Family formation and ethnicity.
Through this paper, the Australian Institute of Family Studies for the first time explores the role of the family among the chief migrant groups in Australia. Using data from the 1981-82 national survey of the Institute's Australian Family Formation Project (AFF Project), this study compres the 565 foreign born and 1979 Australian born, aged 18-34, concerning household structure, family background, marriage and fertility patterns, attitudes and decisions. It found that the Southern European, Middle Eastern and South East Asian groups were more traditional in their views of premarital sex, sex roles and the centrality of the family. They often married people from the same ethnic background. Regarding age at marriage and marriage concepts, the group from the Southern European Middle Eastern region differed from all other groups. It was positive about marriage and childbearing; the family was viewed as the main source of pleasure and emotional support. This group's women married earlier, at median age 21, than those in all other groups and had more stable marriages. However, they wanted slightly smaller families on average than the Australian-born respondents, due to differences in socioeconomic status. The Southeast Asian and Chinese group also differed from their Australian counterparts in that they married much later and wanted smaller families. Only 1 in 10 wanted 3 or more children. 86% of this group under 30 and ever married had had at least 1 child, as had 80% of the Southern European and Middle Eastern women. Only 69% of the Australian born women under 30 had. There was little difference among all groups for those 30-34. In general, all groups agreed on important aspects of family life; all desired small families--the two child family being the norm--and believed marriage partners should have similar goals and values. The report first describes the AFF Project data, the scope of the analysis, the demographic and socioeconomic characteristics of the respondents and their household composition and family history. The report's second part presents the findings on family formation patterns, attitudes and intentions. The last section assesses the main findings of the analysis, the effectiveness of the AFF Project survey questionnaire and makes recommendations for the format of future surveys.
Integrated regional development planning: linking urban centres and rural areas in Bolivia.
Highly polarized settlement systems in developing countries reinforce strong disparities in levels of development between the primate city and other regions and between towns and their hinterlands in rural regions. Primate cities emerge at the expense of secondary cities. Furthermore, market towns and small settlements are usually scattered, unable to provide services to rural areas, and weakly linked to each other. Bolivia does not have an exaggerated primate city because its urbanization and industrialization are still at an early stage. The low density and wide distribution of the rural population coupled with the scarcity of functional market and regional centers is an obstacle to rural development. The mountainous terrain also creates transportation and integration difficulties. The rural population's lack of access to basic services insures that they live in absolute poverty. If integrated regional development is to occur, settlement systems must be created that can stimulate economic activities in rural areas; provide greater access for rural people to town-based markets, services, facilities, and productive activities; and increase the productive capacity of people living in rural areas. Without a hierarchy of settlements, it is difficult to promote agricultural development in rural areas and link the economies of cities with their rural hinterlands. Without accessible markets, farmers have no incentive to increase output, modernize, and adapt technology to local needs. Without integrated settlements, it becomes too expensive for the government to provide services. The US Agency for International Development's Office of Urban Development has completed a project in the department of Potosi in Bolivia in collaboration with the Bolivian government. The project identified the need for services and facilities and located investments to increase the rural population's access to urban functions. The integrated regional development planning in Potosi tries to provide, quickly and easily, the macro-regional information needed to make micro-investment policies and decisions. The methodology can provide substantial new information on spatial structure, create new perspectives on development policy, aid in the identification of projects, and give regional planners new tools and techniques for influencing investment and budgetary decisions.
This paper discusses the utility of litigation for the Chicano community by the Mexican American Legal Defense and Educational Fund (MALDEF), and formulates hypotheses concerning interest group success in the judicial arena. These findings, along with other study results, reveal the following: for interest groups to maximize their chances of success, at least at the US Supreme Court level, they must: 1) recruit expert counsel, 2) use a test case strategy, and 3) cooperate with other groups. Like many other disadvantaged groups, early on Chicanos recognized their inability to seek rights through traditional political avenues and thus sporadically resorted to litigation. MALDEF had difficulty in recruiting experienced Chicano attorneys and in dealing with the Mexican American community at large. In order to broaden the implications of court cases, MALDEF concentrated on a number of important test cases but continued to be particularly interested in education. One of these test cases, Plyler vs. Doe (1982), is a major landmark ruling from the US Supreme Court. In general, this discussion indicates that until 1973, MALDEF functioned more as a legal aid society than as an interest group litigator. It was not until Martinez became leader that MALDEF was reorganized and helped reaffirm the importance of all 3 factors to litigation success, especially for disadvantaged groups.
This article examines the dismissal, conviction, and incarceration rates for about 10,000 Los Angeles male defendants during the late 1970s and compares these rates for Hispanic, Anglo, and black defendants. 3 dependent variables are used in the analysis: 1) if the charge against the defendant is dismissed; 2) if the defendant is convicted; and 3) if the defendant, once convicted, is incarcerated. The 6 independent variables employed are the defendant's: 1) race/ethnicity, 2) offense score, 3) prior record score, 4) employment status, 5) type of attorney, and 6) type of crime. A multiple regression is used to examine the relative rates of dismissal, conviction, and incarceration of Hispanics, Anglos, and blacks while controlling for the other independent variables. Results reveal that there are few differences in the dismissal, conviction, and incarceration rates by ethnic group. The results differ somewhat from previous findings, especially regarding the incarceration rates of blacks and whites. A possible explanation for the lack of discrimination found in this study is that there are fewer blacks in urban areas of the West than in urban areas elsewhere, so blacks may be perceived as less of a threat in the West. However, because there may not be significant discrimination at some stages of the criminal process, does not mean that there will not be significant discrimination at other stages, such as by law enforcement officials.
Using 2 metropolitan jurisdictions in the southwestern US, this study compares the treatment of Anglo, black, and Mexican defendants in the US legal system. Taken from previous studies, a number of legal and extralegal attributes apparently influence case disposition. However, this research not only considers whether race ethnicity per se has an effect on sentence, but also whether other predictors of sentence operate differently across subsamples of race or ethnic identity. Race ethnicity is incorporated into the multiple regression analysis; the results examine the effects of race and ethnicity variables on sentencing after controlling for legal and extralegal attributes of the defendant and the crime. Findings indicate that use of a weapon, conviction on multiple charges, and especially prior felony convictions increase sentence severity. In El Paso, black defendants, regardless of the circumstances of their personal biography and the crime for which they are convicted, are virtually assured incarceration. The findings for Tucson are not as striking as for El Paso, but jury convictions did appear to negatively affect the sentences of both black and Mexican origin defendants. Explanations for this difference are: 1) judges and juries are fairer in some areas than others; 2) there are differences in the criminal justice systems of the 2 cities--El Paso prohibiting plea bargaining and instituting stringent case screening, while in Tucson plea bargaining is the rule; and 3) the sociodemographic composition of the 2 cities is different--El Paso's Spanish origin population comprises 62% of the city total, while only 21% of Tucson's population is so classified.
Americans all: the Mexican American generation and the politics of wartime Los Angeles, 1941-45.
This article analyzes the characteristics of the Mexican American reform-minded political generation of the 1940s who struggled for integration with rather than separation from American society. The Coordinating Council for Latin-American Youth, founded in 1941, was one of the first efforts at community organizing by young Mexican American professionals. This council adopted youth work as a reform program priority. Counseling services and improvements to playgrounds and recreation centers became the aims of the Council's youth work. Next to this, educational reforms, increased job opportunities, anti-defamation, political action, and the establishment of a Mexican American identity, were of concern to the Coordinating Council. Not segregated by law, the Mexican schools were segregated due to housing patterns and the lack of economic and residential mobility among Mexican Americans. This caused serious cultural alienation as they felt pulled in 2 cultural directions. The Coordinating Council pressured school officials to agree in May 1945 to integrate Mexican American children into the nonMexican schools. Similarly, discrimination was found in the job market; again, the Council's opening of vocational classes helped to create skilled workers and opportunities previously unavailable to this population. Although race and class discrimination together with cultural prejudice retarded the integration and assimilation of Mexicans, the Council did aid in making life slightly better for some Mexican Americans. The Council's reform struggles served notice that Mexican Americans would no longer accept second class citizenship.
A note on Mexican American voter registration and turnout.
This study examines the registration turnout linkage of Mexican Americans in South Texas, using precincts with high registration levels of Spanish surnames, and covering more than 20 years, 1956-1978. The main objective is to find out how the ethnic composition of precincts predicts voter turnout in primary and general elections. Mexican American precincts do not stay home for the general election significantly more or less than do their non-Spanish surname counterparts. The results are contrary to the Shinn-McCleskey theory which speculated that Mexican American precincts would evidence a higher level of turnout in the primary than in the general election. Instead, in the predominantly non-Mexican American precincts the turnout in all but 2 general elections is significantly greater than the party primary turnout for that same year. In addition, with Mexican American candidates now having a chance of winning the primary election, Chicano voters have more to gain in participating in the general election.
Using data from a survey conducted during the 1982 California election, this article studies the variations in the race and ethnicity of congressional candidates to estimate the impact of ethnic and racial considerations in voting decisions. A multinomial logit procedure reveals that Mexican Americans are statistically more likely to vote a straight Democratic ticket--even while controlling for party, religion, and employment status--than non-Mexican Americans. In addition, Mexican American voters are more likely to choose the candidate who is also a Mexican American Democrat. To understand the reasons for these patterns it is necessary to examine the differences in candidate and party factors, such as economic policies, abortion issues, and immigration concerns. With the exception of the handgun initiative there is no strong association between being Mexican American and holding any of these policy attitudes. However, party loyalty and candidate evaluations are 2 influencing factors in the Mexican American voters' choice; data indicates that party differences are more substantial than differences on ethnic issues. In sum, Mexican American voters are more likely to condition their vote on their information and evaluation about the quality of the candidate, Mexican American or not.
Hispanic representation in the U.S. Congress.
This article studies the significance of Hispanic representation in Congress between 1972 and 1980 by employing data on the personal traits and voting records of US representatives, as well as information on the nature of the various congressional districts. In the analysis the following questions are examined: 1) how many of the districts with significant Hispanic populations elect Hispanic representatives; 2) do Hispanic representatives adopt a distinctive pattern of roll call voting; and 3) do large Hispanic populations have an effect on the voting behavior of their representatives. Only 6% of the nation's congressional districts have constituencies that are over 1/4 Hispanic, and only 8 districts are over 50% Hispanic. A majority Hispanic population in the district is no guarantee that the district will be Hispanic represented, but it does increase those chances. On the average, Hispanic representatives are more liberal than their non-Hispanic counterparts, after controlling for party and constituency factors. Separate analyses for the 3 areas of the country with major Hispanic concentrations uphold the hypothesized relationship--the more Hispanics in a district, the less conservative the roll call voting of the representative. Because of the paltry number of Hispanics in the House, the most realistic immediate hope for most Hispanics is that non-Hispanic representatives will be responsive to the needs of Hispanic constituents. Thus, in the US House, Hispanics do not lack influence, but rather they lack the influence their numbers warrant.
This study examines labor unrest during the 1930s in the San Joaquin Valley, which was rooted in the unfavorable relationship that existed between industralized agriculture and an exploited force of Mexican workers, whose incomes were well below subsistence levels. The San Joaquin Valley cottom strike is regarded as a landmark event in California's labor history and represents a classic racial-class conflict. The development of large-scale agricultural operations demanded the employment of gangs of wage labor, often on a seasonal, periodic basis. The ordinary social relationships between the small grower and the farm laborer working side by side, will give way in an industrialized setup to an impersonal relationship. Therefore, a major factor determining the size and frequency of agricultural strikes was contingent upon the size of the farm, with large scale farms tending to underpay their labor force to reap greater profits. The political and economic influence established by cotton growers and ginners not only exploited farm workers by denying them decent wages and living conditions, but also enfringed upon smaller growers who depended on cotton gins for financing the cultivation and harvest of their crop. Mexicans comprised a significant part of the San Joaquin Valley's agricultural work force. These workers had to contend with racial attitudes that justified their lowly station in society, an image that they could be easily controlled by employers. During the course of the cotton strike, the preconceived notions that depicted Mexicans as inferior, docile, and subservient influenced growers to take action which they believed would quickly end the strike. However, the oppressed Mexican workers were willing to risk their lives to combat this injustice. The strike succeeded in raising the pay rate form $.60 to $.75, and inspired workers to renew strike activity whenever employers established unfair wages.
This article examines the impact of the 1930s Depression on the Bridgeport, Texas coal miners, who were predominantly immigrant Mexican laborers. During World War I a critical labor shortage developed in Bridgeport, as many local residents had entered the military service. At this point, coal companies initiated efforts to recruit additional labor from Mexico, and the miners began unionization to negotiate for better benefits. The post World War I era saw the end of these benefits, the reduction of wages, and a miner strike. Eventually most of the miners were destitute and forced to return to the mine. By 1930, 2/3s of the miners at Bridgeport were Mexican Americans. The Depression forced the Bridgeport Coal Company out of operation, and the situation created an extreme economic depression for the miners. This dilemna became a burden to the rest of the town and efforts to obtain money to return the miners to Mexico was a strategy that shifted the responsibility to Mexican authorities. The miners and their families were not involved in the organization or implementation of the repatriation movement; those who organized the Bridgeport movement failed to determine whether or not the miners really wanted to return to Mexico. Few of these Mexican repatriates were able to reenter the US during the 1930s.
Mexican American occupational mobility.
Using the 1979 National Chicano Survey, conducted under the auspices of the Institute for Social Research at the University of Michigan, this analysis of occupational mobility within and between Mexican American generations makes use of mobility table analysis rather than previously used multivariate approaches based on scalar measures. The study of occupational mobility also addresses issues related to the structure of the labor market in which Chicanos participate. The 3 issues addressed in this article are: 1) whether men and women differ in their patterns of mobility; 2) the imbalance between upward and downward mobility among a set of occupational categories, and 3) the way in which social background effects later experiences. Using 5 occupational categories (upper nonmanual, lower nonmanual, upper manual, lower manual, and farm), 3 types of analysis are performed: 1) father's occupation; 2) respondent's first full time occupation; and 3) occupation respondents consider their primary source of employment. Results reveal that: 1) except for small differences, Chicano men and women in the labor force experience very similar patterns of mobility; 2) unlike Anglos, New Chicano workers do not benefit from past family achievements, but they are not immune from its disadvantages; and 3) Chicanos are generally unable to make job changes that are sufficiently different to traverse the social distance implied by the 5 occupational categories. Chicanos--men and women alike--are densely concentrated in low skill, low status occupations and consequently experience a great deal of immobility in these jobs. These results show that the patterns of upward and downward mobility for Chicanos correspond closely to those for Anglos. The only asymmetries in mobility are in the table of father's occupation by respondent's first occupation--a pattern similar to that exhibited by Anglos.
The costs of disability for Hispanic males.
Based on the 1976 Survey of Income and Education, this paper analyses differentials in work related health limitations among Mexican, Puerto Rican, Central/South American, other Spanish, and nonHispanic white males in 150,000 households. Whereas Hispanics suffer generally less severe socioeconomic disadvantages than blacks, they have significantly lower occupational status and income than nonHispanic whites and are disproportionately exposed to the health risks associated with poverty. Because of the high chance of bias accompanying self reporting methods, the results showing that disability varies greatly among various Hispanic groups may be overrepresented. Still, it is clear that self reported disability confounds aspects of culture, degree of assimilation, and employment possibilities in a complex manner. Mexican and Puerto Rican origin groups, which are the most seriously disadvantaged Hispanic groups, also suffer the greatest economic impact as the result of ill health. In order to investigate the interaction of Hispanic ethnicity, disability, and the ability to speak and understand English, a series of multivariate analyses are employed. Decreased proficiency in English has a negative impact on economic well being for all groups; and the impact of disability is greatest for those who are least proficient in English. In addition, greater English proficiency is associated with the acquisition of general job skills and a greater ability to keep working at or near one's previous level, while decreased English ability may be associated with more serious health limitations, especially if language ability helps assign individuals to jobs at different levels of the occupational hierarchy. This analysis confirms that, though there are significant group differences depending upon nationality, chronic illness has a prolonged negative impact on the economic well being of Hispanics.
Immigration and perceptions of economic deprivation among working-class Mexican American men.
This study tests the validity of conventional understandings about relative deprivation among Mexican Americans by examining perceived well being in relation to objective circumstances, generation of immigration from Mexico, and assimilation. Interviews conducted with Mexican American men and women residing in Arizona, California, Colorado, and Texas, during 1978 and 1979, reveal that generational differences are the most pronounced for perceived income adequacy, with the mean for the 1st generation considerably lower than those for nonimmigrants. Perceived income adequacy, based upon 5 levels of responses, and income satisfaction, determined by any of 7 responses, indicate the perceived economic well being of respondents. Mean values for income satisfaction and standard of living satisfaction do not diverge widely across generations. Households headed by immigrant men are much worse off economically then those headed by US born men; these immigrant men tend to be less acculturated and assimilated with the dominant society than either of their generational counterparts. Because of this, immigrants, on the whole, do not define their economic status more favorably than do nonimmigrants, due primarily to the fact that income returns for immigrant headed households are drastically lower than those for others. In addition, length of residence in the US has no significant bearing on the first generation's evaluation of their economic condition. Overall, economically deprived immigrants appear no less dissatisfied than other poor Mexican Americans with their objective financial condition; rather than generational status, assimilation, or ethnicity, objective economic circumstances are the most crucial determinants of perceived economic will being. These findings fail to confirm conventional assumptions that immigrants are less apt to engage in protest over work and living conditions because they are content; instead it suggests that they are more vulnerable to apparent passivity because of certain structural factors.
The involvement of special interest groups with clashing philosophical perspectives of the role minority languages and cultures play in the classroom has led to increasing conflict about bilingual education. This paper discusses the various judicial, administrative, executive, legislative, and political means special interest groups in bilingual education have used to accomplish their purposes. The Bilingual Education Act of 1968 was the 1st bill of this kind that encouraged the special educational needs of limited English speaking children, and to provide financial assistance to local schools to carry out these programs. During the next several years, the proponents of bilingual education began to transform bilingual education from a minor curricular innovation aimed at teaching English only, into a major reform aimed at introducing the nonEnglish languages of low status groups into the public schools. By 1976, school districts having 20 or more national origin minority children of the same language group other than English had to develop bilingual education programs or possibly lose their federal funds. From 1977 through 1980, the assimilationists struggled with the pluralists to lessen the growth of federal involvement in local education. The pluralists seek to introduce and incorporate the nonEnglish languages of minority students into the curriculum; the assimilationists propose to limit the further introduction of nonEnglish languages into the curriculum and to reemphasize the need for more English language activities. Since the election of Reagan, the assimilationists have gained the upperhand in bilingual education policy. The issue at hand is not the changing character of the bill's provisions nor the federal promotion of bilingual education, but rather the role that nonEnglish languages associated with low status minority groups should play in education.
Shifts to English as usual language by Americans of Spanish mother tongue.
Drawn from a sample of the 1976 Survey of Income and Education, a probit regression model is used to investigate the factors that determine shifts from Spanish to English language in Hispanic populations. In 1976, more than 1/5 of the Hispanic Americans reported that English was their mother tongue; although most of those whose mother tongue was Spanish were still using it often, about 1/2 of them used English as their main language. Previous study results show that: 1) age is probably the most important factor that determines the amount of exposure to another language; 2) there is a positive relationship between anglicization and length of residence in the US; 3) a person who is married outside his linguistic community faces lower costs of shifts; 4) there are more language shifts among men and among women without children than among women with children; 5) the linguistic composition of the neighborhood in which a person lives influences the shifts to that dominant language; and 6) the higher the educational level of the individual, the more likely to expect language shifts. The regression analysis used to determine the net effects of each variable reveals similarities among Hispanic groups in their shifts to the English language, but there are also some differences, especially among Central and South Americans. Results show that: 1) Puerto Rican immigrants are the most likely to retain Spanish as their usual language; 2) having a nonHispanic spouse decreases by 40% the probability of Spanish retention; 3) and that the presence of younger children in the family increases the probability of speaking Spanish, while having older children decreases it. Overall, Hispanic Americans are shifting to English at a relatively fast pace because they want to improve their economic opportunites. This rapid anglicization of Hispanics may be interpreted as an indication of success, since this study suggests that the best way to improve their economic situation is by implementing policies aimed at facilitating a smooth integration into the English speaking majority.
Language networks and social status among Mexican Americans.
This study explores the impact of interlocking cultural and socioeconomic networks on status attainment and assimilation among Mexican Americans in El Paso, Texas. To move into the middle classes in the US, it helps to speak English and to be embedded in an English speaking network; a Mexican American with a predominance of English speaking associates is likely to have more aspirations, beliefs, habits, and tastes that help socioeconomic advancement in the US, than a Mexican American with more Spanish speaking associates. Social status is determined not only by wealth, power, and prestige, but also by acquaintances, friends, and neighbors. Using 3 types of variables: 1) those relating to Mexican culture and heritage; 2) those indicating past and present socioeconomic status; and 3) a demographic factor of age, results reveal that being in a Spanish speaking network has a negative effect on current socioeconomic status. There is much evidence of assimilation among Mexican Americans; successive generations are better educated, more likely to be bilingual or speak only English, more likely to have half or most of their friends and acquaintances nonMexican, know more about Anglo culture and less about Mexican culture, and live more within the traditions, institutions, and ways of Anglo culture than within the Mexican culture. Participation in Spanish speaking networks has a standardized effect of -.258 on current socioeconomic status, which has a reciprocal effect of participation in Spanish speaking networks of -.266. The economic and political situation of Mexican Americans in El Paso suggests that the negative effect of participation in Spanish speaking networks on expected socioeconomic status is a consequence of structural discrimination.
Language use in bilingual Mexican American households.
Based on a sociolinguistic survey of reported home language use by 75 bilingual American adolescents, it is determined that language choice is closely associated with parent's nativity, siblings language choice, and the adolescent's sex. 3 possible responses to a question specifically focused on respondent's reported home language use were allowed: 1) English as the single language used most often; 2) both English and Spanish used with equal frequency; and 3) Spanish as the single language used most often. Respondents, chosen from a fairly large Californian agricultural community, report that the language used most often by parents for communication at home is Spanish. In addition, an equal amount of English and Spanish is used more often with fathers and younger sisters than with other household members. Controlling for respondent's sex shows that male respondents have a tendency to use Spanish more often than female respondents; regardless of a sibling's age, male respondents use English with sisters and Spanish with brothers, whereas female respondents use English with brothers and Spanish with sisters. A comparison of language use in homes based on parents nativity shows that: 1) a father born in Mexico has a greater effect on the use of Spanish in the home than if the mother was born in Mexico; and 2) both English and Spanish are used equally in those households where parents do not share the same country of birth. Overall, language use in bilingual households appears to be a selective, reflexive, and interactive social process that typifies role relationships among family members.
Change and continuity in Mexican American religious behavior: a three-generation study.
Using a 3 generation study of Mexican Americans in Texas, this study determines the religious affiliations of parents and children, and compares the levels of continuity from generation to generation. The critical variables for this analysis are religious affiliation, frequency of church attendance, and self rated religiosity. The overwhelming majority in all 3 generations report being Catholic; the figures reflect considerable stability in religious affiliation from generation to generation. Within families, among Catholics, 91.2% in the 2nd, and 89.9% in the 3rd generation have the same religious affiliation as their parents and grandparents. Church attendance is highest among older women and lowest among younger men; the greater religiosity of the older generation and of females is also evident in their self-rated religiosity. If conversion to Protestantism is a vehicle for assimilating into the Anglo Saxon core, there is little evidence in this data that Mexican Americans have used this option to further their assimilation. It is important to note that the younger generation tend to define themselves as religious despite their lower rates of church attendance. In sum, despite extrafamilial influences, the family remains an important vehicle through which religious behavior and attitudes are transmitted from generation to generation.
Mexican American intermarriage in a nonmetropolitan context.
Using marriage records of Pecos County, Texas from 1880 to 1978, this analysis traces Chicano intermarriage patterns in a nonmetropolitan setting over an extended period of time. The exogamy rate for individuals is operationally defined as the number of persons in a specific ethnic group who marry individuals outside the group divided by the total number of persons of that given ethnicity who marry. Results show that from 1880 to as recently as 1960, only 2% of the county's Chicano were exogamous; these percentages are considerably lower than intermarriage rates in metropolitan areas. Beginning in 1970, Pecos County exogamy rates show a significant increase when compared to pre-1970 rates; this is important because Texas, compared to other southwestern states, has exhibited the greatest amount of social distance between the 2 populations. The analysis shows an overall outmarriage rate of .091 for marriages and .048 for individuals, documenting a considerable social distance as historically existed between Mexican Americans and Anglo Americans in this region. The differences in intermarriage rates before and after 1970 can be partially interpreted by Alvarez's (1973) sociohistorical concept of 4 significant Mexican American generations and their interactions with the majority society. The increase in exogamy suggests a lessening of normative proscriptions concerning majority-minority contact in at least one area of the nonmetropoitan southwest.
On the nature of Latino ethnicity.
This paper is an attempt toward a theoretical understanding of Latinos as an ethnic group. In an analysis of the social construction of Latino ethnicity by community organization leaders, consideration of possible limitations that may be inherent in this type of group form must be studied. Ethnic consciousness is defined as an awareness of belonging and/or being different; a collective uniqueness derived from shared cultural characteristics such as language and an awareness of being different from other US social groups. The 1st section of this paper shows that Latino conscious behavior is collectively generated out of the interaction of at least 2 Spanish speaking groups; the 2nd section shows the idea of Latinismo as a political phenomenon--a group identity used to gain advantages or overcome disadvantages in society. The overwhelming majority of the study's respondents ( a group of community organization leaders from the Mexican American and Puerto Rican communities in Chicago) define the idea of Latino as a political phenomenon. Overall, although the Spanish language is an important cultural feature of Latino ethnic consciousness, it still cannot be used as the primary defining characteristic of the Latino ethnic group identity and consciousness. The conceptual form of Latino ethnic group identification proposes that social groups, and their members, only compare their position and fate with a limited range of other groups or individuals, usually those a little higher in the social scale. In sum, the social organization of Latino ethnicity represents an attempt to alter existing social and power arrangements between the Spanish speaking society and the larger American society. The politicization of a situational Latino ethic identity and consciousness suggests the mobilization of Spanish speaking groups into a self conscious Latino frame of reference. However, it stresses unique national and cultural identities of the groups that it mobilizes, precisely at the historical moments when these groups are being asked to take on a Latino ethnic consciousness.
Using 1977 data representing 1450 Los Angeles residents, this paper compares responses to the threat of a damaging earthquake among Mexican Americans, blacks, and Anglos, because it is believed that how an individual deals with an earthquake threat is a manifestation of how he will deal with risk and uncertainty. To understand the patterns that distinguish 1 ethnic group from another, it is necessary to look at both convergent adaptive responses to shared life situations. 3 elements involved in the pattern of dealing with risk and uncertainty are: 1) fatalism--thought to be especially prevalent among relatively powerless social classes; 2) orientation toward science--the differential reliance upon magic or religion as contrasted with science and technology as means for controlling uncertainties of the future; and 3) time perspective--Mexican Americans and blacks have been described as living very much in the present, with little concern about events that may occur in the future. These elements are analysed after controlling for education, household income, and occupational status of all respondents. Results reveal that: 1) blacks are considerably more fatalistic about earthquakes than Anglos or Mexican Americans; 2) Anglos are clearly more favorable toward science than blacks and Mexican Americans; 3) Anglos express the least fear of earthquakes, Mexican Americans the most, and blacks were intermediate; and 4) Mexican Americans are about as likely as Anglos to perceive increased concern of earthquakes during the previous year, while blacks are significantly less so. Overall, Mexican Americans share with Anglos a disposition to believe that the future is predictable; they have greater faith than either blacks or Anglos in the manageability of the future about earthquake effects. These results run counter to the usual findings that Mexican Americans are more fatalistic and less future-oriented than Anglos. Because many Mexican Americans are recent arrivals to the US, their perceived opportunities for upward mobility not available in their former country suggests more effective social support networks; therefore, many do not share blacks' more widespread skepticism which emanates from a lack of gains in life situations. Instead, Mexican Americans' pattern of response to the risk and uncertainty associated with earthquakes seems to be an open minded blend of the old and the new.
Five proposals re China's population growth control.
China's population was 540 million in 1949. By the end of 1978 the population will reach 960 million, representing a 2% average annual growth rate. High population growth 1) is costly, 2) makes finding employment difficult, since there is little still land still to be reclaimed and agricultural productivity cannot be upgraded if backward farming techniques are used simply to employ more people, and 3) reduces the quality of material and cutural life. Nearly half of consumer funds accumulated in 1949-1977 was spent to provide basic needs for China's 600 million people. Housing has especially suffered: average per capita living space is only 2 square meters in some cities. With over 100 million primary school children and tens of millions in secondary schools, education funds must be allocated to the lower grades, to higher education's detriment. Each generation's age structure determines the next generation's reproduction scale and speed. This historical principle leads to the following: 1) population growth will continue to be vigorous given growth at a 2% rate, or if a percentage of rural (30%) and urban (10%) couples continue to have more than 2 children, or if every couple only has 2 children; 2) population stagnation requires continuous, persistent efforts, abolishing 2 or more children and encouraging one child per couple. Stagnation can be reached by 2008, with 1,200 million people. Political and ideological education combined with effective economic measures must solve the population problem. 5 strong measures must be taken: 1) economic policies and incentives should assist couples with one or no child, 2) every means should be used to communicate the population problem to the people, 3) population control should be part of the national economy program, 4) 3 births should be prohibited and one child per couple advocated, and 5) a permanent "population committee" should be established to insure ongoing population programs, policies, study, and evaluation.
Objective basis of the common law of population.
This paper examines the relationship between social production and population growth in China's Marxist society. Marxist population theory states that the mode of social production determines the law of population. The law of population is peculiar to that society and is a natural law. Population cannot be studied apart from the specific production mode. Social production also determines the common law of population since the common law exists in the specific law peculiar to a society. Population phenomena, population growth, and relations between population and social economy have common characteristics in different societies. Material production determines population production, and only within the socialist society are the 2 conditions of public ownership of production means and scientific, technological, and medical development present so that population growth is planned. Marx's historical materialism describes the relationship between production relations and productive forces, and may be applied to other social forms. Only through study of historical materialism can people see capitalism's historical limitations and socialism's superiority. Capitalism oppresses and exploits laboring people. The capitalist law of population surplus stems from the capitalist mode of production, and is a special manifestation of the law of conformity between the 2 kinds of production; it results in anarchic competition and periodic economic crises. The law of conformity between the 2 kinds of production does not exist objectively and in different societies cannot be measured by the same rule. This law is the scientific abstraction of the particular laws of all societies; it acts as a particular law only with given modes of social production. In any society, lack of conformity between 2 kinds of production cannot last. In capitalistic societies, the ruling class changes the production relations of some of the superstructure to alleviate the nonconformity between the 2 kinds of production. When nonconformity restricts production growth, social revolution results. The law of conformity between the 2 kinds of production always tends toward conformity from nonconformity. Conformity is the common law of population economy in all societies, and as the social law of population economy it can be sensed by studying Marxist theory, and through people's practical activities.
On the relationship between population growth and social and economic development.
China's population has grown rapidly since 1949, reaching a size of 1,008,170,000 by 1982. Rapid population growth has been encouraged by a high birth rate coupled with low mortality, traditional preference for sons, and the incorrect assumption that man is only a producer and not a consumer. Rapid population growth directly decreases economic development while producing a rapidly increasing labor force requiring an increase in the number of jobs available. Population growth has already reduced arable land from 3 MN in 1949 to 1.5 MN at present and can also cause sanitation and pollution problems. Only by adopting family plnning and the 1 child family can China gradually slow population growth to correspond with economic development; then the state will be able to improve health care and education and, therefore, population quality. China's population policy is not one of NeoMalthusianism, which advocates birth control and late marriage, and assumes the existence of a capitalist system and does not apply to communist systems. Malthus may have attempted to absolve the nourgeoisie from all blame by aiming his preaching against blind reproduction at the poor; he thought that overpopulation would be reduced by pestilence, war, and famine. Protecting capitalism motivated Malthus and other capitalists, but the Chinese want to promote economic development. Marx has refuted Malthus' views on population. While Chinese population policy and NeoMalthusianism agree on advocating birth control and late marriage, their underlying philosophies are different. The author supports laws and policies on fertility and family planning, and feels that population scientists must be involved in all aspects--study, propaganda, and education--relating to family planning.
An objective criterion for measuring the conformity of population growth to economic development.
China's rate of natural increase declined from 2.34% to 1.2% between 1971 and 1978, making China 1 of the developing countries with the lowest population growth rates. However, lowering the growth rate even further is essential for continued modernization. The 1 child policy is designed to lower fertility and promote economic development. Increasing national per capita income is an objective criterion for measuring how socioeconomic development conforms to population growth. Conformity here means not only sustaining life but raising the standard of living, including the production of different types of goods, full employment, and labor productivity. Economic growth must surpass population growth. China is a developing socialist country, which has the goal of providing a rich material life and physical and intellectual development. Population growth must be adjusted to material resources. China has a large population and low productivity. According to Mao Zedang, since China has been building socialism, it has an obligation to economically overtake the US in only a few decades, as opposed to the centuries it took capitalist countries to modernize. The problem of achieving this goal has 2 parts: 1) slowing population growth and 2) increasing production. The speed of population growth will make great differences in national income in 20-40 years. The 1 child family could make a significant difference in increasing national per capita income.
The principal contents and features of the measures for the third national census.
China's State Council issued "The Measures for the Third National Census" on February 19, 1982, after field testing in Wuxi City and Wuxi County in Jiangsu Province and 3 major and 10 minor revisions. 28 articles of "The Measures" define the census's leadership, organization, statndards, quality control, data processing, and published format. "The Measures" fix the date and time of the census as well as the basic demographic and social information gathered by the census. 13 items--name, relationship to household head, sex, age, nationality, residence, education, trade, occupation, employment, marital status, fertility, and survivorship of children--gather information on individuals, and 6 items--household classification, address, household size, births, and deaths-- collect information on households. Census staff are selected locally and receive short training sessions. Census data is collected from census stations and by visiting households. Data should be checked at regular intervals for verification. For the first time, census data will be processed on computers. Since planning for modernization requires data on present conditions, the census is designed to provide accurate demographic information on China. The 19 items included in the census represent a compromise between information needs for development planning and the technology available within a developing country. The census will aid also in establishing domiciliary residence for the population registration system. The third census makes full use of foreign experience but adapts it to the Chinese situation.
Chinese scholars are now compiling the first Chinese population dictionary, which shows the advance being made in the social sciences in China today. This dictionary represents a very important effort because China's population problem remains serious. The population now approaches 1 billion; no other country has a population so large. In the first 5 year plan, China achieved increasing rates of economic development but did not then realize that population control was essential for economic growth. Population growth became out-of-control during the Cultural Revolution due to sabotage from counter revolutionary cliques. Family planning was introduced again in 1971, thanks to the efforts of Zhou Enlai. The contract responsibility system, which has increased grain production by allowing peasants to keep whatever grain remains after their government quota is met, has increased grain production but unfortuantely also provides an incentive for having a big family of farm workers. Education and publicity provide the key to coping with this problem. Socialist production requires planning, including population planning. Population control should not be equated with Malthusianism or NeoMalthusianism, which characterize capitalist systems. China wants socialism. Compiling a disctionary will help to provide the theoretical basis for the practical problem of controlling population growth. Finally, compiling a dictionary requires experience in subjects and in writing and editing. Since the right people must accomplish the work, a team of experts remains the best choice for this task.
Population growth and agricultural productivity in Sub-Saharan Africa.
This paper considers the consequences of rapid population growth on labor productivity in agriculture in Sub-Sahara Africa. Population growth in the region has been rapid and the record of efficient exploitation of argricultural resources has been poor. Yet studies give evidence of large areas of still-exploitable land. The Food and Agriculture Organization estimates that enough land is available to allow food self sufficiency for a population 2.7 times larger than the actual population at present, 10.8 at intermediate, and 31.6 at high input levels. Despite this large potential, population growth is contributing to declines in agricultural productivity even at present, 1st because the distribution of population Sub-Saharan Africa is not congruent with the distribution of natural resoureces; hence there are large differences in population-natural resource balances accross the region with a few countries already at a critical stage of population pressure. 2nd, when agriculture is unable to progress to higher levels of technology during a period of growing demand for agricultural output, the onset of diminishing returns to labor may occur earlier than otherwise as a result of declining soil productivity. Poor fallow practice has been the result of sudden population pressure, with measurable negative effectws on soil productivity and the ecology. Technological infrastructure shifts (such as switching from the hoe to the plow) which would offset these problems and increase output, have ocurred very slowly. So has replacement of usufructuary land ownership with more formal systems, the problem being aggravated by competition for labor by other industries. Development policy will have to address popultion control and distribution, and encourage agricultural development, especially in areas of greatest pressure.
The political socialization of Chicano elites: a generational approach.
This article rejects traditional explanations of elite socialization and suggests a generational model to explain the development of contemporary Chicano political elites. Previous studies of American elites show that preadult socialization has a significant effect on adult attitudes, and that political elites tend disportionately to be raised within a rather economically and racially homogeneous, narrow stratum of American society. To understand the political socialization of Chicano political elites requires a different type of model than may be appropriate for Anglo elites. A generational approach: 1) demands an understanding of prior generations so that they may be distinguished from new generations, and 2) analyzes what the new generation shares in common and how that manifests itself attitudinally and behaviorally. Using data from 241 interviews of Chicanos, representing the highest political officials as of 1980, this generational model is tested. Results show that Chicano elites do come from a different and lower socioeconomic stratum, and, overall, have had fewer political role models in their families. Instead, they become politically involved as a result of discriminatory experiences associated with their class background. More specifically, discriminatory experiences are an important factor affecting the participatory motivations of respondents from low-status families, but these experiences are relatively unimportant motivational sources for respondents from higher-status backgrounds. These results help persuade Chicano constituents that this new generation of leaders understands the Mexican American historical experience and became politically involved in order to change it.
This paper compares the migration of Colombian workers to Venezuela with that of Mexican workers to the US. It focuses on migration's socioeconomic impact and deals with underlying political issues and their relationship to the socioeconomic issues. Chapter 1 describes the macroeconomic and macropolitical characteristics of the 4 countries in the study. The 2nd chapter analyzes the costs and benefits of migration under current conditions. The 3rd chapter examines the political implications of migration, especially the differing perceptions of migration in all 4 countries, from the points of view of both the governed and the governing. The next part of the study systematically compares important aspects of labor migration in neighboring countries. This comparison focuses on: 1) the socioeconomic characteristics of migrant workers, 2) how socioeconomic structure affects decision making, 3) the impact of remittances in the sending countries, and 4) the economic mobility that workers and their families derive from migration. A comparison of the migration streams from Colombia to Venezuela and from Mexico to the US is justifiable because: 1) the migration of Colombians to Venezuela is the 2nd most important migration stream in the hemisphere, 2) both migration streams generate intense controversy, and 3) comparing the 2 migration streams reveals the relationships between a society's structural characteristics and level of capital development and the nature of labor migration to or from that country. Labor migration has existed as long as countries have had unequal levels of development within precapitalist modes of production. The 4 countries in the study differ substantially in structural form and level of capitalist development. The inequalities between the US and Mexico represent a classic case of a periphery-center relationship within a world system model, while those between Venezuela and Colombia correspond to an inter-periphery relationship. This framework helps to explain why the 2 labor migration streams between sets of countries in very different stages of development are actually quite similar.
China's census and the decade beyond.
China's midyear 1982 census, the largest census ever taken anywhere, is required because data from the permanent population registration system are not sufficient for a planned economy; this is China's first legitimate census since 1953. China has a severe shortage of persons with even minimal training in statistics, record keeping, vital registration, and other fields relevant to maintaining an adequate system of permanent population registers. Due to the urgent need for statistical information about the population on which to base current policies, the census was designed as quickly as possible. A preliminary count of the total population--1 billion 8 million persons--was tallied locally from census returns, and then compiled into regional results. However, because the census was closely tied to the permanent population registration system (susceptible to biases caused by Party officials, miscounting of commune households, and the mobilization of unauthorized migrants), it represents an undercounting of the population it attempts to cover. The government policy on population may cause: 1) parents to conceal the existence of a child from census takers; and 2) local officials to misrepresent data because they may be reprimanded if the census count exceeded the population total they reported for 1981. To some extent the tendency to undercount the population is offset by a tendency to overcount some segments of the population such as the deletion of deceased family members from the household register in order to continue receiving rations. Therefore, the undercount is probably concentrated among young children and migrant adults, while the overcount is concentrated among the aged. Results of the 1982 census show that China began the 1980s with a relatively advanced mortality situation, surprisingly low fertility for a developing country, a low population growth rate, and the world's largest national population. Because of China's young age structure and fairly advanced mortality conditions, the crude death rate will remain low during the 1980s. The one child campaign has succeeded in publicizing the negative aspects of rapid population growth for China's economic development, but the production responsibility system--implemented to raise living standards of China's poor agricultural households--appears to give families renewed incentives to bear children. Therefore, a double contract system requiring one child families in households of this production responsibility system, attempts to control fertility. The major change in China's age structure during the 1980s and 1990s will be a reduction in the population under age 15; this will have an impact on the number of school age children at that time. China's 1982 census proves its worth in preparing the whold country to plan for the changing needs of the 1980s and 1990s.
Oral contraceptives and nutrition interaction.
Oral contraceptive agents (OCs) have been a part of the family planning package in India for a number of years, but their acceptability, particularly in low income groups, is quite poor. Clinical trials show a continuation rate over 6 to 12 months of less than 25% to 50%. Recent studies suggest that poor motivation and the inconvenience of having to remember to take a pill daily, rather than biomedical and physiological factors, are the major factors responsible for the discontinuation from OC trials. The interactions between OCs and nutrition are broken down to: 1) the effects of OCs on nutrition status; 2) the effects of malnutrition on some of the well documented and other side effects of OCs; 3) the effects of malnutrition on metabolism of contraceptive steroids and contraceptive efficacy; and 4) a 3 way interaction between malnutrition, disease, and drugs used in the treatment of these diseases. Experiments with rats show that OCs alter the vitamin economy by increasing the cellular requirement for the vitamins by selective increments in specific binding proteins, or apoenzymes, rather than tissue depletion. In a recent special Programme for Research in Human Reproduction (WHO), nutritional status did not appear to have any significant effect on compliance, contination rates, pregnancy rates, prevalence of menstrual side effects, or prevalence of nonspecific symptoms in any of the 3 Indian centers. Overall, data suggest that use of low dose formulations of OCs over a period of 1 year does not significantly alter the existing state of malnutrition in women in developing countries. Although malnutrition does modify the pharmaco-dynamics of contraceptive steroids, the dose of hormones in the contraceptive preparations are adequate to maintain effective blood levels of the hormones. Therefore, OCs can be used by malnourished women for short-term spacing, provided there is adequate education and clinical support to ensure regular tablet taking and for screening women to whom OC use in contraindicated.
The number of India's eligible couples effectively protected by family planning methods has remained at 22.7% since 1981, and the progress made over a period of time is slow. Such low acceptance rates, coupled with low continuation rates of methods, are major problems of family planning programs in India today. This study analyzes the influence of communication relationships in the subsystem network, on continuous or discontinuous use of various family planning methods. The findings of this study can be incorporated into the training curriculum, so that the service providers have a clear understanding of communication networks, cliques, dyads, and triads in villages with emphasis on their relationship to program performance. 4 types of family planning method users are identified: 1) continuous single method users; 2) continuous multiple method users; 3) discontinuous single method users; and 4) discontinuous multiple method users. The 2 types of network subsystems are 1) homogeneous cliques--where people interact among themselves more often than with others, and 2) heterogeneous cliques--where people from different social backgrounds interact among themselves more than with others. Using a sample size of 1067 eligible couples in Andhra Pradesh, a study will be completed in a period of 9 months, from January to September 1985. Project costs are broken down to include salaries to professionals, computer analysis costs, travel, and stationary and overheads on the salaries of personnel. Total projected costs are $11,790.40 or 1.42.900 rupees.
Effects of childhood family structure on marriage.
This paper estimates the effect of variation in parental household structure on the timing of marriage for both males and females, covering the ages of 17 to 29 for women, and 18 to 29 for men. It addresses 2 questions: 1) what is the effect of childhood family structure on later family formation; and 2) does childhood family experience affect later family formation the same for blacks as for whites. 1/3 of white and 60% of black children born to ever married mothers will experience a parental divorce at some point during their childhood; those whose parents are divorced are more prone to divorce themselves. Results reveal that children who are not raised in a family with 2 natural parents present, are somewhat less likely to marry at a given age when they are teens. Those with remarried parents probably experience divorce at an earlier age than those whose parents have not remarried. The results for black males and females are: 1) both are 10% less likely than others to marry; and 2) being raised in an intact family primarily affects black males and white females. Other factors influencing marriage probabilities are: 1) the larger the community, the lower the marriage rate for both sexes; 2) growing up in the South increases the likelihood of marriage at an early age, especially for males; 3) higher parental educational level lowers the likelihood of marriage at a given age for both sexes; and 4) for males, holding a full time job is the most important factor in the likelihood that they will marry in the next year. These results show that the family patterns children experience when they are growing up affect their own patterns of family formation. However, these childhood experiences affect sons and daughters and blacks and whites somewhat differently. Controlling for family structure does not reduce the negative effect of being black on the changes of marrying at various ages. Overall, these conclusions suggest that one should look more broadly at the effects of childhood experiences on other aspects of adult lives.
Population growth and the toxic contamination of the Great Lakes.
The Great Lake region, comprised of 5 lakes--Superior, Michigan, Huron, Erie, and Ontario--forms the largest freshwater system on earth, yet the amount of toxic chemical contamination in these lakes has become a serious problem. In many of the species of game fish that live in the Great Lakes, certain toxic chemical levels are found at dangerously high levels. Toxic chemicals which when released into the environment, or if changed by chemical, physical, or biochemical processes after release, could be detrimental to natural ecosystems or to human health. In the early 1960s, the concern about water pollution in all the Great Lakes became evident; at this time that the species composition of the lakes was drastically altered. Many game fish are now so contaminated that health warnings restricting human consumption of certain species have been announced by most of the states that border the lakes. The toxic contamination problem is getting worse mainly because of the effects of growing regional, national, and global populations; about 40 million people live in the Great Lakes Drainage Basin. There are 3 major pathways in which toxic chemicals enter the Great Lakes: 1) point sources, such as industrial and municipal discharges; 2) nonpoint land runoff, particularly from urban land, agricultural land and roads and highways; and 3) atmospheric deposition. The Great Lakes Drainage Basin encompasses some of the most heavily industrialized areas in the US. In addition, regional population growth tends to increase the amount of toxic chemicals being contributed to the area from municipal sewage systems. Atmospheric deposition is considered the largest source of toxic organics and heavy metals in the upper lakes. The Great Lakes, with their large surface areas and long water retention times, as well as their location at the focal point of a heavily populated and industrialized area, are very effective at collecting and accumulating atmospheric depositions of toxic substances.
Resolving community disputes: social conflict and social control.
Using a 1984 Edmonton area study conducted by the Population Research Laboratory at the University of Alberta, this paper discusses the types of disputes encountered in urban communities, and how they are resolved by the respondents. The traditional view of conflict, that conflict can play a number of positive functional roles in providing a force for community solidarity or allowing for the escape of tension that builds up in tightly knit groups, does not address the negative efects, where conflict can escalate to violence and crime. Disputes which may start as conflicts of interest with limited and negotiable goals, may expand into general grievances which reach beyond the original dispute to include insult, shame, and guilt. Merry identifies 3 types of disputes that can be encountered in urban communities: 1) property crimes and crime-initiated disputes; 2) neighborhood social order problems; and 3) interpersonal conflicts. The demographic characteristics included in the analysis are age; income (less than $30,000; greater than $30,000); marital status; and home ownership (own or rent). Results show that younger, lower income, and more transient groups are involved in disputes revolving around personal threats and attacks, while disagreements over money are more likely to occur in older, more affluent people in neighborhood disputes. Dispute resolution of criminal disputes are conditional on community solidarity; these forms of support do exist, and where they operate they are very important in the resolution process. Money disputes are resolved through the support of a network of intimates, and neighborhood disputes seem to generate feelings of punitiveness, with resolution possible only when this punitiveness is low. The importance of these factors in the resolution process provides support for the view that disputes can be contained through community effort, although some will get out of hand, regardless of the social networks available.
Correlates of metropolitan growth and decline, 1960-80.
This review suggests that the effects of growth and decline on an area's population composition and economic structure are multifaceted and often inconsistent with conventional hypotheses. In the 1960s, metropolitan areas of the US grew by a total of 17%, while in the 1970s the growth was 10%. Because most of the variation in growth rates is due to variation in rates of net migration, this paper classifies cities into 3 categories: 1) in-migration areas; 2) stable areas; and 3) out-migration areas. Between 1970 and 1980 in the US, 42 metropolitan areas were classified as out-migration areas, 106 as stable areas, and 156 as in-migration areas. Variables which affect the migration rate include: 1) changes in racial composition--while southern areas still had the highest percentage Black in 1980, this proportion declined in the south during the 60s and 70s while it increased in the north and the west; 2) the proportion elderly--although the north still had the highest proportion of elderly in 1980, this proportion was much closer to the southern proportion than it had been in 1960; 3) growth of the industrial sector--although related to city growth in the earlier decades of this century, it does not appear to be strongly related to growth or decline during the 1960 to 1980 period; and 4) per capita income--only in small areas of the south and west is the expected positive relationship observed. In addition, net out-migration from older metropolitan areas might lead to a narrowing of the city and suburb disparity which existed in 1970; net in-migration into newer areas might lead to a widening of this disparity in these areas. Overall, the results point to a convergence of metropolitan structure among Standard Metropolitan Statistical Area (SMSA) regions of the US.
Immigration reform: a question of numbers.
The 1984 US population increase of 2.2 million was a result of 1.65 million more births than deaths and 523,000 more immigrants than emigrants; however, because there is no official count of illegal immigration, the Census Bureau does not include illegal immigration in its calculations of US population growth. In 1984 the Immigration and Naturalization Service (INS) apprehended 1.3 million illegal immigrants at US borders. This figure indicates the need for immigration reform, and the exact form the bill takes will strongly affect America's demographic future. The cornerstone of any bill that attempts to control illegal immigration must address the hiring of illegal immigrants--employer sanctions. The Environmental Fund warns against providing amnesty to illegal aliens who arrived in the Us before January 1, 1982; instead, they support a triggered amnesty which disallows an amnesty program from being implemented until a Presidential Commission certifies that illegal immigration is under control. Other important components of an effective immigration reform bill are: 1) an overall ceiling on legal immigration; and 2) guest worker programs which introduce more people to the idea of immigration--legal or illegal. Without proper immigration reform, future efforts to protect wildrness, improve air and water quality, and provide adequate water supplies, may be overwhelmed by population growth.
International migrant workers' remittances: issues and prospects.
This paper studies different aspects of the flow of remittances--that is, the flow of foreign exchange--and how emigration affects the balance of payments. Empirical analyses in the study show that cyclical fluctuations in economic activity in the host countries explain 70%-95% of the variation in remittances flowing into labor-exporting countries. A more detailed analysis of remittance flows into Greece, Yugoslavia, and Turkey shows that the number of migrant workers abroad and their wages together explain over 90% of the variation in inflow of remittances into these countries. Relative rates of return on savings in the host and home countries, and incentive schemes (in the home country) such as the foreign exchange deposit scheme and the premium exchange rate, do not appear to have a significant impact on total remittances. However, the incentives may lead to some reallocation of savings since there is evidence that deposits under the foreign exchange schemes have increased. The proxy for demographic variables--such as length of actual or expected stay and the number of dependents at home--have some influence on per capita remittances. Unless new centers of immigration develop, it seems likely that remittances will stabilize, that is, grow at the same rate as wages in the host country. Per capita remittances may decline as (and if) workers become increasingly integrated into the host society. Empirically, there is little evidence that labor-receiving countries actively encourage trade with the labor exporters or that private direct investment is directed toward countries that are supplying labor. Nor is it entirely clear that such bilateral substitution would be efficient globally. (author's modified)
Time aggregation bias in continuous time hazard rate models for analysing duration data.
This paper shows that frequently used estimators are inconsistent when the only information available are the time intervals in which items fail, assuming the data is generated by an exponential distribution. A situation where time is not continuously measured, but instead grouped into discrete time intervals, is given as an example to test the consistency of an estimator based on the assumption that time is continuously measured. Continuous time estimators may be used to study the duration of unemployment, or time elapsed before a marital disruption occurs. A notation is developed and estimators based on the continuous time and the discrete time case for measurement are set up. Time aggregation bias is estimated, and it is found that relative bias is small when the rate is low relative to the unit of discrete time measurement. The statistical solution to time aggregation in the case of duration data is to specify estimators which take account of the aggregated nature of time. This strategy is applied to real life data to assess the extent to which it makes a difference whether the discrete time or the continuous time estinator is adopted. Results show that the continous time estimator of the rate is always less than the discrete time estimator. Thus, in the analysis of duration data, for example when analyzing the duration of unemployment, researchers may consider adopting estimators which take account of the grouped or aggregated nature of the data on durations.
The changing effect of children on subjective well-being: 1957-1976.
Using data from 2 "Americans View Their Mental Health" (AVTMH) surveys conducted in 1957 and 1976, this paper discusses the psychological well being and coping behavior of adults, comparing those with children, to those without children. Previous studies claim that adults who have children living at home report less happiness than those without children. However, this study is important in that it provides comparable information on the subjective well being and mental health of 2 representative samples of adults at different points in time. The major indpendent variable is parental status, based on the age of the youngest child and the living arrangements of the children. Results support the finding of past studies which show that parenthood has negative consequences for the subjective well being of adults; in most cases these negative effects are limited to, or are more negative for, respondents with children less than 17 years old. On the other hand, results indicate that parents perceive children more positively than do nonparents and that there is some variation among parents themselves. In fact, absent parents are shown to have the most positive views of children of all parents. A similar model examines differences in the response to children over time of respondents from 1957 and 1976 surveys, adding variables for survey year and for the interaction of year and parent status. Results show that there is no negative effect among parents with very young children in 1957 and no variation among parents with children at home in 1976; this suggests that it is 'the times' that make the difference. The cognitive/affective indicators show that parents in general are less well off than nonparents in 1976, whereas psychosomatic indicators show no differences between the 2 groups. Differences in marital happiness are probably due to selection effects: unhappily married couples are more likely to stay married if children are present. In most cases the effects of children become more negative over time; parents with children at home worry more in 1976 than they did in 1957. One reason for the negative effects of children and for the change in effects between 1957 and 1976 may be the changes which have taken place in women's labor force participation. In addition, increases in marital disruption during the 1960s and 1970s have increased the likelihood of stress, therefore it is reasonable to assume that some of the decline in the well being of parents is due to changes in family composition and family roles.
Report on study of minors who came to the Planned Parenthood Clinic for the first time.
Using a population of 59 minor women who came to the Planned Parenthood Clinic of Billings, Montana in 1980 and 1981 for the first time, this paper isolates factors which are critical in the decision making process the minor experiences before coming to the clinic. In depth interviews were conducted on each adolescent ranging from 13 years to 17 years. Background information shows that: 1) 1/2 of the adolescents interviewed have parents who are divorced; 2) only 50% live with their father while 72% live with their mother; and 3) most of the parents do not have much education. Counselors can never assume that an adolescent comes from any particular kind of household. Characteristics of sexual experiences reveal that: 1) 96% of the adolescents had already had sexual intercourse before they came to the Planned Parenthood Clinic for the first time; 2) the average age of 1st sexual intercourse is 15.18; 3) for all but the 16 year age group, the greatest percentage of adolescents have intercourse for the first time during the year that they 1st come to the clinic; 4) 62% of the adolescents have intercourse with more than 1 person, and usually within a few months to 4 years before they come to Planned Parenthood; 5) most adolescents have an unpleasureable sexual experience their first time; 49% were reported as violent experiences; and 6) the significance of sex as expressed by the adolescent women is that of an expression of closeness and love for their boyfriend. When the adolescents come to the clinic for the 1st time they already know what kind of contraceptive they want to use; 88% specifically requested oral contraceptives. Data demonstrate that people or an individual person in the adolescent woman's social network play a key part in the decision of the adolescent to come to the clinic for the 1st time; the adolescent herself, the adolescent and her boyfriend, a parent, a boyfriend alone, a girlfriend, and a sibling, in this descending order, are the persons who initiate the idea. Recommendations for more effective birth control of adolescents are: 1) males should be educated to encourage and show approval towards their partner's contraceptive use; 2) educational programs for parents to deal directly with their child's sexual experiences; 3) all children in the family should be talked to about sex and birth control; and 4) adolescents who do come to clinics should be encouraged by counselors to tell their friends about their experiences there. Studies show that there are direct correlations between high self esteem and adolescent contraceptive use; counselors can link the pragmatic concerns of adolescents for future prospects with the consequences of pregnancy. This, along with workshops which help prepare mothers to talk to their daughters about sex and contraceptives, can help adolescent women get the contraceptive information they need in order to achieve their future goals by reducing the risk of pregnancy.
Women, children, and poverty in America.
US society has yet to develop a consensus about how to provide economic assistance to poor families with children, particularly those headed by women. In 1982, 42% of all black families, 23% of all Hispanic families, and 12% of all white families were headed by women. Because of the high divorce rate, and the high percentage of women having children without marrying, the number of female headed families more than doubled between 1960 and 1982; these families are 4 1/2 times more likely to be poor than a male headed family or one that includes a married couple. These female headed families tend to be poorer than others because women often lack the skills for, or do not aspire to, or are excluded from the higher paying jobs held by men. Other obstacles include: 1) more than 1/2 of all women supporting children alone do not receive any child support from the absent father; and 2) the high incidence of teenage pregnancy interrupts schooling and, therefore, possible employment prospects. The Aid to Families with Dependent Children (AFDC) currently provides cash benefits to 3.7 million families, at a cost of more than $14 billion. Major criticisms of the AFDC program are its dehumanizing effect, its invasion of privacy, its inadequate coverage of the basic needs of poor children, and its undermining of parental responsibility to support their children. Strengthening the earning power of black men might be 1 of a number of possible strategies for pulling black families headed by women out of poverty. The Ford Foundation supports projects that: 1) deal with sex discrimination in employment, 2) promote the healthy development of infants in high risk families, 3) reduce school dropouts, 4) help ensure the observance of civil rights, 5) and assist the development of poor communities. In cluded in the foundation's work is: 1) social welfare policy research; 2) welfare to work strategies and initiatives; 3) investigations of the feasibility of providing more stable employment and career opportunities for low income home health care workers; and 4) attempts to promote the economic independence of women who head families. A prime focus of the Foundation is on teenage pregnancy and teenage parents. Delaying 2nd pregnancies seems to be one of the hardest results to achieve; one answer to this problem is involving teenage fathers in counseling programs. This confronts them with the results of their sexuality, as well as allowing the young mothers to return to work or school. Private philanthropy can contribute to assuring an adequate standard of living for all children, by showing which approaches of assistance are most successful, by disseminating information about these findings, and by setting up programs to help counteract poverty and associated problems in all communities.
Normalization issues in latent variable modeling.
Using structural equation models with latent variables on data that are somehow grouped or paired can result in erroneous and inconsistent conclusions. When using grouped data, paired comparisons can be affected by the normalization technique used; it is important to use the one which will produce consistent and meaningful results. This study discusses and critiques 3 proposed solutions to this problem: 1) the equality restriction on indicator coefficients; 2) Wilson's approach, and 3) the standardization approach. Wilson's rationale is that multiplication by the adjustment factors rmoves all within population variance differences; the adjusted items will all have the same variance as the 1st item. However, the arbitrary choice of which group to use as the reference population leads to radically different conclusions about the interpopulation ratio of latent variable variances. This method suffers from the same lack of invariance it attempts to solve, and since there is no way of testing the validity of the assumptions underlying the method, it cannot be regarded as a viable solution to the normalization problem. The latent variable standardization method puts all variables on the same scale, making it easier to compare the effects of variables measured in different metrics. Although this method is superior to Wilson's, it still unnecessarily obscures cross-population or other comparisons. The best alternative is that in which corresponding indicator coefficients are constrained to be equal, therefore making it possible to estimate meaningful metric effects, avoiding the disadvantages of standardization. The problems of this approach are: 1) in some instances, the rejection of the restriction can be dealt with without making major changes in the model; 2) model respecification and reconceptualization is sometimes necessary; and 3) there are certain types of data for which the approach is meaningless and actually disadvantageous. Overall, it is always preferable to analyze covariances of observed variables rather than correlations; hypotheses concerning correlations of observed indicators can easily be tested when analyzing covariances.
Reflecting their intellectual roots in sociology and actuarial science, demographers generally rely on decomposition as a research method and account for macrodemographic events by considering the shifting weights between subgroups exhibiting relatively stable but different patterns of behavior. Economists, on the other hand, usually seek to account for such events by analyzing the choice behavior of individuals, families, and establishments. This paper argues for a judicious marriage of these 2 research traditions to produce a modeling strategy that, for example, would first decompose the structure of migration and population redistribution processes to identify what attributes of those processes are relatively stable and unstable oveer space and time, and would then forecast only those dimensions of the processess that remain unstable. The result would be a combination of the classical demgraphic projection in which all depends on the continuation of past or current trends, and the classical economic forecast in which all depends on an explanatory theory. (author's modified)
Parametrized multistate population dynamics and projections.
This paper reports progress on the development of a population projection process that emphasizes model selection over demographic accounting. Transparent multiregional/multistate population projections that rely on parametrized model schedules are illustrated, together with simple techniques that extrapolate the recent trends exhibited by the parameters of such schedules. The parametrized schedules condense the amount of demographic information, expressing it in a language and variables that are more readily understood by the users of the projections. In addition, they permit a concise specification of the expected temporal patterns of variation among these variables, and they allow a disaggregated focus on demographic change that otherwise would not be feasible. (author's modified)
An elementary simulation model of the job matching process within an interregional setting.
Using a dynamic multiregional model, this paper discusses the job search and migration process and how they are affected by welfare levels, regional wage scales, and stress. This model relaxes the homogeneity assumptions; therefore, different skills and skill requirements exist. Despite the obvious importance of wages to both the worker and employer, the model assigns workers to jobs without regard to the wage paid; the objective function maximizes society's benefits rather than that of either the worker or the employer in isolation. 2 extreme salary distributions are used: 1) salaries are depressed to the point where the marginal worker receives a salary approaching zero; and 2) the employees control the gaming process and thus accept only high salaries. The interregional model assumes 2 types of people exist--movers and stayers. Migration occurs in response to a difference between a person's current level of utility and that level thought to be obtainable in another region. Proximal regions with lower stress values will reduce flows to more attractive, distant regions. An optimal interregional matching requires workers to engage in an interregional search for better opportunities; welfare levels and regional wage scales are determined. Welfare differentials perceived by the workers give rise to stress, and migration occurs if the experienced level of stress is greater than the perceived risk. Despite some limitations, the basic model formulated here produces reasonable results and further study is warranted. The introduction of the game theoretic formulation of the labor market into the geography literature provides a new and potentially important way to study labor migration.
Two distinct approaches to assessing the effect of geographic scale on spatial interactions are modeled. In the first, the question of whether a distance deterrence function, which explains interactions for one system of zones, can also succeed on a more aggregate scale, is examined. Only the two-parameter function for which it is found that distances between macrozones are weighted averaged of distances between component zones is satisfactory in this regard. Estimation of continuous (point-to-point) functions--in the form of quadrivariate cubic polynomials--for US interstate migration streams, is then undertaken. Upon numerical integration, these higher order surfaces yield predictions of interzonal and intrazonal movements at any scale of interest. Test of spatial stationarity, isotropy, and symmetry of interstate migration are conducted in this framework. (author's modified)
Despite the fact that the male-female sex ratio at birth is 105, all US age groups 15-19 or older were predominately female by 1960. Until 1910, waves of male immigrants insured that there were more males than females; the balance did not shift until 1940. Feminization is most pronounced in older age groups since these groups (except 75 and over) have always had high sex ratios, and possibly because of increased non-whites and decreased foreign-born whites. This paper concentrates on sex ratio changes among the white population. 1930-1950 appears to be the critical period when the transition from predominately male to predominately female occurred. Fewer foreign born whites entered the population, and the sex ratio of this group fell. The foreign born population also was an aging one--in 1940 they accounted for 1/4 of the white population over age 50. Fertility and mortality are behavioral factors relevant to sex ratio changes. Decreasing fertility from 1930-1940 slightly decreased the sex ratio, but the fertility increase from 1940-1950 slightly increased it. Mortality changes from 1930-1950, especially among females, may be the more important factor. Fertility and mortality changes reflect changes in the population's age structure, and hence, the sex ratio. Because of minimal mortality differentials at youngest ages, effects of fertility changes in sex rates occur at these ages; mortality change effects occur at ages 10 and over. Analysis of the native white population for 1940 and 1950 against the 1930 age structure confirms that demographic processes reduced the sex ratios by 0.4 and 1.0 respectively. Current changes that could influence the American population's gender compostion include 1) low fertility levels which could further decrease the overall sex ratio, resulting in a sex ratio of 94.5 by 2025 if completed births are 1.6 per woman, 2) the increasing Hispanic population, which has a higher sex ratio (99.3 in 1980) and higher fertility, 3) the increasing black population, which should raise the black sex ratio, and 4) changes in female labor force participation patterns that could halt or slightly reverse the mortality gap between males and females.
Last year, concern was voiced about the population explosion; now the concern is about the population implosion, the possibility that developed country fertility rates will lead to their extinction. The alarmist tone has been a traditional one in demography since Malthus. The author focuses on the likely impact of replacement fertility on long-term economic growth. First, key demographic trends are presented for developed countries as well as factors contributing to their economic growth during the 20th century. Replacement fertility means a smaller dependency burden, an older labor force, and an increasing need to finance retirement. Economic growth can be accounted for by labor force growth--the length of the average work week, population growth, and entry and retirement ages. Changes in labor productivity may be even more important than changes in labor force growth; this is most influenced by technology improvements and education. With lower fertility, female employment rises. One study of labor force age notes that an older labor force can become unprogressive, falling behind in technology and economics. Age may be most important where knowledge changes rapidly. Aging may mean a less mobile, and therefore less adaptable, labor force. The relative costs of dependency between the young and the old differ among countries; however, investments in the young are investments in human capital, which will become available at a later date. The consumption of the retired population is largely financed by public pay-as-you-go pension funding, other pensions, and savings. All pension plans face adjustment problems during the transition to a stationary population. An aging society spends for more on the elderly; it also spends much less on the young. Developed countries will have decreasing populations but most likely not for a long period of time. The literature is inconclusive on the relationship between aging and savings. Adjustments to changing age structures can result in substantial varaations in demand, especially for housing. Their severity, especially in light of the recent baby boom, should not be overlooked.
Changing patterns of first marriage in the United States.
This paper uses US Census and Current Population Survey (CPS) data, from 1880 to 1983, to calculate age-specific first marriage probabilities and to examine historical trends in first marriage by age, race, and sex. Because there is no consistency in pattern fluctuation across 5-year age groups, the authors reorganize the data according to period. The data clearly documents the marriage boom following World War II, but reveals that the boom did not affect all age groups: teenage marriage rates continued to rise until 1956 before sharply and steadily declining; rates for those aged 19-23 remained high throughout the 1950s and 1960s; and compared to the younger groups, rates for those aged 24-28 and 29-33 declined immediately after the postwar peak. The substantial marriage probabilities' decline during the 1970s reversed the marriage boom effects and returned marriage propensities to prewar levels. Variations from the broader marriage trends show that the war did not affect black men or women, nor white or black male teenagers. For the 19-23 age group, the postwar boom affected whites much more than blacks and decreased previous marriage probability differences between the sexes. For the 24-28 age group, white males' marriage probabilities exceeded white females' after the war, and after 1930, rates for black women fell below those for black men. 1970 data sets show steady marriage rates during the first 2-3 years of the decade, but a substantial drop between 1973 and 1977. The latter years of the decade saw a leveling off of rates and CPS estimates for the early 1980s continue this trend. Marriage decline during the 1970s was large (especially for black women), and it occurred at all ages. Between 1971 and 1979 age-specific marriage rates at ages less than 25 declined by about 40%. The 1940s and 1950s boom as well as the 1970s decline mostly affected the young. The age/period model allows for more ready interpretation of period events than would a cohort model, since although rates vary across ages, race, and sex, the shift timing occurs across all these variables. The data indicate that individual or societal characteristics, rather than differences between birth cohorts, best explain the marriage trends after World War II and in the 1970s. Cohort analysis further confirms a 1970s marriage decline; the authors question whether the decline is a short-term deviation from the boom years, a return to prewar levels, or the beginning of a long term decline.
Migration patterns during Italian urbanization, 1865-1921.
This article examines European migration behavior using 1865-1921 population register data from Casalecchio di Reno, a rural outpost near Bologna, Italy. The register records 10,600 immigrants and 9,600 emigrants, with a peak in the ealy 1870's of over 87 immigrants per 1000 persons, and 78 emigrants per 1000 by 1918. The author focuses on male immigrants over age 10, to Casalecchio, and documents a striking decline in services as a life stage for young people, a trend across Europe. Although population movements were quite local, the immigrants from Bologna increased over time, from about 1/4 to almost 1/3 of all immigrants; immigrants from more distant areas grew from 2.2% to 9.1% by the early 20th Century. Nearly 1/2 of Caselecchio's immigrants left the commune within 5 years, and 70% left within 20 years. The authors use age, marital status and kin ties, and place of origin and date of entry to calculate the hazard rate for emigration from Casalecchio. Retention rates increased as Casalecchio's agrarian economy base switched to wage labor, and as immigrants tended to be older and members of migrating households. Migrants from nearby or from similar agricultural areas remained in Casalecchio longer than other immigrants. Younger men and unmarried men, servants, and persons unrelated to the household head were more likely to emigrate. The authors examined the 63% of immigrants to Casalecchio who had left the area by 1921. Between 1865 and 1882, 44.1 returned to their rural place of origin, and 30.9 moved to Bologna; but from 1897-1915, equal proportions (39.8% vs. 39.0%) were return and stage migrants. The data illustrate that a strong current of urban-rural migration complemented the rural-urban migration, with Casalecchio as an intermediate stopping point. Return migration was 3 times the rate of emigration to Bologna by men from the rural plains. Rural-urban migration only fully developed in Central Italy when urban centers offered increased economic opportunities; long distance migration increased although migration from nearby rural areas supplied most migrants to the city.
Variations in interstate migration of men across the early stages of the life cycle.
Although past research strongly associates age and geographic mobility, some more recent research shows that inclusion of life cycle variables such as marriage and family size almost completely eliminates this relationship for individuals aged 19-40. This paper focuses on life stage variations in interstate migration for young men. Retrospective life histories of a 1969 random sample of 851 white US males, aged 30-39, provide 2,107 person-place matches for analysis. The authors examine interstate migration across 3 life cycle stages: 1) single, 2) married with no children in the household, and 3) married with at least 1 child. Previous research suggests that single and married but childless men will have the highest rates of interstate migration, and married men with children will have the lowest rates. Life cycle stage variations in interstate migration is examined in terms of 1) economic and related motives and 2) community ties. Testing the 3 control variables, childhood place, age, and education, the authors find that single males are most likely to live where they spent their childhood, and that married males without children have slightly higher education levels. Tests for job rewards--wages and prestige--indicate that job rewards increase as individuals move through the life cycle, thus wages are highest for married men with children and least for single man. These differences in resources and rewards may explain life cycle variations in interstate migration since single men have more to gain by migrating. Married men with children have an average 6 year residence length, compared to slightly more than 3 years for the other 2 stages. The probability of migrating declines more rapidly over time for married males with children than for single males, possibly due to greater community ties by the former.
The effect of changing demographic composition on recent trends in underemployment.
The authors do not believe that the secular increase in US unemployment and underemployment, from the late 1960s into the 1980s, results mainly from changes in the labor force's demographic composition. They show that labor force behavior analysis for short term and short-to-medium comparisons does not require unemployment or underemployment crude rates adjustment. 1970 and 1980 census and Current Population Survey (CPS) data show a substantial proportionate increase in the labor force aged 20-34 over aged 40-64, and increased participation by females, ranging from 5.5% for women aged 40-44 to 8.4% for women 25-29. Effects on unemployment and underemployment by age-sex changes in the labor force can not easily be predicted since women have a 1% higher unemployment rate than men, and increases in younger and older age ranges may increase unemployment, while increases in middle age groups may decrease it. The age-by-age percent female changes probably produce an unemployment and underemployment net increase. CPS information for odd, even, and all years, from 1969-1980, provide data for demographic composition rate adjustment. Analysis shows that age-sex composition change over the 1969-1980 period had only negligible absolute or relative effect on underemployment trends. Additional rate adjustment further validates the authors conclusions and demonstrates how adjustments that use external standards can give very different conclusions. Examination of detailed information on age-sex composition change shows that the various changes tend to compensate for one another, cancelling out any net effect on unemployment and underemployment.
African rural settlement patterns.
Rural settlements, characterized by illiteracy, traditionalism, isolationism, and an agricultural economy, dominate Tropical Africa. This paper presents an historical review of settlement evolution from before colonial rule to the present, to provide a better understanding of rural life for government policy formulation purposes. Before colonial rule, the early 19th century slave trade drove many villagers into scattered, remote settlements which were further established by increased food production, and decreased migration. After Africa's partition (1885), various governments concentrated dispersed settlements for security and administrative control. Rural settlements were transformed through colonial force, desires by the villagers for more land and wealth, and new settlement establishment by Europeans. In present day Africa, improved communication, a more diversified economy, and less traditional conservatism still influence rural settlement patterns. Resource development and agricultural and medical reasons currently act to change settlements, but villagers are now compensated for such moves and may even improve their earning power from them. The author describes settlement patterns in Sierra Leone, which typify much of Tropical Africa. Hill settlements, which offered security against intertribal wars, predominated in the 19th Century, but the Hut Tax War (1989) brought tranquility and an improved economy. Today, much of rural Sierra Leone has lost its population to diamond and iron mining areas. Modernization has changed food, housing, settlement size, and arrangement and farming techniques. The author emphasizes the strong environmental influences on settlement evolution and development, and urges a greater understanding of rural settlements to aid in future planning for Tropical Africa's people.
Many baby boomers, young adults born in the US since 1949, began their careers in the last 11 years, a period which has seen no rise in real wages or real family income. Workers, aged 25-34, increased from 17 million in 1970 to over 30 million today. Wages increased between 1946 and 1973, then worker productivity stagnated and inflation increased. High energy costs may largely explain this "quiet" depression. Lifetime income expectations changed as people, especially the baby boomers, earned less money than they anticipated. Baby boomers faced low starting wages and high housing costs. College freshmen attitudes reflect the baby boomers' apprehension: 69% of males and 58% of females consider financial well-being essential or very important, as compared to 50% of males and 30% of females in 1972. Contrary to some theories, an increase in service jobs does not explain low wages. More than half of all workers were in service production in 1950, and real earnings still increased until 1973. Rising consumption levels characterize post World War II family life and young families use 3 demographic strategies to maintain these levels: 1) postponement of marriage, 2) dependence on 2 incomes, and 3) reluctance to have children. Some experts predict a 2-3% annual growth rate, which should increase real wages, for the rest of the 1980s. The authors suggest that baby boomers may be less selfish than fearful of their financial security.
Rating America's metropolitan areas.
Boyer and Savageau, in Places Ranked Almanac, evaluate metropolitan characteristics using 9 categories: the arts, climate, crime, economics, education, health care and environment, housing, recreation, and transportation. In 1983, Boyer and Savageau ranked the US's 329 metropolitan statistical areas and found the following locations to be the most livable: Pittsburgh, Boston, Raleigh-Durham, San Francisco, and Philadelphia. The findings cause controversy because 1) many people do not agree with the results, and 2) other studies find southern metropolitan area living to be poorer than Boyer and Savageau's rankings indicate. Disparities exist because Boyer and Savageau 1) use only quantitative data which cannot capture personal values, and 2) weight each category equally, resulting in bias towards the largest metropolitan areas. This article's author uses a 1,122 person random sample of New York residents to provide a subjective measure for Boyer and Savageau's 9 dimensions. New Yorkers choose, in order, economics, climate, crime, housing, education, health care and environment, recreation, transportation, and the arts as the most significant features in choosing a city. By assigning numerical values to each category, the author reranks the metropolitan areas. Long Island's Nassau and Suffolk counties head the list, followed by Connecticut's Norwalk, Bridgeport, New London, Danbury, and Stanford, and New Jersey's Middlesex. Raleigh-Durham and Asheville, N.C. also rank high; Pittsburgh is 6th in the ranking. The author's top 25 cities offer above average economic growth, lower housing costs and crime rates, and good climates. They tend to be medium-sized, metropolitan areas in the East; San Francisco is the only western city represented. Rated substantially higher by the author, than in Places Rated are smaller, new-growth locations in the South, especially in Texas. American businesses which establish new branches and relocate employees would do well to examine a metropolitan area for its livability before deciding on the move.
Computers stand out at Tenth Population Census Conference.
The 10th Population Census Conference (April 29-May 3, 1985), in Honolulu, Hawaii, featured sessions on computers, fertility and mortality estimation, population projections, and mid-decade censuses and surveys. Senior officials from 15 national statistical offices attended sessions on computers in data analysis, integrated microcomputer systems and workstations of the future, and heard presentations on automation plans for the 1990 US census and New Zealand's Department of Statistics' census operation. 5 fertility and mortality estimation papers discussed own-children fertility estimates for Japan, Korea, and Pakistan, parity progression ratios use in estimating total fertility rates, and results from the 1981 Indian census. Population projection reports included presentations on 1) number and characteristics of Thailand's households, 2) Hong Kong projections based on period fertility rates, 3) computer-assisted Sri Lanka projections for 1981-2001, 4) Philippine population projections, 5) cohort-component projections for Australia, 6) Malaysia projections for 1985-2000, and 7) 1981 census based population projections in Bangladesh. Special country-specific studies included papers on 1) the 1983 Korean National Migration Survey, 2) Indonesian migration, 3) Indian immigrants in the US, 4) China's 1982 census, 5) Malaysia's census publications and demographic studies, and 6) the Bangladesh Bureau of Statistics' census and survey programs. A discussion on the 1980 World Census Program, which had as its goal the quality improvement of worldwide data, led into a discussion on the activities of the US Census Bureau's International Statistical Programs Center (ISPC) for the 1990 census. The conference included a demonstration of an integrated census data processing system recently developed at ISPC, and concluded with a session on mid-decade censuses and surveys.
The private sector, with its manpower and many resources, can greatly aid in linking family planning with overall socioeconomic improvement. This study examines a family planning program at the Harrisons and Crosfield head office, in Kuala Lumpur, Malaysia as a case study of 1) an integrated service delivery system in the private sector and 2) family planning among the rural population. The objectives are to 1) study the organizational and administrative framework and operation mechanisms for family planning services delivery by the company, 2) explain the program's performance monitoring and evaluation, 3) examine the roles and attitudes of involved personnel, 4) investigate estate workers' fertility and attitudes about birth control, and 5) assess the likely impact of the estate on program performance. 1975-1979 records for workers on 61 West Malaysian estates provide data. The National Family Planning Board (NFPB), which was designed to function in cooperation with other organizations, provides family planning services through a multiphase approach. Although overall responsibility for the family planning program remains with the NFPB, birth control services are provided as an integral component of health services. Implemented in 1971, the program served 5.6 million people by 1975. The NFPB works closely with the Federal Land Development Authority (FELDA) land schemes which provide land and services to migrants. The program also uses traditional birth attendants; key issues surrounding their involvement include their 1) motivational role, 2) attitudes and personal motivation, 3) education and supervision, and 4) acceptance of monetary incentives. The First Project (1974-1979) aims to 1) strengthen and intensify family planning and maternal and child health programs, 2) develop effective manpower and incorporate population education in schools and in the University of Malaysia, and 3) provide equipment, training facilities, and advisory services. The Second Project aims to further improve and strengthen the services, especially for the urban population, and to improve family health care and nutrition. The main goal, finally, is to develop the program into a Population and Family Health Project that goes beyond family planning and develops health infrastructure and manpower.
Metropolitan area of Rio de Janeiro.
Brazil's capital city, Rio de Janeiro, has been called Latin America's slum capital, and is slowly losing its political position to Brasilia and its cultural and economic leadership to Sao Paolo. Rio's metropolitan area includes 14 municipalities and had a population of 9.64 million in 1984, making it Latin America's 4th largest and the world's 14th largest metropolitan area. The 452-square mile central city contains 5.35 million people. Projections predict that Rio will be the world's 9th largest city in the year 2000, with a population of 13.3 million. Rio encompasses sharp social and economic contrasts; population density varies from 30,686 to 124 people per square mile and per capita municipal budgets range from $100 to $12.50. Like most metropolitan areas, Rio's suburbs show its greatest growth. The peripheral municipalities which held only 24% of the population in 1940, now have about 45%. Low land prices and government housing attact poor families to these areas which tend to be economically sluggish. Rio's fertility rate (2.8%) is the lowest in Brazil (4.2%) and life expectancy is somewhat higher than the national average. Low fertility and declining migration result in small households and increasing age structure. 2.2 million households, with 3.8 persons on an average, and 1.3 million households, with 3.6 persons, inhabited the metropolitan area and its municipality, respectively. Less of Rio's population are black (10%) or of mixed descent (39%) than in the rest of Brazil; the population is 97% Brazilian-born. Most metropolitan homes are owner occupied, but Rio also has many highly visible slums. Rio has an 84% literacy rate; 5% of the population have university degrees. The area's geography requires massive daily movement by nearly 60% of the population, and several municpalities function largely as commuter towns. Service jobs (especially for women) account for 27% of all jobs with manufacturing and tourism next in importance. Median monthly income varies from $58-$238.50 thoughout the municipalities. Compared to other major international cities, Rio is an inexpensive city. At least 50% of households own radios, televisions, refrigerators, but cars and telephones are still luxuries.
This study examines the economic characteristics of US households in 1984 by examining mean incomes and program participation statuses for different types of labor force households. The average household income for the 84 million nonfarm household in 1984 was $2260 per month, with White households having the highest averge, Spanish the next highest, and Black households the lowest average. In addition, households with the highest average monthly incomes are married couples with a householder under 65 years of age; this group has an average monthly income of $3010 and a means tested program participation rate of 11%. Female householders with no husband present, and with children under 18 years, are the most likely population group to receive means tested benefits. Women who are over 65 and living alone have the lowest incomes. The effect of labor force activity on incomes and program participation is evident in most of the household types studied; for a female householder with no husband and living with her own children under age 18, average monthly income is $470 when no member of the family has a job, $950 when someone is looking for work or has been laid off, and $1490 when someone has a job. The means tested program participation rates for these same categories are 88%, 68%, and 38%, respectively. Overall, earnings from a job are the dominant source of income, accounting for 78% of all income received; property income and social security are the next most important sources. Among the 12.4 million households in the lowest income category, 2.6 million receive an average of $340 from earnings, 4.4 million receive an average of $40 from property income, and .7 million receive an average of $170 from private support payments.
A bibliography of elderly migration literature.
Because of their rapid growth as a population subgroup in most western societies, the elderly have become an increasingly conspicuous focus of research among many of the social sciences. Since the mid-1950s the quality and quantity of empirical knowledge concerning elderly migration has rapidly increased. The majority of studies forcus on 1 of 4 basic questions central to all migration research: who migrates, why do they migrate, where do they migrate, and what are the effects of their migration. This 8 page bibliography provides a comprehensive listing of the 2 types of studies done on this topic: 1) the undertakings by gerontologists which utilize the concepts and hypotheses of resarch on the elderly by examining the determinants and individual level impacts of elderly migration; and 2) the undertakings by geographers, sociologists, demographers, and other social scientists which focus on the migration decision making process among the elderly, in addition to examining aged migrant differentials and spatial paterns.
Policy studies on the family: a selected bibliography.
This 9 page bibliography covers articles on family planning policies in English language journals. Covering the years 1973 to 1981, these articles pertain to cost effectiveness, social implications, political factors, health impacts, quality of life indicators, and changing sex roles, and how these relate to family planning programs. Developing countries, as well as the United States and other developed countries, are included in the scope.
Adolescent parenthood: January 1980 through June 1984.
This January 1980 through June 1984 Medline bibiography updates a January 1975 through April 1978 literature search on adolescent pregnancy. 129 citations are listed with Medical Subject Headings (MESH). These articles are selected from some 3000 English and foreign language journals and monographs. Because the growth of reasearch projects in adolescent pregnancy has now extended into the area of adolescent parenthood, this bibliography includes citations to: 1) antenatal care; 2) physiolgic and psycosocial aspects; 3) obstetric risks; 4) maternal role and models; 5) neonatal outcome; and 6) long term consequences of teenage parenthood. In addition, studies on the adolescent father and education for young parenthood are included. Citations selected on adolescent pregnancy are limited to those indicating parenthood in their titles or abstracts. The appendix are includes selected monographs and conferences from the Catline database and periodical articles from the July 1984 Medline database.
A critical question for expert and laypersons is whether India's lands can support its large and growing population. This is where the "carrying capacity" comes in, for it is the number of people or animals that an area of land can support on a sustainable basis. Not 1 expert in India has attempted to quantify the carrying capacity of the area under a single development block, let alone the entire country. In late 1983, the Food and Agriculture Organization (FAO) released an extensive study on the question of what India's land is physically capable of producing on a sustainable basis, without entering the realm of social organization and land reform. The picture of India that emerges from "Potential Population Supporting Capacities of Lands in the Developing World" is both exhilirating and sobering. India has enormous problems yet also has an equally enormous natural resource base for solving its problems. Assuming high and intermediate levels of inputs, the potential population supporting capacity of India's lands increased to 6.84 and 3.53 persons per hectare. India's lands could have fed as much as 3 1/2 times the existing population in 1975. By the year 2000 the picture changes for the better because of India's massive irrigation development plans. To obtain an estimate of the land that would be under rainfed production, FAO experts substracted the land under irrigation and land under nonagricultural uses. To get an estimate of the land under nonagricultural use, the study takes an average figure of 0.05 hectare per person of nonagricultural land. This means that in 1975 India needed 31 million hectares on nonagricultural land (10% of the total land area) and by 2000 it will need 52 million hectares (16% of the total land area). In this way, the study obtains a number of agro-ecological cells available for rainfed cultivation. After selecting the input level (low, intermediate, or high), each agroecological unit is then analyzed separately for 18 different crops, including grasslands, to get an estimate of the livestock potential. Thus, the study obtains the crop which is most productive under the unique circumstances of each agroecological unit. This gives the total productivity of each agroecological unit. What the FAO study shows clearly is that the key factors that will determine future success are good soil and water management measures. Both elements are totally lacking in India's agricultural management system. Probably more than family planning programs, India needs national "ecodevelopment" programs.
[Contraceptive habits in women born in 1936. Results of a health survey at ages 40 and 45]
Contraceptive practice among 541 women born in 1936 and living in a suburb of Copenhagen, Denmark, is examined. The data are from a prospective health survey. Consideration is given to the women's contraceptive practice at ages 40 and 45 and to changes in contraceptive practice and attitudes toward contraception between those ages. (summary in ENG) (ANNOTATION)
Maternal and infant mortality.
The author examines the factors affecting maternal and infant mortality in India. Consideration is given to the practicality of India reaching targeted reductions in such mortality by the year 2000. The need for more fundamental changes in attitudes toward the health and welfare of women and children, rather than an improvement in health services, is stressed. (ANNOTATION)
Trends in cancer mortality in Italy between 1951 and 1978 are described for six major cancer sites and for cancer as a whole. The statistical model used separates factors associated with age, period of birth, and period of death. Comparisons are made with the situation in England and Wales. The impact of changes in life-style, including alcohol consumption and cigarette smoking, is also considered. (ANNOTATION)
[Menarche in Denmark from the 1830s to 1983]
"Variations in the age at the menarche during the period 1835-1983 were examined on the basis of reassessments of earlier Danish data and the author's own investigations. A continuous decrease in the age at the menarche, totalling 3 years, was found from 17.4 years in 1835 to 14.4 years in 1945. A continued drop, although at a somewhat slower rate, was observed during the period 1950-1983, that is, from 13 3/4 to 13 years." (summary in ENG) (EXCERPT)
[Analysis of geographic differences in mortality in Spain]
An analysis of regional differences in mortality in Spain is presented using official data for the years 1975, 1976, and 1977. The authors discuss the differences observed and the standard mortality ratio as a tool for more efficient health administration. (summary in ENG) (ANNOTATION)
[Cause of death statistics and age]
Possible sources of error in cause of death statistics are discussed. Particular attention is given to the fact that cause of death notification may be more reliable for deaths occurring in hospitals than for those occurring elsewhere. It is noted that place of death was included in official statistics of the Federal Republic of Germany from 1968 to 1978. An analysis of these data indicates that "there was a positive correlation between a high rate of death in a hospital and a low rate of deceased 65 years of age and older, in natural causes of death only." Some additional data for Stuttgart in 1983 are also analyzed, and it is suggested that place of death should again be included in official records. (summary in ENG) (EXCERPT)
[Smoking and mortality risk among middle-aged Norwegian men]
Data from a study on migration in Norway are used to examine mortality from causes related to cigarette smoking in 1981. The data concern 12,000 middle-aged men and were collected during the period 1965-1974. The focus is on age at death and causes of death. The results indicate that the age group 35 to 44 years is at greatest risk and that the major causes of smoking-related mortality are ischemic heart disease, followed by lung cancer. (summary in ENG) (ANNOTATION)
Two decades of sterilisation, modernisation, and population growth in a rural context.
Explanations for the slight increase in the rate of population growth as recorded in the 1981 census of India are sought in the concept of survivorship. The authors investigate "the relationships among sterilisation, modernisation, and survivorship in a north Indian village based on studies made in 1958-59, 1977-78, and 1983. Comparison of the demographic data for the decades of the 1960s and 1970s reveals to some extent the degree to which sterilisation has affected survivorship. Multiple regression analysis is used to reveal the relationships among sterilisation, survivorship, and various aspects of modernisation." (EXCERPT)
[The effect of smoking on mortality among married couples]
A follow-up study concerning the effects of smoking on mortality among married couples in Denmark is presented. The data concern 1,007 couples originally examined in 1953-1954 who were followed up over a 25-year period. Consideration is given to both direct and indirect effects of smoking. The effects of active smoking, particularly on male mortality, are evident; there is no correlation observed between mortality and passive smoking. (summary in ENG) (ANNOTATION)
Reducing black neonatal mortality [letter]
The author of this letter asserts that the differences in weight-specific mortality between blacks and whites of low birthweight is even greater than that reported by Binkin et al. In addition, all mortality rates, but particularly those in the 500-1499 gm birthweight group, are higher than those reported by Binkin as a result of under-reporting of deaths in very low birthweight groups. Binkin et al included 609,191 white sigletons in their analysis and 75,735 blacks--6.4% and 2.9% fewer, respectively, than registered in the vital records of California. As a result, black births are more completely reported. A review of US natality statistics revealed that 3.6% of all white births lacked gestational age information compared to 4.4% of black births. Thus, gestational age underreporting is similar to birthweight underreporting in that both cluster among the smallest infants where mortality and failures of reporting are greatest. The consistently lower mortality rates among blacks in the low birthweight groups suggests a need to separate white and black mortality rates in area studies as well as studies in which the mortality rate of low birthweight infants serves as an index of the quality of medical care.
Contraceptives and the under 16s [letter]
The British Association for Counseling welcomes the recent House of Lords decision authorizing physicians to make contraceptives available to girls under 16 years of age without parental consent. Although the Association does not condone sexual intercourse among adolescents under 16 years of age, it recognizes that impaired family relationships all too often make it unrealistic to insist that parents be consulted about their children's sexual behavior. In such situations, the role of contraceptive counseling is crucial. Before adolescents are referred to a family planning clinic, an intermediate step may be referral to general counseling agencies or to a counselor working within the primary care team. Physicians must gain knowledge of local counseling resources and also strive to develop their own counseling skills. However, the potentially significant role that counseling can play in the family planning decision making process has been hindered by the National Health Service's nonrecognition of counselors in general practice and the lack of adequate funding for counseling centers.
Contraceptives and the under 16s [letter]
The majority ruling of the House of Lords on the Gillick case has reinforced the already onerous burden on doctors in deciding whether the girl under 16 really understands the doctor's advice. Lord Scarman was quite explicit in what this understanding covered: "There are moral and family questions, especially her relationship with her parents; long term problems associated with the emotional impact of pregnancy and its termination; and there are the risks to health of sexual intercourse at her age, risks which contraception may diminish but cannot eliminate. It follows that a doctor will have to satisfy himself that she is able to appraise these factors before he can safely proceed to contraceptive treatment. And it further follows that ordinarily the proper cause will be for him, as the guidance lays down, first to persuade the girl to bring her parents into consultation, and if she refuses, not to provide contraceptive treatment unless he is satisfied that her circumstances are such that he ought to proceed without parental knowledge and consent." Doctors practicing in family planning clinics may well feel that this responsibility cannot be exercised without the full cooperation of the family doctor. (full text)
Contraceptives and the under 16s [letter]
The author of this letter asserts that the recent House of Lords ruling on contraceptive provision to females under 16 years of age fails to clarify many situations that confront medical practitioners. The judgment states that physicians can overrule the parents' rights to be notified if there is evidence both that the parents have in some way abdicated their parental duty and that the girl is of sufficient maturity to understand family planning advice. However, the author points out that the fact that a girl is having sexual intercourse and does not want her parents to know does not imply parental abdication. If physicians make incorrect judgments, they are liable to be sued by responsible parents. Family planning physicians will have to obtain an opinion on the quality of the parents before deciding how to proceed. The British Medical Association is urged to produce fact sheets both for doctors, informing them what to assess in a youngster so as to conform with the spirit of the law, and for parents, advising them on how to encourage their daughters to talk about sex, pregnancy, and contraception.
Sulpiride and the potentiation of progestogen only contraception [letter]
Dr. F. Winton (19 October, p 1127) states, "Sulpiride is a dopamine blocking agent and is liable to give rise to . . . tardive dyskinesia." Sulpiride is quite unlike the conventional neuroleptics in its dopamine blocking action, and also has a uniquely selective pharmacological profile. Animal models, furthermore, have shown that long term administration of sulpiride did not result in the supersensitivity phenomenon which occurs with conventional neuroleptics and which is related to the mechanism of tardive dyskinesia. In terms of clinical evidence, in spite of its use for over 10 years in mainland Europe and for 6 years as a psychotropic agent in Japan, the author is unaware of a single patient who has developed tardive dyskinesia as a result of treatment with sulpiride in the absence of a history of treatment with conventional neuroleptics. (full text)
What accounts for the varying growth rates in India, Pakistan, and Bangladesh, 1950-1980?
Gross domestic product rates for India, Pakistan, Bangladesh, and Pakistan-Bangladesh together are presented for the period 1950-80. All countries demonstrated a lack of consistency in their economic growth, especially Bangladesh where the annual growth rate ranged from -12.3% in 1972 to +9.7% in 1976. In each country, over half of the actual growth was absorbed by population increases. Pakistan demonstrated the best growth overall, whether measured in actual or per capita growth rates, and Bangladesh showed the poorest record. Except for the 5-year period coinciding with the revolt in Bangladesh, the Pakistani growth rate exceeded that of India, presumably because of the external assistance Pakistan received. The Pakistan-Bangladesh growth rate exceeded India's growth rate in the 1965-70 period. Growth patterns in Pakistan and Bangladesh were not strikingly different during the 20 years these countries were united (average of 4.9% in West Pakistan and 3.6% in East Pakistan). On a per capita basis, West Pakistan was able to control its population growth more effectively than East Pakistan. The study of countries in the Indian subcontinent offers those interested in economic development an opportunity to assess the influence of cultural and political factors on economic growth.
Preliminary estimates of fertility decline in Bangladesh.
The Bongaarts model of proximate determinants of fertility was used to determine whether a fertility decline occurred in Bangladesh during the intercensal period 1961-74 to 1974-81. This model focuses on changes in 4 proximate determinants of fertility: marriage, contraceptive use, incidence of induced abortion, and duration of breastfeeding. Available data suggest that Bangladesh's total fertility rate declined by about 16% between 1975-83, from 6.88 to 5.77. The index of proportion married declined from 92 in 1974 to 86 in 1981. The percentage of eligible couples protected by contraception is judged to have increased from 7.7% in 1975-76 to 14.6% in 1979-80 and is still gradually rising. The index of abortion is assumed to have remained unchanged throughout the study period due to the repressive character of Bangladesh's abortion law. Finally, the average duration of breastfeeding is assumed to have remained at 26 months between 1975-83. The fertility decline in the younger age groups reflects the effect of rising age at marriage, whereas the decline among women over 25 years of age reflects increased use of fertility control methods.
Husband's occupation and marital fertility in four Muslim populations.
This study, based on World Fertility Survey data collected in the mid-1970s, analyzed the association between marital fertility and husband's occupation in 16,500 currently married women aged 15-49 years in Bangladesh, Java, Jordan, and Pakistan. Current fertility (number of children born in the 5 years before the survey) did not differ substantially by husband's occupation in Bangladesh; the difference in total marital fertility rate between the highest and lowest fertility category was only 0.4 child. In Jordan and Pakistan, professional and clerical occupation was associated with the lowest fertility; in Java, current fertility was lowest among those married to men employed in the agriculture and household sector. Analysis of variance indicated that husband's occupation had a significant effect on fertility only in Java and Jordan. Mean children ever born was highest in all the occupational groups in Jordan and lowest in Java. The low fertility in Java compared to the other populations studied is believed to reflect their moderately longer duration of breastfeeding and higher use of efficient contraceptive methods. These results failed to support the observation that agriculture and household activities are conducive to higher fertility.
Postponing or preventing deaths? Trends in infant survival.
According to the author of this letter, the weight-specific neonatal mortality declines reported by Buehler et al in their article on infant survival in Georgia are questionable. There is no clear pattern that associates the weight-specific mortality decline with increased utilization of neonatal intensive care units (NICU). In the 500-999 gm group, where NICU care would be most indicated, the mortality decline in Georgia between 1974-75 and 1980-81 was 23.4% compared with 33.3% for infants weighing over 2500 gm, presumably the least likely to receive NICU care. The better survival among infants admitted for intensive care may have resulted from a selection bias that has spuriously lowered the neonatal mortality rates among very low birthweight infants. Newborns must live long enough to be eligible for transfer to NICU care. Moreover, although efforts have been made in Georgia to overcome underregistration of births and deaths, underreporting still persists.
The authors induced ovulation in 34 cycles in 16 women following the administration of gonadotropin-releasing hormone (GnRH). In 2 patients 2 control cycles were induced. The patients self-administered GnRH through an indwelling intravenous catheter every 2 hours for 18 hours per day. In subsequent cycles the dose interval, dosage and infusion site, intravenous or subcutaneous, were varied. In all patients the estradiol, follicle stimulating hormone and luteinizing hormone were measured, and follicular development was assessed ultrasonographically. Based on this preliminary study, a total of 34 cycles were studied in 16 women treated with 10 mg of self-administered GnRH intravenously every 2 hours during the day. Apparent ovulation was documented in all 34 cycles, and 11 pregnancies occurred. It appears that self-administered GnRH is economical and safe and achieves satisfactory results with respect to both ovulation and pregnancy. (author's)
Quantitative pathologic changes in the human testis after vasectomy: a controlled study.
To determine whether there are any deleterious changes in the human testis after vasectomy, the authors obtained testicular biopsy specimens from 31 healthy men undergoing vasectomy reversal and from 21 healthy, fertile volunteers. Morphometric analyses of these specimens revealed a 100% increase in the thickness of the seminiferous tubular walls (p < 0.001), a 50% increase in the mean cross-sectional tubular area (p < 0.001), and a significant reduction in the mean number of Sertoli cells (p < 0.01) and spermatids (p < 0.01) per tubular cross section in the post-vasectomy group, as compared with the control group. Focal interstitial fibrosis was observed in 23% of the specimens from the post-vasectomy group and in none from the control group. There was a significant correlation (p < 0.01) between interstitial fibrosis and infertility in patients who underwent a surgically successful vasectomy reversal (sperm in the ejaculate). None of the other measured characteristics correlated with infertility after vasectomy reversal. The authors conclude that significant morphologic changes occur in the human testis after vasectomy. The presence of focal interstitial fibrosis was associated with a high incidence of infertility in this series. (author's)
Case 46-1985 [A 32-year old woman with a cystic hepatic mass]
This case, drawn from the records of the Massachusetts General Hospital, involved a 32-year old woman admitted to the hospital because of a cystic liver mass. 5 months before admission, the patient experienced diarrhea and fever; 3 months before admission, a pressure sensation was felt in the epigastrium and a mass was noted. Ultrasonography revealed a separate cystic mass, 6 cm, in the left hepatic lobe. The patient had used a norethindrone-mestranol oral contraceptive (OC) for 2 years (beginning 8 years before hospital entry) and had taken medroxyprogesterone acetate 2 years later to treat endometriosis. Cysts of the liver are uncommon lesions and encompass a heterogeneous group of disorders. Liver cell adenoma has increased in frequency since the widespread use of OCs, and focal nodular hyperplasia, although apparently not related developmentally to OC use, tends to be considerably more vascular in women using contraceptive agents. In this case, the clinical course, normal laboratory findings, and radiographic features were consistent with a diagnosis of bilary cystadenoma. It was further postulated that the periportal sinusoidal dilatation noted was a coexistent pathologic entity related to the use of OCs. Since completion of this case, the literature has reported 17 cases of hepatobiliary cystadenoma, all occurring in women and 4 involving malignant change.
The effects of vasectomy on the testis.
The increased use of vasectomy for population control has led to a large number of animal studies on the morphologic, physiologic, and immunologic responses to this procedure. The extent, nature, and timing of morphologic alterations in the testis showed marked species variations and ranged from autoimmune orchitis to an absence of detectable changes. Physiologic studies indicated, contrary to expectation, that the hydrostatic pressure was elevated only in the distal part of the epididymis and not in the seminiferous tubules of several species. Immunologic studies have shown an increase in serum levels of antisperm antibody after vasectomy in a large number of species, but marked differences have been noted even between strains of a given species. In most cases, sperm appear to escape the duct system at some point, causing the formation of a spermatic granuloma. The location and time of development of granulomas after vasectomy may be related to regional differences in the distensibility of the duct system. Difficulties in obtaining tissue specimens have limited information about potential morphologic alterations in human testes after vasectomy, but spermatic granulomas have been reported. In addition, 50-70% of men are reported to have elevated serum levels of antisperm antibody after vasectomy. The relatively small proportion of men who become fertile after vasectomy reversal by vasovaostomy (40-70%) may involve antisperm antibodies in the serum or reproductive tract fluids. An immunologic response to extravasated spermatozoa may be involved in testicular alterations after vasectomy. The mechanism of the pathogenesis of testicular changes after vasectomy remains an important focus for research as the demand for vasectomy reversal continues to grow.
A comparison of the effects of nonoxynol-9 and chlorhexidine on sperm motility.
The effects of Nonoxynol-9 and chlorhexidine on sperm motility were compared using the objective Transmembrane Migration Ratio method. These agents were found to be of similar potency in inhibiting sperm motility. The concentration which reduced sperm motility by 50% (EC50) were 0.205 mg/ml for Nonoxynol-9 and 0.215 mg/ml for chlorhexidine. The implications of these findings in relation to the comparison of the effects of drugs on sperm motility and the development of new contraceptive agents are discussed. (author's)
Reproductive endocrine effects of intranasal administration of norethisterone (NET) to women.
4 consecutive menstrual cycles were studied in 6 healthy parous women. A solvent mixture comprising propylene glycol:ethanol:water (3:3:4) was sprayed intranasally daily using a glass atomizer between days 5 and 24 of the 1st (control) menstrual cycle. Norethisterone (NET) was dissolved in the solvent and similarly administered at a daily dose of 100 mcg during the 2nd and 3rd menstrual cycles. Nasal sprays were not administered during the 4th post-treatment cycle. Blood samples were taken during 4 consecutive cycles between days 8 and 15 and again between days 20 and 24 of the cycle to estimate levels of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone (P). These studies revealed that nasal sprays of NET were well accepted and that no adverse clinical effects or menstrual disturbances occurred. NET inhibited ovulation in 1 cycle. The E2-induced mid-cycle rise in FSH and LH was either suppressed or inhibited in 9 out of the 12 treated cycles. P levels in 3 treated cycles were indicative of luteal inadequacy. These endocrine effects of NET persisted into the post-treatment cycle in 2 cases. (author's)
Serum lipid levels before and after vasectomy in men.
The blood lipid profile was determined in 62 men, 24-62 years old, before and 2, 6, and 12 months after surgical occlusion of the vas deferens. No statistically significant differences were found in mean body weight, blood pressure, serum levels of non-esterified fatty acids, total lipids, triglycerides, total cholesterol and alpha, beta, and prebeta fractions of the lipoproteins, which were measured before and after surgery. When the serum levels of the alpha and beta fractions were considered in the same subject, it was observed that 12 months after vasectomy a similar percentage of cases showed a predominance of either one of them. Hence, no modifications on the lipid profile of these subjects were found that could indicate an increased risk of arteriosclerotic disease. (author's)
Plasma concentrations of cholesterol, HDL-cholesterol, and levonorgestrel were determined in 2 groups of women using levonorgestrel-releasing subdermal implants. 1 group used 6 capsules (NORPLANT-R); the other 6 covered rods. Plasma concentrations of levonorgestrel decreased to 300 pg/ml at 8 weeks and to about 230 pg/ml by 50 weeks. Concentrations among covered rod users were 1.4 to 1.7 times higher at comparable time periods. Total serum cholesterol and HDL-cholesterol were decreased as compared with controls at all sampling intervals during the 114 weeks of the trial, although the differences did not meet tests of significance at all time periods. Decreases during the test period were of the order of 10%, except for total cholesterol among covered rod users where the decrease was less. Cholesterol to HDL-cholesterol ratios did not differ significantly from control values at any sampling period. (author's)
Norplant contraceptive implants: a new contraceptive for women.
This article summarizes current knowledge on the mechanism of action, side effects, and effectiveness of Norplant contraceptive implants. The most common side effect of the implant method is its disruption of the menstrual cycle, especially in the 1st few months of use. Long intervals without frank bleeding may occur and be misinterpreted as pregnancy in women who have not been counseled about this possibility. The average annual continuation rate was 84/100 in a study of 324 women from several countries who were followed for 5 years after Norplant implantation. The net cumulative pregnancy rate for the 5-year study period was 0.6/100. Reasons for method termination included menstrual problems, other medical problems (headache, depression, fatique), planning pregnancy, and other personal reasons (change in marital status, change in residence). To provide training for doctors, nurses, and counselors, the Population Council has established a network of 5 training institutions. Within the next few years, drug regulatory agencies are expected to approve use of Norplant implants in many countries. Although at present the method is available only in Finland and Sweden, Thailand and Indonesia are considering the method and clinical trials are underway in India, China, Brazil, and the US. A consulting committee of the World Health Organization has concluded that Norplant implants are a suitable contraceptive method for use in family planning programs.
In this paper, an epidemiological analysis was performed using an international data set exclusively on the expulsion problem associated with postpartum IUD insertions. The insertor's experience in postplacental insertions is probably an important determining factor for IUD expulsions. Immediate insertions were made (within 10 minutes after placental delivery) during the woman's postpartum hospitalization. No significant differences were detected between the standard Lippes Loop D and Copper T IUDs and their counterpart Delta devices specifically designed for postpartum use, between the 2 types of Delta devices or between the hand and inserter methods. A case control analysis also did not detect any significant association between IUD expulsions and mild complications occurring or management performed during the 3rd stage of labor and delivery. The practical implications of those findings, the methodologic problems of this analysis and future research strategies are also discussed. (author's)
Tenth Asian and Oceanic Congress of Obstetrics and Gynaecology.
The 10th Asian and Oceanic Congress of Obstetrics and Gynecology, held in Sri Lanka in September 1985, was entitled Health of the Mother and Child by the Year 2000. Most of the 300 participating physicians were from developing countries. Particular emphasis was placed on the high rates of maternal mortality in developing countries. Even where maternal-child health programs have been established, maternal health tends to be neglected. In some developing countries, maternal mortality rates are 500 times greater than those in developed countries. Training of traditional birth attendants and better provision of family planning were urged to reduce maternal morbidity and mortality. Other actions proposed at the conference included health education, mobile antenatal clinics in rural areas, establishment of more peripheral hospitals, and improvement in social and economic conditions. To reduce infant mortality, growth surveillance, oral rehydration, breastfeeding, and immunization were urged. A special session on planned parenthood for maternal-child health noted family planning's potential for preventing the complications of childbearing and abortion. Finally, it was pointed out that although family planning is supposed to be a basic human right for individuals and couples, political constraints on the manufacture, delivery, and free choice of methods persist in many countries.
Perinatal and infant mortality.
Australia's infant mortality rate fell below 10/1000 live births for the 1st time in 1983 (9.6/1000). Internationally, Australia ranks 12th in infant mortality among countries with populations over 2.5 million. Contributing to this relatively poor international standing has been the high incidence of low birthweight infants, high postneonatal mortality in disadvantaged population groups such as the Aborigines, and the completeness of registration of infant mortality in Australia. There is a legal requirement that perinatal deaths from at least 20 weeks gestation or 400 gm birthweight be registered. In 1983, the national perinatal mortality rate was 12.2/1000 births. The greatest reduction in neonatal mortality has been among infants weighing 1000-2499 gms. Most of the recent improvement in the low birthweight component of the neonatal death rate is attributable to the better survival of these infants, not a major reduction in the incidence of low birthweight. Several proposals are made for improving the data on perinatal and infant mortality in Australia. These deaths should be routinely linked to the maternal and fetal or neonatal data in the perinatal morbidity data collections to facilitate identification of risk factors. Also, pregnancies terminated after diagnosis of fetal abnormalities should be included in these perinatal data collections. Steps such as educating the community about the adverse effects of alcohol and smoking in pregnancy, increased planning of pregnancy, better detection of high risk pregnancies, and regionalization of the care of pregnant women at high risk of complications could contribute to further reductions in infant and perinatal mortality in Australia.
Stillbirth, neonatal, and postneonatal infant deaths in Western Australia were analyzed from 1970 to 1981. Falls in all 3 rates were apparent. The neonatal mortality rate showed the sharpest decline, from 14.05 to 5.47/1000 total births. The stillbirth rate dropped from 12.64 to 8.31, and the postneonatal infant mortality rate fell from 6.24 to 2.27. The intrapartum stillbirth rate for nonmalformed fetuses of over 28 weeks gestation fell from 2.55 in 1970 to 0.68 in 1981. The largest percentage of stillbirths, 37% in both 1970 and 1981, was associated with birthweight under 1000 gm. Congenital malformation as a cause of neonatal death doubled from 20.9% in 1970 to 39.2% in 1981. In the postneonatal period, crib death accounted for 35.2% of deaths in 1970 and 51.9% in 1981. Recent improvements in perinatal and infant mortality are attributed to better obstetric and pediatric services as well as the introduction of neonatal intensive care units. 4 conclusions are drawn from these findings: 1) the major causes of perinatal and infant deaths--congenital malformations, stillbirths of unknown cause, preterm births, and crib death--should be investigated further; 2) given the current low levels of mortality, further improvements in health care cannot be expected to generate additional dramatic declines, and the task is to develop indices of perinatal morbidity as measures of care and to identify problem areas; 3) prevention of preterm births and malformation has the potential to reduce both morbidity and mortality; and 4) declines in community-based factors such as standard of living, immunization coverage, and access to medical care are certain to have a negative effect on infant mortality rates.
Guidelines for choosing a pregnancy test.
This article presents data on the relative sensitivity, incubation time, specimen volume, and reaction time of a wide range of pregnancy tests, including radioimmunoassay (RIA), enzyme-linked immunoabsorbent assay (ELISA), home tests, tube tests, and slide tests. RIA testing is expensive and requires a laboratory, skilled professionals, and highly sophisticated equipment. However, its added sensitivity and specificity permit measurement of human chorionic gonadotropin (hCG) as early as 8 days after ovulation. Newer tests that make use of beta-hCG-specific antibody bound to latex particles are easy, reproducible, and give results within 90 minutes. At this point, ELISA testing is most popular. Its advantages include stability of the antigen enzyme conjugate and test reagents, simple equipment needs, and the absence of nuclear waste products. It offers 5-minute results coupled with a sensitivity of 25-50 mIU/mL. Pregnancy tests can be used to detect normal or ectopic pregnancy, predict threatened abortion, or follow up spontaneous abortion. Other uses include diagnosis of trophoblastic disease, molar pregnancy, choriocarcinoma, or benign inflammatory disease. Titers of hCG should rise during normal pregnancy and drop after abortion. Qualitative new generation beta-specific latex tube tests based on agglutination inhibition are adequate for diagnosing pregnancy in the normal patient. Because of their speed and increased sensitivity, ELISA tests are replacing older immunoassay systems. RIA testing will remain for ongoing qualitative evaluation of pregnancy prognosis and tumor follow up.
Male involvement in family planning: strategies for action.
The Secretary-General of India's Family Planning Association stresses the need for increased involvement on the part of men in fertility control campaigns. Most family planning programs are designed for women and fail to acknowledge men's involvement in decisions about contraception. Recommended are program approaches that build on men's positive attitudes toward family planning and their awareness of their responsibilities to both family and society. Male components should be integrated into ongoing program activities and backed up by a sound information, education, and service strategy. The support of formal and informal leaders in the community and use of local infrastructures for communication is essential. Cooperation with relevant governmental and nongovernmental organizations is desirable. Strategies to increase shared responsibility for family planning include identification of local values and traditions that encourage joint responsibility, stimulation of discussions on the roles and responsibilities of both sexes, promotion of family life and parenthood education programs, extended collaboration with trade unions and predominantly male groups such as the armed forces, and involvement of men in efforts to promote the rights of women. In cases where the level of knowledge and support for family planning is favorable, contraceptive practice by men themselves can be promoted. Such an effort can be facilitated by encouraging male opinion leaders to support male contraceptive practice and involving satisfied male acceptors in promotion.
New horizons in population education: FPAI's pioneering role.
The role of the Family Planning Association of India (FPAI) in population education is reviewed since 1971, the year this program was formally initiated. Today, most FPAI branches have strong population education programs. A population education unit has been established within the Ministry of Education and Culture and technical guidance is provided by the National Population Education Project (NCERT) staff. 12 states have introduced population education in their elementary teachers' training curriculum and 16 states have developed instructional material for teachers. In addition, 5 states have been promoting population education research. In the nonformal sector, population education has been linked with the National Adult Education Program. A 1975 FPAI-sponsored conference entitled Tommorrow's Parents Today was the 1st attempt to reach out to youth on a wide scale. A subsequent conference (All India Youth Conference on Population Education, 1977) focused on the theme Population 2000: A Challenge to Youth and drew up a plan of action that included expansion of sex education, raising the age at marriage, improving women's status, and promoting education on contraception among young people. Today the FPAI has several Sex Counseling Education, Research and Training centers that are especially geared to the counseling needs of youth. These centers should play a greater role, especially in 1985, the International Year of the Youth. More collaboration is needed with environmental programs. As the formal sector becomes increasingly covered by government, the FPAI will have to intensify its efforts in the nonformal sector. It is important that resources and energies not be dissipated in an effort to start rival programs in areas where programs already exist.
Risk of teenage pregnancy in adolescent sex play.
This article describes a case in which a 15-year old Indian girl was impregnated by her 17-year old brother through casual sex play. Neither sibling had any knowledge of conception or contraception. Although the girl was 34 weeks pregnant at the time she was seen by the author, the pregnancy had not been noticed by those in her home or at her school. The infant was subsequently put up for adoption, and the girl and her brother were given counseling to deal with their feelings of guilt and shame. The author has seen 94 cases of this type. Taken together, they suggest that teenage pregnancies in India largely result from sexual activity with family members (brother, cousin, sister's husband). They reflect a lack of sex education. Infants from such liaisons must be put up for adoption, and confinement in a nursing home is essential during the last 2 months of pregnancy to protect the family from social scandal.
Microsurgical vasovasostomy for reversal of elective bilateral segmental vasectomy.
Microsurgical vasovasostomy for the reversal of elective bilateral segmental vasectomy (vasectomy, vas ligation) was done in 57 patients (61 operations) between May 1977 and March 1984. The length of time between elective segmental vasectomy and and subsequent vasovasostomy ranged from 12-216 months; the longest period between vasectomy and vasovasostomy resulting in a subsequent pregnancy was 108 months. The patency rate was 83%, with 51% of these patients fathering 1 or more children (overall pregnancy rate of 41%). Unlike previous studies, the authors' study showed no positive correlation between the presence of postvasectomy sperm granulomas and either patency or pregnancy rate after microsurgical vasovasostomy. The major factor that seemed to affect the success of the procedure was the number of years between vas ligation and vasovasostomy. (author's)
A study of the influence of ovulation stimulants and oral contraception on twin births in England.
A study of 111 mothers of twins in Nottinghamshire, England in 1981-82 showed that at least 12 had used ovulation stimulants, compared to 2 of 102 mothers of singletons. Thus, the use of ovulation stimulants increased the twinning rate of this population by about 10%; this may explain the recently noted levelling off in the secular decline in twinning rates. In contrast to a recent study in France, no association between twinning and prior use of oral contraceptives was seen. (author's)
The pattern and attitude of Nigerian women in Benin City towards female sterilisation.
All the cases of female sterilization at the maternity unit of the University of Benin Teaching Hospital, Benin City, Nigeria, between January 1974 and December 1981 are analyzed. There were a total of 248 sterilizations out of 19,905 deliveries, an incidence of 1 in 80 or 1.25%. There were 176 voluntary sterilizations out of 3256 grand multipara, an incidence of 1 in 18 or 5.6%. To find out the background of the practice level, 560 grandmultipara were interviewed about their attitude towards female sterilization. Reasons for the low acceptance level included desire for more children, permanent nature of the procedure, opposition from relations, blockage of tubes at reincarnation, fetal wastage, and religious opposition. (author's)
In 1974 Morton et al. gave their 1st report on the application of the rosette inhibition assay for the detection of early pregnancy in mice. Since then, this phenomenon has been described as well in other mammals, such as sheep, pig, cattle, rat, and humans. It is possible with this test system to detect pregnancy within hours after fertilization. Because the success rate of the test depends on various nonstandardizable factors, it is not surprising that some laboratories have failed to confirm Morton's results and the results of others. Although their failure might be explained by differences in methodology from that of Morton, it remains unclear exactly how variations in the methods used influence the mechanisms allowing the detection of early pregnancy factor (EPF). Therefore, as has been previously pointed out by Whyte and Heap, the function of EPF must be viewed somewhat skeptically and needs further investigation. The study presented incorporates a modified assay to investigate EPF levels in serum from patients with a normal intact pregnancy as well as in patients before and after therapeutic abortion. A discussion of the mechanism of EPF activity on rosette formation is also included. (author's)
The sexual revolution is here--almost.
Recent social and technical developments have dramatically altered the ways in which sexual matters are regarded and are expected to produce a sexual revolution in upcoming years. This revolution is exemplified in currently emerging reproductive techniques, alterations in male-female life patterns, the breakdown of rigid definitions of acceptable sexual expression, and a shift in the acceptable sources for determining our appraisal of moral-ethical issues. There has been a shift from acceptance of religious edicts to a concern for fulfilling human needs. Technological advances have divorced reproductive processes from genital copulation. Increasing exposure to environmental pollutants may lead to the existence of germinal storage banks. Contraceptive technology has made it possible for women in particular to redirect their lives, bypassing childbearing in some cases. By the year 2000, it is speculated that little attention will be paid to male-female physiological differences. In turn, the disassociation of sex from reproduction and the changing nature of sex roles have made homosexual relating more acceptable. It is possible that the categories of homosexuality and heterosexuality will become obsolete within the next few decades. If sexism is to be eliminated from our thinking, males and females must be viewed as persons 1st--persons with a deep concern for others and for experiencing a satisfying life. All these developments constitute a genuine sexual revolution.
Down syndrome and parental coital rate [letter]
The author of this letter refutes the existence of a causal relationship between low parental coital rates and Down syndrome. If the relationship were in fact causal, one would expect to find a disproportionately high number of infants with Down syndrome born to women in subgroups with low coital rates (eg, those who have illegitimate children or those married for long durations). However, when maternal age is controlled, the incidence of Down syndrome is no higher in illegitimate than legitimate infants or in infants born to women married for long as opposed to short durations. In addition, births of Down syndrome infants are not preceded by unusually long fallow periods, nor is the fertility preceding such births lower than that preceding the birth of normal infants. In cases where mothers of Down syndrome infants have low coital rates, a systemic malfunction may be responsible for both factors. It is possible that fathers of children with Down syndrome may play a more central role than is currently recognized. When maternal age is controlled, paternal age is positively associated with the probability of the birth of an affected child, and husband's age is associated with coital rate.
Down syndrome and parental coital rate [letter]
The author of this letter presents data suggesting that practice of the ovulatory method of natural family planning may constitute the underlying link between a high incidence of Down syndrome and infrequent intercourse. The role of the aging oocyte in the production of autosomal trisomies is recognized. Analysis of Down syndrome births in Western Australia in 1966-75 revealed an incidence among Catholic women more than double that noted in all other religious groups (1.935/1000 live births versus 0.842/1000 live births). This high incidence was fairly constant throughout the period under study, was apparent in all maternal age groups, and was unrelated to birth rank or ethnicity. This statistically significant association must reflect some practice common to Catholic women.
Pathology of colposcopic findings in 2635 diethylstilbestrol-exposed young women.
An analysis of 6055 colposcopically directed biopsy specimens from 2635 diethylstilbestrol (DES)-exposed women and 445 biopsy specimens from 277 nonexposed women was undertaken to correlate microscopic findings with colposcopic patterns. All examinations were performed using a standardized protocol which required that each participant have colposcopy, cytologic smears, and biopsy of abnormal colposcopic lesions. The findings of colposcopic "columnar epithelium, gland openings, and Nabothian cysts" correlated most often with glandular epithelium in the biopsy specimen. "White epithelium," which includes 3 related colposcopic patterns, mosaicism, punctation, and white epithelium, was associated most frequently (82-93% of cases) with squamous metaplasia, but occasionally with dysplasia and carcinoma in situ (CIS)(0-6%). The presence of dysplasia or CIS in any individual biopsy specimen occurred most frequently with the observation of higher graded lesions by colposcopy or a prior diagnosis of dysplasia. (author's)
An international response to a global concern.
The history of the World Health Organization's (WHO) Special Program of Research, Development, and Research Training in Human Reproduction reflects the worldwide development of ideas to address a global concern repeatedly identified in the various resolutions of the UN General Assembly and the World Health Assembly. The year 1952 emerges as the first in which family planning and fertility regulation became a subject of concern of global dimensions. In 1952 the International Planned Parenthood Federation (IPPF) was founded in Bombay, and the Population Council was established in New York. In the 2nd half of the same decade, the Ford Foundation (New York) initiated an international program of sponsorship in a then very sensitive area -- research and training in the reproductive sciences. This program gradually became a principal source of support for the entire field in the 1960s, but was gradually deemphasized. Repeated Swedish and Norwegian proposals in the mid and late 1950s requesting that the UN take an official stand and encourage activities in the field of human reproduction failed to find the necessary support. The majority of Member States were opposed to the idea. An important milestone indicating a significant change in the general attitude was the establishment by the Secretary-General of the UN, in 1967, of a trust fund to finance activities in the population field. In 1969 this fund was renamed the UN Fund for Population Activities (UNFPA). A retrospective analysis of the resolutions of the World Assembly (WHA) during the past 2 decades provides an opportunity for the in-depth assessment of the mandate of the Special Program. It also provides convincing evidence indicating that the WHA resolutions reflected the gradual development of new ideas in the international arena and at times preceded and catalyzed these developments. It appears that the Special Program was never intended to develop into a kind of intergovernmental pharmaceutical enterprise. The mandate formulated by the WHA was considerably broader. It was recognized that a number of pharmaceutical houses and also nonprofit organizations are devoting and will devote themselves to the task of developing new fertility regulating agents. It was also recognized that the intergovernmental structure and established ability to efficiently collaborate with governments representing different political persuasions places WHO in a unique position to promote progress in this complicated field.
140 women with cervical intraepithelial neoplasia (CIN) found during pregnancy were compared to 280 pregnant age-matched controls. Information was obtained on obstetrical and gynecological history, sexual behavior, contraceptive use, and smoking of the female and of the male partner. Oral contraceptive (OC) use for 60 months or more was significantly associated with CIN. This significance vanished when the effect of confounding factors was controlled for in a log linear analysis. According to these results, longterm OC use does not seem to be a causal factor of CIN, but these women constitute a high risk group due to sexual history and smoking habits and should thus be referred for a regular cytological screening. (author's)
Dose-related changes in LH bioactivity with intranasal GnRH agonist administration.
In order to evaluate changes in bioactive (bio) and immunoreactive (i) luteinizing hormone (LH) and in follicle stimulating hormone (FSH) after intranasal administration of a GnRH agonist, 2 doses (125 mcg and 250 mcg) of nafarelin acetate were administered for 14 weeks to 7 normal women. Maximum changes in gonadotropins were observed 2-4 hours after both the 1st and last doses. However, the maximum acute responses of iLH, bioLH, and FSH were significantly reduced after 14 weeks of treatment while no changes occurred in the bio:iLH ratio. The decrease in these acute responses were not dose-related. Serum iLH and FSH levels obtained prior to each dose (baseline) were not significantly altered by 14 weeks with either dose. However, baseline serum bioLH was significantly reduced compared to pretreatment by 14 weeks but only with the 250 mcg dose (p < 0.05). This level was also significantly different from the level of bioLH achieved with 125 mcg (p < 0.05). The bio:iLH ratio was significantly decreased with the 250 mcg dose. Although serum estradiol and progesterone levels suggested ovarian follicular activity and luteinization with the 125 mcg dose, this did not occur with 250 mcg of intranasal nafarelin. These data support a dose response effect of intranasal agonist treatment on the bioactivity of LH and also suggest the relevance of measurements of bioLH in assessing the effectiveness of agonist therapy. (author's)
Cervical dilatation with sulprostone prior to vacuum aspiration: a two-dose, randomized study.
The results of a randomized study are presented, comparing the efficiency and tolerance of 250 mcg or 500 mcg of 16-phenoxy-w-17,18,19,20-tetranor-PGE2 methyl sulfonylamide (Sulprostone) as a pretreatment to vacuum aspiration for termination of pregnancy in the 8th to 12th week of gestation. 200 patients, mainly nulliparous, received either 250 mcg or 500 mcg Sulprostone intramuscularly 3 hours prior to vacuum aspiration. The patients were continuously supervised during treatment and during at least 3 hours after the operation. Side-effects and analgesic injections administered were recorded. At operation the degree of cervical dilatation, amount of blood loss, and other operative complications were registered. Both doses of Sulprostone administered 3 hours prior to vacuum aspiration were equally effective in dilating the cervix and controlling the preoperative blood loss in late 1st trimester abortion patients. When the dose was doubled from 250-500 mcg, no significant further dilatation of the cervix was achieved. Instead, there was an increase in the frequency of gastrointestinal side-effects and the need for analgesic injection for relief of painful uterine contractions. (author's)
The authors studied the inhibitory effect of a triphasic oral contraceptive (OC) regimen on the pituitary and ovarian function in 29 normal, healthy women. ORTHO 7/7/7 tablets contain a constant low dose of ethinylestradiol (EE) and a stepwise increasing level of norethindrone (NE). The pills for the first, middle, and last weeks of the 21-day regimen contained, respectively, 0.5, 0.75, and 1.00 mg NE, and all contained 0.035 mg EE. The subjects were divided into 3 groups on the basis of their histories of OC use. 10 had not taken an OC in the previous 2 months, 10 were switched to this study from a fixed dosage combination OC containing 0.050 mg estrogen, and 9 had been taking ORTHO 7/7/7 tablets for 5 or more cycles. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone were measured and statistically compared with those from 5 normal, untreated women. The results from all study cycles showed that the 4 hormone profiles were significantly suppressed as compared to the normal patterns. Thus, 1 mode of action of this new triphasic OC is to inhibit ovulation by suppression of pituitary-ovarian function. This OC treatment appeared to be equally effective among women with varying prior histories of OC therapy. (author's)
Lymphocyte subsets in women on low dose oral contraceptives.
Oral contraceptive (OC) users have been reported to have a higher incidence of viral, bacterial, and fungal infections. This study was undertaken to try to elucidate some of the mechanisms responsible for this increased susceptibility to infection. Peripheral blood lymphocytes were labelled with murine monoclonal antibodies directed against T cells and the various lymphocyte subsets: helper cells, suppressor/cytotoxic cells, or natural killer cells. The lymphocytes were then analyzed on Coulter Electronics Epics V fluorescent activated cell sorter (FACS). A total of 27 control and 33 OC users were studied. In comparison to the control group, there was no significant difference between the 2 groups in percentage or absolute numbers of total T cells, helper cells, suppressor/cytotoxic cells, or natural killer cells. This study suggests that the increase in herpes virus, C. trachomonas, candida, and other infections in women taking OCs is not related to alterations in the numbers of T lymphocyte subsets or in levels of NK cells. (author's)
This issue presents, in comparable form, the major findings of all World Fertility and Contraceptive Prevalence Surveys available from developing countries--89 in all from 49 countries, covering women age 15--44 married or in union. These surveys, which constitute the largest body of knowledge on fertility and family planning available, reveal striking differences in family planning practices. The percentage of couples who use fertility control methods ranges from under 10% in most African countries south of the Sahara to 40% in the Latin American and Caribbean countries surveyed. The great majority of women have knowledge of at least 1 family planning method, usually a modern one. In over 80% of countries surveyed, at least half of contraceptive users relied on oral contraceptives, the IUD, or voluntary female sterilization. Worldwide, family planning is more often used to prevent births when desired family size is complete than to space births. Survey results further indicate that making family planning supplies and services more available increases their use, and women who can obtain services close by are more likely to use family planning. Fertility remains high in some countries of Africa where breastfeeding, postpartum abstinence, and disease-induced infertility are decreasing. On the other hand, fertility is falling in much of the world, particularly in Latin American and the Caribbean. Women who marry at age 22 years or above average at least 0.5 fewer children than those who marry at 18 or 19 years of age. The survey findings also provide evidence of the importance of birth spacing to infant and child survival. Finally, it is noted that these fertility and family planning surveys have led to significant program and policy changes. By providing data to evaluate and direct programs, these surveys are helping to improve services that reduce fertility and promote family health.
Breast cancer and oral contraceptives [letter]
Due to the high relative risks found in the authors' study of oral contraceptives (OC) and breast cancer, the findings of Dr. Sahel and colleagues came as a surprise, and the contradictory results between the 2 studies may be explained by a Stadel's statistical analysis. There is a strong time trend in the exposure to OC in young ages, and the Stadel study design fails to take this effect into consideration. This could imply that the young OC starters among the controls represent women born recently and thus having short latency times. The relative risk would be biased downwards because of the interaction bias from the shorter latency times for this young group. Adjusting for age alone will thus eliminate such a bias. Multivariate analysis ought to include a coefficient for the interaction between age at diagnosis and exposure to OC at young ages. In an effort to validate the authors' results, the age specific incidence of premenopausal breast cancer in Sweden was investigated to see if there has been any increase that could be explained by an increased risk from OC. A latency time of at least 10 years was assumed and the time period 1965-81 was divided into 2 parts (1965-71 and 1972-81) of which only the latter was expected to show any increase in incidence (because of the latency time). The trend in the incidence was then calculated for the 2 age groups, 30-39 and 40-49. Only the younger was expected to show any increase in incidence, because of the possibility of starting OC use at a low age. The results were striking. Both age groups ought to exhibit the same pattern in incidence with respect to diagnostic changes but only the younger showed a significant trend (3% annually, p = 0.002) in the 2nd time period. None of the slopes was significant in the 1st period. The authors also looked for specific characteristics among the breast cancer patients in an extended material (150 patients) to see if the early OC starters (before age 20) differed from the rest. The authors found a higher frequency of patients with axillary metastases in the early starters.
Republic of Korea (Country/Area Statements).
The government of the Republic of Korea took specific measures in its fifth 5 year plan, 1982-86, to integrate its fertility control program within the community development program, including primary health care services, medical insurance programs, and other social welfare programs. Korea hopes to accomplish fertility replacement by 1988. Yet, even if current population control policies envisaged by the government were to be successfully carried out, the population of the country is unlikely to stabilize before the mid-21st century at around 61 million. This is a population size that the Republic of Korea could hardly be able to accommodate, given its limited resources. Under these circumstances, the government has had to establish new population targets and population policies. The Republic of Korea is frequently cited as 1 of the few countries where planned fertility control has succeeded through the government's strong support of its family planning program. Korea's family planning program emphasizes the provision of contraceptive services, and information, education, and communication activities through home visits by family planning field workers and through government-designated private doctors' clinics. The major birth control methods provided are the IUD, oral contraceptives (OCs), sterilization for males and females, and menstrual regulation. Non-medical methods -- condoms and foam tablets -- also have been provided. All contraceptive services are provided free of charge by the government. Sterilization acceptors numbered 1.1 million as of 1983, approximately 19% of the total number of married women aged 15-44. During this period, Korea experienced rapid urbanization with the result that in 1980, 57.3% of the total population resided in large cities. With the establishment of the Population Policy Deliberation Committee, population distribution measures were reinforced through related ministries. The population policy has had a definite fertility reduction goal for the last 25 years. In 1973, the government issued an executive order directing all ministries to cooperate in family planning promotion and in the carrying out of the Maternal and Child Health Law, which permitted induced abortion for certain medical and social reasons. In the 1980s the government revised the program to take into account the newly emerging industrial sector and the goal of the establishment of a welfare society by 2000. To implement the 5-year plan from 1982-86, population and fertility control policies were instituted by presidential order.
Thailand (Country/Area Statements).
This discussion of Thailand reviews population growth, fertility and mortality, migration and urbanization, the integration of population and development, the role of nongovernmental organizations (NGOs) in population activities, and the field of population training. The 1980 census reported a population of about 44.8 million; the 1970 census count was about 34.4 million. Both were most likely undercounts. Because of a rapid reduction in fertility after 1970, changes in the age structure of the population became apparent during the last decade. The percentage share of population under 15 years of age dropped from 45% in 1970 to 40% in 1980, while the 15-64 age group rose from 52% to 55% during the same period. The over 65 age group increased from 3% to 5%. The rate of population growth decreased to 2.5% and 2.1% in 1976 and 1980, respectively. A target rate of 1.5% has been set to be realized by the end of the 5th National Economic and Social Development Plan (1982-86). After 1960, the year before the 1st plan took off, the high birthrate started to decline slightly. The 1964-65 Survey of Population Change (SPC) revealed a birthrate of about 42/1000. Another survey in 1974-75 showed that the crude birthrate had declined to 35.6/1000 as compared with an estimate of 26.0/1000 in 1983. The reduction in the fertility rate varied from region to region with the North showing the most rapid reduction in fertility between 1964-73. The 1st SPC revealed a crude death rate of 11/1000 in 1964-65 for the whole country. This rate is currently estimated to be about 7.5/1000. Family planning has been integrated into Thailand's health service program since 1973, and performance has been impressive. The number of new acceptors surpassed the target of 3.6 million during the 4th plan period. The Contraceptive Prevalence Survey (CPS) revealed that the percentage of married women aged 15-49 who were practicing various methods of contraception was about 51 in 1978 and about 59 in 1981; the rate had been 35% in 1974-75. At this time, about 62% of urban dwellers or more than 5 million people earn their living in Bangkok Metropolis; the remainder live in scattered small towns. Being the center of employment opportunities, the flow of migrants from the countryside to Bangkok is highest compared with other interregional movements. There has been a major stream of an estimated 230,000 Thai workers to the Middle East in 1983. The integration of population and development continues to be limited and obscure in the planning process, but Thailand has had for some time a population planning unit in the national planning agency to enable it to integrate population into development planning. NGOs have played a key role in family planning and population quality improvement activities in Thailand. In the field of population training, Thailand has 4 national academic institutions involved in demographic training at the master's and doctorate levels.
The Netherlands: country profile.
This discussion of the Netherlands covers the country's cities and regions, population growth, households and families, housing, contruction, and spatial planning; ethnicity and religion; education; labor force and income; consumption; and transport and communications. As a small and mineral poor nation with a seafaring tradition, the Netherlands survives on foreign trade. In 1983, total export earnings amounted to nearly 62% of the entire national income. Over 72% of Dutch exports go to other member countries of the European Economic Community (EEC), but imports are more diversified, with 47% originating outside the EEC. Since 1848, the Netherlands has been a constitutional monarchy with a parliamentary form of government. As such, it is one of the most stable democracies in the world. The main administrative units are the 11 provinces, of which Noord-Holland and Zuid-Holland are the most populous and economically most important. Amsterdam remains the commercial center of the country, but its role as the principal port city has been taken over by Rotterdam. No community has more than 700,000 inhabitants, but the country as a whole is highly urbanized because of the large numbers of medium-sized cities. In 1983 the population of the Netherlands totaled 14.34 million, compared to 5.10 million at the turn of the century. In 1965, the total fertility rate was 3.0. The death rate has virtually stabilized at 8/1000. The Dutch life expectancy stands at 72.7 years for men and 79.4 for women (1983). Natural increase has already dropped to 0.4% a year. Apart from the slight impact of net immigration, the positive growth rate reflects the large proportion (53%) of the population in its reproductive years. Mean household sizes in the 11 provinces vary from 2.5 in Noord-Holland (in 1981) to nearly 3 in Overijssel and Noord-Brabant, whereas the proportion of 1 person households ranges from 16% in Drenthe and 17% in the somewhat traditionalist southern provinces of Limburg and Noord-Brabant to 27% in Noord-Holland and 28% in Groningen. Only 26% of the Dutch own their own homes. The Netherlands has historically been a nation of little ethnic, religious, or cultural conflict. The central government finances education at all levels, making education and science the 2nd largest budget item (19%), preceded only by welare and social policy (22%). In 1983 the economically active population consisted of 3.8 million men and nearly 2 million women.
The authors examined hospital discharge records in 1980-81 for singleton 3rd trimester deliveries in Scotland. They compared 3000 women who had previously experienced induced termination of pregnancy and 4000 who had experienced spontaneous abortion with primigravidae and with women in their 2nd pregnancy, their first having resulted in a livebirth. 2 aspects of low birthweight were examined: delivery before the 37th completed week of gestation and low birth weight for gestational age. Comparisons were further controlled for maternal height, age, sex of infant, marital status, and social class. Women with previous spontaneous abortions experienced significantly increased risk of preterm delivery but not of low birth weight for gestational age. Women with a history of induced abortion also experienced increased risk of preterm delivery, but for women aged 18-24 years, risk of low birthweight for gestational age was significantly reduced compared with primigravidae. (author's modified)
A recent report on teenage pregnancy, published by the Alan Guttmacher Institute in New York, is a comparative study of teenage sexuality and fertility in 37 developing countries. It includes a detailed examination of the factors associated with teenage pregnancy in 6 countries (the US, Canada, France, England and Wales, Sweden, and the Netherlands), which have teenage pregnancy rates ranging between 96/1000 15-19 year olds (US) and 14/1000 (Netherlands). England and Wales with a rate of 44/1000 holds the middle ground. 3 factors identified by the study as contributing to the high teenage pregnancy rate in the US are the lack of sex education in schools, restricitons on teenage access to confidential contraceptive services, and confused messages about sex. Whatever the outcome, the majority of teenage pregnancies are unintended. Although some teenagers use condoms, this medthod has a poor image among young people who consider them as embarrassing to obtain, inconvenient to use, and generally unmanly and unreliable. The advent of oral contraceptives (OCs) resulted in a shift in contraceptive responsibility from young men to young women and from non-medical to medical methods. This may in part account for the relative lack of research on young men's attitudes to contraception and pregnancy. Although medical methods, especially OCs, are regarded as more convenient and more effective, they are less easily available. Many young people are reluctant to consult their general practitioner about contraception as they fear embarrassment or lack of confidentiality. They may not know where else to go and even if they know of a clinic, they may fear disapproval and may worry that they will have to be examined. A further problem for teenagers is that nearly all contraceptive methods demand continuing motivation. Many young women find it difficult to accept that they need contraception at all. It has been shown that those young women whose parents have been open with them about sex and have accepted the possibility that they might have premarital sex are far more likely to use contraception that those whose parents do not mention sex at all or strongly disapprove of premarital sex and do not allow discussion. In Britain increased access to contraception has contributed to an increase in the use of contraception by teenagers, and this has led in turn to a fall in Britain's teenage pregnancy rate. It is necessary to resist any moves which would lead to less sex education in schools or further restrictions on access to contraception for teenagers, for the evidence from the US makes it clear that such moves would have no impact on the number of teenagers who become sexually active but would lead to a rise in the pregnancy rate.
Breast cancer and oral contraceptives [letter]
The November 2nd editorial accompanying detailed publication of the negative findings of the large Centers for Disease Control study (CASH study) of breast cancer and combination-type oral contraceptive (COC) use makes it clear how confusing the situation is. This author's approach (besides collecting better data) is based on the belief that epidemiological data look contradictory because analyses have been simplistic, not because the CASH, Los Angeles, or Oxford data are bad. What is needed is to introduce more biological thought into the analysis. Mitotic activity of the relevant tissue is the key to understanding the effects of hormones on hormone-dependent cancers, and the proof is the protective effect of COCs against endometrial (and ovarian) cancer. Early menopause substantially reduces the risk of breast cancer and COCs induce a state approximating a temporary artificial menopause. The author would, therefore, expect COC use to reduce breast cancer risk unless COCs have a direct contrary, i.e., stimulatory effect on the breast. Mitotic activity in breast tissue of women on COCs is near normal. This is interpreted to imply that COCs have a similar effect to ovarian hormones on the breast. Mitotic activity of women with normal cycles reaches a peak during the luteal phase. This is interpeted to imply that progesterone is probably an important breast mitogen. Raised estrogen and/or progesterone levels increase breast cancer risk. Thus, low dose COCs should be better than high dose COCs. For any given COC formulation, its effect must be measured relative to the hormonal state that the woman would have been in had she not been using that COC. The above reasoning leads one to consider looking for an increased risk from COCs taken at times of frequent anovular cycling or at times when the cycle length is long. The following analyses of published epidemiological data might cast light on the situation: 1) restrict analysis to women who have had their 1st full-term pregnancy before age 25 and never gook OCs before age 25 or after age 40. These women have never been shown to be at increased risk from taking COCs. 2) hormone-responsive breast cancer cells may have their growth inhibited by progesterone, and the response appears even more significant if an estrogen-progesterone combination is used. These are just 2 suggestions for further analyses of epidemiological data on breast cancer and COC use.
Social skills and responses in simulated contraceptive problem situations.
A behavioral-analytic assessment strategy (Goldfried and D'Zurilla, 1969) was used to construct contraceptive problem situations representative of social interaction tasks which were postulated by Byrne (1983) as antecedent to the use of birth control. This study tested the hypothesis that differences in social skills (of rights assertion and expression of positive thoughts and feelings) are related to the effectiveness of participants' role-play responses in contraceptive problem situations. A sample of 87 students (45 females and 42 males), all active daters, served as anonymous participants. Partial correlation procedures, in which variance due to knowledge of birth control was controlled, revealed that the positive self-expression skill related to effectiveness for both sexes in initiating conversations about contraception topics. The rights assertion skill related to ability for both sexes to inquire about and request contraceptive materials from a druggist. Although both types of social skills were expected to relate to effectiveness in discussing birth control issues with a dating partner, results were less consistent for these situations. Both conceptual and methodological limitations are discussed as well as implications for the application of social skills training in human sexualtiy programs. (author's)
This study measured major immunoglobulin levels in the serum of 10 breastfeeding mothers and their infants before insertion of the Norplant contraceptive implant (at 30-39 days postpartum) and again 5 months after insertion. 10 women who were also breastfeeding but either used no contraception or used barrier methods (diaphragm or condom) served as controls. Comparison of preinsertion and postinsertion mean serum concentrations revealed a significant rise in IgG and a significant decline in IgM in both groups of mothers. IgA concentrations declined after 6 months postpartum in both the study and control groups, but the difference was statistically significant only for women in the Norplant group. There were no significant differences between the 2 groups in changes occurring after 5 months. Similarly, there were no group differences, either at study admission or after 5 months, in the immunoglobulins of infants of Norplant-using women and controls. Overall, the changes in maternal and infant immunoglobulin levels noted in this study are similar to those expected during parturition and infancy. These results provide no evidence that use of hormonal contraception in the immediate postpartum period can make both mothers and infants more susceptible to infection. It is noted, however, that immunoglobulin levels are only 1 aspect of the immune system.
This double-blind study is concerned with the efficacy and safety of a new prostaglandin El-analogue (16,16'dimethyl-trans-delta2PGE1-methylester)(GEMEPROST) (ONO 802), which was administered as a single 1 mg vaginal pessary 3 hours prior to legal abortion. The efficacy of the prostaglandin was assessed by the largest size of the dilator meeting no resistance when inserted in the cervical channel. Furthermore, the quality of the cervix and the effort needed for further dilatation was evaluated. The average size of the cervix prior to dilatation was found to be 10 mm, in comparison to only 7 mm in the placebo group (p < 0.001). 80% of the patients of the Gemeprost group did not need any further dilatation, i.e., the dilatation procedure of the cervix was easier than in the group without treatment (19%). The incidence of uterine pain was more frequent in the Gemeprost group (40%) than in the placebo group (7%). Analgesics were not required. The frequency of gastrointestinal side effects was rare in the Gemeprost group (13%) and in the placebo group (11%) compared with other prostaglandins. By the preoperative application of a new prostaglandin El-analogue (1 mg) prior to vacuum aspiration in the 1st trimester of pregnancy sufficient softening of the cervix and a dilatation of the cervix was achieved. It significantly reduces the need for further mechanical dilatation of the cervix as well as the force needed to perform this dilatation. These effects reduce the trauma associated with mechanical dilatation and therefore diminish the risk of subsequent complications. (author's)
Luteal phase pregnancy and tubal sterilization.
The effectiveness of several measures that may reduce the risk of luteal phase pregnancies after interval tubal sterilization was analyzed. Using data from the Collaborative Review of Sterilization on 5495 women, 18 luteal phase pregnancies were identified. Women who underwent sterilization after their estimated data of ovulation had a low risk of having a luteal phase pregnancy if they used oral contraceptives (OCs) or an IUD in the month before sterilization. Of the 18 luteal phase pregnancies, 14 (78%) occurred among the 16.8% of the women who were sterilized after their estimated data of ovulation and who had used barrier, rhythm, or withdrawal methods of contraception in the month before sterilization. The use of concurrent dilatation and currettage in these women at increased risk of luteal phase pregnancy did not lower risk to that of women who were sterilized before their estimated date of ovulation. (author's)
Abortion in America: 12 years after Roe v. Wade.
In the US the abortion debate has transcended the realm of medicine, pervaded the public consciousness, and entered national politics. Anti-abortion activists have never been more vocal and visible than in the past 5 years, and some profile activists have resorted to violence. Anti-abortion activists have gained increased influence under the Reagan administration. The President has embraced right-to-life leaders. With the approval of President Reagan, the Justice Department has asked the Supreme Court to overturn the landmark 1973 Roe v. Wade decision. The Supreme Court established with that decision that a woman's right to privacy entitles her to a safe, legal abortion, but that this right is not unqualified. It ruled that decisions about abortion in the 1st trimester of pregnancy be left to the woman and her physician and not be regulated by the state. The Court ruled that 2nd trimester abortions could be regulated by the state "in ways that are reasonably related to maternal health" (i.e., restricted to hospitals, but this restriction was eased in the 1983 Supreme Court decisions which affirmed Roe v. Wade). The Court allowed states to regulate, and even proscribe, abortions performed in the "stage subsequent to viability." In its brief, the Justice Department charges that the Roe decision was "a source of instability in the law" to be reconsidered and abandoned, as the principles of the 1973 ruling were so sweeping that they block "modest and reasonable" state and local governmental efforts to control legalized abortions. The brief was filed July 15, 1985 in 2 appeals involving Illinois and Pennsylvania laws that restrict abortions. This request marks the 1st time in 31 years that the government has asked the justices to reverse themselves on a basic constitutional decision. Parties on both sides of the abortion debate agree that it is unlikely that the same justices who voted 6 to 3 in a similar case 2 years ago to reaffirm a woman's right to an abortion would overturn the 7-to-2 Roe decision. In 1981, most abortions were obtained by young women, unmarried women, and white women. About 1.6 million abortions were reported for the US in 1981, representing about 26% of pregnancies that year. The US abortion rate remained essentially stable in 1981 and 1982 after rising each year between 1973 and 1980. The annual increases in the years just prior to 1980 were small. In 1981, as in 1980, 91% of abortions were performed at 12 or fewer weeks past the last menstrual period. Abortion services are most available, and rates are highest on the East and West coasts. 12 years after abortion was made legal in the US, the debate may get louder as prochoice activists launch efforts to match the campaign of the right-to-life movement.
Barrier methods of contraception.
Barrier methods of contraception make up an essential part of the present contraceptive range, and doctors need to know in detail how to choose and fit them as well as how to instruct patients in their use. This discussion reviews the mode of action of the barrier method and then focuses on the vaginal diaphragm, the cervical or vault cap, the collatex (Today) sponge, condoms, emotionl problems associated with the use of barrier methods, advantages of barrier methods, and future developments. Barrier methods of contraception are only effective if used consistently and carefully. Failure rates vary greatly between studies, but in selected populations the failure rate for the diaphragm with spermicide can be as low as 1.9/100 woman years (wy) and for the condom 3.6 per 100wy (Vessey et al., 1982). If known user failures are removed, the figure for the condom can drop to as low as 0.4 per 100wy (John, 1973), which compares favorably with that of the combined oral contraceptive. Other studies quote failure rates of 10 per 100wy or more. These methods call for considerable participation by the patient at or before each act of intercourse and there is, therefore, great scope for inefficient use, either as a result of poor instruction or because couples find that they interfere with happy, relaxed sexual activity -- or fear that they may do so. Doctors need to understand the feelings of their patients before recommending them. The aim of a barrier method is to prevent live sperm from meeting the ovum. This is accomplished by the combination of a physical barrier with a spermicide. In the case of the condom, the integrity of the physical barrier is the most important factor, although some patients feel more secure with an additional spermicide. The vaginal barriers used at present do not produce a "water-tight" fit, and the principle is that the spermicide is held over the cervix by the barrier. It is also possible that the device acts partially by holding the alkaline cervical mucus necessary for sperm transportation away from the acid vagina where the sperm is delayed and killed. The choice of available vaginal diaphragms is increasing. Despite some suggestion that the "fit" of a diaphragm is not crucial, supported by the argument that the vagina increses greatly in volume during intercourse, the best available figures for reliability are from studies of family planning clinic patients who have traditionally been fitted with great care. There are no good data about the effectiveness of the cervical and vault caps, and it is better to fit a diaphragm if this is possible. The Today polyurethane foam sponge is impregnated with the spermicide nonoxynol-9 and, as marketed, it is for use as often as desired up to 24 hours, plus 6 hours before final removal to ensure all vaginal sperm are killed. Condoms bearing the British Standards Institute Kitemark have been tested to a high standard an in view of the good results that can be obtained it seems likely that most failures are due to inefficient use. Advantages of barrier methods include some portection from sexually transmitted diseases and a reduction in the incidence of pelvic inflammatory disease.
Africa and the origin of AIDS.
The theory that the retrovirus that has been implicated as the primary cause of Acquired Immune Deficiency Syndrome (AIDS) originated in Africa has been strongly attacked on both scientific and political grounds. Researchers base this claim in part on the fact that antibodies to the virus have been detected in frozen serum samples collected in Africa many years ago, and the disease appears to have spread more widely in some parts of the continent than it has in the West. African governments object strenuously to any suggestion that the disease may have originated in their countries. Some African scientists argue that searching for the origin of AIDS serves no useful purpose. Research presented at the International Symposium on African AIDS in Brussels cast some doubts about the early serological data, while other findings greatly strengthened arguments for an African origin of the disease. Contrary to the idea that such studies serve no purpose, the findings could ultimately be extremely important to understanding the nature of AIDs. The evidence in support of an African origin came from groups headed by Max Essex of the Harvard School of Public Health, S. M'Boup of Dakar University in Senegal, and Francis Barin of the Hopital Bretonneau in Tours, France. Essex presented data that a retrovirus isolated from wild African Green monkeys is very similar to the AIDS virus. The suspicion is that the virus may recently have crossed the species barrier and infected man. Essex has obtained some evidence to support this suspicion. Serum samples taken from prostitutes in Senegal were found to have been infected with the monkey virus istelf, rather than the closely related AIDs virus. Antibodies to the monkey virus were found in 30 out of 289 samples tested. A hopeful aspect of this finding is that none of those who tested positive had any signs of AIDS or AIDS-related diseases. Similary, African Green monkeys infected with the virus are healthy. Essex also presented that that raise some questions about serological investigations of AIDS in Africa. He found that serum from only 53% of individuals in the US who have antibodies to the AIDS virus react with proteins from the monkey virus, while almost 100% of serum samples from similar antibody-positive Africans cross-react with the simian viral antigens. Whether or not African and American strains really are different must await analysis of the precise genetic sequences of virus isolated from Africans. This is now under way in several laboratories. Another aspect of the link with monkeys is that Essex together with researchers from the New England Regional Primate Research Center has isolated a virus from macaques which were displaying many of the symptoms of human AIDs. Essex's work supports the hypothesis that the AIDS virus originated in Africa, but several scientists question the validity of earlier findings that antibodies to the AIDS virus are present in stored serum samples originally collected several years ago. Guy de The of the Faculte de Medicine Alexis Garrel in Lyon, France, reported that antibodies were detected in 1 to 3% of serum samples collected from Uganda, Kenya, Tanzania, and the Ivory Coast in the early 1970s.
[Population changes and social welfare tasks]
Efforts to control population growth made during the last 20 years are expected to maintain a stable population in the future. We cannot limit our concern to the control of population growth but must consider the social welfare task in the aspect of population stability. It is not because population changes set limits to artificial control, but because the order of population changes presents a desirable sign for low fertility. Another important concern is to pay attention to how to make human beings already born and those to be born in the future enjoy their quality of life. Socioeconomic stability requires economic stabilization to meet basic essential needs. Changes in population structure, along with the quantitative growth of population, make changes in patterns of social welfare demands. When the pyramid type of population structure becomes changed to the bell or pot type of population structure, changes in education and employment as well as changes in problems of the aged and medical demands must be made. On the other hand, population changes accompany value changes in the process of modernization of society. These multiple social changes bring about a value of individualism and a nuclear family norm, and an enlargement of women's social participation which, in turn, can cause family problems. At the same time, social deviations and failures may be increased in the industrial society, and, thus, welfare countermeasures have to be taken. In this respect, the base of social welfare for meeting basic demands must be formed not in the past, narrow sense but in the long range and multisided aspects. (author's modified)
According to figures from the Family Planning Association, 4 million people use the free family planning services, 2.3 million attending general practitioners and 1.7 million attending clinics. A report from the association warns that cutbacks in clinic services (1.7 million attend clinics and 2.3 million attend general practitioners) could affect consumer choice in contraception, since clinics not only offer a wider range of contraceptive methods than general practitioners but also serve to train general practitioners in contraception. At present, the pill is prescribed to 84% of general practitioner patients compared with 55% of clinic attenders. Less than half of general practitioners fit the IUD and the diaphragm. Women who choose to attend clinics declare that they prefer the anonymity, the non-disease orientation, the specialist knowledge, and the greater chance of talking to a female doctor. Women who choose to visit their general practitioners prefer the familiar setting, the doctor's knowledge of their medical history, continuity of care, and the lack of emphasis on sexual matters. On the basis of the report, the Family Planning Association recommends that efforts must be made to maintain existing services provided by family planning clinics; that district health authorities should provide free family planning services offering all methods of contraception to women and men; that related services should include postcoital contraception, sterilization, youth sessions, pregnancy testing, subfertility testing, psychosexual counseling, and well-woman screening; that clinic services and opening times should be advertised locally; and that greater cooperation should be encouraged between clinics and general practitioners. (full text)
The maternal death rate is high in grand multiparas giving birth in remote villages in Milne Bay Province, Papua New Guinea. Such women are often reluctant to go to the hospital for delivery. However, many of them have accepted the idea of going to the hospital to await delivery and postpartum tubal ligation. The results and benefits of this program are discussed. 43% of grand multiparas suffered 1 or more complications during their hospitalization; 77% were sterilized. Considerable morbidity and mortality can be prevented by an active program for hospital management of grand multiparas. Costs of such early referral are at least partially offset by decreasing costs for late emergency transfer of obstetric disasters. 47% of emergency air charters for obstetric complications were for grand multiparas. Numbers of such emergency transfers have decreased as increasing numbers of grand multiparas have been referred early for delivery and tubal ligation. (author's modified)
Trends in sexually transmitted disease incidence in Papua New Guinea.
A retrospective study of gonorrhea and syphilis from Health Department records was carried out in Papua New Guinea. During the 10 year period (1974-83), 101,636 new cases of gonorrhea and 34,422 of syphilis were reported among the general population of Papua New Guinea. The incidence of both sexually transmitted diseases have significantly (p < 0.005) increased over the decade despite the introduction and implementation of the National Sexually Transmitted Disease Control Program. Some aspects which contribute to the present increase in sexually transmitted diseases are segregation of health and non-health services, insufficient staff training, and increased immigration to urban centers. (author's)
1 major side effect of the administration of gossypol as a male fertility regulating agent is the occurrence of hypokalemic paralysis. The common causes of hypokalemia in clinical practice and previous studies of gossypol-induced hopokalemia in animals and man have been studied. The available evidence suggests gossypol induced renal leakage of potassium. The most likely mechanism is a direct toxic effect of gossypol on the renal tubules. (author's)
In the US the proportion of teenagers who are sexually active has plateaued, or even decreased a little; marital births to teens have dropped significantly so that an increasing proportion of births to teenagers takes place out of wedlock, and the number of and rate of abortions have remained the same for several years. About 6% (62/1000) of US girls aged 15-17 had either a birth or an abortion in 1981 as did 14% (144/1000) of 18-19-year-olds. This review of the comparative study of teenage pregnancies in developed countries summarizes the principal findings of a 2-stage study carried out by the Alan Guttmacher Institute (AGI) with the collaboration of members of the staff of the Office of Population Research at Princeton University. The weight of the evidence, with all its limitations, rests heavily on Sweden and the Netherlands, which fall into the category of "welfare states." Young people grow up in an atmosphere of trust and acceptance by their families and their society and, in return, most of them achieve adulthood by acting responsibly. The reward for this behavior is the assurance of social supports throughout one's lifetime, even when employment opportunities are limited. England and France follow this pattern of national commitment, social benefits, and openness about sex to a lesser degree. Compared to the US, in all of these countries the message is more consistent; children do not grow up with such a dissonance between public and private morality. The study makes it clear that unintended childbearing is a problem somewhat unique to the US in comparison to western European countries. The major findings challenge the US to respond to 2 levels of directives. A climate has to be created that accepts the fact of premarital sex and gives young people the equipment to experience it responsibly. For the US, this directive is complicated by the social conditions in which many young people live today. The compounding effects of poverty and minority status are grinding under a whole generation of young people whose options are severely limited. To change the sexual climate, it is necessary to do something to alleviate the social and economic problems of the children in the inner cities and the Appalachian region of America. For those impatient with more global issues, the study offers some specifics in the field of sex education. Teacher training appears to be an almost universal need.
A multilevel analysis of fertility behavior in Korea.
This analysis of the socioeconomic determinants of fertility behavior in Korea develops a model that simultaneously considers both individual and community-level differences. The model includes 3 fertility process components: onset, early fertility, and later fertility, which are defined by reference to maternal age. The analysis traced the effects of respondents' education and childhood residence through their intermediate consequences for work experience before and after marriage, husbands' education and occupation, current residence, childhood mortality, and sex composition of offspring. The data were derived from the 1974 Korean National Fertility Survey. The results of this analysis indicate that socioeconomic development results in increased age at 1st birth and reduced number of children. Socioeconomic development is accompanied by desires for smaller family size, creating the conditions for fertility decline even in the absence of a national family planning program. The results for early fertility supported the hypothesis that there would be no effect of employment in the modern sector before marriage on fertility before age 30 years in traditional contexts, but a positive effect in transitional contexts. Aside from age at 1st birth, none of the micro coefficients were statistically significant in explaining the early fertility model. For later fertility, the relationships between micro and social context variables were negative, as hypothesized, but dampening effects of development due to family planning were not detected. Childhood residence played a small role in explaining fertility measures, but women's education did not work either additively or interactively.
Breast-feeding: nature's contraceptive.
Our ancestors achieved the lowest rate of reproduction of any living mammal by the postponement of puberty until well into the 2nd decade of life, a maximal probability of conception of only about 24% per menstrual cycle even when ovulation had commenced, a 4-year birth interval as a result of the contraceptive effects of breastfeeding, and sharply declining fertility during the 4th decade of life, leading to complete sterility at the menopause. This pattern of reproduction was ideally suited to the prevailing lifestyle of the nomadic hunter-gatherer. The postponement of puberty resulted in a prolonged period of childhood dependency, thus enabling parents to transmit their acquired experience to their offspring. Long birth intervals were essential for a woman who had to wander 1000 or more miles each year in search of food, because she could not manage to carry more than 1 child with her at a time. The lifestyle of comparatively recent times of a settled agricultural economy made possible subsequent rural and urban development, but this transition from nomad to city dweller also stimulated fertility. The cultivation of crops and the domestication of animals led to the development of permanent housing, where the mother could leave her baby in a safe place while she worked in the field. The resultant reduction in mother-infant contact coupled with the availability of early weaning foods reduced the suckling frequency, thereby eroding the contraceptive effect of breastfeeding and decreasing the birth interval. The model conquest of disease eventually led to rapid rates of population growth. In the developed countries of Europe and North America, reproduction was subsequently held in check by the use of artificial forms of contraception, but this has yet to take place in the developing countries of Asia, Africa, and South America. For a developing country, contraceptives are expensive, may be culturally unacceptable, and carry health risks. Breastfeeding is 1 form of contraception that should be culturally acceptable to all societies. Breastfeeding is preferable to natural family planning methods, because the contraceptive protection afforded by breastfeeding requires no equipment apart from a baby and places no constraints on intercourse at any time. There is no question which of the two represents the more natural form of family planning. Clearly, breastfeeding is nature's contraceptive.
Evaluation removes obstacles to sterilization in Brazil.
In 1978, Centro de Pesquisas de Assitencia Integrada a Mulher e a Crianca (CPAIMC) in Rio de Janeiro began to offer interval sterilizations in an attempt to increase the access of poor women to sterilization services. By the end of 1984, the program had provided in excess of 19,000 sterilizations, making CPAIMC Brazil's largest single source of voluntary interval sterilization. Despite the program's success, CPAIMC was concerned that obstacles still existed in the poor woman's path to sterilization access. A study was conducted by Family Health International (FHI) in collaboration with the Pathfinder Fund and CPAIMC's Department of Information, Evaluation and Research to locate possible barriers. The study indicated that less than half of the women who requested sterilization between June 1 and August 31, 1983 actually had the procedure. During that period, 1256 women requested sterilization at the CPAIMC clinic. Of these, 925 were approved, and 639 were scheduled for surgery. Only 559 were actually sterilized within 3 months of receiving approval. 1 possible reason why women were not receiving the surgery was that the women requesting sterilization actually were not highly motivated to obtain the service. Yet, study results indicate this probably was not the reason. During initial interviews at the clinic, many women said they had thought very carefully about being sterilized, and more than 40% reported deciding to have a tubal ligation before their last pregnancy. Almost 3/4 of the women reported that they did not plan their last pregnancy, and almost 2/3 indicated that the pregnancy was unwanted. About 63% were contracepting, and many were using effective methods. More than half of the non-contraceptors were not using a method because they had just ended a pregnancy and were not sexually active. As a group, the women requesting sterilization were highly motivated to avoid having more children. Age and number of children were the most important criteria used by the clinic to determine a woman's eligibility for sterilization. Women who were at least 30 years old and who had 3 or more living children usually were approved for surgery. During the study period, a woman who did not use oral contraceptives, an IUD, or injectables was required to receive a Depo-Provera injection on the 5th to 8th day of her menstrual cycle before surgery was scheduled. This requirement was aimed at reducing the incidence of pregnancies among sterilized women. The number of clinic visits necessary to complete the requirements for sterilization apparently made the difference. Women who needed the Depo-Provera injection had to make more visits and were less likely to follow through to obtain the sterilization. As a result of the CPAIMC study, the clinic has changes its procedure for scheduling sterilization surgery. It is likely that even relatively small changes in service provision may yield significant increases in family planning prevalence and thus increase the coverage and quality of health care in Brazil.
[Fertility decline and family life cycle in Korea]
For the last 20 years, Korea has experienced a tremendous socioeconomic development, which is expected to continue into the future. This paper attempts to examine the relationship between family life cycle in Korea using actual data. Fertility reduction in the past 2 decades is largely attributed to birth control, rising age at marriage, and expansion of educational opportunity that came into being in the wake of rapid socioeconomic development. Fertility decline among younger women (20 years old and younger) is associated primarily with rising age at marriage. The mean age at marriage has increased from 22 in 1960 to 24 in 1983. Fertility decline for older women (30 years and over) is associated with the adoption of contraceptives, especially sterilization. As a result, the peak age at fertility decreased from about 32 years in 1960 to 27 years in 1983, while the length of each phase of the family life cycle has shown consistent change. The interval from marriage to the birth of the last child is shortened about 1/3 from over 10 years in 1960 to 3 years in 1983. Despite these recent changes in women's role, Korea still has a long way to go before realizing full participation of women in all aspects of development because legal, social, and institutional barriers still remain virtually intact. However, women are now encouraged to participate in various activities such as working for factories, companies, or government offices, producing a diversification of socioeconomic and family structures. 1 of the important changes in women's concepts about their role is that they now can achieve self-realization and earn income for their families through participation in economic activities. As a matter of fact, the women's labor participation rate in Korea has steadily increased, especially before and after child bearing ages. The number of economically active women has increased very fast in the 30 year age group since 1972. More women are engaged in professional, clerical, sales, and service work and tend to remain longer at their jobs. It is significant to note that the expansion of employment opportunities for women will inevitably bring about a reduction in fertility. As social modernization continues, women's role in Korea will be changed greatly and at the same time their role changes will inevitably lead to declining fertility. (author's modified)
Asymptomatic perforation of the small intestine by a Copper-7 intrauterine device.
The case of a 32-year old woman (gravida 3 para 2) in whom a Copper-7 IUD perforated the uterus, lodging both within the myometrium and the lumen of the small intestine is described. The patient presented in the emergency room 18 months after IUD insertion with heavy vaginal bleeding and passage of tissue. A diagnosis of spontaneous abortion was made. In this case, the small bowel had to be resected and side-to-side anastomosis was performed. This patient was asymptomatic until 3 weeks prior to admission. Other cases demonstrate acute symptoms of peritonitis and intestinal obstruction or more chronic complaints of vague abdominal pain and diarrhea. An IUD string that is not visible at the external os of the cervix generally reflects upward retraction of the string or unnoted spontaneous expulsion of the IUD. However, on occasion it can be associated with uterine or even intestinal perforation, as occurred in this case. Pain on insertion, also noted in this case, can serve as a warning sign of perforation. In this patient, the device was inserted 5 weeks after delivery, lending support to the recommendation that puerperal insertion be avoided. It is important to know the exact location of an ectopic IUD to prevent dangerous attempts at removal through the vagina. Laparoscopy and ultrasound are generally helpful in localizing the IUD and preparing the patient for laparotomy and possible bowel resection.
[Reflections on endometrial osteogenesis. A report of three cases]
The authors report 3 cases of endometrial ossification. They believe that the presence of bone in the uterus is associated with 2 very distinct situations. One is the retention in utero of fragments of fetal bone after a late abortion. In this case, the bone fragments have a recognizable morphology and a well differentiated structure. The other situation is osseous metaplasia of elements which are believed to be of Mullerian origin, arising in the myoendometrial transitional zone. (author's)
Risk approach in maternal care: how beneficial is this approach in reality?
A community based study was conducted in rural areas of the Comprehensive Rural Health Services Project, Ballabgarh, by the All India Institute of Medical Sciences to measure the incidence of risk factors (mainly based on interrogation and simple clinical examination) in pregnant women, their distribution and magnitude, the risk of bad outcome, and utility of this approach in the field. The incidence of risk factors was 9.6%. Severe anemia in current pregnancy, neonatal death in last pregnancy, or more than 1 stillbirth in previous pregnancies, 3 or more successive abortions, or more than 10 pregnancies accounted for 84.8% of those with a single risk factor. The relative risk of bad outcome in pregnancies with risk factor is 4.69 times more than in those without risk factor. Pregnant women with severe anemia in current pregnancy or either neonatal death in last pregnancy or more than 1 neonatal death in previous pregnancies had a relative risk of 4.27 and 7.89, respectively. If the stillbirths' group and abortion group are combined with neonatal death group the relative risk is still high, i.e., 6.35. These individual risk factors are easily identifiable by trained paramedicals or health volunteers, but the sensitivity (29.6%) and predictability (17.8%) of this approach are very low. (author's)
A health belief model approach to adolescents' fertility control: some pilot program findings.
The authors report initial findings from a community-based intervention intended to strengthen unmarried teenagers' fertility control behaviors (i.e., abstinence or consistent contraceptive usage). The Health Belief Model (HBM) was used as a conceptual framework for developing curriculum materials and for evaluating a 15-hour educational program targeted at 13-17 year olds of both genders. Interview data pertaining to sexual and contraceptive perceptions, knowledge, and behaviors were collected 3 times in a no-control, short-term, longitudinal study design: (1) just before; (2) immediately after; and (3) 3-6 months following the intervention. Dependent variables of major interest were changes in perceptions, knowledge, and self-reported fertility control behaviors. Based on data from the 120 teenagers who completed the followup (80% of those completing the intervention), the authors found: (1) consistent contraceptive usage increased significantly; (2) changes in HBM-based contraceptive perceptions and sexual knowledge at immediate post-testing were predictive of increases in contraceptive usage at longer followup; and (3) the majority (62%) remained abstinent from preintervention to followup. These findings, study limitations, and suggestions for a future controlled study are then discussed. (author's)
Melasma is localized hyperpigmentation over the forehead, upper lips, cheeks, and chin. In this study, evidence suggesting an association between autoimmune thyroid disorders and melasma and the relationship of thyroid disorders to the origin of melasma is presented. A total of 108 nonpregnant women, aged 20-56 years, were divided into 2 groups for the purpose of this study: 1) melasma, 84 patients; 2) control group, 24 patients from the Dermatology Clinic matched for age and sex. Microsomal thyroid autoantibodies (MCHA) were sought in all subjects. TRH-TSH tests were performed in patients with melasma and in those women with goiter and/or positive MCHA tests from the control group. Studies were completed with serum T4, T3, and antithyroglobulin antibody (TGHA) measurements in all patients with thyroid abnormalities. In patients with melasma, the frequency of thyroid disorders (58.3%) was 4 times greater than in the control group. The MCHA-negative patients had 1) simple goiter (13.1%), 2) Plummer's disease (2.4%), and 3) TSH hyperresponse to TRH in nongoitrous patients (10.7%). Patients with positive MCHA tests (32.1%) were divided into 2 subgroups. 1 comprised those women with an apparently normal thyroid gland and thyroid function (n=7), while the other included all patients with goiter and/or subclinical hypothyroidism (n=20). Regarding the origin of the melasma, it was found that 70% of women who developed melasma during pregnancy or while using oral contraceptives (OCs) had thyroid abnormalities compared to 39.4% of patients with idiopathic melasma. Subjects from the control group had a 12.5% incidence of thyroid abnormalities, and only 8.3% had positive MCHA. Estrogen, progesterone, or both could be the triggering factor in the development of melasma in women who have a particular predisposition toward both melasma and thyroid autoimmunity. Patients with idiopathic melasma had a lower frequency of thyroid abnormalities, suggesting that there may be different genetic patterns linked to autoimmune thyroid disease. The authors conclude that there is a true association between thyroid autoimmunity and melasma, mostly in women whose melasma develops during pregnancy or after ingestion of OC drugs. (author's)
Patient flow analysis: instructions for the study coordinator.
Patient flow analysis (PFA) is a self-evaluation tool designed by the Centers for Disease Control for the purpose of collecting information on the flow of patients through a clinic in terms of time and money. Through use of this method, bottlenecks in patient flow can be determined. The study coordinator is responsible for instructing clinic staff in the data collection process, recording data that describe the general clinic setting, checking all data forms for completeness, submitting all completed forms to the state coordinator, working with the state coordinator to correct errors identified by data processing, and interpreting findings. 5 forms are used to collect information about a clinic session: clinic register, personnel register, patient register, patient sign-in sheet, and personnel worksheet. Chapters in this manual provide detailed instructions on the use of each of these forms. The manual closes with a checklist for PFA studies.
Phasing the introduction of MCH/FP services: the Sudan Community Based Family Health Project.
The Sudan Community-Based Family Health Project, initiated in 1981, is based on the phased introduction of health services through successive rounds of field-level retraining and household visiting. Needs and resources assessment led to the development of projects in 4 areas: oral rehydration, family planning, immunization, and nutrition education. Services were delivered by largely illiterate, government-trained midwives who are widely available in the Sudan. The midwives attended short training courses in the projected health interventions; training was also provided to paramedics and community leaders. Each round of sequential intervention was preceded by a short, focused retraining session. Midwives presented family planning in the context of a discussion about birth spacing and introduced oral contraception (OC). The midwives were trained to check for contraindications to OC use and to explain possible side effects to OC acceptors. Of the 4 project interventions, family planning and oral rehydration were judged to have been most successful. The largest increases in use of both oral rehydration and contraception were noted among women who had the lowest levels of education and had been most inaccessible to health services in the past. The success of this project is attributed to its use of village midwives, the focus on selected health interventions, the development of protocols for the introduction of each project, and the phased introduction of maternal and child health services.
The migration response to relative deprivation.
In this paper the authors define the relative deprivation of a person with income y as an increasing function of the percentage of individuals in the person's reference group whose income is larger than y. Satisfaction is obtained by adding up the marginal utilities of income over the range of income a person possesses. Migration from 1 reference group to another is modeled as a response to relative deprivation and satisfaction. A strong incentive to migrate exists if relative deprivation decreases while satisfaction rises with migration, and a weak incentive exists if the individual increases or decreases his satisfaction and deprivation at the same time by migrating. The authors derive conditions under which different incentives, weak or strong, hold for different individuals. In general, the richest individual in a society will not have a strong incentive to migrate but may have a weak incentive to migrate, whereas the poorest individual may have a strong incentive to migrate and also a weak incentive to migrate. The analysis enables the authors to explain several perplexing migratory phenomena, identify income inequality as a distinct explanatory variable of migration, and establish an incentive to migrate in situations where the utility-social welfare approach does not. (author's modified)
Games trainers play: experiential learning exercises.
This volume presents a series of learning exercises intended for the use of trainers in the area of human resource development. The training aids presented were designed to provide vivid illustrations of key points within a lesson. These games are part of the process element of a learning experience. In contrast to other experiential exercises, games tend to be brief, inexpensive, participative, adaptable, low risk, and single focus. They can be used as session icebreakers, to involve the trainees, as illustrations, or as session closings. Such games incorporate several classical principles of learning, such as repetition, reinforcement, association, and use of the senses. The chapters in this volume focus on conference leadership, climate setting, presentation, methods, motivation, self-concept, learning, communication, listening, perception, problem solving, evaluation, and transfer of training. For the over 100 games that are cited, information is given on their objective, procedure, materials required (if any), and time required. In addition, discussion questions are suggested.
Postcoital contraception plays a direct role in preventing some pregnancies and an indirect role in prompting women who have not been contraceptive acceptos to review their contraceptive practice. At present, administration of 4 oral contraceptive (OC) tablets in 2 doses 12 hours apart and within 3 days of intercourse is the method of choice. Ovrn or Eugynon 50 is traditionally used, and a 4-tablet packet specifically for postcoital purposes is now on the market. Side effects are less severe with this method. In some cases, however, IUD insertion may be preferable. Failure after IUD insertion is extremely rare, whereas 1-5% of women treated postcoitally with hormonal methods become pregnant. The IUD can be effective more than 3 days after intercourse. Moreover, the IUD can continue to be worn, protecting the woman from future threat of unwanted pregnancy. On the other hand, an IUD needs skillful fitting, is painful, and probably has more side effects than the oral regime. Only the woman who is to receive the treatment can decide which is the most appropriate method for her. Other preparations currently under study include epostane, a blocker of progesterone metabolism, and RU486, a progesterone receptor blocker. If postcoital contraception is to become more widely used, advertising must be done to inform the public of its existence.
Intra-uterine contraceptive devices.
Among the advantages of IUDs are the device's high continuation rate, the lack of systemic side effects, and the absence of a need for continual motivation to practice contraception. The effectiveness of plastic IUDs is directly proportional to their surface area, but the degree of excessive bleeding experienced is inversely related to device size. Thus, devices represent a compromise between large size for effectiveness and small size for acceptability. The optimum time to fit an IUD is during the 1st hald of the menstrual cycle. Absolute contraindications to IUD use include the presence of active pelvic inflammatory disease, undiagnosed irregular bleeding, a history of ectopic pregnancy or tubal surgery, and a distorted uteine cavity. Failure rates associated with IUD use range from 2-3% in the 1st year and then decrease. Since the main mechanism of action appears to be production of a sterile inflammatory reaction in the uterine cavity, the IUD prevents intrauterine pregnancy more effectively than ectopic pregnancy. Nonetheless, there is little evidence to suggest that IUD use actually increases the incidence of ectopic pregnancy. Resumption of fertility after IUD removal is not delayed. There is not need to change inert plastic IUDs in women who remain symptom free. The copper devices should be changed every 3-4 years. A search is under way for antifertility agents that can be incorporated into the device to reduce side effects. In general, the IUD is most suitable for older, parous women.
A series of experiments were conducted to analyze the sodium-lithium countertransport in subjects with hypertension, chronic hypokalemia, and those taking oral contraceptives (OCs). A significantly higher transport rate was observed in hypertensive subjects than in normotensive controls. An elevated sodium-lithium transport rate was also observed in normotensive women on OCs compared to women not on hormonal medication. Patients with chronic hypokalemia showed the highest values of all. No significant correlation between age and transport values was found in any of the groups. These results have been confirmed in other studies. It is concluded that antihypertensive medication does not correct the underlying pathophysiologic changes of the cell membrane. The results suggest that regulation of the sodium-lithium countertransport by the renin-aldosterone system seems possible.
Altered erythrocyte cation transport related to hypertension or oral contraception.
Intracellular cation concentrations (Nai, Ki), and the influx of Rb86 and of Na22 were measured in rythrocytes of 22 normal women with no family history of hypertension, 16 women with untreated essential hypertension, and 14 normotensive women treated with hormonal contraceptives. Values for total Rb influx, and for its components denoting sodium pump activity (ouabain-sensitive) and Na, K co-transport (ouabain-resistant, frusemide-sensitive) were significantly greater in the hypertensive and contraceptive treated groups than in the normal group. Na, K cotransport measured by Na influx (fursemide-sensitive) was found to be significantly increased in the contraceptive treated but not the hypertensive group. Passive sodium diffusion (frusemide-resistant Na influx) and Ki did not differ significantly between groups. Nai was lower in the hypertensive group than in the other 2 groups. These findings support the hypothesis that hypertension or hormonal contraception are associated with increased leakage of K ions from erythrocytes, without a corresponding increase in passive Na influx: the change in cell membrane permeability is compensated for by increases in Na, K co-transport and sodium pump activity, adjusted to allow for altered differential permeability to K and Na ions. (author's)
Long-term regret among 216 sterilized women: a six-year follow-up investigation.
6 years after tubal sterilization 16 of 208 women reported serious regret. The desire for another child in a new relationship was given as the main reason for later regret, although other causes were also reported. No association between age, parity, time, or type of tubal sterilization and later regret was demonstrated. However, a greater proportion of regretters than of the remainder had been recommended for sterilization by a doctor at an abortion application. The regretters had undergone more abortions before their sterilization, and the study revealed more unstable marriages with consequently less support from the spouse at sterilization in the regretting group. Post-sterilization regret is discussed within the framework of life events and social support. (author's)
Methodological issues in studies of premenstrual changes.
The main methodological issues that should be considered in studies of premenstrual changes are discussed. They include: the selection of well-defined groups of subjects who reflect the diversity of subtypes of premenstrual changes (PMC); the confirmation of retrospective reports through daily monitoring of changes by ratings, or by objective procedures when possible; the need to consider the diversity of premenstrual biological changes instead of comparing average levels, since there is a likelihood that different pathophysiological changes are connected with diverse behavioral and mood changes; application of a multivariate, time-related approach to explore the pathophysiology of PMC; the need to exclude placebo responders prior to the active drug phase in treatment trials; and the need for such trials to be double-blind, placebo-controlled, and, if possible, of a crossover design. Attention to such issues should lead to increased consistency of findings across studies and eventually to a better understanding of the pathophysiology of PMC and to a rational, effective treatment. (author's)
Absence from work following vasectomy.
This study investigated absence from work after vasectomy in 90 men who underwent the procedure on an outpatient basis. At the follow up visit 7 days later, 37 of the 80 employed patients (46.2%) revealed that they took time off from work following vasectomy. The mean number of days missed was 5.12 days (range 1-10 days). When expressed in terms of all patients in the series, the mean number of days lost was 2.37 days. The main reason given for absence from work was pain or discomfort (27 patients). The majority of men taking time off were from social class 3. Patients were more likely to take time off work when the procedure was performed at the beginning of a week. 29 patients had surgery under local anesthesia and 61 received general anesthesia; there was no significant difference between these 2 groups in absence from work. These results suggest that the assumption of an immediate return to work after vasectomy may be inappropriate for a substantial number of patients. If patients were advised to take 1 day off work following surgery, they might be less inclined to take more time.
The reversal of female sterilization by microsurgery: experiences with first 50 cases.
Follow up data are presented of 50 cases of female sterilization reversal by microsurgery. These cases were drawn from a series of 152 women requesting reversal. 102 of these women were not accepted because of the following contraindications: age over 37 years, lack of ovualtion, general health impairment, infertile partner, tubal disease, and insufficient tubal length. The mean age of the 50 subjects was 28.84 years; the mean number of pregnancies was 1.98 and the mean number of living children was 1.56. The duration of infertility ranged from 7-132 months, with a mean of 57.98 months. 60% of these women had remarried since sterilization. The microsurgery included end-to-end reanastomosis or uterotubal reimplantation. Isthmic-isthmic reanastomosis was easiest, as was reversal of sterilization by either Pomeroy's technique or Falope ring. Of the original 50 cases, there were 6 dropouts. A total of 39 cases (31 with tubal reanastomosis and 8 with uterotubal implantation) were available for follow-up 6 months after microsurgery. Full-term intrauterine pregnancy was achieved by 22 (71%) women in the end-to-end group and 4 (50%) women in the implantation group during the follow-up period (6 months-3 1/2 years). The selection criteria used in this series are believed to be responsible for the high rate of success. Other contributory factors included microsurgical techniques and operator skill. No association was observed between reversal success and duration of sterilization.
The effect of the chronic use of combined oral contraceptives (OCs) on the "activity coefficients" (alpha = coenzyme-stimulated activity/basal activity) of erythrocytic glutathione reductase and aspartate aminotransferase was studied in 2 groups of 90 female volunteers each; 1 of the groups, from the state of Yucatan in southeast Mexico, presented clinical lesions of vitamin deficiency, while the other group, from Mexico City, did not have any clinical evidence of vitamin deficiency. One half of the women (45) in each group were chronic OC users and the other half were not. The results were analyzed comparing OC users with non-users in each location. For both glutathione reductase and aspartate aminotransferase, the Mexico City OC users had significantly higher (p < 0.001) alpha values than nonusers, while in the Yucatan women, the alpha values were similarly high independent of OC use. (author's)
[[Report on services activities, first six months 1985]
The data on PROFAMILIA'S activities for the 1st half of 1985 reflect a decline from the corresponding period for 1984. Nevertheless, the data also show that the program is recovering after a period of attacks and uncertainty. Colombia's family planning program is now recognized as the best in Latin America and is among the 6 best in the world. PROFAMILIA has contributed to this achievement as the main private provider of family planning services. During the period studied new users decreased by 8.2% over the corresponding semester of the previous year; follow up visits dropped by 6.8%; total visits, by 7.3% and surgical sterilizations by 13.7%. Vasectomies, however, rose by 39.1% Cytologies decreased by 0.8%, while pregnancy tests dropped by 3.5%. Over-the-counter sales of contraceptives show that the pill rose by 67.9%, while condoms dropped by 2.2%. The community distribution of contraceptives registered increases in both the pill (by 8.9%) and the condom (by 6.9%). Wholesale figures for the pill decreased by 26.8%; those of condoms by 84.6%. The latter drop can be attributed to the marketing of other brands at prices that are competitive with those of PROFAMILIA. The net result of all these changes is that total sales of the pill fell by 14.1% while sales of condoms declined by 77.6%. At the same time, the years of protection decreased by 19.0%.
Yoruba traditions, among which polygamy and large numbers of children are characteristics, remain strong and relatively unchanged today in the hamlets and villages of wouthwestern Nigeria. This paper describes features of reproductive life and the role of modern family planning as it has been presented by a large village-based program utilizing traditional birth attendants and voluntary health workers. By age 45-50, the women interviewed in the baseline survey had given birth to an average of 7.34 children. About 1/2 of these women were in polygamous unions. Although declining, infant and child mortality are still quite high. The spacing of children by traditional means is part of the Yoruba culture. A deliberate postponement of pregnancy is achieved through postpartum abstinence, typically of 2 to 3 years duration among traditional village women. Although awareness of modern methods was low and the availability of family planning services was minimal or non-existent, substantial interest was found in the concept of family planning. The potential demand for permanent methods of family planning among the rural sample is relatively small, existing only at very high parity levels. Actual use of modern contraception (2%) lagged well behind the expressed attitudes. In the areas of rural Oyo State where modern family planning was introduced, a significant degree of acceptance has been found, although stiff opposition to family planning has also been encountered that has had the effect of limiting public discussion. The post-survey conducted in 1985 showed that approval of family planning increased from 20% to 50% among respondents in these villages. The increases in family planning knowledge and approval were matched by a corresponding increase in contraceptive use, though the actual numbers remained low (an estimated 13% prevalence). But this will likely translate into increased fertility control in the future when the current cohort are closer to having the number of children they want to have. Premarital and extramarital use of contraception is also reported.
Managing the replication of a pilot project: Oyo State, Nigeria.
The worldwide experience in the case of pilot projects in primary health care is not very satisfactory. An exception is the Oyo State Community-based delivery (CBD) program which consists of the recruitment of village-level voluntary health workers that are trained and supervised by the existing staff at the local rural health facilities. There were a number of reasons for the success of the CBD program: 1) No new facilities were built; no additional staff were created for the program. 2) The program was planned to minimize costs so that it would be easy to replicate on a larger scale. 3) It utilized indigenous customs, language and supplies. 4) Reliance was placed on traditional leadership for community organization. 5) The community was interested in self-improvement. 6) The staff was committed, working long hours under difficult rural conditions. 7) A high level of services was rapidly achieved, including prenatal pill disbursements, contraceptive disbursement deliveries, health talks and home visits, and treatments for malaria, cough, worms, diarrhea, wounds, and anemia. 8) Integrating health with family planning promotion improved contraceptive acceptance. 9) The use of pictographs and other appropriate communications aided learning and recordkeeping by non-literate workers. The expansion and replication of this pilot CBD program encountered many difficulties, but it can serve as a model for other programs of similar scope. The pilot program, which was run by the staff of the Fertility Research Unit of the University College Hospital, Ibadan, has been completely taken over and expanded by the state Ministry of Health after a 2 1/2 year apprenticeship period. Difficulties during this period included bureaucratic delays, communication and coordination in new program areas, lack of commitment by some local government nurses and withdrawal of the initial monetary incentives to the workers. However, the expanded program is probably more effective that the pilot project due to the greater perticipation of all governmental health personnel.
Self-concept and autonomy are typically negotiated during adolescence, a time when many females also become sexually active. Nonuse and discontinuation of contraceptives by teenagers place them at high risk for pregnancy. The present study explores the relationship between these psychological factors and contraceptive noncompliance during adolescence. 21 sexually active young women requesting contraceptives at a California university hospital's general adolescent medical clinic and 34 requesting contraceptives at a college student health service recruited through a newspaper advertisement were entered into the study. Prior to receiving their contraceptive pills, each subject completed 2 psychological tests. Despite demographic differences between groups, scores on the 2 psychological tests were not significantly different. The mean score on the Piers-Harris Self-Concept Scale was 61.7 for the younger clinic group and 68.4 for the older college students. Similarly, mean scores on the autonomy scale were 2.9 and 3.9, respectively. Compliance rates did, however, differ between the 2 groups, with 48% of the clinic group being compliant at 4 months, compared to 70% of the college student group. Although the total Piers-Harris score did not differentiate compliant from noncompliant subjects, the Behavior subscale of the Piers-Harris test proved to be a reliable discriminator. Similarly, results on the autonomy instrument distinguished between those who proved to be compliant and those who did not. Thus, adolescents who have a positive self-concept, as measured on the Behavior subscale of the Piers-Harris test, and a higher autonomy score appear to be more likely to be compliant with regard to oral contraceptive use.
Is there a connection between a woman's fecundity and that of her mother?
Data on the fertility of mothers and daughters in 10,931 mother-daughter pairs were obtained from family reconstitution studies based on English parish registers between the 16th and 19th centuries. This paper seeks to evaluate the proposition that more fecund mothers tend to have more fecund daughters. There seems to be no association between the fertility of daughters and that of their mothers; however, the correlation coefficient apparently indicates a very small, yet significant, positive association. This small positive association between the fertility of daughters and that of their mothers in the whole sample is due entirely to the situation in 1 parish. A woman's fertility might depend on her husband's biological characteristics as well as her own. Thus, the finding here is not only that there is no association between the fecundity of daughters and that of their mothers but none between that of daughters and fathers either.
Nutritional status and age at secondary sterility in rural Bangladesh.
In a prospective study of 2324 women in Matlab, Bangladesh, the occurrence of primary and 2ndary sterility by age groups was examined. The results were related to the nutritional status of the women, as assessed by measurements of height, weight, arm circumference and ponderal index. Approximately 98% of the women who were in the age group 15-19 were found to be fertile. This proportion decreases gradually up to the age group 30-34 years and thereafter declines sharply, reaching only 31% in the age group 45-49. The height data suggest no significant difference in the age pattern of sterility among the 3 groups of women, although there is a slight tendency that women who were less tall reached menopause earlier than the other 2 groups. Variations in weight are more conspicuous than in height. There is the suggestion that thinner women may experience an earlier menopause. Women having an arm circumference less than 21 cm, between 21-22 cm, and 23 cm and above, and currently aged 17 years, have an expected fertile life estimated at 25.0, 25.8, and 26.6 years respectively. The median ages at sterility were 42.8, 44.0, and 44.3 years respectively with a difference of about 1 year between the 1st 2 groups. This suggests that sterility occurs earlier among the thinner women. Since detailed investigation of nutritional status was not possible, it was assessed by anthropometry. There was strong evidence that nutritional status is an important factor in the estimated age at sterility, with thinner women experiencing an earlier menopause. Although it is impossible to measure the onset of sterility, one can obtain a minimum estimate of it from the age-specific distribution of the proportion of women who have not produced a child for 5 years of being at risk.
Communication support for population activities in Sub-Saharan Africa.
Communication support activities play an important role in population programs. They provide information to potential users about family planning and, if appropriately planned, are a means of mediating cultural adaptation to population change and new technology at both individual and societal levels. This paper provides an overview of the position of sub-Saharan countries with respect to current efforts in population communication. The findings indicate that there is an absence of long-term, comprehensive planning for national population communication programs in sub-Saharan Africa. Program activities, with few exceptions, are limited in number and scope. The majority of activity has been limited to technical training for health personnel, or clinic-based information and education activities directed toward women of childbearing age who attend maternal and child health facilities. There is little research and evaluation data available by which the effectiveness of existing programs can be judged and cost-benefit analyses are infrequently conducted. The absence of national communication efforts and of specified linkages between communication efforts and program activity are attributed to inadequate political and administrative support for population programs. This points to a clear need for donors to support communication efforts aimed at political leadership, and ultimately, the institutionalization of population concerns. Support and assistance in the planning function of communications support activities would be a logical extension of the role the World Bank has played as an advocate of development planning. (author's)
[Conjugal unions and reproductive strategies in Brazil]
Data from the 1960 and 1970 censuses and from surveys conducted by the Brazilian Center for Analysis and Planning between 1975 and 1977 were used to analyze changing patterns of conjugal unions in Brazil. Consensual unions have increased significantly throughout the country, at the expense of religious unions and often even of legal unions. More recent unions tend to be consensual while older unions are religious. Most of the unions surveyed (88%) were 1st unions; of these 71% were legal unions. The proportion of religious unions has declined over time, dropping from 18.4% among those cohorts united before 1960 to 7.3% among those united after 1970. The decline has been particularly marked in urban areas, where the proportion fell from 14.0% to 2.6%. Questions concerning the relative advantages of the different types of unions reveal that informants of both sexes consider civil marriages to be better because they provide economic and psychological security to families, spouses and children in addition to social legitimacy and legal protection. Financial aspects are considered particularly important for women, while the legality of the union is seen as especially advantageous for men. The absence of legal ties and material insecurity are considered to be the chief advantages of purely religious unions. At the same time, the lack of legal restraints against "switching wives" is seen as the major advantage of consensual union for men. Yet the instability of relations is seen as the main disadvantage of consensual unions. 1/2 of all informants feel that couples should separate if the marriage is not going well. Curiously, those from the more traditional sectors of the country tend to be more pro-separation. Although consensual unions are found at all socioeconomic levels, they predominate among the less affluent. In most regions, women in religious unions tend to have more children on the average, than the rest; those in consensual unions have the fewest. Between 1970 and 1976, the average age at which unions are entered tended to rise. Informants indicated that the best age for women to marry was between 20 and 24 years; for men, 25-29 years. The ages for both sexes are lower in the rural areas. Marriage is seen as a rite of passage into responsible maturity, and women are considered to mature earlier than men. As the age at marriage increases and unions are postponed, fertility can be expected to decrease.
Abortion: toward a standard based upon clinical medical signs of life and death.
In its Roe vs. Wade decision (1973), the US Supreme Court ruled that, in the 1st trimester of pregnancy, the woman's right to privacy outweighs any state interest in prohibiting abortion; in the 2nd trimester, the state's interest in maternal health can justify regulating the woman's decision but the state cannot interfere in the decision of the woman and the doctor to terminate the pregnancy; in the 3rd trimester, the state's interest in protecting potential human life can outweigh the mother's interest and prohibit the decision to abort. In so ruling, the court adopted a viability standard based on the fetus's ability to survive outside the womb as the criterion to determine the relative weights given to privacy and protection of life in abortion cases. The viability standard, however, is likely to change as new technology enables embryos to survive outside the womb at earlier stages of gestation. This essay proposes that the viability standard be replaced by objective criteria based upon vital signs which separate well being and life from death. Existing technology to monitor the vital signs of the fetus would provide the means to assess evidence of human life, and hence when the state's interest would override the woman's right to privacy. The vital signs standard would shorten the time in which women seeking abortions must decide to abort. The proposed standard would be clinically verifiable, and be consistent with other medical criteria for deciding life and death. It would depend neither on a physician's subjective judgement nor on changing technology. Yet it would maintain consistency with the Supreme Court's prior decisional law and leave a woman's constitutional right to privacy basically intact.
Socioeconomic status and infant mortality among Hispanics in a southwestern city.
Recent investigations of infant mortality in the Southwest part of the US have shown that Spanish surname infant death rates are lower than might be expected from the relatively low socioeconomic standing of the Spanish surname population, a phenomenon that appears to be confined to the neonatal componont of the infant mortality rate. The relationship between socioeconomic status (ses) and infant mortality is examined overall and separately within the Anglo and Spanish surname populations of Corpus Christ, Texas. The investigation utilizes data from the 36 Nueces County census tracts. Most recent data on infant, neonatal, and postneonatal mortality was provided by the local health department. Subjects were limited to Anglos and those whites with at least 1 Spanish surname parent. The 1979-1983 cohort is analyzed. Information from the 1980 US census was utilized to divide the 36 census tracts into 3 SES groups: high, medium and low. The most immediately striking aspect of the findings is the significant inverse gradient in Anglos between SES and both the total infant mortality rate (IMR) and the neonatal mortality (NMR), a gradient which is nonexistent in the Spanish surname population as well as overall. In addition, Anglos and Spanish persons differ significantly with respect to all IMRs and NMRs. In the high and medium SES groups and overall, all Anglo rates are lower, while in the low SES group, Spanish surname rates are lower. These findings suggest that, among Anglos, SES is a crucial factor in infant deaths, whereas, among the Spanish surname population, having a medium or high SES does not offer any additional protection against mortality. Alternatively, lower SES does not translate into significantly lower infant mortality among Spanish persons. These findings provide support for the study's hypotheses that the SES-infant mortality association is weaker among Spanish persons than among Anglos. The analysis also shows the importance of analyzing the SES-infant mortality association separately by ethnicity. Studies in larger cities and also studies utilizing matched birth and death records are needed to further elaborate these findings.
Fertility at low and high altitude in central Nepal.
Since the 1930s, a number of different studies have tended to show that fertility is lower at high altitude. The present investigation attempts to provide some answers to this question by examining completed fertility rate (CFR) in Highland and Lowland villages in Central Nepal and relating rate differences to age at menarche, age at 1st childbirth, age at 1st marriage, incidence of venereal disease, birth control (vasectomy or hysterectomy), length of postpartum amenorrhea, and breastfeeding. Data was obtained by direct questioning, and under-reporting of births thus cannot be excluded. Fertility histories were taken from post-menopausal women over the age of 45 years. Results indicate no significant difference in reported menarcheal ages between highlanders and lowlanders. Age at 1st marriage and 1st childbirth were both significantly later in highlanders. CFR was significantly lower in highlanders. It would appear that the reduced fertility rate at high altitude can be partly attributable to later age at marriage and later 1st childbirth. Other factors, e.g., husband absenteeism and remarriage have also been suggested as possible contributors to the observed difference. This paper presents the results of a multiple regression analysis using 9 dependent variables: ages of marriage, 1st childbirth and menarch, the average gap between pregnancies, the average amount of time the husband was away, the number of marriages, presence or absence of venereal disease at some time, whether birth control was practiced and altitude status. Average pregnancy gap, age at 1st childbirth and presence or absence of venereal disease were the only variables that independently made a significcant contribution to CFR variance. The increase in pregnancy gap may be related to longer periods of breastfeeding in high altitude women and there would be a concomitant delay in recommencement of menstruation. In testing the hypothesis, no difference is found in reported duration of breastfeeding or in postpartum amenorrhea. The age at marriage and age at 1st childbirth accounted for over 16% of the explained variance in CFR. Some of the observed difference in CFR can be explained by the difference in marital age but not by the interval between marriage and 1st childbirth, as it was very similar in both groups. The lower CFR among the high altitude population could be due to lowering of biological fecundity at high altitude, or simply a matter of choice. The difference might reflect human reproductive hormone differences between high and low altitude populations. Further research will be needed to determine whether or not differences in CFR can be explained by variation in these factors.
Update on oral contraceptives.
This 5-member panel discussion provides an update on various aspects of oral contraceptives. To increase the safety of oral contraceptives, the estrogen content has been substantially reduced since the introduction of these agents in the 1960s. While just as effective in preventing pregnancy as their predecessors, the new formulations are much safer in terms of their effects on carbohydrate metabolism, blood coagulability, lipoprotein levels and cardiovascular problems. The lower estrogen content also makes oral contraceptives available to older women. Nonsmokers and those without hypertension, hypercholesterolemia or diabetes can safely use low-dose oral contraceptives up the age of 45 and possibly longer. Due to the increased risk of cardiovascular disease associated with smoking combined with oral contraceptives, heavy smokers over 30 should refrain from using oral contraceptives. Although much remains to be learned about the effects of oral contraceptives on blood pressure, there may be a correlation between oral contraceptives and blood pressure elevation. Triphasic oral contraceptives, generally promoted as being closer to the natural cycle than monophasics, do not actually mimic the menstrual cycle and may result in poor cycle control. Oral contraception is considered the most effective reversible method of birth control; noncompliance is the greatest single limitation in successful prevention of pregnancy. Noncontraceptive benefits include protection of the endometrium, reduced incidence of premenstrual syndrome, dsymenorrhea, follicular and corpus luteal cysts, and pelvic inflammatory disease. Despite these benefits, there are contraindications, such as vascular disease, coronary artery disease, or a history of carcinoma. Side effects include breakthrough bleeding, amenorrhea, nausea, breast tenderness and depression. Steroid contraceptives have some androgenic activity, the most common of which is weight gain.
The provision of sterilization services by private physicians.
Obstetrician-gynecologists are 4-5 times more likely to perform vasectomies, than are general surgeons or general or family practitioners. Catholics are less likely to perform either procedure than are nonCatholics. Particiaption in a group practice and having a practice in the North Central region of the country are associated with carrying out a larger average number of both male and female sterilizations. More than 1/2 of female sterilizations are performed as inpatient hospital procedures, and most of the remainder are done in hospitals on an outpatient basis. 2/3 of vasectomies, on the other hand, are performed in doctors' offices, while most of the rest are performed as hospital outpatient procedures. About 1 vasectomy in 12, however, is performed on an inpatient basis--possibly because general anesthesia is used, or the procedure is performed along with other surgery. The average cost for an inpatient female sterilization in 1982 was US$1335. The cost for a hospital outpatient sterilization was not much less than that. The total cost of a vasectomy ranged from an average of US$511 for an inpatient procedure to US$240 for 1 performed in the office. The average cost is higher when the sterilization is performed by an obstetrician-gynecologist or a urologist than when the service is provided by a general surgeon or general/family practitioner. 58% of physicians performing female sterilizations accept Medicaid reimbursement, and 12% reduce their fees to accomodate low-income patients. The proportions for doctors who perform vasectomies are 51% and 12%. Private physicians most likely to make these attempts to be financially accessible to the poor are those who are located in nonmetropolitan areas and those who practice in the North Central region of the coutnry. A group practice is also associated with fiancial accessibility among providers of vasectomy, as is specialization in either general surgery or general/family practice among providers of female sterilization. (author's modified)
Calculation of age-specific fertility schedules from tabulations of parity in two censuses.
The mathematics of stable populations recently have been generalized to cover populations with time-varying fertility and mortality by a modification incorporating the sum of age-varying growth rates in place of the fixed growth rates of a stable population. Equations that characterize non-stable populations apply to any cohort-like phenomenon with a measurable property that cumulates gains or losses through time. In particular, the equations fit the relation between a population's average parity at a given age and age-specific fertility rates previously experienced at lower ages. Techniques devised to derive an intercensal life table from single-year age distributions in 2 censuses are adapted to estimate accurate intercensal fertility schedules from distributions of parity by age of woman in 2 censuses. The 1/1000 sample survey of fertility conducted in China in 1982 included data on age-specific fertility rates by single years of age for each calendar year from the 1950s to 1981. The rates taken from the survey validate those predicted by the techniques described in the paper. Data from the censuses of Korea of 1970, 1975, and 1980 also agree with estimated age-specific fertility rates. The method is also extended to estimation of age-specific fertility rates by order of birth. Census data from Korea for 1970, 1975, and 1980 are also used to verify these estimates.
Practical aspects on the estimation of the parameters in Coale's model for marital fertility.
A model for marital fertility 1st proposed by Coale (1971) has proved useful in assessing the degree of fertility control when applied to large populations, such as when a large number of births is observed. However, when small populations are considered, it is necessary to take random variation explicitly into account. This paper gives a simple Poisson process model and the corresponding maximum likelihood estimation procedure and shows how to make the necessary calculations with the statistical computer program package GLIM. The deviations from the model and the precision of the likelihood estimator given are not strictly universal since they are based on the situation in an example. However, they are generalizeable because they are not heavily dependent on the distribution of births by age groups. If GLIM is not available, any package containing a linear regression procedure, which allows a weighted analysis, can be used. In either case, goodness of fit tests are available.
Parlange, Guilfoyle, and Rickson (1983), in attempting to highlight the problem of ecological fallacy in the estimation of family fertility rates from the expected probability of a child surviving to a given age of a parent, tried to examine Krishnamoorth's (1979) model. The authors agree with Parlange et al. in principle that due consideration to homogeneous subgroups makes the group that is under study more representative of an individual family and hence a more accurate predictor of its behavior. But in their attempt to refine Krishnamoorth's model to demonstrate this, they have made mistakes in mathematical logic. Parlange et. al. introduce order-specific birth rates into the model, so that the model deals with a probability density. The authors maintain that Parlange's formulation of the probability that a father of a given age has his 1st son already dead is incorrect. The 2nd major drawback in their model is that there is no provision for the natural condition that the ith son cannot be born before the (i - 1)th son. The basic problem in Krishnamoorthy's (1979) model according to Parlange et al. is that it is formulated in terms of the average family in the population rather than the individual couple. Krishnamoorthy (1980) attempted to rectify this by developing a model using a nonhomogeneous Poisson process, which is not free from stringent assumptions. The correct solution to the problem can be obtained only when a model incorporates the joint probability density of ages of fathers at births of sons of different order. Such an attempt would be purely academic, since joint distributions are hardly available for any population.
Mortality levels and family fertility goals: a reply.
The authors' previous paper (Parlange et al., 1983), dealt with the problem of estimating group fertility rates from the expected probability of a child surviving to a given age of a parent. By incorporating birth order in a comprehensive model, the authors were able to predict group fertility rates more accurately than a competing model found in the demographic literature (Krishnamoorthy, 1979). In reply to Krishnamoorthy and Kulkarni's response (1985) to their paper (Parlange et al., 1983), the authors state that Krishnamoorthy misunderstands their revisions of his model. Rather than formulating a model in terms of the individual couple instead of the average family as Krishnamoorthy claims, the authors actually follow Krishnamoorthy's approach but improve the definition of his control group. Since they analyze the group rather than individual experience, Krishnamoorthy's objections are not valid. The authors' point is that the more the group model is specified, the greater its accuracy in predicting group survival rates. Their formulation leads to an understanding of group behavior which is not necessarily the optimal mode for predicting the behavior of individuals, which would require a different formulation.
As in most developing countries, the vital registration system in Sudan is unreliable and other data is scarce. The First Population census of 1956 reported a crude death rate of 18.5/1000 and an infant mortality rate of 94%; the data, however, revealed many inconsistencies. The Second Population Census of 1973 as well as the Sudan Fertility Survey of 1979 (SUDFS) provided data on the number of children ever born, divided into those who had died, and those still living, tabulated by age group of mother. Also included were the "orphanhood" questions--questions asked to respondents as to whether his/her father and mother is still alive. The purpose of this paper is to use information from the 1973 census and 1979 survey to investigate the pattern and level of mortality in the north of Sudan. Estimates of child mortality are derived from Brass's technique, which uses the proportion of children surviving among those ever born to women of known age groups to derive the probabilities of dying between birth and age x. This information, along with the information on adult mortality obtained from the orphanhood questions is used to construct a life table. Results indicate that the mortality experience of the Sudan population is very similar to that of Brass's standard. There is, however, a slight divergence in the relationship between child and adult mortality. It is confirmed that infant and child mortality is greater than what would be implied by the mortality of adults. The years from 1973 to 1979 showed a slight improvement in mortality conditions. Life expectancy at birth rose 1.5 years in the period 1973-1979; almost no change took place before 1973. The results of this study are compared to those of Demeny, who used the Coale-Demeny life table model to analyze the 1956 census.
Health personnel training in the Nicaraguan health system.
This article explores the policies and early experiences of the extensive changes in the preparation of health personnel in Nicaragua; massive changes in the health care system were launched after the victory of the Sandinista Revolution in 1979. It reviews the status of health personnel training in the country today, the integration of these programs into planning for the health system, and problems arising their rapid appearance. The Unified National Health System was established in 1979 in an attempt to transform some of Latin America's worst health indices. This system is based on the stated principles of planning, regionalization, public participation, and primary care. To implement these policies, high priority has been given to the development of health professions training programs appropriate to the system's special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of meidcal students by a factor of 5. Formal residency training in primary care specialties has been established. Training for allied health professions has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a trmendous need for educational resources, both human and material. The greatest constraint in expanding medical education was the lack of qualified teachers. As a solution, the new health system has made public sector employment much more available and attractive; most Nicaraguan physicians today divide their time between public and private practice, and the pressures on voluntary teaching time are heavy. The Health Ministry has developed strategies for making clinical teaching more attractive and prestigious in compensation. Medical curriculum reform since 1979 is designed to turn out doctors capable along 4 lines: clinical service, teaching, administration and research. Special importance is placed on integrated teaching and service. These multiple objectives are built into the teaching program from the very beginning. To date there are 6 schools of nursing in the country (4 before 1979), with 5 times the pre-1979 enrollment. Nicaragua has made a deliberate decision not to train mid-level medical workers. However, volunteer health personnel, the Brigadistas, have played a definite role in Nicaraguan communities. They concentrate on public education and mobilize the people for immunization and sanitation campaigns. Additionally, traditional birth attendants in rural areas have been recognised by the Health Ministry and been given training to upgrade their performance. Much in the new System has emulated policies of Cuba, especially the emphasis on public education, models for personnel training and community-oriented primary care.
The development of handicap with aging in Australia and Indonesia.
The results of 2 national surveys from Australia and Indonesia are used as a basis for making a cross-national comparison of the prevalence among older people of severe handicap in 2 areas of mobility (walking inside the house, walking outside the house) and 3 areas of self care (bathing, dressing, and eating). The Australian survey was conducted by the Australian Bureau of Statistics, in 1981, and the Indonesian survey was performed by the Research and Social Development Unit of the Indonesian Department of Social Welfare in collaboration with the Central Bureau of Statistics. The age-specific prevalence of handicap at 55 and over is 4.3 times greater on average in Australia than it is in Indonesia. Prevalence of handicap increases exponentially with age in both countries, but approximately twice as fast in Indonesia, while the familiar cross-over between sexes appears to occur 7-15 years earlier in Indonesia. That is, men are at greater risk than women of developing handicap in later middle age but tend to change places with them in this regard on further aging, and this phenomenon takes place earlier in Indonesia. Discussion of these findings in demographic terms suggests the following hypotheses. The age-specific incidences of handicap are higher in less developed countries like Indonesia than they are in more developed ones like Australia. The age-specific death rates of handicapped people exceed those of non-handicapped people, and these differences are greater in less developed countries than they are in more developed ones. The age-specific death rates of handicapped older males exceed those of handicapped females, but to similar degrees in all countries, regardless of their degree of development. Finally, although the process of aging advances more rapidly in Indonesia than in Australia, the population of handicapped people in the former country is maintained at a lower level by higher group-specific mortality rates.
Fiction is used to present feminist positions on abortion. The difficulties and stigma in obtaining an abortion in the US, before its legalization, is told through the story of a pregnant 15-year old in the 1960s, when few physicians would risk performing the operation. Those who did actually prescribed large doses of medication to induce miscarriage and avoid surgery. After giving up hope, the adolescent in this story finally turns to her parents, who are ashamed and shocked at the news. Nonetheless, they make secret arrangements to send her to a clinic in England. These obstacles and the psychosocial stress that accompanies them are contrasted with the situation that prevails a decade or so after the feminist victory in making abortion legal. Although abortion has become legal, it still results in traumatic emotions for a number of women. And, though the feminist emphasis is on keeping abortion safe, legal and funded, yet, it is stressed that proper contraceptive use will spare women the unpleasantness of an abortion.
Indirect estimates of fertility for small geographic areas in the Philippines.
Levels of fertility were estimated for small geographic areas in the Philippines for the periods around 1970 and 1980. 2 sets of estimates were computed by using 2 different but related methods: the Bogue-Palmore and the Rele regression techniques. Both techniques are based on the principle that fertility is a function of the age and sex structure of the population and its prevailing level of mortality. The estimate is made by fitting a linear equation wherein the total fertility rate is the dependent variable. Rele has shown that in most populations at a given level of mortality there is a nearly linear relationship between the child-woman ratio and gross reproductive rate. The Bogue-Palmore method is similar but substitutes the infant mortality rate for the expectation of life at birth. The 2 techniques yield varying levels of fertility at the national level. Rele's method for the period 1975-1980 gives an overall total fertility rate (TFR) of 4.95, while the Bogue-Palmore method gives an estimated TFR of 5.08 for 1980. At the regional level, the latter technique also yields higher estimates in all regions. But the 2 methods show a high degree of consistency in terms of the relative levels of fertility by region. These results were externally validated by using estimates from other independent sources. In the absence of more refined measures, the estimated TFRs appear to reflect true levels. The computations reveal that Manila has the lowest fertility level in the country, and that there are substantial fertility differentials among provinces. The overall decline in the TFR was about 11% during the decade. The proportion of provinces with low TFRs (under 4) rose from 5% in 1970 to 22% in 1980.
Introduction: the client's perspective in primary health care.
The criteria that define primary health care (PHC) dictate that PHC programs be instituted in response to both the client's perspective and needs. However, the client's perspective and role in PHC has been supported in theory but not in reality. The purpose of this volume is to emphasize the importance of this perspective to the success of PHC programs by exploring a series of cases in different settings. The papers are limited to 2 areas, Latin America and India, where PHC has a longer history. Most PHC programs suffer from failure to accomodate 3 basic facts: 1) clients' perceived needs may vary widely from planners' epidemiologic definition of needs; 2) PHC is inextricably interwoven with socioeconomic and political processes; and 3) the effectiveness of PHC programs depends in large part on prospective clients' perception and use of PHC services in combination with other Western and traditional health care services. This series is aimed at the health planner who might perceive through these anthropological case studies how client-oriented research and services could contribute to more successful PHC programs.
Local health knowledge and universal primary health care: a behavioral case from Costa Rica.
This paper describes a group of rural people living in 2 communities in the Atlantic lowlands of Costa Rica and the health options available to them, namely health posts, clinics and hospital services, private physicians and the traditional health system (bush medicine). The health posts are part of a comprehensive rural health program initiated by the Ministry of Health to offer basic health services to communities. The major barriers to the functioning of the PHC program are administrative: poor transportation, scheduling, and lack of personnel. People said their reason for not using the health posts is lack of confidence in their reliability. The people's perspective about the solution to the problems of the health care system demonstrates some understanding of their own problems. The most frequently suggested change in the system is to have a permanent physician in the communities, followed by the suggestion to have a permanent nurse and more medicines at the health post. All their suggestions involve the health post, the most underutilized health resource in the community. Other suggestions involve the community level and the overall health delivery system and general improvement of living, especially economic, conditions. Health seeking strategies demonstrate a utilization patterns are: perceived seriousness of the illness; cost of services and methods of payment; perceived efficacy of the provider and treatment; accessibility and transportation. Consultations with family and friends, praying, and using bush medicines were reported for almost all illness episodes. The people of the 2 communities are active participants in their health care and in the health care system. The majority assume that there are limited health resources and that they must utilize all the alternatives. Preventive medicine is practiced by most of the people by keeping the body in balance through proper use of diet, drinking bush teas, avoiding certain behaviors and/or situations and using doctors' medicines. The major factors that motivate their health seeking behavior are based on a combination of bush and Western knowledge in a pragmatic framework. There is a negotiation process between bush and scientific medicine in the cognitive processes of the people. A participatory model for PHC in which the micro and macro systems become interdependent is suggested. Health planners should ask whether the program will have access to people, an answer to which is possible through knowledge of the culture, i.e., the clients' perspective. The planner should also pay attention to the factors that motivate people to seek health care, and policies should involve community people in the planning process. Local participation in PHC is crucial in integrating the various levels in the health system. PHC must begin at the local level and with community involvement in planning. The specifics of the policies and plans, however, must be left open to negotiation, depending on the culture and structure of the involved communities.
Cultural interpretations of states of malnutrition among children: a south Indian case study.
This paper highlights laypersons' ideas about the classification, etiology, prevention, and appropriate treatment of 7 children's illnesses among a South Indian population. The ayurvedic practitioner is identified as a primary health care resource in rural India having an important role in nutrition. A wide variety of causal factors are associated with these 7 children's illnesses. Elicited responses related to ideal illness categories, not illness experiences. Etiological factors entertained often focused as much on the mother or family unit as the child. Etiological factors include insufficient diet, overheat, bad blood, "pitta" (a humoral substance associated with overheat and yellow excretions from the body), "kapha" (associated with phlegm), ancestors, spirits and deities, heredity, contagion, sin "karma", stars and planets. By far, folk dietetics proved to be the major cognitive domain of etiological reasoning for 5 of the 7 illnesses. While states of malnutrition are linked to inappropriate diet, lay concepts of appropriate diet are markedly different from that of biomedicine. Folk preventive/promotive health behavior and home care is briefly addressed. Health care seeking for the 7 children's illnesses was often not limited to 1 medical system. The data suggest that major states of children's malnutrition are recognized as a complex of illnesses by the South Kanarese people. Primary health care for these illnesses is largely a combination of folk and ayurvedic remedies. Allopathic practitioners, while accessible in the study area and popular for the treatment of many other ailments during their primary stages, are generally not consulted by villagers for the 7 children's illnesses specified, until they have become acute. Suggestions are made with respect to the training of community health workers and the involvement of ayurvedic practitioners in promotive health education. Health educators could identify, and health education efforts address, folk illness categories and the major health concerns of the lay population. Innovative health education efforts can be developed based on a convergence model of communication and a negotiation model of health/nutrition education. The key to such a model of education is lending credence to pervasive lay health concerns, contingent cultural values, and the implications of responsibility attribution. It might be possible to integrate biomedical concerns for calories, protein, and vitamins with folk dietetic concepts such as hot/cold, body humors, and digestive capability. Careful attention to the ecological character of the humoral tradition and a groups-at-risk approach sensitive to existing health concerns, the use of folk illness categories as points of reference, and culturally responsive training in health communication could contribute significantly to the development of a bottom-up approach to health education befitting the primary health care orientation.
The health guide scheme--the Mysore District, India: the community's perspective.
In order to make health services more accessible at the village level, the State of Karnataka began a Primary Health Care (PHC) Program involving Health Guides (HGs). These are local villagers who are trained in basic health services and who work in their own village. This research was conducted among village community members living in the Mysore District, where HGs had been working for 1 year. A total of 240 household members were interviewed using pretested, semi-structured survey instruments in 30 selected villages. Results indicate that 70% of the household members surveyed were aware of the HG scheme, and 58% said the HG was always or often available to them. According to the official guidelines set down by the State of Karnataka, the village community was requested to recommend 2 or 3 persons considered suitable by them to become HG candidates. However, survey results indicate that 99.6% had not been involved in the selection process in any way. When asked what the 4 most important functions of the HGs were, the household members responded overwhelmingly (98.3%) that the sole function was treating minor ailments. More of the household members surveyed went to the HGs to receive medical services than to any other persons. Of those who made HG contact, 52.2% reported that they were very satisfied and 44.4% said they had been partially satisfied by the medical services they had received. The vast majority of the community reported that they felt very little work was being done in the area of prevention (soakage pits, sanitary latrines, water supply, family planning and immunization). But these items were not perceived to be very important and seem to have little impact on the community's acceptance of the HG scheme and on its further continuation and expansion. A large majority of those interviewed wanted the HGs to visit their homes more often for health-related services. 20% of the community household members said they would be in favor of financing the HG honorarium or the HG drug supply, currently provided by the Government of India and the State of Karnataka. Finally, 92.1% felt the HG scheme should be continued in their area and 91.7% felt it should be expanded to other areas of the State. Suggestions are offered regarding ways to improve the community participation in this pilot area. Examples include regular home vistis by the HGs to all households using complete up-to-date household surveys; pictorial signs aroung the village area to advertise HG services; spending more time during training sessions on preventive aspects of the HG job and the adequate explanation of the philosophy of the HG scheme, with particular stress on the importance of preventive and promotive services. Such steps will ensure relevancy of the programs, ensure success of immediate activities, and pave the way for long-term changes in the communities themselves.
The Tuberculosis Control Program began its reorganization in 1979, when the Honduran Ministry of Public Health designated tuberculosis as one of its priority problems. Administrative and logisitical problems faced by the program were exacerbated by the public's negative image of the disease and the consequent rejection of anything related to it, including medical diagnosis and treatment. A baseline investigation was carried out to determine the knowledge, attitudes and behaviors of the public, patients and patients' relatives regarding tuberculosis (TB). Sampled were 361 healthy adults, 75 tuberculosis patients, 55 relatives of patients, 20 health personnel, 12 nurses in 12 health centers, and 3 epidemiologists. Data was gathered using surveys (healthy population), focus groups (healthy population, patients) unstructured interviews (relatives, health personnel, nurses and epidemiologists) and focused interviews (relatives). The investigation confirmed the existence of social rejection toward TB. The disease is considered quite contagious, and is associated with extreme poverty, filth and malnutrition. The patients stated that this rejection is 1 of the greatest burdens of their disease; they considered themselves a danger to others and expressed feelings of guilt. The most recognized symptom was coughing and expectoration. A person with a persistent cough does not however, want to think of TB, except as a very remote possibility. Health personnel also fail to perceive a persistent cough as a respiratory symptom and possible indicator of TB. Cough syrups and bronchial decongestants are the most widely distributed medicines in rural health centers. Both the patients and the general population queried knew that TB is curable, although they doubted that the patient could recover his/her full health. Patients' fear was that the long period of treatment would inevitably lead to their neighbors discovering that they had the disease and rejecting them. The health system's capacity to diagnose and treat TB was also analyzed. Several problems were detected in the diagnosis of respiratory cases, e.g., difficulties leading to long delays in the collection and analysis of sputum samples and in the subsequent reporting of the findings. Moreover, instructions given to the patient are quite vague as to exactly what quality sputum is needed and how best to obtain it. These problems affect the number of patients who are diagnosed and treated, but seem to have little bearing on those already being treated. An education campaign was prepared based on these findings. Its goals were toinform the population at large that TB patients no longer transmit the disease, that they can be completely cured if treatment is begun promptly, and that a persistent cough lasting for more than 15 days may be a symptom. A pamphlet has been developed to better educate the patients and their relatives. It is concluded that an understanding of and familiarity with the client's perspective can help educational programmers identify exactly which facts or opinions must be reinforced or modified so that beneficial health services are utilized.
This paper addresses an urgent problem faced by Amerindians: how Western techniques of primary health care (PHC) can be taught in a way that will most effectively upgrade their standard of health without interfering with traditional concepts of medical dare or disrupting community life. The results of a consumer-based evaluation of PHC training of Jivaroan women suggest that techniques found to be effective in nonindigenous settings are not as successful when applied in some indigenous communities. The primary problem of training indigenous health workers, obtained during a study of the effectiveness of the national Peruvian traditional birth attendant (TBA) training program, lies in the conceptual differences between the interpretation of the economic system, organization of the health system, and perceived health needs of indigenous Indian communities as viewed by national and regional health planners vs. the views of members of these communities. It is argued that the most effective method of evaluating the effectiveness of the Peruvian TBA training program is 1 which combines an examination of the process of training (user's perspective) as well as its product. A triphasic research strategy was designed to follow the strucutre of the operational and administrative features of the Peruvian PHC system and also to recover information from the community level. The results of the regional survey indicate that the program was effective in teaching TBAs to utilize Western methods of obstetrical and gynecological care for treatment of patients during the maternity cycle. Analysis of quantitative and qualitative data found the program was most successful in highland, coastal and lowland rural and semi-urban areas where Quechua and/or Spanish was spoken. However, the community studies revealed a wide difference in the response to the program that was highly dependent upon sociocultural variables. This influence was particularly evident in the results of a case study carried out in community of lowland tropical forest Indians. It is argued that without modifications, the standard Peruvian TBA training program was an inappropriate means of providing PHC. It did not fulfill the community's felt needs for a higher standard of health care, due to the conflicts between the norms of the program and the structure of the community's social and cultural matrix. The application of a consumer-based research methodology illustrates that it is the consumers who ultimately determine whether a health program can be a success or a failure.
Hepatitis B virus (HBV) infection is highly prevalent in the tropics. Active immunization is the most effective strategy to interrupt continuous transmission and reduce the human reservoir of HBV. In a study of Nigerian infants and older children, doses of 2 ug of a vaccine given subcutaneously 1 month apart induced antibody (anti-HBs) response in 80% of older children (ages 2-15 years), and in 88% of infants. The efficacy and immunogenicity of the vaccine compared favourably with the conversion rate of 90% in those given 5 ug per injection. Intradermal vaccination using 2 ug injection was less efficient but induced positive responses in 74% of the recipients. No untoward effects were documented in all the recipients. The use of reduced dose schedule will save cost of vaccination especially in developing countries. Intradermal application is feasible and may be useful in mass campaigns. (Author's modified)
A cross-sectional survey and a 1 year surveillance was carried out in April 1983 and from May 1983 up to April 1984 in 5 villages in a swampy area in South Sumatra province of Indonesia to describe the prevalence and the incidence of diarrhea and diarrheal-related mortality in the area. Point prevalence of diarrheal attack was 8.6/1000 population, period prevalence in the last 2 weeks was 12.1/1000 population and the annual incidence was 187.8/1000 population. Diarrhea related mortality was 10.4 % of the total mortality, 12.5 % of infant mortality and 36.8 % of 1 to 4 years age group mortality. The seasonal incidence was negatively correlated with rainfall. The mode for age specific incidence was between the ages of 24 to 35 months. The average duration of diarrhea recorded in the surveillance was 3.36 days; 6.1% of the episodes lasted more than 7 days. Only 0.8 % cases suffered diarrhea 4 times or more in 1 year. Based on the assumption that the reported annual incidence indicates the number of diarrheal attacks which need external help, the recall period prevalence reflected diarrheal attacks which need either self intervention or external help; point prevalence reflected the total diarrheal attacks, some of which are self limiting. It was calculated that 66.3 % of diarrheal attacks disappear without any intervention, 13.8 % disappear with self intervention, 19.8 % are cured with external help and 0.4 % lead to death. (author's modified)
Determinants of child health status: a study in rural Karnataka (India).
A variety of physiological and biological interactions and their synergistic effects determine growth status as well as susceptibility to illness. Studies on the interactive relationship between nutritional status and morbidity have shown the synergistic effect of the 2 variables but there have been few studies which have investigated the multivariate relationship between growth status and the predictor variables, and similarly between morbidity and other variables. This study was designed to identify variables in the family and child subsystem which determine child health status in 2 selected rural areas of Karnataka, India. The multivariate approach stresses the importance of controlling for age as 0-12 and 13-36 months. The results show that some of the variables which explain the differences in weight for age are the direct influence of socioeconomic status and operate indirectly through morbidity and per capita expenditure on food. Other variables explaining the weight for age of the child are calorie intake, birth order and family size. On the other hand, the variables which explained the weight for age of children in the age group 0-12 months, were calorie intake and morbidity, at 1% significant levels and mothers' age and sibling mortality at 5% significant levels. A systems view of the problem recognizes the significance of variables and, therefore, the need for an integrated approach to the management of child health services. (author's modified)
An approach to evaluating the quality of primary health care in rural clinics in Ghana.
This study is a simple, low cost assessment of the quality of care in a rural primary health care setting, using the Danfa Health Center and 3 satellite clinics. The evaluation data are based on structured observations of the care provided by medical assistants (MAs), midwives and community health nurses (CHNs), providers serving the greatest proportion of the population. The clinical conditions (topics) selected for study were care of pediatric malaria, prenatal midwifery care, and postnatal health education. Attention was focused on the collection of process data relevant to health services research, because although analyzing structural characteristics is easier, presence of structural facilities does not guarantee access and use. Criteria were developed by 2 physician specialists and reviewed by peers in the University of Ghana Medical School, and the Ministry of Health. The health center and 3 satellite clinics under study serve a population of about 12,000, 48% of which were under 15. MAs were found to rigorously follow only 2 test criteria: questioning regarding duration of fever, and prescription of medicine. Other tests such as blood films were not performed often enough by expected performance level standards, although noncompliance might have been justifiable in the case, for example, of the MA's not palpating spleens where most people have enlarged spleens. Midwives met standards for 6 of 12 performance protocols; still disquieting. Requesting inexpensive hemoglobin lab tests, for example, might be desirable. CHNs showed a considerable disparity with acceptable standards, exceeding them in only 1 out of 12 procedures. More experience is needed to select criteria carefully and observe reasons for noncompliance. A greater involvement of personnel in the process of evaluation would facilitate constructive changes for improved quality of care and staff training.
Sex-education needs and interests of high school students in a rural New York County.
75 boys and 88 girls from 3 high schools in a rural county of New York state took a sex-education quiz and were asked to describe their sexual and contraceptive experiences and sex-education interests. Consistent with most previous research, nonvirgin teenagers who earned better grades on the sex-education quiz failed to use more effective contraceptives than nonvirgins who had performed poorly on the quiz. There was a striking similarity among students' descriptions of sex-education interests, regardless of their gender, previous enrollment in a health course, or experience with sexual intercourse. Very few teenagers (9%) were completely satisfied with their high school's current sex-education program. The majority (57%) wanted to learn more about contraceptives and venereal disease prevention, either as the primary focus of their sex-education curriculum or in combination with other topics such as sexual values, the biology of reproduction, and information about the human body. Many adolescents (19%) seemed confused about their sex-education needs and described a vague interest in everything sexual. Only 2% of the students thought sex education should provide them with erotic information or techniques for increasing sexual pleasure. The remaining students wished that their sex-education courses would give them additional information solely about sexual values (5%) or the biology of reproduction and knowledge about the body (8%). (author's modified)
Cognitive aspects of health survey methodology: an overview.
The past 25 years have seen the development of a wide variety of sample surveys dealing with the nature and distribution of illness and disability, and with the utilization of health care service. The sample survey is currently the most widespread and influential instrument for judging the health status of the nation and for guiding health policy. The knowledge, beliefs, and attitudes of survey respondents "subjectively" affect what the survey seeks to "objectively" measure. Even as statistical sampling has been refined, so is it important to reexamine what the cognitive sciences have to offer for survey interview structure and content, especially where an interview is used to collect data about individual behavior or attitudes. Dialogue between cognitive scientists and survey researchers has begun to take place only recently. The Advanced Research Seminar on Cognitive Aspects of Survey Methodology, held in 1983, inspired several projects. One would explore attitudes organized into cognitive structures connected with certain topics, termed "schemata," an example being a "welfare cheats and chislers" schema for attitudes toward Medicaid. A national survey could be a tool in the development of a national inventory of cognitive abilities (yet another vital statistic). A study which entailed having respondents think out loud when responding has given insights into retrieval cues for good recall. Further work is necessary on relative benefits of reporting on self versus reporting on others. The article also speculates on some changes that might be made in the National Health Interview Study that might affect its accuracy. They include identifying the household medical "gatekeeper," changing terminology and restricted-activity questions to forestall underreporting, and some examination of the problems of the subjective side of health.
The National Center for Health Statistics has embarked on a major project to combine the respective strengths of cognitive psychologists and survey researchers in a common effort to improve the design of survey questionnaires. This methodological research is conducted within the framework of the National Health Interview Survey (NHIS), the nation's main source of information on the health of civilians. Better quality of such information--from recall to response rates--can aid both scientific inquiry and public policy. Temporal dating is important. When reference periods are not bounded there is a net forward telescoping. Survey design experiments prior to a national consumer expenditure survey on household repairs helped to reduce telescoping by means of an initial interview to bound the reference period. Another study concerned with cognitive processes for recalling and estimating dates found that the more a subject knew about an event, the more recent it would seem. The 1st of the 2 studies was aimed at survey error for a specific survey, while the 2nd was concerned with cognitive process. In the NHIS suppement to the 1986 questionnaire, cognitive issues examined will be respondent recall and information strategies and judgements when asked about unfamiliar items. Laboratory research will focus on survey reporting of chronic health conditions and on retrieval of health information from memory by respondents. It is possible that laboratory based research is more cost-effective for the study of cognitive problems than field research. Further research could focus on decision-making strategies for medical and policy decisions and control of nonresponse in survey. Findings will have a broad applicability to scientific surveys generally.
Cognitive aspects of health surveys for public information and policy.
Health survey data are an important and efficient source of information for policy makers and administrators. But caution is warranted: surveys do not show cause-and-effect relations, and they are no substitute for randomized controlled experimentation in predicting behavior. The variety of surveys--governmental and private--is increasing. This article suggests improvements in both methodology employed and interpretation of results. Health policy must be formulated on the best available information, as was the National Institute of Health policy on weak and equivocal blood cholesterol experiments. But, in the long run, controlled trials will help to increase the effects of interventions and hence the policies themselves. A statement based on data from the National Health and Nutrition Survey, dealing with the effects of calcium, potassium, and sodium on blood pressure, did not attempt to analyze nonresponse bias and drew conclusions that did not take the definition of hypertension into account or control background variables such as age. Nutrient intake data might have been improved, for instance, by substituting serum calcium measurements for 24 hour recall exams. The Equitable Healthcare Survey, designed for cost containment policy, did not use detailed questions on health conditions and illnesses to assist respondents in providing reasonable responses. Questions asked of physicians involved considerable judgement and calculation, yet only 9% said they were "not sure." Survey assessments of risk are even more problematic. The current governmental stance toward funding of survey research and data collection undercuts its ability to make informed policy choices, and will force it to rely upon data emanating from organizations likely to be affected by policy changes. Government-sponsored surveys are the focus of innovative research efforts that will improve the entire survey enterprise.
[Report of clinic activities, third quarter, 1985]
During the 3rd trimester of 1985 PROFAMILIA's family planning programs continued their rise; current data show increases over the corresponding figures for 1984, when the program was the target of severe criticisms. A comparison with the data for the 3rd trimester of 1984 shows that new users rose by 6.8%; follow-up visits, by 4%; total consultations, by 5%; surgical sterilization, by 19% and cytologies, by 18.9%. The retail sale of pills increased by 170.4%, while that of condoms rose by 68.1%. In the area of wholesale selling of contraceptives, the sales of the pill decreased by 53.8%. This drop is attributed to new regulations which restricted the wholesale distribution of certain brands of oral contraceptives; these will be available only through over-the-counter sales or through community health clinics. Total sales of the pill decreased by 35%; those of the condom rose by 307.3%. The program carried out 6889 pregnancy tests and provided 308,704 years of protection against pregnancy to its users. The latter represents a drop of 3.4% over the previous year.
Time budget analysis as a tool for PHC planning (with examples from Ethiopia).
Health or development programs that do not take into account the way in which real life communities structure and value their own time are often "time stealing," and when communities find time inputs are too expensive, many adverse effects on community health and development appear. Even the spare time produced by leisure and seasonality may be mitigated by time costs related to sickness, and taking long journeys to reach areas of services. 1 effective way of introducing time, in health and social development, is to prepare a sheet of community activities, where alternative uses and effective allocations of time become a primary concern of community planning. This paper applies a time budget analysis to examples from Ethiopia. In a study done in a rural community, it was found that 11.5 to 12.4 hours/day were devoted to labor. A separate study showed that 71% of children dying in children's wards had conditions that could have been avoided if children had been hospitalized earlier. Other countries, by mobilizing maternal-child health services, have reduced infant mortality. Time budgets for rural Ethiopia indicate that because of backward technology, the present labor supply will not significantly increase land under cultivation. The impact of illness and death on time allocation is also heavy: a family death means a suspension of labor for 7 days. Some of the obstacles to the efficient use of time are cultural/linguistic differences, communication barriers, limited coverage by health services, pressure on personnel and other problems, and 1-way bureaucratic communication. The 10-Year Perspective Plan for Health in Ethiopia (1985-1994) will address some opportunity cost problems by emphasizing locally-appointed health workers, relying on cheaper (and more) health units, introducing double staffing, improving budgets, and assuring accessibility of the referral centers. An appendix details time research methodology.
What caused India's massive community health workers scheme: a sociology of knowledge.
A program to train community health workers (CHWs) was initiated in India in 1977, using a rhetoric that referred to claims for the success of health policies in China. The goal was the training of 1 worker/1000 rural people by 1981 (total 580,000 in India), all of whom were to be literate and capable of 2-3 hours/day on health care in their communities. Their work would not be part of the health service bureau supervisory hierarchy, although they would have referral responsibilities. This paper begins by considering conflicting interpretations of the program when it was implemented. The medical establishment was very much against the project, citing the absence of pilot projects and lack of participation by medical schools. Other criticisms accused the program of being a propaganda ploy, attempting to use a medical placebo to sustain a system of exploitation of 1 standard of medicine for the "classes" and 1 for the "masses." The program instructors were not trained in the goals of the program, and often ignored the extensive institutional structure of indigenous medicine. Women represented 10% of CHW population, although women workers would probably have been more effective. In addition, the program failed to utilize the substantial body of ethnographic work on medical practices and traditions. This type of knowledge might have helped the medical establishment to understand the way in which cosmopolitan medicine was interpreted and accessed by the "masses." There has also been a failure to take into account elitism, colonialism, and the lack of prestige enjoyed by the ideologies of social medicine.
From China to Africa: the same impossible synthesis between traditional and western medicines.
This paper questions the relevance of the Chinese Medical Model for African countries in the process of designing new health care delivery systems. It discusses only 1 aspect of the whole model: the official use of traditional practitioners, and questions more generally the place of traditional Chinese Medicine in the medical care system. The example of a pre-revolution outbreak of cholera is cited, where vaccination was integrated into a series of mostly religious public health measures, some of which were accidentally beneficial (abstaining from fruit and vegetables, which were generally washed with contaminated water) and some not. Local medicine must be regarded as a mixture of sound knowledge and magic which is impossible to radically replace. The recognition of traditional medicine as being scientifically as well as ideologically acceptable came several years after the Chinese revolution. The institution of the "barefoot doctors" program in 1965 appeared to be yet another rethinking of philosophy. In Africa, some attempts have been made to integrate traditional with cosmopolitan medicine. Maximum benefit will clearly be derived from plans which reform the entire health system, decentralizing it and de-stressing curative medicine, approaching the old medicine with an open mind by confronting it in its totality and not by observation of individual therapeutic methods, and allowing cosmopolitan medicine to be questioned by traditional. Integration should not take place in rural areas or in primary care settings only. Conditions should be improved for traditional healers to practice in their own settings, and recognition should be made of their role in treating illnesses resistant to Western therapy. Policy changes will need to be based on a better knowledge of traditional medicine and a recognition of its adaptability to change and new bodies of knowledge.
A longitudinal study of the reporting of emotional and somatic symptoms during and after pregnancy.
In Winnipeg, Manitoba, Canada, 108 pregnant women, most of their husbands and a comparison group of non-expectant parents were recruited for a long-term study which involved responding to a 55-item Symptom Checklist (SCL) and the Beck Depression Inventory (BDI) 3 times during pregnancy and once during the 1st postpartum month. Responses to the SCL were factor analysed, and the 4 groups were then compared on their factor scores as well as their scores on the BDI using discriminant analysis and trend analysis. The discriminant analyses were done twice: once using all the data provided by all subjects and once using only subjects with no missing data. At each measurement period, the pregnant women were distinguished from the other groups by a different factor of the SCL: at 3-5 months, it was 'Feeling Sick;' at 6-8 months, it was 'Feeling Overweight;' at 9 months, it was 'Feeling Overweight/Physical Stress;' and at postpartum, it was 'Physical Stress.' Also, trend analysis showed a significant tendency for the scores of pregnant women on the SCL 'Negative Emotional State,' factor and on the BDI to increase over time, in contrast to those of the other groups.
Traditional healing rituals in many parts of the world seem to derive from a model of cyclical renewal provided in the 1st instance by menstruation. Health is seen as dependent upon a correct balance between polar opposite states, e.g. "heat" and "cold", "dryness" and "wetness." Nature seems to achieve such balance by alternating regularly between opposite states such as night and day, wet season and dry. One such cycle is that of the moon, which figures heavily in the rebirth ideology of Australia, where the Moon character is associated with characters who, in mythology, elected or were permitted to be reborn (hence waxing and waning). Humankind is associated with a character in all of the moon-myths who elected or was forced to die permanently. Shamans in Australia are individuals who have gone through a symbolic death and rebirth, and who are therefore competent to heal. The logic of healing rites is that humans, too, should be able to move through "death" to "new life" by keeping closely in tune with wider rhythms of renewal. It is argued here that women should achieve this by menstruating in synchrony with the moon, which periodically "dies" and is "reborn." Among the California Yurok, menstruation is for women a period of formidable personal power, optimally in phase with the moon and around which husbands should organize their lives. Amazon Indian mythology shows striking similarities to Australian. The earth with its seasons is thought to have its own moontime links as humans do. Cycles are considered necessary not only cosmically, but also to individuals, inducing men to attempt to imitate the cleansing effect of menstruation.
Women heal women: spirit possession and sexual segregation in a Muslim society.
In the Moslem Northern Sudan, persons suffering from spirit possession have recourse to healing cult groups. They are prominently led by women in this area. Sexual segregation and sexual asymmetry are prominent features of Northern Sudanese society. Women's sexuality and fertility are powerful and polluting, carrying with them the danger of dishonor and needing to be controlled and directed to their "proper" social ends by men. Men pay for their daughters' infibulation, retain the right to dispose of them in marriage, honor their wives after childbirth, and claim children of the union for their patriline. Normally, a woman's only source of status is through her father's and then her husband's patriline. In the latter she becomes important only by contributing sons. However, it is women who actually practice infibulation and who keep firmly within their hands all the ritual surrounding vital stages of their life cycle. Throughout, women symbolically assert the fundamental nature of their reproductive power. The healing cult of the zar fits into this symbolic system with its woman-centered, woman run curative ritual. The female leader of the cult group is often the antithesis of what normally determines the status of a Sudanese woman: descended of slaves or the lower classes, divorced (often willingly), widowed, or childless, independent and apt to receive strangers at home or visit themselves. They have risen above the normal requirements and are turned to by other women attempting to come to terms with their own. In zar, as in other life-cycle rituals, women are reaffirming their social importance, forcing men to acknowledge publicly that the basis of their society rests upon female reproductive power.