social and technological innovation, cultural development is necessary so that it can become a socially acceptable practice. Thus, the management of family planning programs requires administrative innovation, particularly within more traditional institutional settings. An issue which ran throughout the workshop was the need for training in all areas of program management, including the use of information systems and in planning and programming.
Current trends in male contraception.
Current research which may lead to the development of a male contraceptive is described. Male contraceptives have not been developed because basic understanding of the complex male reproductive system has lagged at least 15 years behind that of the female. The current level of knowledge is almost comparable to that preceeding the development of oral contraceptives for women. It is hoped that a male contraceptive will soon be developed which will be highly effective, reversible, self-administered, coitus-independent, and free from dangerous side effects. Analogs which stop sperm production in male rats are now being carefully tested on a small group of volunteers. If analogs in limited clinical trials prove successful, it will be 10-15 years before they become generally available. Another protein hormone which is being tested in inhibin, a testicular hormone responsible for the feedback control of pituitary FSH. Another compound being investigated which seems highly effective in stopping sperm production is gossypol, a component of cotton-seed oil discovered by Chinese scientists. The compound does have some side effects, but even if long term studies show significant side effects, a safe and effective analog in gossypol could be synthesized; this would also take 10-15 years before it would be generally available. In addition to certain disadvantages with the methods currently available to men, there are problems of acceptance and consistent long-term use resulting from misconceptions and ignorance. Nevertheless, males continue to participate in the use of family planning methods in large numbers. With the current level of research it seems certain that a wide range of useful male contraceptives will be developed in the next 10 years. These new contraceptives will be more effective and safer than those currently available to men, will better meet individual needs and preferences, and will offer more of an opportunity for males to share in the responsibilities of contraception.
Influence of psychosocial factors on adolescent compliance with oral contraceptives.
This paper prospectively tests the influence of a variety of sociomedical and psychosocial factors on compliance with oral contraceptives among adolescent females from a population at high risk for pregnancy. 56 females aged 14-19 yr from a lower socioeconomic background received a battery of pretest measurements and were then given Ortho-Novum 1/35 combined with riboflavin during an initial visit and 1-, 2-, and 4-month follow-ups. Compliance was measured at each follow-up using a Guttman scale consisting of: 1) avoidance of pregnancy; 2) appointment adherence; 3) pill count; and 4) urinary fluorescence for riboflavin. 6 factors were found to be significantly associated with noncompliance: 1) multiple sexual partners; 2) appointment being made by the adolescent; 3) low evaluation of personal health; 4) feelings of hopelessness; 5) worry about becoming pregnant; and 6) previous abortion. These finings suggest that certain indicators of sexual activity and social psychological status may help to predict noncompliance in some adolescent females. (author's modified)
Female sterilisation sequelae--a two year follow-up study.
A 2-year prospective study was done on 1859 women who underwent sterilization in Baroda, India. The majority were sterilized by the modified Pomeroy or tubal ring techniques. The incidence of gynecological problems, changes in menstrual patterns, gynecologic surgery and pregnancy following sterlization are analyzed. The incidence of acute and chronic pelvic infection was 1.6 and 5.2% at 6 months; 2.2 and 4.3% at 12 months; 1.6% and 2.9% at 18 months; and 1.3% and 2.0% at 24 months. The incidence of incision-related complications was 2.7% at 6 months; 0.9% at 12 months; 0.6% at 18 months; and 0.3% at 24 months. The incidence of keloid appears to decrease after 6 months. The incidence of uterine disease ranged between 0.9% and 2.6% at the various follow-up visits. Pelvic pain was the most frequently reported postoperative complaint. The vast majority (93%) reported no change in menstrual cycle regularity. More than 80% reported no change in the duration of menstrual flow. Most women (69.7% to 87.5%) reported no change in the amount of flow. There was a significant decline in the incidence of amenorrhea at the various follow-up visits. The majority (more than 84%) reported no change in dysmenorrhea. Within 6 months, only 1 (0.1%) woman underwent gynecological surgery. 8 (1.0%) underwent gynecological surgery between 6 and 12 months. Between 12 and 18 months, gynecological surgery was reported for 16 (1.9%). Between 18 and 24 months, 23 (1.3%) underwent gynecological surgery. 9 pregnancies were reported for a 0.5% rate. No ectopic pregnancies were reported.
The sequelae of tubal sterilization.
28,766 cases of tubal sterilization were studied prospectively in India from 15 September, 1976 to 30 June 1978 to assess mortality and morbidity following the operation. Age, parity, religion, education, occupation, and income are given. Route of sterilization was abdominal in 26,647 cases--(92.63%) and vaginal in 2119 cases (7.37%). 91.4% were done by laparotomy and 8.6% by laparoscopy. 13,250 ligations were done during the postpartum period; 930 (3.45%) were postabortal; 4504 were interval cases; and 10,007 (34.79%) were done concurrently with other surgery. 12 ligations were done in antenatal cases where pregnancy was allowed to continue. Surgical occlusion was done in 26,303 cases while nonsurgical methods (electrocautery and silastic bands) were used in 2463. The majority of surgical occlusions were by the Pomeroy technique. Spinal anesthesia was used in 12,384 cases (43.05%), local in 10,151 (35.28%), general in 6104 (21.23%), and epidural and ketamine in 127 cases (0.44%). Immediate complications were encountered in 339 cases (1.18%). 61 of these (18%) were due to anesthesia and 278 cases (82%), due to surgery. 19 deaths (6.6/10,000) occurred due to complications--6 of which were due to anesthesia (2.08/10,000) and 13 due to surgery (4.52/10,000). Complications due to anesthesia (excluding postoperative vomiting) occurred in 61 cases--32 immediate and 29 delayed. Immediate surgical complications consisted of: hemorrhage (53 cases); broad ligament hematoma (4 cases); shock (10 cases); and visceral injury (103 cases). 24 visceral injuries occurred with laparoscopic sterilization (10.48/1000). 25 occurred with laparotomy (1.02/1000), while 17 (8.2/1000) injuries occurred during 2110 culdotomy ligations. Delayed complications occurred in 108 cases (3.75/1000). The main complication with sepsis--occurring in 84 cases despite the fact that practically all received antibiotics postoperatively.
Famines, epidemics, and population growth: the case of India.
The factors which determined India's rate of population increase from 1872 until the present are examined and 3 periods with very different rates of population growth are distinguished. The annual rate of growth during the 1st period, from 1872 until 1921, was only .37%; during the 2nd period, from 1921 through 1951, it accounted for 1%; and since 1951 it has exceeded 2% a year. The traditional explanation for the sharp rise in population growth rates between the 1st and 2nd periods (improvements in public health, sanitation, nutrition and general growth of the economy) is rejected. These factors only became significant after 1951. During the 2nd period (1921-1951), the chief cause for the sharp rise in population rates was the decline in mortality rates due to the absence of major famines and epidemics. In the 1st period (1872-1921), famines, plague and influenza caused large increases in mortality; but in the decade 1921 to 1931, when all of them were absent, the rate of population growth was comparable to that experienced between 1921-1951. During this period, only a small % of the population was affected by the increases in urbanization, sanitation and nutrition. The changes which affected the majority of the population were those which reduced the risk of famine and epidemics: improvements in the transport network which assured the availability of food; diversification of the economy which changed the economic opportunities available to families in drought-prone regions; and government relief efforts which provided money to buy food. In addition, after 1921, the decline in the number of epidemics introduced into India contributed to a reduction in mortality rates. There is no evidence to suggest that there were any fundamental changes in demographic patterns from 1921-1951.
Housing and population census, 1979: summary results for localities in the East Bank.
Summary results from the 1979 census of Jordan are presented. Data are included on housing, households, and total population by governorate and sex; rural and urban population; and population by minor civil division. (ANNOTATION)
Migration and settlement: a multiregional comparative study
"In 1976, the International Institute for Applied Systems Analysis initiated a study of migration and population distribution patterns in its seventeen member nations. In each country, the analysis was carried out by national scholars using techniques of multiregional demography. In this paper the authors describe the organization of the study, discuss the data bases used, evaluate the main results obtained, and review some of the methodological research that has been generated by the study. Among the...conclusions are recommendations for researchers wishing to carry out a multiregional demographic analysis." Consideration is given to national and subnational patterns of mortality, fertility, and migration; age composition; and regional population distribution. (EXCERPT)
[A demographic survey in the Lobi-Dagara region (Upper Volta--1976)]
Demographic trends in 22 villages in the southwest region of Upper Volta are described over the period 1961 to 1976. Data are from a survey undertaken in 1976. A high rate of natural increase coupled with a high rate of out-migration is noted. It is also shown that the high rate of out-migration of women of childbearing age is resulting in a substantial increase in the rate of demographic aging. Variations in migrant destinations are analyzed over time. (ANNOTATION)
[Family and family demography in Africa]
A general introduction to the demographic study of the family in Africa is presented. Topics considered include the definition of the family and household, consanguinity, alliances, inheritance, and dwellings. Most of the examples provided concern the Mossi of Upper Volta. The complexity and variety of family organization in Africa are emphasized. (summary in ENG) (ANNOTATION)
At odds: women and the family in America from the Revolution to the present.
This book is a synthesis and reinterpretation of research on the history of women and the family in the United States over the past two centuries. A primary argument is that "the equality of women and the institution of the family have long been at odds with each other." It is suggested that the existence and character of the historic family depended on women's subordination and that women's increasing autonomy developed simultaneously with the emergence of the modern family. The book is based on both statistical evidence and personal writings and focuses primarily on white, middle-class, nineteenth-century families, although a chapter is also included on black and immigrant families. Topics discussed include the internal dynamics of the family, women and the demographic transition, fertility control, abortion, women's sexuality, suffrage, and female employment. (EXCERPT)
[Mariatang: a survey using complementary sources in the Dagara region (Upper Volta)]
Results from a 1976 study of demographic trends in the parish of Mariatang, in the Dagara region of Upper Volta, are presented. Data for the study are from two independent sources, parish registers and a retrospective survey. The analysis indicates that infant and child mortality, after declining somewhat, have stabilized, and fertility has remained high. The value of supplementing data from the parish registers with information from an independent source is noted. (ANNOTATION)
Pregnancy in adolescence: needs, problems, and management
This volume consists of 19 original contributions on aspects of adolescent pregnancy in the United States. The book is designed as a reference source for teachers and pupils in such fields as human sexuality, population research, adolescent behavior and psychology, family interaction, adolescent health, parenting, psychology of self-destructive behavior, and counseling and intervention techniques. Chapters are included on the incidence and outcomes of adolescent pregnancy, as well as possible interventions; medical and psychosocial risks in the pregnant adolescent; differences among adolescent contraceptors; psychological barriers to contraceptive use; the influences on and implications of adolescent contraceptive behavior; the delivery or abortion decision; method discontinuation and implications for teenage contraceptive programs; male decision-making on sex, contraception, and pregnancy; and birth spacing among teenagers.
The results of a survey of fertility and infant mortality in Upper Volta are presented. The data are taken from parish registers and a retrospective field survey and concern approximately 2,000 mothers and 9,800 children. A general decline in infant and child mortality over time is noted, and its relationship to the location of health clinics is discussed. (ANNOTATION)
The primary objective of this work is to present a comprehensive, annotated bibliography of demographic studies on the black population of the United States. The bibliography is arranged under six substantive headings: fertility; nuptiality, family, and fertility outside marriage; fertility regulation, with subsections on family planning and birth control, abortion, sterilization, and genocide concepts; health and mortality; migration, urbanization, and ecology; and population growth, composition, spatial distribution, and vital rates. An introductory review essay and an author index are also included. The bibliography and abstracts are drawn to a considerable extent from the POPLINE data base.
A study of cases of tubectomy.
Tubectomy has been done since 1951 in the Hospital for Women and Children, Egmore, Madras, India. 50 to 60% of the tubectomies were puerperal and the rest were done as gynecologic operations. Since the Medical Termination of Pregnancy (MTP) Act, concurrent and abortal sterilizations are done. There has been a steady increase of puerperal sterilization. Concurrent sterlization seems to have replaced the interval sterilizations that were done before the MTP Act. Postabortal and puerperal sterilizations are done 24-72 hours after delivery or abortion. Concurrent sterilizations are done after suction at the same time. Wound infections account for most of the complications. Mortality rate in concurrent sterilization is 0.025%. 3 of these were due to spinal anesthesia; 1 was due to a perforation during suction that was missed. Pelvic infection rate is high in concurrent vaginal tubectomies but there is no mortality. Tubectomies done under local anesthesia are safe. The incidence of tubectomy of para V+ has gone down since the MTP Act. The acceptance of sterilization of para IV is highest during puerperium. The majority want 3 grown up children before accepting tubectomy. Maximum acceptance of tubectomy is seen in para III during MTP and para IV during puerperal sterilization. Hospitals are understaffed. Before 30 years of age, 61% of the women have 4 children and 31% have 5.
A follow-up study of 2799 female sterilizations at Associated Group of Hospitals, S.P. Medical College, Bikaner, India was carried out from April, 1976 to December, 1979. Pomeroy's method was used in 2563 cases (91%). Other methods used were: Uchida's--216 cases (7.72%); total salpingectomy--15 (0.54%); Madlener's--2 (0.07%); Vianese's, Purandare's, and Shirodkar's--1 apiece (0.04%). 2099 cases (74.99%) came for follow-up. 88.99% did not have any complaints. 4.34% complained of lower abdomen pain; 3.29%, backache; leukorrhea, 1.95%; 1.05%, psychological symptoms; and 0.38% dyspareunia. Menstrual complaints included lactational amenorrhea, 14.63%; delayed and scanty period, 0.33%; menorrhagia, 3.19%; and dysmenorrhea, 0.23%. Most of the menorrhagia was seen in the 26-30 year-old group. 63 patients (2.59%) had induration or serous discharge from abdominal wound; 47 had wound sepsis; 2 had gaping wound; 2 incisional hernia; and 1 had a keloid abdominal scar. Erosion of the cervix occurred in 1.79%; cervicitis, 1.43%; vaginitis, 0.71%; genital prolapse, 0.43%; pelvic inflammation, 1.18%, and tubo-ovarian mass, 0.25%. There was no mortality due to the operation. There were 4 failures; all done by the abdominal route--2 Pomeroy's and 2 Uchida's. The failure rate was 0.14%.
A special metal cannula has been devised for extra-amniotic injection of ethacridine lactate for midtrimester abortion. 45 women in Ahmedabad, India, who were from 12-20 weeks pregnant, had medical termination of pregnancy (MTP). 125 ml. 0.1% of ethacridine lactate was instilled. Ages ranged from 15-42 years, most were between 21 and 30. There were 8 primigravidae--7 young, unmarried girls and 1 divorcee. There were 24 cases with parity 4 and above. Ethacridine lactate was successful in all cases. 35 cases aborted after 1st instillation, and 7 after the 2nd. 3 cases are considered failures, as they did not agree to the 2nd instillation. They preferred hysterotomy with tubal ligation. The success rate is 90.9%; the corrected rate should be considered 100%. The injection-abortion interval is 29 hours in women who are 17 to 20 weeks pregnant. From 13 to 16 weeks, it is 46 hours. This is more than reported by other series--it could be due to the catheter being eliminated. 10 women who were 13-16 weeks pregnancy required supplementary oxytocin drip. 6 of these had incomplete abortion and required evacuation. The 12 women who were 17 to 20 weeks pregnant needed no additional procedure. 25 cases from 13-16 weeks, and 10 cases from 17-20 weeks aborted with 1 instillation. 7 cases aborted after the 2nd instillation. Complications include: 3 cases of vomiting and 6 cases of abdominal pain. This method does away with indwelling catheterization--a potential infection source.
Histological study of fetal pituitary in midtrimester abortions by betamethasone.
Hypothalamo-pituitary-adrenal axis plays an integral role in humans in the initiation of uterine contractions of labor. The cellular morphology of the adenohyphophysis has been studied in abortuses of betamethasone-induced midtrimester abortions. The aim is to see whether there is any influence of the drug on the fetal pituitary. The study was conducted in the Department of Obstetrics and Gynecology, M.L.N. Medical College, Allahabad, U.P., India in collaboration with the Department of Pathology and the Department of Anatomy, M.L.N. Medical College. 60 midtrimester pregnancies (14-20 weeks) were given an induced abortion with a single dose of 40 mg. intra-amniotic betamethasone. The overall success rate was 88.2% and the mean induction-abortion interval was 52.8 hours. 6 hysterotomy specimens served as controls. Slides were studied for the cellular differentiation of the chromophobe cells into chromophil cells. Special emphasis was put on the 3 types of anterior pituitary cells: 1) chromophobes, 2) basophils, and 3) acidophils. The histology of the posterior pituitary was also studied. In the betamethasone-induced abortuses, there was a predominance of basophil cells in the anterior pituitary. The study is being continued; special stain technique is being used to detect further differentiation of basophils into alpha, beta, and delta cells. As delta basophils are known to secrete adrenocorticotropic hormone (ACTH), it was thought that increase in the % of basophils has caused increased secretion of ACTH, which in turn stimulated fetal adrenal cortex causing its premature maturation and thus establishing the integrity of fetal pituitary-adrenal axis leading to midtrimester abortion.
Complications of medical termination of pregnancy--eight year experience.
A retrospective study of 8736 medical terminations of pregnancy (MTP) was undertaken at the All India Institute of Medical Sciences Hospital from April 1972 to December 1979. Pregnancy up to 6 weeks was terminated surgically by menstrual regulation (MR) or medically using prostaglandins for menstrual induction. Vacuum aspiration (VA) was used up to 10 weeks. Up to 20 weeks was terminated with prostaglandins or 20% saline. The surgical method of abdominal hysterotomy as the primary procedure was done with concurrent sterilization. Postabortal follow up was done at 2 weeks, 4 to 6 weeks, and long-term. A psychological study was done for 12 to 18 months postabortion in 125 women. 13.5% (1179) of 8736 women were nulliparous while 86.4% (7557) were multiparous. There were histories of previous abortions in 17.7% (1550). The ages ranged from 13 to 45 years. There were 1133 menstrual regulations (13.0%), 40 menstrual inductions (0.5%), 5035 vacuum aspirations (57.6%), 2198 prostaglandin abortions (25.2%), 59 hypertonic saline abortions (0.8%). and 251 hysterotomies (2.9%). Complications were noted in 11.4%, of which 1.6% were major while 9.8% were minor. MR was unnecessary in 19.2%. Menstrual induction was done within 56 days of the last menstrual period. Vaginal suppositories of 15 methyl prostaglandin F2 were administered--3 hourly for 4 doses. Success rate was 70.0% and 65.0% respectively. Gastrointestinal disturbances were the only side effects noted. Prostaglandin F2 and its methyl analog were administered between 15 to 20 weeks to 59 women. Hypertonic saline 20% was also administered to 15 to 20 weeks gestation. Side effects are given. The majority were able to overcome postabortion psychological complications.
Induction of second trimester with intrauterine catheter.
225 cases of midtrimester abortion induced by intrauterine catheter from June, 1979 to May, 1980 at Kasturba Hospital, New Delhi, India were studied. Catheters were introduced into the fundus of the uterus. Intravenous syntocinon drip was started--dosage varied between 5-60 units. 61 (27.1%) were less than 20 years old. 5 (22%) were more than 40. 63 (28%) were unmarried; 85 had 2-3 living children. 77 (34.21%) had more than 4 children. 99 (44%) were 16 or more weeks pregnant. 157 (69.77%) aborted within 48 hours. The induction-abortion time interval varied between 6-120 hours. There were 2 failures, for which hysterotomy was performed. Fever and foul-smelling discharge were the main complications in patients who did not abort within 24 hours. There was no cervical tear or hemorrhage. 12.45% accepted family planning methods--26 sterilizations and 2 IUDs. The induction-abortion time interval is too long for this to be considered an ideal method.
Ethacredine as a midtrimester abortifacient.
A critical review of 60 cases of abortion induced by ethacridine lactate is presented. Of those who were 12-14 weeks pregnant (group 1), 2 of the 3 abortions were successful, for a 66.7% success rate. Of those who were 14-16 weeks pregnant (group 2) 10 of 11 were successful--90.9%. Of those who were 16-18 weeks pregnant (group 3), all 12 were successful--100%. In group 4 (18-20 weeks), abortion was successful in 29 of 34--85.4%. 53 of 60 were successful. Of the 7 which failed to abort, 5 were due to technical errors, like bleeding while introducing the Foley catheter through the internal os. The remaining 2 failed because the drug did not act as an abortifacient. The mean induction-abortion interval was 53.5 hours in a group 1. In group 2, the mean induction-abortion interval was 37 hours and 35 minutes; group 3--33 hours; and group 4--34 hours, 25 minutes. The number of complete abortions was 55--92%. In early midtrimester, the success rate declined to 66%. There were 40 unmarried women. 46 were Hindu; 6 Christian; 7 Muslim. Many were illiterate, some had primary education; some had gone to high school; none went to universities. Reasons for termination of pregnancy are given. 6 patients had fevers. Supplementary therapy (pitocin) was required in 33 cases of 55--7 needed it to expel the placenta. Advantages of the procedure are given. 17 of 53 needed check curettage. Nabriski and Kalmanovitch report that the drug should be used with caution in heart disease with insufficiency, renal or liver diseases, hydramnios, pregnancy associated with hypertension, previous scar in the uterus, and suspected placenta previa or low-lying placenta.
Data from the Indian Council of Medical Research (ICMR) collaborative study on short-term sequela of induced abortion were analyzed. 17,628 women who came to 13 postgraduate teaching hospitals from different regions of India for medical termination of pregnancy (MTP) were studied prospectively from December 1, 1975 to March 31, 1977. Immediate complications included hemorrhage and cervical injuries. Delayed complications include postabortal bleeding; incomplete abortion; pelvic infection, peritonitis, and septicemia. The failure rate varied between 2% and 25% depending upon the method. Among 1958 women who had second trimester MPT with nonsurgical methods only 1677 aborted (85.7%). Most obstetricians waited 6 to 8 hours afterwards to see if the women would abort. 55 women (2.8%) did. Immediate complications relating to the management of method failure include postabortal bleeding, incomplete abortion, and pelvic infection. Nonexpulsion or incomplete expulsion of placenta occurs in a sizable portion of women who undergo second trimester MTP by nonsurgical methods. It is possible that the retained placenta--complete or partial--may contribute to immediate complications such as hemorrhage, and to delayed sequela such as pelvic infection. 2.7% expelled the placenta spontaneously within 15 minutes after fetal expulsion. 86% of the spontaneous expulsions of the placenta occurred between 15 and 30 minutes after fetal expulsion. It is preferable to proceed with surgical removal of the placenta if it has not been expelled within 30 minutes of fetal expulsion. Amount of blood loss is given. The effects of education, economic status (income), parity, and previous induced abortion on complications following MTP are given.
Ethacredine lactate for termination of pregnancy in high risk cases.
This study was undertaken to find out the efficacy of ethacridine lactate for termination of pregnancy in high-risk cases. 41 cases with obstetrical/medical complications admitted during 1975-79 at Grant Medical College, Bombay, India and B.J. Medical College, Poona, India were included. Ages varied from 19 to 32 years. 4 patients were nulliparas--in the rest, parity varied from 16 to 30 weeks except for the 1 case of anencephalus who was 36 weeks pregnant. Indications for therapeutic termination of pregancy included 4 cases of heart disease, 3 eclampsia, 5 preeclampsia, 8 missed abortions, 2 intrauterine death of fetus, 8 previous cesarean sections, 2 pulmonary tuberculosis, 2 carcinoma of the breast, and 1 each of chronic nephritis, neurological disorder, encephalitis, fibroid with pregnancy, meningeal tuberculosis, and anencephalus. Induction-abortion time varied from 12 hours, 30 minutes to 36 hours, 10 minutes with a mean induction-abortion interval of 28 hours, 30 minutes. All the patients responded and successful termination of pregnancy occurred in all the 41 cases giving a success rate of 100%. Abortion was incomplete in 2 cases of heart disease, 2 cases of missed abortion and 3 cases of previous cesarean section. In all these, digital evacuation was done. Studies have shown that ethacridine lactate 0.1% injected extraamniotically had no adverse effects on the mother even if intravasation occurs. The drug has potent and widespread bactericidal properties and does not damage the feto-placental unit. It was observed that the induction-abortion interval in the present series is much shorter than other cases of medical termination of pregnancy, where the mean interval was 35 hours, 21 minutes. It is possible that the uterus in these high-risk cases is more vulnerable and stimulation of the uterus occurs quickly.
Preventive aspects of M.T.P. and implementing family planning devices in overlooked group.
Suggestions for prevention of medical termination of pregnancy (MTP) are given. Groups of people in whom MTP can be prevented are classified into: 1) young adolescent girls; 2) teenagers in secondary schools or colleges; 3) those who are about to be engaged or are engaged; 4) educated--either married or about-to-be married; and 5) girls and women alone--separated, unmarried, deserted, or widowed. In studying biology, especially the human reproductive system, young adolescents become sex conscious. Necessary information should be provided. In the 2nd group, the boys and girls are going through a period where they have neither complete knowledge of sex nor its consequences. The girls--victims of the consequences--should be educated. In the 3rd group, girls and boys are fully aware of the consequences; they get victimized by their impulses. They take chances and have to face undesired and unwanted situations. These people should be advised about family planning methods. In Gujarat state, another group exists which avails itself of MTP--they are boys and girls who are officially married. They see each other very often. According to the laws of society, they are not supposed to have a child. This is called "anu." The 4th group asks for MTP on a socioeconomic basis. They want to terminate the pregnancy because of further education, or a foreign job. The 5th group seeks MTP again and again. They should be sterilized permanently. MPT can be prevented in all these groups. Teachers, parents, family doctors, paramedical staff, social workers, family planning workers, and gynecologists should be available to guide these people.
Medical termination of pregnancy.
Prostaglandins are today approaching the status of being the drugs of choice for medical termination of pregnancy (MTP). There are other aspects of obstetrics and gynecology, however, in which prostaglandins can be used. They can be used to induce term labor, since they decrease cervical resistance and stimulate myometrial activity. For cervical priming prior to early abortion or induction of term labor, prostaglandins E2 (PGE2) and PGE2 analogs seem to be most suitable to evacuate the pregnant uterine cavity. With PGE2 there is a softening of cervical consistency and a dilation of the cervical canal. Different types of gels have been used for intravaginal and intracervical applications. A new gel has been elaborated for local application of prostaglandins. So far it has been used mainly for intracervical application of PGE2. Before clinical use, the obstetrician has only to add a few milliliters (ml) of saline. With this new gel technique, 800 patients have been treated mainly to prime the cervix before abortion by dilation and evacuation (D and E), or before induction of term labor. Practically no side effects have been seen. No one has aborted before scheduled D and E. In term patients, the number of cesarean sections has decreased significantly after PGE2 gel priming. Several controlled, double-blind studies have proven that it is the PGE2 component, not the gel application per se, that produces priming of the cervix. Preliminary results show that to receive a comparable effect of cervical priming of 0.5 mg. of PGE2 applied intracervically, 15 mg. of PGE2 has to be applied intravaginally. Intravaginal application produces side effects. Studies in cooperation with the Karolinska Institute in Stockholm are now comparing intracervical application of PGE2 in gel with intravaginal application of 9-methylene PGE2 in suppositories for priming the cervix.
Medical termination of pregnancy in India.
Medical termination of pregnancy (MTP) is now legal in India. Abortions up to 20 weeks can be terminated on humanitarian, eugenic, medical, and social grounds. State governments are responsible for the proper implementation of MTP. They have been requested to supply equipment to all MTP service centers. The central government has supplied more than 300 suction evacuators to different institutions. 161 hospitals have been approved as training centers. A training curriculum has been drawn up for undergraduate medical and nursing students. To March 31st, 1980, 6209 doctors have been training in MTP techniques--of these, 1605 physicians from primary health centers have been trained. There are about 3000 MTP service centers in India. Information on MTP services is disseminated throughout the country by central and state government media. The Indian Council of Medical Research undertook a multicentric, nationwide, prospective study of the short-term sequela of induced abortion. Methods used by surgeons for MTP are: 1) instrumental evacuation by the vaginal route; 2) stimulation of uterine contractions; and 3) major surgical procedures. The number of pregnancy terminations is steadily increasing. During '78-'79 312,754 MTP were done; in '79-'80 it was 306,878. The total number of terminations since MTP was legalized is 1,526,657 from April 1, 1972 to March, 1980. The importance of accepting post-MTP contraceptives cannot be overemphasized. Concurrent sterilization and IUD insertion is increasingly popular as a postabortion contraceptive method. Abortion mortality figures are given.
Evaluation of medical termination of pregnancy with critical analysis of abortion.
A critical anlaysis of 1666 medical terminations of pregnancy (MTP) is presented during the 2.5 year period from 1978 to June, 1980 in Calcutta National Medical College Hospital and Lady Dufferin Hospital, Calcutta, India. 3163 cases have been admitted for treatment of spontaneous and induced abortions. During this 2.5 year period, there is an increase in the total abortions from 16.6% in 1978 to 24.9% in 1979 and 36.2% in 1980. This is almost a 2.5-fold increase in the incidence of abortion in 1980 over 1978. There is a very slight decrease in the number of criminal abortions. There is also a slight fall in the number of spontaneous abortions. The MTP-delivery ratio was high in 1980--184/1000 as compared to 1978--39/1000. Most women who sought MTP were in their early 20s (21-25)--39.1% of the total; 1.6% adopted the method in the 5th decade of life. Most had 2 children; 66.63% had an income of $40 or less per month; only 6.78% were earning $51-60 per month--the rest (26.59%) were earning US$41-50 per month. Most were married--85.47%. Of the rest (14.52%), 9.9% were single. 2.7% were widowed and 1.91% were divorced. Of 1480 parous women, 68.24% sought abortion when they had both male and female children. 21.62% adopted the procedure with only male children, 10.13%--only female children. 50.67% chose MTP when their last child was more than 25 months old. 23.11% conceived and sought abortion within 1 year of their last birth. During the first trimester, only evacuation was performed; in midtrimester different methods were adopted. 64.22% reported at 13 weeks onwards; 35.77% within the first trimester. Methods used were dilatation and evacuation; hysterotomy; and abortions induced by saline solution, prostaglandin F2C (methyl comp), and prostaglandins with urea. 12.9% had minor complications; 0.6%, major complications like uterine perforation; and 0.1% death.
Trends in medical termination of pregnancy in Delhi.
From Apirl, 1972 to September, 1977 there were 755,869 medical terminations of pregnancy (MTP) reported in India with 2165 centers providing this service. From October, 1972 to December, 1979 1,438,331 MTPs are reported with 2934 centers providing service. Uttar Pradesh state reports 278,761 MTPs till 1979. Delhi has performed very well--a total of 71,433 MTPs are reported and 79 centers till December, 1979. Data was collected from various institutions in Delhi for 4 years 1976-79; and from Chandigarh for 1978 and 1979. In Delhi, there was a trend of more rural women asking for MTP in 1978. It was not maintained in 1979, however. The figures for rural women from Chandigarh are much better than for Delhi. The mean age of women requesting MTP was statistically higher in 1976 (29.4) but did not vary significantly in 1978 and 1979. In Delhi, the differences among the illiterate are highly significant and the proportion of college educated showed a marked increase in 1979. The number of illiterate women requesting MTP is much higher in Chandigarh compared to Delhi. The proportion of unemployed in Delhi over all the years is highly significant; the trend is the same in Chandigarh. Compared to all other religions the proportion of Hindus is highly significant in Delhi; in Chandigarh there is an increased number of Sikhs. Currently married women are in the majority. The proportion of women having 2 living children is highest; those with more than 3 has been decreasing from 1976 in Delhi. The average family size increased from 2.13 in 1977 to 2.2 in 1978 to 2.6 in 1979 in Delhi. In Chandigarh the trend is similar. The number of acceptors of MTP using no contraception was highest in 1978 (84.89%). Most of the women reported for MTP between 6 and 8 weeks. Termination procedures include: vacuum aspiration, dilatation and curettage, hysterotomy, and drug-induced abortions.
Termination of mid trimester pregnancy by hypertonic saline.
250 cases at the R. G. Kar Medical College and Hospital Family Welfare Clinic, Calcutta, India were studied from June, 1978 to June, 1980. The majority (77.2%) were married. The duration of pregnancy was 13 to 15 weeks in 44.4%; 16 to 20 weeks in 55.6%. 17.2% were primigravidae. 37.2% had 3 children. The vaginal route of saline instillation was chosen in 121 cases (48.4%); the abdominal route in 129 (51.6%). Successful abortion occurred in 245 cases (98%) within 72 hours. In all failed cases (2%) saline was instilled per abdomen. Causes of failure were twin pregnancy and bicornuate uterus. 60 cases (49.58%) out of 121 of the vaginal route group aborted within 24 hours; only 34 of 129 cases in the abdominal route group did. Complications with saline instillation were: retention of placenta, 51.2%; cervical injury, .8%; pyrexia, 4%; pelvic infection, .8%; and hypernatremia, .4%. There were no major complications. The saline instillation method has many advantages over the hysterotomy or prostaglandin methods. The transvaginal approach is preferred.
A comparative study of prostaglandin and 40% urea for midtrimester abortion.
A comparison has been made to evaluate the efficacy and safety of 40% urea solution and prostaglandins for inducing midtrimester abortion. 328 Indian women with gestational age ranging from 12 to 20 weeks, were included (184 in the urea group; 144 with prostaglandins). Prostaglandins were instilled through intraamniotic, extraamniotic, and intramuscular routes. In the extraamniotic route prostaglandin (15 methyl F2) was given. Ages ranged from 15 to 45. Most were nulliparous (50% and 38%) and 14 to 18 weeks pregnant. In the urea group, complete expulsion of the placenta was achieved in 90.7% of the cases when urea was combined with syntocinon. 60% had complete expulsion of the placenta in intramuscular prostaglandin administration; as did 50% of the extraamniotic group. Retained placenta was more common if the gestational period was less than 16 weeks. Blood loss was almost minimal where urea and syntocinon were used. In urea patients 77% aborted within 48 hours, 23% aborted after 48 hours; the maximum interval being 120 hours. In the intramuscular prostaglandin group, 45% aborted within 12 hours; another 45% within 24 hours; only 2 took more than 24 hours. In the urea group, there were no complications, except for 1 asthma attack. In prostaglandin patients, 60% to 80% had marked nausea and vomiting. All complications were relatively fewer in the intramuscular group. In the urea series, 3 cases failed; in the prostaglandin group--15, all in amniotic instillation. There was no failure in the intramuscular group.
The various systems of traditional medicine in the countries of the Western Pacific Regions have several characteristics, including a long history, usually dating back many centuries. The resources in medicinal plants are rich, especially in the subtropical and tropical zones, although their development in different countries is unequal. While accepted by the general population, particularly among rural inhabitants, traditional medicine is often rejected or ignored by modern medical practitioners and by the more affluent and educated classes in some countries. Practices observed in the region follow 1 of 2 patterns. 1 model is highly institutionalized, with formal academic training in a variety of disciplines in recognized schools, professional associations, and official recognition. The Chinese system and Hindu medicine practiced in Malaysia, Singapore, Fiji, and Australia follow this pattern. The 2nd pattern is less well defined and institutionalized but nevertheless deeply rooted in the culture of the particular community in which it is practiced. The role of traditional healers in the region; the Chinese system of traditional medicine; traditional medicine in China today including the practice of acupuncture; research in herbal drugs; traditional Chinese medicine in other countries including Vietnam, Malaysia, the Republic of Korea, and Japan; and folk and tribal medicines in the Philippines and rural Malaysia and South Pacific countries such as Papua New Guinea, Kiribati, and Fiji are discussed. WHO stimulates the development of traditional medicine in the region by supporting research, training traditional practitioners and encouraging their integration into health care systems as well as their participation in information sharing publications and activities.
Report on the Population Education Workshop in Alexandria, Egypt, August 2-11, 1983.
The Egyptian Ministry of Education (MOE) has planned annual workshops that provide an orientation in population education to primary, secondary and normal school teachers throughout Egypt. This is a report on the planning, structure and evaluation of the 1983 workshop, held in Alexandria. Its ultimate objective is the introduction and integration, in the Egyptian school system, of non-traditional teaching methods and materials for the subject of population. A correspondence course prepares the participants for the workshop. Demographic concepts and measures, factors influencing population growth, the consequences of population pressure on Egypt, the physiology of reproduction, population policies and planning for the future, are given special attention in the workshop curriculum. Moreover, a variety of non-traditional teaching methods, which are learner-centered, encourage inquiry and problem-solving, are identified as an important focus of the workshop. The appendices describe the workshop agenda; the results of a pretest-posttest attitudinal questionnaire used as an evaluation tool; and a variety of appropriate non-traditional methods and materials for population education at the school level. Finally, recommendations by participants and consultants illustrate the successes and limitations of the workshop as well as proper steps to implement in future efforts.
Vertical vs horizontal health programmes in Africa: idealism, pragmatism, resources and efficiency.
Argument still rages over whether vertical health programs--attacking 1 or a few health problems--should still be set up in developing countries, or whether all their efforts should be devoted to establishing a horizontal multi-problem approach such as primary health care. This paper argues that the debate can be made rather more informed firstly by a consideration of the technologies available to improve health and the methods of delivery to which they are most suited; secondly by a consideration of their effectiveness and the organizational feasibility of different strategies of delivery; and finally by investigation of the total costs and cost-effectiveness of different delivery systems. 2 studies are worth mention: the 1st one estimates the cost of attaining an infant mortality rate of 50/1000 by assessing what levels of inputs, for health services, water supply, excreta disposal and education is associated with the level of GNP per capita. The 2nd study looks at the costs of achieving health for all in Upper Volta, the poorest country in Africa. A projection of the costs implied a 5.5 times increase in recurrent costs, and a 4.6 increase in per capita recurrent costs. Particular attention is given to the contribution of economic analysis to elucidating these issues, and a variety of cost-effectiveness studies are reviewed to see what information is available on the way in which particular health programs such as malaria control and immunization activities can be organized in order to maximize their cost-effectiveness.
Health and culture in an African society.
Medical practitioners should try to identify cultural practices, and classify them according to whether they are beneficial, harmless, uncertain or harmful. Cultural beliefs about disease causation in Ganda society fall under the following categories: magical, which includes diseases caused by angry gods, evil eye, witchcraft, as a result of infringing social rules; infectious, which includes diseases acquired through close contact with an infected person; and hereditary, which includes diseases with known causes that are usually treated by Westernized medical practitioners. Examples of magical supernatural diseases are diarrheal diseases and malaria. Diarrheal disease in young children is considered to develop if a child is touched, given food or clothed by 1 of the parents or even by a stranger who has had intercourse but has not washed his hands. Malaria is thought to be due to a bird flying over the child, explaining the rolling of the eyeballs in convulsions to look at the bird. Diarrhea and malaria are treated with herbal baths and other forms of traditional drinking. Special reference is given to mothers and children which constitute a very vulnerable group as well as forming the majority of the population.
This report presents the conclusions of a study conducted in order to help develop programs of health education in Maternal and Child Health (MCH) in Malawi. After describing the geography, climate, and population of the region, the history and development of the National Health Policy in relation to health education is reviewed. This leads to an analysis of the need for an increase in health educators. The role of health education, as adumbrated by the World Health Organization (WHO), is summarized; concepts of health education as perceived by developing countries in Africa, and Malawi in particular, are noted. An overview of the various health education services in the state is provided, and includes government agencies, training schools, primary and secondary schools, health centers and clinics, the university, and nonprofit organizations; administrative problems within the Health Extension Services Unit are highlighted. A list of training facilities is given, along with a critique of their curriculum content; this is followed by a synopsis of potential sources of health education manpower. Areas for increased field research are indicated. Programs sorely needing health education services are noted; agency coordination problems are also indicated. Health magazines are briefly discussed. The study concludes by pointing out the need for more sophisticated training methods, and the impact of health education on MCH activities.
Preventing adolescent pregnancy: community solutions.
On May 10, 1983, key leaders from the District of Columbia (D.C.) convened to discuss methods of preventing teenage pregnancy and abortion. Participants included leaders from the D.C. government, schools, clinics and hospitals, youth agencies, and community organizations. This report provides an overview of the proceedings, along with a summary of workshop strategies, and a list of resources that will provide training and technical assistance. Existing D.C. policies that can strengthen pregnancy prevention efforts are noted, followed by a discussion of the factors that contribute to the high rate of unintended teen pregnancy, including: a lack of responsible decision-making, inadequate contraceptive services, commercialization of sex by the media, and parent-teen conflicts. Emphasis is given to additional factors that exist in the Black community. The successes and problems of several programs are summarized, including sexuality progams for fatherless boys, sexuality education in the public schools, and a TV documentary on "Teen Sexuality". The workshop reports focus on the development of programs that will: help resist premature sexual activity; and provide instruction and incentives in contraceptive use. A list of community resources (including family planning and prenatal care clinics, and pamphlets), and fact sheets, (on teenage sexuality and sex education) are appended.
Abortion: a guide to making ethical choices.
A mature attitude toward abortion rests on responsible decision-making and action taking, not on the belief in irreversible events. Abortion is therefore a choice which should be made if it is the most correct and responsible action in view of one's own circumstances. There are a number of doubts, concerns and moral--as opposed to medical--questions that women may be asking themselves as they face this serious choice. The guide addresses these issues to help women think through that choice. It is important to know, for instance, that the Pope has never formally proclaimed a doctrine of faith on the matter of abortion. The Catholic Church, when considered in its diversity, teaches that some abortions can be moral; the conscience of a person is the final arbiter of any abortion decision. Conscience is humans' progressively refined ability to think about situations and evaluate their moral goodness/badness. With respect to abortion, this means that a woman should make the choice that seems best to her. The fear that having an abortion will result in excommunication from the Church is dismissed here. A distinction must be made between committing the sin of abortion and having an abortion. The former obtains when people act against their own conscience. The attitude toward abortion as murder and the issue of the fetus' afterlife are responded to in terms of personhood, a complicated concept on which there is no legal, scientific or religious consensus. Instead, the answer is a function of the time period and its prevalent beliefs. Today, the viability of the fetus has become an important determinant of life. Having an abortion, giving birth, and use of contraceptives when no children are wanted, are responses to which a woman is entitled. Her choice is moral when based on responsible and conscious decisions and actions. The views of Protestantism and Judaism on abortion are clarified briefly.
Laws and policies affecting the training and practice of traditional birth attendants.
This paper attempts to create awareness of the need for a detailed analysis of laws and policies concerning traditional birth attendants in order to legitimize their activities. More and more developing countries are expanding the functions of traditional birth attendants (TBAs) to include maternal and child health, family planning, and first aid in the community. Primary health care needs more health workers and the TBAs are a good resource if adequately trained. A few countries have begun to use them for delivery of family planning services. The countries which have accorded legal status on TBAs have been successful in implementing policies to expand their role in primary health care. In most countries, however, the TBA has no legal recognition. The article argues that once they are trained, they should be recognized. A broad range of factors work to restrict their integration into primary health care programs. A number of aspects must be addressed before any legislative move is made to expand the role of the TBA in primary health care. These include training, registration, acknowledgement by the government, licensing, supervision, disciplinary procedures, remuneration, standards of care, and negligence. TBAs can be useful in contraceptive distribution, as they already are in various countries. In Iran and Pakistan they have been trained to insert IUDs and in Mexico they have been trained to give injections. Many TBAs perform abortions, regardless of its legal status. If they were registered and trained in family planning, they could refer unwanted pregnancies to trained health personnel. They can also encourage sterilization. Regardless of whether TBAs are given recognition, the fact is that they deliver an estimated 60-80% of the babies in the world, and are likely to continue doing so. Laws and policies affecting the practice and training of TBAs should be identified, studied, and reformed. Legislation is needed to protect the TBAs, to assure that they are trained, and to protect the community against substandard care.
An examination of the relative confidence that can be placed in the data from demographic sample surveys is presented, with particular reference to the need to analyze differences among the findings from various surveys. Some basic procedures for estimating the accuracy of sample survey data are proposed and tested using data for Upper Volta for 1960-1961. Topics considered include variance of crude demographic rates, rates and quotients by age and derived functions and parameters, and variance of life table functions and parameters. (ANNOTATION)
Maternal mortality associated with induced abortion.
At the K.E.M. Hospital in Bombay, 37 deaths have occurred as a result of induced abortion from 1972-78. 17 of these deaths were due to criminal interference done outside of the hospital.
This article was written by the National Labor Organization of India and deals with current issues to improve the population problem of India. Population growth is adversely affecting the economic structure. With the aid of artificial means (oral contraceptives) to limit the birth rate, there are still serious attempts required to install family planning ideas into worker's mind. In this view, trade unions have a vital role to play in the education of the workers and their families by means of program activities, journals, and newspapers. The concept of family planning must grow from within. The Government and Family Planning Institutions should create a better atmosphere in order to communicate the problem to the working class. In order to achieve the objective of control over population growth, a series of recommendations are made, all of which deal with the creation of a popular movement for family planning, extension of financial assistance to family planning programs, the role of trade unions, women's status and education, incentives, family welfare and education, age of marriage and child labor.
This article, written by the U.T.U.C. secretary, analyzes the population growth problem of India. It specifically examines the issue of birth rate being responsible for the low productivity and poverty in India. A brief history of the Family Planning Program in India is given. It is assumed that the capitalistic economy in India is the basic cause for the sluggish economic growth. The problems of unemployment, under-employment and poverty are directly caused by the socioeconomic pattern and not in the least by the growth rate of the population. Family planning divorced from social planning of production and distribution is a negation of the social objective of abolishing poverty.
Discusses the history and sociocultural aspects of family planning in Japan. In the context of family planning, Japan could be considered a developing country until the end of World War II. The social developments that took place between the World Wars led to changes in the traditional ideal of the ancestral family and more towards an emphasis on the nuclear family. It was not until after WWII that family planning on a modern contraceptive basis was introduced on a large scale. Post-war Japan responded promptly and positively to authoritatively imposed birth control, making it one of the few favorable exceptions in the comparative study of family planning in various countries. Abortions were relied upon at 1st and then birth control. Recent data shows that the age structure of the population has changed considerably over the years due to the decrease of infant and child mortality and decline in the death rate of advanced age groups. The low reproductive rates over the past decades are reflected in changes in the age structure. But despite the decrease in fertility, Japan's population is still growing. This is because life expectancy is still increasing. The forecast for family planning in Japan on the basis of contraception seems very favorable. There has been a considerable drop in the number of abortions, in addition to a decrease in the birth rate. The modern Japanese is eager to learn, and accessible to innovations. There is also a degree of conformism in Japanese society, which favors practicing contraception. It therefore appears that family planning will virtually completely displace legal abortion and will become very effective in achieving a planned and purposive population policy.
Discusses how the social structure of the family and the cultural background of Islam have affected family planning in Egypt. The author tries to determine to what extent modern methods of family planning progressed in Egypt after the revolution of 1952. The revolutionary government was the 1st Egyptian government to recognize the existence of a population problem, and strive for a national population policy. In the 1960's, the government started a family planning program. Many family planning centers were set up and are still growing. But it was not until 1971 that the government officially began a policy directed towards a slowdown of the population growth. The author also explores the attitudes of the government towards the population problem, and the response of the population toward the introduction of family planning. At 1st the government's efforts at family planning met with opposition from the religious leaders (although Islam does not disagree with family planning) and the upper classes. The masses received them with indifference. Birth control is finding growing acceptance in Egypt now, but the decrease in population growth is too slow to noticeably ease the population pressure within a short time.
"In this paper [the authors] develop and implement an econometric methodology estimating a family-specific exogenous component of life-expectancy in order to determine the responsiveness of fertility to exogenous changes in child mortality. [They] use a generalized waiting time regression model applied to length of life which is viewed as the output of a production process. [They] allow for family-specific heterogeneity in duration of life and for time-varying explanatory variables. The heterogeneity component retrieved from the production function estimation is used to estimate the impact of exogenous child mortality on a measure of fertility." The data concern 1,938 children from 311 families included in the 1976 Malaysian Family Life Survey. This paper was previously published in Econometrica (Chicago, Ill.), Vol. 51, No. 3, May 1983, pp. 731-49. (EXCERPT)
Voluntary childlessness and the Women's Liberation Movement
"This study examines the relationship between involvement in the Women's Liberation Movement and voluntary childlessness. Data from two separate probability samples of [U.S.] university women were used to test the hypothesis that involvement in the Women's Liberation Movement is positively related to actual and expected voluntary childlessness. Analysis reveals that a pattern exists which is supportive of the hypothesis but the relationship is not a strong one. In addition, the majority of women, regardless of involvement in the Movement, have or expect to have at least one child." (EXCERPT)
Birth control socialization: how to avoid discussing the subject
The transmission of sexual and birth control information from parents to children is examined using data from questionnaires completed by 16 working-class and 10 middle-class families in Minneapolis, Minnesota. The results confirm that neither parents nor adolescents engage easily in birth control socialization. (ANNOTATION)
Contraceptive behavior among unmarried young women: a theoretical framework for research
The process of adoption of effective methods of contraception by unmarried young women in the United States is examined. In order to take into account both individual decision-making and negotiation with contraceptive providers, "a two-dimensional framework for understanding contraceptive adoption and continuation by unmarried young is proposed, incorporating a 'social-psychological model' of individual decision-making and an 'interpersonal model' of factors affecting provider-client interaction." The framework can be used to analyze variations in contraceptive continuation. (EXCERPT)
Contraceptive use by college dating couples: a comparison of men's and women's reports
The relationship between contraceptive use by unmarried U.S. couples and prior sexual experience of both the woman and the man is explored, together with the level of agreement between partners in reports of contraceptive methods used. Consideration is also given to the boyfriend's social characteristics as correlates of contraceptive use. The data concern 101 college dating couples in the Boston, Massachusetts, area who were initially recruited into the study in 1972 and followed over a two-year period. "Stages of contraceptive use were decreasingly related to the women's prior sexual experience, and decreasingly related to the man's. Agreement on birth control methods was very high for reports of prescription methods at most recent intercourse, but low for reports of no birth control at first intercourse. Use of prescription methods at most recent intercourse was more strongly related to the women's social characteristics (father's education, religious background) than to the man's. Results suggest that focusing on women as individuals is a useful strategy for research on contraceptive use, at least for unmarried women." (EXCERPT)
[Population policies in Europe]
A review of population policies in Europe is presented. Attention is paid to fertility policies and their effectiveness, with particular emphasis on the experience of the Socialist countries of Eastern Europe. The author concludes that short-term effects of pro-natalist measures are noticeable, but long-term effects are questionable. (summary in ITA) (ANNOTATION)
Results from the Netherlands censuses of 1930, 1947, 1960, and 1971 are examined to determine the influence that religious denomination and social group have exerted on the fertility of marriages contracted before the wife is age 25 in the period 1876-1959. An analysis of the data indicates that in 19th and 20th century Holland both religious denomination and social group had an important influence on fertility and that both variables overlap each other; it is concluded that the religious denomination has had the strongest influence on the differences in fertility, although the social group also had effects on fertility behavior. Roman Catholics had the highest average number of children/marriage, followed by Calvinists and Dutch Reformed. Catholics gave birth to nearly 5.4 more children than their Protestant colleagues. Certain groups can be identified which were especially responsible for the late decline in fertility in the Netherlands; Roman Catholics, particluarly those working in the agricultural sector but also Catholic workers and self-employed outside agricultural workers insofar as they lived in the south of the Netherlands or in some specific regions in the west. One theory of why these groups had high fertility was that many 19th century family households were characterized by a combination of the following elements: 1) the familial nature of the economic production, 2) labor was the dominant factor of production, and 3) net transfers of goods, money, and services within the households took place from young to old. Among Catholic households there was an especially high proportion of family businesses for which large families were advantageous, in addition to resistance to fertility decline as that involved changing established moral standards. The latter resistance was strengthened by the strong religious and social framework of Catholics. By exercising influence and social control within this institutional framework it was possible also to maintain the taboos regarding the use of contraception for a long time, well into the 20th century. Also, the church's social program tried to mitigate the personal and social disintegration, including birth control, that one associated with industrialization. An indirect cause of Catholic high fertility was the sense of sacrifice generated by the large hard-working Catholic family which was proclaimed to be the cornerstone of society. In addition the lower breastfeeding rate, higher infant mortality rate, and high percentage of children contributing to family income helped to maintain high fertility.
A note on life tables and nonlinear death processes
"This note is viewing survival data of a natural cohort as being generated by a possibly nonlinear, nonhomogeneous death process. It proves that the usual conditional distributions of the number of survivors at a certain age are binomial if and only if the death process is linear. Thus the customary statistical methods for the analysis of life table data are, strictly speaking, invalid whenever the underlying death process is nonlinear. For example, if a contagious disease is the cause of some or all of the deaths, the deaths will not be independent and the death process, not linear. One should then base the statistical analysis on a model for the spread of the disease rather than the routine binomial model." (EXCERPT)
Federal statistics in a complex environment: the case of the 1980 census
A discussion of the 1980 U.S. census is presented. The authors suggest that the taking of a national census is not just a statistical exercise, but an exercise involving ethics, epistemology, law, and politics. They contend that conducting a national census can be defined as an ill-structured problem in which the various complexities imposed by multidisciplinarity cannot be separated. "The 1980 census is discussed as an ill-structured problem, and a method for treating such problems is presented, within which statistical information is only one component." (EXCERPT)
Results of the 1981 census of Luxembourg are presented. Data are included on the total, Luxembourgeois nationality, and foreign population by sex, age, and marital status; Luxembourgeois population by how nationality was obtained; and foreign population by nationality, sex, and place of birth. Several tables of retrospective data are also included. (ANNOTATION)
Sampling variability of SRS vital rates, 1975-77
"The present study endeavours to measure the sampling variability of birth and death rates for the period 1975-77 separately for rural and urban areas [of India]. It is hoped that this study would equip the users of the SRS data with a measure of the reliability of the estimates of vital rates and would provide guidelines for improving the existing sample design." Extensive tables present estimates of the birth rate, death rate, standard error, and coefficient of variation for rural and urban areas separately; average estimated standard error and coefficient of variation of Sample Registration System vital rates; confidence limits for estimated birth rates and death rates for rural and urban areas separately; birth and death rates based on a three-year moving average, 1970-1978; and variability and confidence limits of birth and death rates for rural and urban areas using a three-year moving average. (EXCERPT)
This report presents 1980 census data on internal migration by occupation for Japan as a whole and for prefectures. Data are included on employed persons 15 years of age and over who moved after October 1979 by place of previous residence or present residence, occupation, employment status, five-year age group, and sex. (ANNOTATION)
[Population forecasts, 1980: a sensitivity analysis of the forecasting model]
The results of a sensitivity analysis of the latest official forecasts of the population of the Netherlands are presented. The effects of various changes in marriage rates on population forecasts up to the year 2030 are first considered using a process of computerized simulation. Fluctuations in some selected parameters are also examined using time-series analysis and by assuming a binomial distribution. Some critical parameters affecting future population forecasts are identified. (summary in ENG) (ANNOTATION)
Counterurbanisation and rural rejuvenation in Britain--an evaluation of population trends since 1971
"This study aims to test whether Britain has experienced over the past decade a turnaround in the population trends of its rural and more remote areas similar to that recorded for the early 1970s in North America, Australia and a number of European countries....The main questions which this paper tries to answer concern whether it is possible to detect a rural rejuvenation in population trends from aggregate data, whether the signs of its emergence vary with distance from the main centres of urban population, and whether any such trends have developed progressively over time...." The data for the study are taken from official sources, including the census, and concern the period 1951 to 1981. The results suggest that "Britain's non-metropolitan areas did experience a marked turnaround in population trends over the last few years, similar in direction to the experience of other countries. Whereas during the 1950s and 1960s these areas were losing population at an accelerating rate, the early 1970s saw a remarkable shift into substantial growth, also going against the national trend of slower growth...." (EXCERPT)
Muslims and minorities: the population of Ottoman Anatolia and the end of the empire
An attempt is made to describe the population dynamics of Ottoman Anatolia, which is approximately equal to modern Turkey, for the period 1878 to 1914. Consideration is given to the Muslim, Armenian, Greek, and other population groups separately. "After those population numbers have been analyzed and estimated for the period prior to World War I, the fate of the communities during and after the war has been considered, with the intent of finding how many died in the disaster." Appendixes are also included on population estimates for Turkey in 1927 and 1922, migration, the methodology used, and the available sources of data and their reliability and accuracy. (EXCERPT)
Atlas of 1980 population census of Japan
This publication consists of 10 maps presenting data from the 1980 census of Japan by shi, ku, machi, and mura. Maps are included on rate of population change in 1980, 1970, and 1960; unemployment rate in 1980, 1970, 1960, and 1950; sex ratio in 1980; percent working age population in 1980; and number of persons per household in 1980. (ANNOTATION)
[Migration in the Caribbean Basin]
A review of recent migration trends in the Caribbean region is presented. The region is defined as those countries and territories in or surrounding the Caribbean. Consideration is also given to migration from the region to the United States. The characteristics and consequences of these migration trends are discussed. (ANNOTATION)
Migration regions of the Philippines
"In contrast to results for several other nations, hierarchical regionalizations based upon 1960 Philippine lifetime migration do not indicate that islands act as migration regions....Inter-island links seem to be more important than intra-island ties. Northern Luzon, the Bicol Peninsula and the Southern Philippines are among the regions that appear. Manila and its suburban province of Rizal are exceptional both for the breadth and strength of their interprovincial migration ties." (EXCERPT)
1978 population census. Vol. V: fertility and mortality data for rural and urban areas of regions
Results from the 1978 census of Tanzania are presented concerning fertility and mortality. The data are shown by region and by rural or urban area. Data are included on women 12 years of age and over by age, number of children ever born, number of surviving children, and year of last birth; male and female population by age and survival of mother; ever-married males and females by age and survival of first spouse; and eldest living children by age and survival of mother. (ANNOTATION)
1978 population census. Vol. VI: private households and housing characteristics
Results of the 1978 census of Tanzania are presented concerning private households and housing. The household data include information on households by region; household heads by sex and age; size of household; and distribution of private households by location and citizenship of household head for wards, districts, and regions. (ANNOTATION)
Comparisons of fatness in premenarcheal and postmenarcheal girls of the same age
"Triceps and subscapular skinfolds of 2,251 premenarcheal and postmenarcheal girls from three different [U.S.] surveys were analyzed to ascertain whether there was a critical level of fatness below which menarche did not take place. The evidence did not indicate the existence of a threshold level that could be considered critical with respect to menarche." (EXCERPT)
Perinatal mortality survey: Siriraj Hospital, Thailand, 1979
Results of a survey of perinatal mortality in Thailand are presented. The data concern approximately 23,000 births occurring at the Department of Obstetrics and Gynaecology, Siriraj Hospital, Bangkok, in 1979. The analysis focuses on the 401 infant deaths that subsequently occurred during the first year of life. (summary in THA) (ANNOTATION)
The relationship between nutrition and longevity is examined using data from a variety of sources from around the world. The relationship is considered separately for children, adults, and the elderly. The conflicts between the different objectives pursued through nutrition are noted, and the possible need for individuals to trade off health at younger ages with longevity is considered. (ANNOTATION)
[On the program for the use of the 1981 census of population and housing]
The development of a program to insure maximum use of information obtained from the 1981 Cuban census of population and housing is discussed. Some past policies and laws directed toward the use of census data are first reviewed. The principal objectives and content of the program are then described. A list of the principal publications and analyses used in program development is included. (summary in ENG, RUS) (ANNOTATION)
Advance report of final divorce statistics, 1981
Summary tabulations from the final divorce statistics for the United States for 1981 are presented. It is noted that the number of divorces increased for the nineteenth consecutive year, rising to 1,213,000 in 1981. Topics covered in the accompanying analysis include children involved in divorce, duration of marriage, and age at divorce. Selected data for previous years are also included. (ANNOTATION)
This journal, previously published under the same title as a complimentary newsletter, is now available only by subscription, currently at 50 dollars a year. The journal will continue to focus on statistical analyses, as well as the broader aspects of preventive medicine and public health, and will contain items of demographic interest, primarily concerning the United States. The present issue includes an article on the population outlook for the United States up to the year 2050. (ANNOTATION)
The effects of some conditions of destabilization on the widowhood mortality technique
"The validity of the Widowhood Mortality Technique is based on the assumptions that mortality and nuptiality conditions have been stable, and that marriages occur in the population in accordance with a monogamous schedule of nuptiality. A breakdown in any of these conditions...causes confounding effects in the widowhood mortality estimates, rendering them different from the actual levels of mortality prevailing." In the present research, "a simulation approach is adopted to demonstrate the effects of declining mortality, changing (increasing) nuptiality and polygyny on the widowhood method. Time dependent mortality and nuptiality functions were introduced for the simulation of declining mortality and increasing nuptiality conditions by interpolating at yearly intervals between various initial and final period schedules, and deducing specific cohort schedules. The effects of polygyny [were] incorporated in the simulation by compounding different beta-type distribution functions for polygynous second marriages with the Coale-McNeil function for first marriages, with the further condition that polygynists experience higher, lower or equal mortality as monogamists." (EXCERPT)
Female labor force participation, female mortality, and the sex mortality differential in Wisconsin
"The purpose of this study was to examine the relationship between the participation of women in the labor force, female mortality, and the male-female mortality differential. These relationships were examined through comparisons of age, sex, marital status, and occupation-specific death rates for all causes of death combined and for selected causes of death." Data are from "death certificates provided by the Wisconsin Bureau of Health Statistics for the years 1968-1972 and 1974-1978, and population data provided by the 1970 Public Use Sample of the Census and the 1976 Survey of Income and Education. The population under study was confined to the white civilian population of Wisconsin 16-64 years of age." (EXCERPT)
"The dissertation represents an effort, previously untried, to integrate diverse sources of information about recent (post-1965) legal immigrants' and illegal aliens' employment, and relate the findings to contemporary issues in American immigration policy. Seven hypotheses are examined with published data from the United States Immigration and Naturalization Service and the 1970 census, additional government reports, working papers, and other literature....[The focus is on] employment in the secondary labor sector, where native born minorities (blacks and Hispanics) are more concentrated than native born whites." It is found that there are "differences, by origins, in illegal aliens' lower level employment that strikingly resemble the distinctions found among legal immigrants....Thus origin, not just legal or illegal status, apparently bears a closer relation to the type of work performed by recent entrants than has been recognized before." (EXCERPT)
Perinatal mortality: changes in the diagnostic panorama, 1974-1980
An analysis of perinatal mortality trends in Sweden is presented. The data concern 17,813 births recorded in the town of Malmo from 1974 to 1980. Problems concerning the definitions of spontaneous abortion, perinatal mortality, late fetal death, early neonatal death, etc., are discussed. (ANNOTATION)
[Families today and families tomorrow]
Changes in family characteristics over the past 50 years are examined, with particular reference to the situation in Western developed countries. A trend toward the formation of small households consisting of one or two persons only is noted. With regard to the next 20 years, the author discusses whether such a trend away from the traditional nuclear family is likely to continue, or whether it will be reversed as part of a cyclical system related to economic conditions. (ANNOTATION)
[The countries of the world faced with the aging of their populations]
The problems posed by demographic aging, not only in developed countries but also in a growing number of developing countries, are examined. The author summarizes the main recommendations of the first international conference on demographic aging, held in Vienna in 1982. (ANNOTATION)
[Migration flows and their possible impacts on the French population]
The author suggests that like most developed countries, France can expect to receive a growing number of immigrants from different cultural backgrounds over the foreseeable future. This increase in migration is likely to continue whatever changes in migration laws are implemented. The consequences, particularly the need to adapt to the existence of a multiracial society, are examined. (ANNOTATION)
[French demographic projections]
The methods used to prepare official population projections for France are described, and likely forecasts of population developments up to the year 2050 are summarized. In the absence of substantial international migration, the author shows that since mortality is likely to remain unchanged, variations in fertility will control the size of the future population. Four alternative hypotheses concerning fertility are described, and their relative impact on the aging of the population is considered. (ANNOTATION)
[The determinants of marital mobility]
A study of the determinants of remarriage is presented using official French data and the methods developed for economic analysis. Particular attention is given to the role of the economic benefits and costs of remarriage, with reference also to the division of assets from the previous marriage and the costs of divorce. (summary in ENG) (ANNOTATION)
[The demographic aspects of aging]
An analysis of demographic aging is presented, with particular reference to Hungary. Separate consideration is given to those aged 60 to 69, 70 to 79, and 80 and over. A review of demographic aging in Hungary from the end of the nineteenth century to the present day and a forecast of future trends in aging to the year 2000 are provided. The author notes that the population aged 60 and over has increased from 7.5 percent of the total population to 17.1 percent between 1900 and 1980 and will increase to 19 percent by the year 2000. Changes in life expectancy over time are also considered, together with mortality trends of the elderly, including differential mortality by sex. Changes in the family conditions and residential patterns of the elderly are reviewed, and comparisons are made with the situation in other European countries. (summary in ENG, RUS)
The historical demography of highland Guatemala
This publication contains 16 papers originally prepared for a symposium on the historical demography of highland Guatemala, held in Albany, New York, in October 1979. The aim of the symposium was "to summarize the findings to date on highland Guatemala historical demography, and lay the groundwork for future studies." Separate sections are included on the pre-Hispanic period, the colonial period, and the modern period. Individual papers deal with topics such as sources of data, population and agricultural adaptation, prehistoric demography, patterns of demographic change, native population decline, social and demographic patterns in an eighteenth-century census, mortality, demographic characteristics of peasant systems, changes in ethnic population proportions, and the interrelationships among demography, development, and modernization. (EXCERPT)
Various aspects of migration patterns and future migration policy in the USSR are examined. Three processes are noted: population movement to the underdeveloped eastern and northern regions, uninterrupted movement of rural inhabitants to the cities, and intensification of urbanization and growth of suburbs. These processes raise several questions of planned growth involving the limits of natural resources, the required level of economic and social services, and genetic and ethnic issues. (summary in ENG) (ANNOTATION)
[Population migration between city and village]
Trends and patterns of rural-urban migration in the USSR are analyzed. Motives for migration from one type of area to another are examined. Methods of controlling such movements are discussed, especially as they affect the efficient utilization of labor and the elimination of social distinctions between rural and urban areas. (summary in ENG) (ANNOTATION)
[Labor shuttle migration of the population]
Shuttle migration is defined as the time and distance covered by workers regularly commuting to and from work. The social impact of this type of migration (for example, its impact on labor efficiency and productivity) is assessed in an effort to improve transportation services. Social policies to alleviate problems caused by shuttle migration are also suggested. (ANNOTATION)
Sample Registration System, 1970-75
This report concerns the working of the Sample Registration System [SRS] for each of the five zones of India for the period 1970-1975. An attempt is made to analyze "the levels, trends and differentials in regard to population composition, fertility and mortality at the national level for the period 1970-75 and also to highlight the broad differentials among states and by rural and urban areas. Based on the SRS mortality pattern for the period 1970-75, [life] tables have been constructed separately for rural and urban areas, the details of which have been included in a separate chapter. A chapter on evaluation of the SRS death registration for 1970-75 using [the] Brass Technique is also included." (EXCERPT)
"The paper aims at demonstrating two descriptive methods applied to the model depiction of [the] spatial distribution of population." The concept of population potentials is first discussed, and a two-dimensional picture of the population potential pattern is then developed with the aid of trend functions. Data are for the district of Querfurt in the German Democratic Republic. (summary in ENG, RUS) (EXCERPT)
On estimators for dual record systems
"Three estimators of the number of events missed in a dual record system of data collection are briefly reviewed. An empirical study by Chandrasekaran and Deming which compares the performance of their estimator with that of Greenfield is then considered and some further calculations on their data are presented." The data are for Indonesia. (EXCERPT)