[Fertility of the Yi women in Liangshan]
An attempt is made to determine the causes for the high fertility rate of the Yi women in Liangshan, China. The Yi are one of China's 54 ethnic groups, the largest group of which are the Hans (making up 95% of China's population). The area surveyed was Liangshan Yi County, having a population of 1.4 million. The survey included Yi women between the ages of 13-29 and compared them on the basis of previously gathered fertility statistics dealing with 1st and 2nd marriages and changes in household arrangements. According to a 1980 report, 16.37% of 36,302 infants of Yi women were the 1st child, 20.33% were the 2nd, 19.05% were the 3rd, 16.55% were the 4th, and 27.36% were the 5th child. These figures show that the Yi women's fertility is still extremely high (and has been for the last 15 years). Their fertility rate is 3.03 times higher than that of the Han women and 1.5 times higher than the national average for women. Possible causes for this rate may be early marriage (the average age for marriage being 19), divorce, and remarriage, and changes in household arrangements (where married women cohabit with men other than their husbands). These findings indicate a great need for family planning in order to prevent further adverse effects on economic growth, living standards, and public health (e.g., malnutrition has been found among some babies).
[Population and regional development planning]
In Mexico, regional, sectorial, and global planning have reached a level of effectiveness never achieved previously, with the National Development Plan now including the proposals and goals of the National Population Council. But the coordination of regional and demographic policies is more than just a problem of interinstitutional coordination; the main difficulty is that both phenomena, spatial distribution of productive activities and growth and distribution of the population, are manifestations of economic development in its entirety, but each occurs at different rhythms and responds to different policy instruments. The growing preoccupation with incorporating regional and demographic variables into planning is the direct result of a recognition of the limitations of the planning process as currently practiced, and especially of regional planning as an instrument of development. Regional planning is the least developed aspect of planning in Mexico. Demographic phenomena such as natural increase and migration are the direct results of development. If demographic factors can be related to other social and economic indicators, the spatial development strategy can be translated into qualitative goals. The most urgent need is for a deeper linkage between demographic and regional policy. Regional and demographic policies interact in 4 areas: control of the growth of Mexico City and the pace of urbanization on the national level, management of urban migration, and interurban population distribution. A great challenge to regional and demographic policies will be to identify the principal attractions of Mexico City for migrants. If the principal attraction is the enormous concentration of industry and jobs, a different policy will be required than if the principal attraction is availability of services. The pace of urbanization should be determined by the creation of jobs, the capacity of public financing, and the level of productivity in agriculture, but interventions may be needed in both rural and urban areas if a satisfactory regional and demographic balance is to be achieved. Minimal living standards should be provided for the entire population, especially the poorest and most rural, and levels of income comparable in terms of effective demand should be guaranteed for rural workers in order to control migration and restore order to the growth of cities. Modernization of rural areas can enable them to support larger populations. Rural population should be aggregated into small centers of over 2500 in order to facilitate service delivery without incurring the economic and social costs and changes of economic activity that accompany traditional urbanization. Priority rural zones for public action should be identified. The complexity and interdependence of all the factors determining settlement patterns demand an integral planning process incorporating all elements.
The results of a survey done on women in rural Shanxi Province, China, involving 767 1st-time and 475 2nd-time insertions of IUDs are compared and analyzed. The length of IUD retention in the 1st-time insertion group was found to be significantly less than that of the 2nd insertion group (P < .01). Statistical evidence indicates that there is no significant relationship between the factors leading to termination of initially inserted IUDs, and the length of IUD retention following 2nd implantation. Instead, it would appear that IUD insertion is safer, more economical, less complicated and more effective the 2nd time than initial IUD insertion. This preliminary conclusion was based on 5 key factors: IUD expulsion due to natural causes, pregnancy during IUD use, unforeseen pregnancy, IUD removal due to medical complications, and IUD removal for non-medical reasons. The authors propose that further investigation of 2nd IUD insertion be conducted in order to derive a more supportable conclusion from the statistics presented.
An IUD releasing 20 mcg/day of levonorgestrel (LNg20) was compared with a Copper T IUD (TCu 380 Ag) in a randomized trail involving 2244 women 7 centers in the US, Brazil, Egypt, Chile, Singapore, and the Dominican Republic. The cumulative gross pregnancy rate at 2 years was 0.2 for the LNg 20 device and 0.9 for the TCu 380 Ag IUD. There were no ectopic pregnancies in more than 1600 woman-years of use of each device. The removal rates due to oligomenorrhea or amenorrhea were 10.7/100 among LNg 20 acceptors compared with only 0.2/100 among TCu 380 Ag acceptors in the 2-year study peroid. Removal rates for pain and/or bleeding did not differ significantly between devices. Hemoglobin rose an average of 0.5 g/dl in the LNg 20 group and declined an average of 0.2 g/dl in the TCu 380 Ag group. At the end of 2 years, the continuation rates were 59.4/100 among LNg 20 acceptors and 67.5/100 among TCu 380 Ag acceptors. This difference is ascribable to the scanty and infrequent bleeding patterns associated with the former device. It is concluded that both these IUDs provide highly effective intrauterine protection. (author's modified)
[Communication patterns with respect to family planning among colored youth in Eersterust]
In this investigation, 600 blacks from Eersterust, South Africa, ages 13-25 years were surveyed by questionnaire about various aspects of family planning and use of contraceptives. The aim of the research was to determine the flow of information with regard to family planning among the black youth. Special attention was paid to their familiarity with certain concepts used in family planning, certain opinions and behavior patterns related to family planning, and also to the role of the family planning clinic, the church, the school, and the family in the entire process. The influence of sex and age variables on the respondents' replies was checked statistically by means of the P3F computer program. The most important results can be summarized as follows: Between 18-32% of the total survey group had never heard of concepts such as contraceptives, family planning, and illegitimacy. These results indicate a lack of knowledge, especially in the younger age group (13-15 years) and proportionately more among men than women. Virtually everyone who heard of contraceptives had also heard of the pill while 12% of the respondents had never heard of the injection, and approximately 25% had never heard of an IUD or a condom. Of the respondents who had heard of contraceptives, 50% did not know whether contraceptives had any harmful side effects. The various harmful side effects that were mentioned revealed misconceptions and naivete on their part with regard to contraceptives--especially about the pill, IUD, and injections. It is concluded that there is great need among young blacks for such information, which should be provided early in life, perhaps from age 13 onward. More than 25% of the respondents who had heard of contraceptives did not know from which stage in life a girl could become pregnant after having had sexual intercourse. Proportionately, significantly more men than women and significantly more of the respondents in the 13-15 year age group said that they did not know. This also reveals a lack of knowledge. The majority (80%) of the respondents who had heard of contraceptives indicated that they had not used any method to prevent pregnancy when they engaged in intercourse. Once again those in the youngest age group did not use a method of pregnancy prevention proportionately. The apparently large measure of ignorance and/or unconcern revealed by the survey group was confirmed by the fact that more illegitimate than legitimate babies had been born. The largest number of illegitimate babies were born to those ages 17-21. 2/3 of all 1st babies were not planned and none of the respondents had taken any precautions to prevent pregnancy. 60% of the respondents who knew about contraceptives felt that they should be more easily obtainable. Family planning clinics are at present the largest suppliers of contraceptives. Friends played an important role in respondents' discussions on contraceptives. 46% who knew about contraceptives indicated that they had heard about them for the 1st time from friends, as opposed to 7% who had heard about them for the 1st time from a family member. Almost 1/2 of the respondents who had heard of contraceptives also indicated that most of their discussions on this subject had been with friends. Those ages 13-15 indicated proportionately significantly more than those in the other groups that friends had been their information source on contraceptives. More than 1/2 of the respondents declared that their 1st preference would be to talk about contraceptives with a family member. The investigation revealed, however, that the family, church, and school play a very small role in the dissemination of information on contraceptives and family planning to the black youth. Results indicate that a large percentage of those responding and proportionately more of the men and those in the age group 13-15 had little family planning knowledge. Research must be undertaken to understand how the family, church, and school can play a greater role in providing family planning information. (author's modified)
Some differences in fertility related attitudes and behaviour by ethnicity in Peninsular Malaysia.
The author attempts "to identify fertility patterns among the three ethnic groups [Malay, Chinese, and Indian] in Peninsular Malaysia; to explore differences in fertility desires and fertility regulation behaviour by ethnicity; [and] to estimate the fertility inhibiting effects of the intermediate variables, especially contraception, on the current fertility level of each ethnic group." Aspects considered include the level and pace of fertility and the impact of nuptiality; attitudes and behavior regarding desired family size, desire for more children, and family planning; contraceptive knowledge; and the relationship between desire for more children and contraceptive use. Data are from the 1974-1975 First Country Report of the Malaysian Fertility Survey. (EXCERPT)
Some aspects of reproductive behaviour changes in China, 1950-79.
The author uses data from the 1982 National One-per-Thousand Population Fertility Sampling Survey "to examine the changes in the starting and ending ages of childbearing of Chinese women during the period 1950-79." The mean age at first birth (MAFB), mean age at last birth, and mean reproductive span are estimated. The estimates are used to analyze time trends and rural-urban differentials, and a comparison is made between MAFB and mean age at first marriage to check the validity of the indirect estimates. Changes in reproductive speed over the three decades are also examined. (EXCERPT)
Denmark's Law Number 236 of May 1984 amends the 1979 Law on health measures during pregnancy and the duties of county authorities to provide guidance on contraceptive methods. All persons born or resident in Denmark are entitled to free guidance in this area from a physician or a clinic established for this purpose. Communes are authorized to enter into an agreement with a private institution regarding the operation of contraceptive guidance clinics. Such guidance may be made available to persons who are under 18 years of age and unmarried or have been declared incapable of managing their own affairs without the consent of a parent or guardian. The Minister of the Interior is charged with developing guidelines concerning the provision of guidance and ensuring that the population receives information on contraceptive methods.
A semi-Markovian multistate analysis of sexual union formation in Flanders, Belgium.
Recent life style changes in marriage and union formation dictate the consideration of a set of states different from the traditional ones considered so far. This study initiates a multistate analysis of sexual union states rather than the traditional marital states. This study is further restricted to analyzing the transitions that occur before the first birth. It provides a semi-Markovian analysis of transitions among the sexual union states, thereby examining the effect of duration in a specific state on the transitions to other states, using data on women from the Flanders region of Belgium from the NEGO IV Survey conducted in 1982-1983. The sexual union states considered are 1) non-virgin, 3) 1st cohabitation, 4) first marriage, 5) first birth, 6) widowed, 7) divorced, and 8) remarried. Results confirm that the generality of incidence of 1st sexual intercourse is outside marriage for young women in Flanders. Despite the increase of cohabitation in recent times, it still seems to be an alternative practiced only by a minority in Belgium. Among Flemish women, cohabitation serves as a stepping stone to marriage; most of the cohabitants marry sooner rather than later. Religiosity is a powerful constraint from premarital sexual activity, cohabitation, and childlessness. Transitions are generally faster and within shorter durations in less educated women. More educated women tend to cohabit, and less educated women tend to marry. 81% of cohabiting women marry within 2 years of cohabitation, indicating that cohabitation serves as a "trial marriage." This framework, although it ignores age of entry into a particular state, highlights the impact of religiosity and educational level on the duration of a state.
Young adults' contraceptive practices: an investigation of influences.
A social-psychological approach to understanding preventive behaviors was developed, incorporating the Health Belief Model and other factors, to offer a means for evaluating the extent to which contraceptive behaviors in young adults are influenced by individual and group characteristics. The study group consisted of 283 unmarried US college students, who, on the average, were 19 years of age. Dangerous misconceptions prevailed with regard to respondents' knowledge of areas including anatomy, physiology, and appropriate use of effective contraception. 68.2% of the sample said that they had experienced coitus. Of those reporting coital experience, 56.6% did not take adequate precautions to prevent pregnancy at the time of their 1st coitus. Among the sexually experienced, 76.9% reported use of specific methods deemed effective at last coitus. More than 60% underestimated pregnancy rates of adolescents, and approximately 43% agreed that "pregnancy just isn't something that would happen to me or a sexual partner." 85.1% agreed that dealing with an unplanned pregnancy would be painful, and 86.7% disagreed that contraception made coitus less enjoyable. 94.7% believed that males and females should share the responsibility for birth control. However, 72.5% of both sexes thought males should be responsible for birth control availability while, in a separate item, 88.3% felt it was the female's responsibility. Furthermore, 27.3% held the notion that females with accessible contraception would be deemed promiscuous. 52.4% agreed that coitus should be spontaneous, 40.8% also felt that birth control makes intercourse seem preplanned. Effective contraceptive behavior associated most strongly with respondents' perceiving relatively few barriers to use of contraception, maintenance of extensive interpersonal skills, and their regarding peer norms as consistent with effective contraceptive behavior.
This bibliography includes 100 printed documents and 6 films and videocassettes dealing with problems of communication and population in Senegal. An introduction lists the objectives of the governmental Communications Unit and its Center for Documentation. The works are classified into 18 major categories following the system of the Multilingual Population Thesaurus of POPIN (Population information network). Each citation includes the author, title, source, and key words indicating specific content. 18 references concern demographic research and methodology. 10 concern age, sex, and ethnic composition of the population. 39 concern culture, education, and information, 15 concern administration, legislation, and government policy. 2 each concern psychological factors, health, and nuptiality. 4 concern family planning and fertility. 1 each deal with family and households, social organization, the active population, employment, and population dynamics and the reproduction rate. 3 concern morbidity and mortality. The audiovisual documents include 4 videocassettes and 2 films.
Systematic temporary labor migrations from the Republic of Korea started after the 1st oil shock and increased significantly after that. The annual number of workers leaving for overseas jobs was less than 10,000 before 1972. During the last 5 years, an annual average of 148,000 workers left Korea, with most of them going to the Middle East. In June 1984 about 220,000 Korean temporary workers were employed abroad. This study examines the data on 2 companies--a sample survey of 1000 employees in 1 and general reports on workers and their families in another--for problems encountered by overseas workers and their families. Data scarcity due to the fact that there is no coherent policy, public or private, for overseas workers once they return home was a major problem for this study. Overseas workers made a significant contribution to paying for Korea's oil imports and economic development in the 1970s and 1980s. The contribution is made through the migrant's hard work in an inhospitable climate and with a long separation from his family. Owing to the recognition of the workers' contribution and sacrifice, there has been a definite improvement in Korean laborers' working and living conditions abroad. However, no comparable improvements have been made in the programs dealing with the welfare of retrning workers and their families. Recommendations to improve these programs include 1) improving the job security of returning workers, especially through unemployment insurance; 2) adopting preventive measures to deal with possible family problems created by a workers' long absence, such as screening both workers and families before employnment; 3) shortening the period of family separation; 4) creating mothers' clubs for the wives left behind under the guidance of the company personnel office; 5) instituting a rational system of remittance management; and 6) establishing a direct line of communication between workers and families, such as a telephone day where families can come to the office to telephone workers abroad. Further research and new data are needed to formulate a coherent policy toward returning workers and their families.
Returning Filipino overseas contract workers: the case of Barangay Vergara, Metro Manila.
From 1976 to 1982, a total of 1,205,098 Filipino workers were employed overseas, sending home foreign exchange remittances estimated at US $3.45 billion. Since the overseas employment program was instituted as a major government policy in the Philippines to solve temporarily the problems of unemloyment and the balance of payments, hundreds of thousands of Filipino workers have left the country in search of better work opportunities. This paper examines some of the social and economic aspects of return migration in Barangay Vergara, 1 community in metro Manilla, using data from a pilot study of 59 return migrants. 58 of these returnees were male and half had been unemployed prior to migration. Economic reintegration is the major difficulty confronting the returning overseas contract worker. This problem will assume greater magnitude as more and more workers return to the country. Workers acquire new skills abroad, but their usefulness on returning is still a question. Gains from overseas employment may be adequate only to meet the basic needs of workers and families, particularly for those who have had a short overseas employment experience. Virtually no one in this study used remittance for more productive investments. Overseas employment does not seem to create problems of readjustment into the family and the community for the worker, possibly due to the relatively short duration of absence. Overseas employment does not seem to have a lasting effect on changing gender roles in the family, especially in decision making. A large-scale study of return migrants is needed to gain a more in-depth understanding of return migration.
Economic diversity, family strategy, and fertility in a Mexican-American community.
"This paper examines the determinants of fertility and fertility differentials among Mexican American women in a community in south Texas." The relationship between economic change and fertility is analyzed. Fertility trends among families working in agriculture and those working outside agriculture are compared. Data were collected between 1976 and 1981 in a rural Texas-Mexico border region. (EXCERPT)
Contraceptive needs in the 21st century: a demographic analysis.
Contraceptive needs in the 21st century are examined. A demographic scenario to the year 2025 is presented including projections of total population, women in reproductive ages (and among them, those in marital union), the number of married women who will require contraception, and the number of users of specific contraceptive methods. The Bongaarts and Potter method, as used here, involves a multistage sequential procedure. In the 1st stage, the required contraceptive prevalence rate in the year 2025 is obtained by using current and projected fertility rate, current and projected rates of use-effectiveness, and the current contraceptive prevalence rate. In the 2nd stage, the estimated number of contraceptive users is obtained by using the contraceptive prevalence rate obtained in stage 1 along with the projected population by age and sex and the proportion of women currently married in reproductive ages. In the final stage, the projected number of contraceptive users is broken down by specific methods using the projected percentage distribution of contraceptive users by methods and the estimated total number of contraceptive users obtained in the 2nd stage. Most of the data needed for obtaining the estimates in stage 1, 2, and 3 are taken from various UN publications, in particular, the 1984 assessment of population trends in individual countries and territories of the world and the 1983 assessment of contraceptive levels and trends. The data on use-effectiveness by methods comes from Bongaarts and Potter (1983). The most important input into the method of estimation is the projected total fertility rate (TFR). The projections indicate that to achieve a fertility target of 2.40 in developing countries and 2.12 in developed countries by the year 2025, the contraceptive prevalence rate has to increase correspondingly from 38.0 to 65.1% in developing countries and decrease correspondingly from 68.0 to 66.2% in developed countries. In absolute terms, this would mean that there would need to be 699.4 million contraceptive users in developing countries and 127.6 million in developed countries. The needed proportion of contraceptors among married women in the yar 2025 will be the lowest if the current emphasis on sterilization that exists in developing countries is maintained and, at the same time, the efficiency of the use of contraceptive methods is improved. In sum, the regulation of global fertility and individual reproductive behavior to fertility regulation methods, and encourages development of new contraceptives.
Some aspects of family, fertility and family size limitation among Muslims in an urban setting.
The author investigates family size, fertility, and birth limitation among "two ethnic sub-groups, namely, Momins and Koknis, among the Muslims residing in Bhiwandi, a place near Bombay in the state of Maharashtra [India]." The data are from a survey of 1,290 Momins and 645 Koknis and a study involving a subsample of 163 Momins and 97 Koknis. Differences between the subgroups are noted in sex ratio, age distribution, marriage age, marital status distributions, family size, family characteristics, education, occupational diversity, living conditions, fertility, and knowledge, attitude, and practice of family planning. (EXCERPT)
Illegal immigrants in Texas: impact on social services and related considerations.
A 1982-1983 survey of 868 undocumented aliens and a number of providers of public services showed that the state of Texas receives more from taxes paid by undocumented persons than it costs the state to provide them with public services, such as education, health care, corrections, and welfare. The same survey showed that 6 cities in the state (Austin, Dallas, El Paso, Houston, McAllen, and San Antonio) together expended more to provide services to undocumented aliens than they received in taxes. The survey concentrated on undocumented persons not detained by the immigration authorities and found that this group constituted a distinct population from those in detention centers in that the former exhibited normal characteristics of settled families, while the latter were predominantly the familiar young, single, and peripatetic males. A related finding is that the households of the transient group consist predominantly of undocumented persons whereas the households of the settled group contain a greater mixture of legal residents and illegal aliens. Undocumented persons do indeed use public services, primarily education and health services. They are rarely recipients of welfare services or food stamps. Undocumented persons do indeed pay taxes and those taxes that go to or revert to the state of Texas clearly exceed the cost to the state to provide services to those people. On the other hand, local governmental units (below the state level) in Texas must expend more to provide public services to illegal aliens than those governmental levels receive from the taxes paid by these persons. This is an administrative issue relating to the recipients of tax dollars and the government level on which the burden falls to provide certain services, primarily health care and education. Finally, since only about half of the settled population is in the job market in Texas, a quick fix of deportation of these persons would not create an equivalent number of jobs.
Attitudes of Mexican Americans toward irregular immigration.
This inquiry focuses on the attitudes of 314 Mexican Americans toward issues relating to current US immigration policy. Telephone and personal interviews were conducted in Hidalgo and Travis counties, Texas, with Mexican-Americans. Virtually all respondent groups oppose an increased rate of immigration, consider illegal immigration to be an important problem, support stricter enforcement of immigration laws, and believe that undocumented workers take jobs no one else wants. Half of the respondents identify illegal immigration as a regional rather than a personal problem. At the same time, the data suggest significant differences in both direction and intensity of attitudes between Mexican Americans of different generations, income, occupational levels, and region. There is general opposition to the requirement of a national identity card, but widespread support for penalizing employers of undocumented workers and for granting amnesty to undocumented workers. These findings allow an examination of the extent to which the Mexican American leadership, which has been overwhelmingly opposed to the Simpson-Mazzoli bill, accurately reflects the views of the Mexican American people. The leadership and the population at large agree on 2 of the 3 issues, amnesty and the national identity card, but disagree on employer sanctions. 1st, it may be that the leadership holds the kinds of jobs for which undocumented workers are unlikely to compete, so they may not feel threatened. 2nd, they may feel that instituting employer sanctions will create incentives for employers to discriminate in their hiring practices against all Latino-looking job applicants. Non-elite Mexican Americans who support employer sanctions may believe that the only way they can compete for jobs is to make it impossible for elites to be hired. Both groups appear to fear that, regardless of the specifics of immigration reform, Mexican Americans are likely to encounter increased discrimination in the job market.
Cultural pluralism and the future of American unity: the impact of illegal aliens.
This paper explores the question of the impact of illegal migration on American unity and cultural pluralism in the US. Assuming that over time the descendants of undocumented workers now in the US will behave substantially like descendants of those who immigrate legally, the long-term impact of illegal migration barely will be noticeable provided it is reduced substantially in the future. The process of acculturation will work in the same way for both groups as it has for other ethnic groups in the past, given comparable levels of education and length of family residence in the US. The author takes special notice of the illegal migration of Spanish-speaking workers and hypothesizes that the behavior of their descendants will not differ from that of the descendants of other immigrants, legal or illegal, in ways that disrupt fundamental patterns of American political unity and cultural pluralism. (author's)
Problems and possibilities in the study of American immigration and ethnic history.
In the study of the history of immigration and ethnicity scholars often write about their own ethnic groups. For several reasons that pattern has led to an over-emphasis on the new immigrants of the early 20th century, a limitation of focus to the experiences of the 1st and 2nd generations of individual immigrant groups, and a disinterest in immigration and ethnicity as processes. Efforts to produce comparative studies of various kinds and to use survey data as a source of primary information about later generations may help correct those shortcomings. Today, the study of immigrant and ethnic history is at an important moment in its evolution. The concentration of attention on individual nationalities, the focus on the immigrants and their children to the neglect of the experiences of later generations in America, and the imposition of interpretive schemas that tell more about the ideology of the host society than about the experiences of the newcomers have left disturbing gaps and imbalances in the investigation. (author's modified)
Migrant labor in agriculture: an international comparison.
The May 1984 Conference on Migrant Labor in Agriculture at the University of California-Davis discussed papers by 22 farm labor experts from 12 nations. Each industrial nation utilizes a different set of public and private policies to supply workers for labor-intensive agriculture, but none is entirely satisfactory. Labor-intensive agriculture is becoming more dependent on workers who are shut out of labor markets. Some countries have simply accepted foreign workers in agriculture, while others have adopted policies to integrate farm and nonfarm labor markets. Polices to reduce agriculture's reliance on workers-without-options include restructuring employment practices to employ fewer seasonal workers for longer periods, mechanizing production, and importing fruits and vegetables from nearby developing countries. This article explains the salient features of labor-intensive agriculture, the various polices for obtaining seasonal farmworkers, and options to reduce farming's dependence on migrant labor. (author's)
Migration and development in the Caribbean: relating policies and people.
Throughout the 20th century, the US has feared that political instability in the Caribbean area could be exploited by adversaries; therefore, the US and the nations of the Caribbean share a compelling interest in the region's development. The dramatic increase in legal and illegal immigration to the US from the Caribbean in the last 2 decades has offered an additional human reason for US interest in the region. This migration has also created a new source of dependence and vulnerability for the region. Curtailment of migration would undoubtedly affect the region, and if the effect were social and political instability, then the US would also share those consequences. The 1984 Conference on Migration and Development in the Caribbean held discussions to 1) enhance the benefits of migration to Caribbean development, 2) identify development strategies, policies, and projects that would reduce pressures that have accelerated the rate of international migration, making it less manageable and more costly, and 3) identify ways to reduce dependence on migration by expanding employment and assisting economies in the region to become more self-reliant. The attitudes of both US and Caribbean participants seemed to reflect a considerable degree of ambivalence on the migration issue. The US views itself as "a nation of immigrants" and yet is troubled by the recent large influx of immigrants, particularly illegal migrants and refugees. While Americans recognize that the "brain" reduces the development capacity of developing countries, the US still needs and benefits from young immigrants trained in the sciences, engineering, and computers. Caribbean participants were also ambivalent about immigration. They consider immigration "a way of life" and a "right," but they also recognize that there are significant developmental costs to some types of migration. While many want the US to keep a wide open door to Caribbean immigrants, they are aware that most Caribbean Community (CARICOM) governments are currently closing the door to immigrants even from other CARICOM countries.
The influence of legal status on the labor market impact of immigration.
This article explores US labor market changes that would take place as a result of an amnesty that would regularize the status of undocumented workers without changing the total size of the alien workforce. The theoretical analysis suggests that the influence of legal status on market wage rates and on minimum wage enforcement is weak and that to the extent that there is an effect, it depends on particular institutional arrangements. Although data are not adequate for a definite measurement of these effects, those data that are available support this conclusion. It appears that the presence of undocumented as opposed to resident aliens can weaken union organizing efforts. (author's)
Sources of international migration statistics in Africa.
The sources of international migration data for Africa may be classified into 2 main categories: administrative records and 2) censuses and survey data. Both categories are sources for the direct measurement of migration, but the 2nd category can be used for the indirect estimation of net international migration. The administrative records from which data on international migration may be derived include 1) entry/departure cards or forms completed at international borders, 2) residence/work permits issued to aliens, and 3) general population registers and registers of aliens. The statistics derived from the entry/departure cards may be described as 1) land frontier control statistics and 2) port control statistics. The former refer to data derived from movements across land borders and the latter refer to information collected at international airports and seaports. Other administrative records which are potential sources of statistics on international migration in some African countries include some limited population registers, records of the registration of aliens, and particulars of residence/work permits issued to aliens. Although frontier control data are considered the most important source of international migration statistics, in many African countries these data are too deficient to provide a satisfactory indication of the level of international migration. Thus decennial population censuses and/or sample surveys are the major sources of the available statistics on the stock and characteristics of international migration. Indirect methods can be used to supplement census data with intercensal estimates of net migration using census data on the total population. This indirect method of obtaining information on migration can be used to evaluate estimates derived from frontier control records, and it also offers the means of obtaining alternative information on international migration in African countries which have not directly investigated migration topics in their censuses or surveys.
The development of an integrated system for the collection, processing, and dissemination of international migration statistics poses special problems for the identification and measurement of certain categories of persons who cross international boundaries in Africa. These include 1) border inhabitants who make frequent and irregular visits across borders and 2) nomads, refugees, and travellers whose residence cannot be determined. This paper discusses in detail some of these problems and suggests possible solutions for dealing with the classfication of 2 members of this group: nomads and refugees. 4 methods have been experimented with to enumerate nomads who are always on the move: 1) the group assembly method, 2) the tribal or hierarchical approach, 3) the enumeration area approach, and 4) the water point approach. The primary characteristics of nomads are 1) the movement of a group for purposes of finding water and grazing areas for its herd, 2) the difficulty of assigning usual place of residence to the group because it is constantly on the move, and 3) 2 patterns of nomadic movements--1 with consistent and predictable movements and 1 with inconsistent and frequent movements across borders. African refugees are characterized by 1) uncertainty surrounding the duration of stay and the direction of future movements, 2) mostly illiterate refugees from rural areas, and 3) a much smaller number of refugees, mainly the educated, opting to stay in urban areas. 2 difficulties with including refugees in an international migration system are 1) the uncertainty surrounding the intended or actual period of stay and 2) refugees who do not come directly under the administration of host governments or aid agencies since they do not live in organized settlements but rather with relatives and friends across the borders. These refugees are very
Compared with the 2 other main demographic variables, fertility and mortality, the procedures for the collection and tabulation of migration statistics are not well developed or standardized. The 1980 UN recommendations on international migration proposed the identification of 4 major categories of arrivals, namely: 1) long-term term immigrants, 2) short-term immigrants, 3) short-term immigrants returning, and 4) nomads. The same statistics could also be collected for departures. In order for African countries to implement all or some aspects of the 1980 international recommendations, which are considered long-term goals, a step-by-step or phased approach has been proposed as the best stragegy to follow. This approach emphasizes border data collection rather than field investigations to generate statistics on a continuous basis. Another feature of the phased approach is that countries should formulate programs separately for the development of immigration, emigration, and stock international migration statistics. The following factors could be taken into account when devising the phased program: 1) whether the country is a net immigration or emigration country, 2) the extent and magnitude of immigration to the country, 3) the effects of the immigrant populations on the socioeconomic and demographic features of the population and their consequences for social amenities. The 1st step in the development of a phased program should involve a meticulous evaluation of the current state of the national statistics on immigration. The primary objective at the 1st stage should be the collection by all countries of information that will enable the identification of the internationally recommended categories of immigrants from among all persons entering the country. The next phases should have the objectives of collecting information on the characteristics of persons included in the recommended categories of immigrants.
Demographic transition in small countries.
Half of the world's 200 countries have less than 3.37 million inhabitants, and many of these small countries are often assumed to experience rapid demographic transition. This is true of many of the small island populations of the developing world, especially those with largely immigrant and pluralistic populations, unusual family structures, and rapid economic development. Smallness of population alone, however, is not sufficient to ensure rapid demographic transition and many small countries of mainland Africa have experienced little transition. (author's)
A geographical approach to some demographic features of the Moslem countries.
This paper considers some demographic aspects of the world's Moslem population. Main sources of information are evaluated, and a definition is laid down for a Moslem country. Proportions of Moslem population are given for some 20 Asiatic and 30 African countries. Geographical distribution of Moslem countries as well as of the total world population are studied in some detail with due attention being devoted to Moslem minorities in non-Moslem countries such as China and the USSR. Population density, annual growth rate, life expectancy, age and language distributions are among the demographic features discussed comparatively at country and continent levels. Special attention is given to urbanization in the Moslem world. Finally future trends are discussed by using the usual statistical methods. It is thus established that by the year 2000 the proportion of world's Moslem population will rise to 22.4% as compared with 18.3% in 1975 and that the pressure on natural resources of the Moslem countries will be more than twice that in 1975 which is an alarming fact. It is hoped that the study will assist Moslem leaders in adopting sound population policies in their respectivie countries. (author's)
Some economic implications of population dispersion in Canada.
In New Brunswick, as in the rest of Atlantic Canada, the quality of life is highly prized, and for many inhabitants this means a rural life style. New Brunswick (with the exception of Prince Edward Island) is the most rural of the Canadian provinces. In addition, over time it is becoming more rural. This paper examines some of the economic implications arising from the rural life style. The provincial government also has expressed concern over rural dispersion in New Brunswick, hence this paper is predominantly policy-oriented. It argues that social costs are considerable, and advocates increased emphasis on user-pay pricing. The intention is not to prohibit rural non-farm residence, but merely to charge rural dwellers a portion of the social costs they impose. The political feasibility of such a policy is open to question, but the alternatives may be increased tax rates or a reduced level of service, and these may be even more politically unpopular. (author's)
Recent population growth in India.
Apart from a generalized discussion on the trends of population growth in India during the post-Independence decades and its socio economic implications, this paper examinies in some detail the spatal patterns of population change in India during 1971-1981. The discussion is mainly based on what has emerged on 3 maps depicting percentage change in general and rural and urban population change in India during this decade. While areas of rapid growth of population continue to be associated with net in-migration resulting from: 1) the development of manufacturing industries, mining, trade, and miscellaneous services, all leading to acceleration in the process of urbanization, 2) the development of irrigation and reclamation of land bringing about increased intensity and extension in farming, and 3) infiltration from neighboring countries, particularly from Bangladesh. The areas of relatively low growth are mostly those which have suffered net out-migration induced by pressure of population and paucity of resources or a desire to seek better avenues of employment elsewhere. Superimposed on this is the new trend of declining rate of natural increase, such as in Kerala and Tamil Nadu, which has played its own role in bringing down the overall growth rate. Likewise there are areas, such as in Uttar Pradesh, Bihar, and Rajasthan, where recent breakthroughs in the mortality rate, with the birth rate staying at a high level, has stepped up the process of demographic dynamism. A comparison of the spatial patterns of 1971-1981 with those witnessed in precious decades brings out important chnges in these patterns which are occurring as a result of the various areas of the country getting into different phases of the second stage of the "demographic transition." With a view to bringing the benefits of socioeconomic progress to the door steps of all sections of the society in all parts of the country, it is necessary to bring about a substantial decline in the birth rate without any further loss of time. (author's modified)
This paper analyzes the impact of various factors on variations in the rate of natural increase of population in Western Maharashtra, India. By using district level data, coefficients of correlation have been calculated between the rate of natural increase, the birth rate and the death rate on the 1 hand and different factors affecting them on the other. The analysis shows that in Western Maharashtra the birth rate is high in response to the high death rate and the high infant mortality rate. It is also revealed that the rate of natural increase of the population declines with an increase in the proportion of working females as well as the proportion of educated males. All this signifies that the region under study is in the 2nd stage of the "demographic transition." (author's)
Spatial patterns of out-migration in Maharashtra: 1961-71.
In view of the importance of migration in Maharashtra state. India an attempt is made to identify the areas of out-migration, and to assess the probable causes for it. The analysis is confined to the decade 1961-1971 and based on secondary data, with the taluka as the unit of analysis. The total number of births and deaths in each taluka for the period of study was complied and enabled the natural increase of population to be computed. A comparison of this with the actual increase as indicated by the census made it possible to identify the areas of out-migration. The study revealed that the out-migration talukas were located in 3 areas and that the relative significance of out-migration varied. The analysis indicated that the causes of out-migration were probably unfavorable relief efforts, susceptibility to drought, closure of household industries, and the 'pull' effect of metropolitan centers like Bombay. (author's)
Female migration to Taipei: process and adaptation.
Women form an increasing proportion of migrants and of the non-agricultural labor force in Taiwan. However, many questions regarding female migration in Taiwan have remained unanswered since the focus of the migration literature in the past has been on male migration. This paper examines the decision process of rural-urban migration and adaptation of rural female migrants to the Taipei metropolis. The analysis is based on interviews of 96 female migrants who have moved to Taipei from villages. The reasons for migration are severalfold. With rapid expansion of employment in the manufacturing and urban service sectors, women are attracted to urban occupations, most of which require unskilled labor. Migrants are also motivated by psycho-social reasons. The "glamour" and "convenience" of city and greater chances for further education through work-study programs are all perceived by migrants to provide alternatives to hard and unrewarding farm lives. Though the initiative and final decision to move come from the migrants themselves, most only do so, however, with the consent and advice of their parents. The choice of moving to Taipei, rather than some other city, is mainly influenced by friends or relatives who are alrady there. Their initial jobs and accommodations are arranged by friends and relatives. The majority of women are employed in unskilled or semi-skilled occupations. Even though they change jobs frequently in order to find better employment terms and pay, they experience limited upward mobility. Homesickness, unfamiliarity with the city environment, limited resoureces, and social lives are major problems for the rural female. Freequent home vistits are made in between jobs to relieve themselves of homesickness and the pressures of city life. Once settled, they do not segreate themselves by village origin in their occupation or palces of residence in the city, but they have a tendency to interact socially with other migrants of rural origin rather than city people. (author's)
Spatial mobility and reasons for migration of Japanese women.
This paper discloses, istly, the spatial mobility of Japanese women and its change mainly between 1970 and 1980, through comparison with the men's mobility, in respect of distance of movement, age patterns, and labor force status, using population census data. Secondly, the chief reasons for the migration of women by types of migratory flows are examined using the data derived from the survey on reasons for migration conducted in 1981 by the Land Agency of the Government of Japan. Results show that the spatial mobility of Japanese women is smaller than that of men in long distance movements but is almost the same in short distance moves, and that the age pattern of spatial mobility of the women is nearly the same between both distances of movement. Also, it is disclosed that the mobility of women not in the labor force is higher for the whole country but lower in metropolitan areas than that for men. The prime reason for the migration of women is employment, the as same as that for men for the whole nation, but this varies between the types of migratory flows. (author's)
Changes in the industrial structure of India's male working force, 1961-81.
The post-Independence period in India has witnessed a gradual decline of some occupations and services and the emergence of others. In the present paper an attempt has been made to analyze the change in the industrial structure of India's male working force by calculating an index of change. The index so calculated for 2 decades separately (1961-1971 and 1971-1981) is portrayed cartographically. The overall low degree of change recorded by the country's male working force establishes the weakness of India's industrial infrastructure. Consequently, the secondary sector seems to have failed in generating employment opportunities on a large scale. Regionally, the peripheral areas have recorded a higher incidence of change than the interior heartland of the country. The areas that were overwhelmingly agricultural and had experienced developments in the field of agriculture alone exhibited a low degree of change in comparison to those that had experienced developments both in the field of agriculture and industry. During the last inter-censal period (1971-1981) the country recorded an accelerated rate of change in the industrial structure of its male working force. Spatially too, the increasing rate of change has spread to new regions. (author's)
[Metropolitan areas in Mexico, 1980]
Urban trends in Mexico from 1960 to 1980 are analyzed using multivariate analysis techniques. The authors note that the total number of metropolitan regions has increased from 12 to 26 during this period. Differences between the stage in urbanization reached by the Mexico City region and other urban centers in the country are noted. In Mexico City, the authors observe a decline in the population of the central city region coupled with rapid growth in the surrounding municipalities. (SUMMARY IN ENG) (ANNOTATION)
The 1986 7th annual report of the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) summarizes the major accomplishments of the center's 5 working groups. Among the highlights of 1985 was the immunization phase of a vast trial of a new oral cholera vaccine, whose 1st results indicate the prevention of cholera may be in sight. >75,000 diarrhea patients, mostly children, were treated, and the Urban Volunteer program continues to provide help to underpriviledged residents of Dhaka. Research and service were also combined in several maternal-child health programs and in the Mirzapur Handpump Project, which attempted to promote use of tubewells and latrines and good hygience generally. At ICDDR,B >700 Bangladeshi physicians, researchers, and health professionals attended courses at the center, and there were international conferences throughout Asia. Center facilities were improved: the microbiology and immunology laboratories were renovated, and the installation of computer mainframe data handling facilities was initiated. The center suffered from considerable financial difficulties due to a shift from core to project funding by important donors, among other factors. Some examples of project summaries of individual working groups include: The Comunity Service Working Group's Maternal and Child Health and Family Planning activities in Matlab delivered Services to 94,000 people, including measles immunization for 45,000 children: 87% of those aged 9 months -5 years. The Disease Transmission Group tested a rapid diagnostic test for enterotoxigenic E. coli. The Host Defense Group investigated antibody responses to shigella dysentery. The Nutrition Working Group studied the effects of zinc supplements on weight gain in malnourished children. The Pathogenesis and Therapy Working Group performed clinical and epidemiological studies on diarrhea associated with measles. Included in this report are summaries of publications, a sketch of organizational finances, and staff and committee lists.
Maternal energy metabolism in humans, an annotated bibliography.
This bibliography has been prepared for nutritionists, health professionals, scientists and policymakers with an interest in maternal nutrition. The scientific papers of this bibliography deal with the energy metabolism (energy intake, energy absorption and exchange, energy expenditure and body composition) of women during their reproductive years. The bibliography is composed of 2 parts: 1) a list of all articles included, with codes describing the nature and content of the publications; and 2) the bibliographic references and summaries of the articles. Articles are arranged alphabetically by name of 1st author. Part I consists of charts indicating the subject matter of articles by country. Articles on the following areas are included: determinants of energy requirements; habitual energy intake; suplementation or restriction of energy supply; body composition (height, weight, weight changes, body surface, skinfolds, fat mass, fat-free mass and body water); and energy expenditure (basal metabolic rate, metabolic rate in standardized activities, diet induced thermogenesis, physical activity, total weight change in pregnancy, fetal weight/birth weight, placental weight and milk production).
AIDS: a special report on acquired immunodeficiency syndrome. rev. ed.
This report is intended to answer a range of questions that people have about AIDS--what causes it; who is at risk for contracting it; how is it spread; how infectious is it; what are its symptoms; and how can one avoid transmitting or acquiring it? The report discusses HIV (Human Immunodeficiency Virus), the test which can detect whether someone has been exposed to the virus, and the meaning of the test results. Finally, the report sets forth specific information related to the school setting. The seriousness of the AIDS epidemic and the absence of a cure causes many people who are not well informed about the disease to feel that an individual's confidentiality should take 2nd place to protecting society as a whole. However, the City of New York feels strongly that the names of people who have AIDS or who are infected with the HIV should not be revealed. Revealing to the public the identity of persons who may have been exposed to HIV could subject infected persons and persons with AIDS to wrongful discrimination in such matters as employment, housing and insurance. It is not necessary to identify persons because of fear of casual contact; AIDS is not transmitted through everyday contact with people or objects.
[Evaluation guide for the feasibility of a health maintenance organization].
This monograph discusses the Health Maintenance Organization (HMO), a system of complete prepayment of comprehensive health services, that has become increasingly popular in the US. It is a mechanism by which the private sector in medicine can contribute good quality and efficient health care. Different health insurance strategies are defined. HMOs are set apart from traditional indemnity insurance, which is seen as inefficient and favoring fragmented care. HMOs make physicians more fiscally responsible, and encourage prevention of serious illness by making the HMO responsible for expenses incurred. HMOs fall into different groups, for example, staff models (physicians are employees); group models (physician groups contract with the HMO); and independent practice associations (looser associations of physicians in fiscal agreements with each other and with hospitals); and HMOs owning hospitals or contracting with hospitals. Different types have different advantages, e.g. an HMO incorporating hospitals and physicians has the advantages of universal medical records. HMOs adapt well to a variety of health services systems: both with and without government involvement. Approaches for evaluating the feasibility of HMOs are given. Important factors include the legal climate and characteristics of populations to be served; the existing health care delivery system insurance regulation; advertising regulation; rules governing the practice of medicine by corporations; and the health services planning climate. New HMO proposals must examine commercial feasibility and the regional extension of the plan, and include a strong marketing strategy. Anticipated costs and capital needs must be examined. Information presented in chart form include: items to be budgeted (e.g. radiology, out-of-region emergency care); types of marketing and administrative expense; steps to be taken when calculating premiums; and calculation of break-even points for HMOs, which usually operate at a loss at first.
A population education program was launched in 1978 within the existing framework of the Project on Small Farmers and Laborers that is currently in progress in 8 villages in Bangladesh. A workshop developed materials and methods and a workplan that the village level action research fellows could use. The workshop design was flexible; the idea being that the workers learn from process as well as content. Budgets and content for village level workshops, as well as formats for benchmark questionnaires to test workshop effectiveness, and the outline of a field workers' manual, were discussed. There followed reports on materials pre-tested in several of the villages: displays and education materials, including materials developed in the Philippines. An example is a short drama, in which a farm family, its crops destroyed by a storm, must react by removing the children from school. It is made clear this would not be necessary if there were fewer children, and that family planning (FP) does not go against religion. Other educational materials evaluated included felt boards, poem recitals, question and answer discussions, and others. Line agencies next presented papers on diverse topics, e.g. multi sectoral approaches to population education; a scheme of the Ministry of Information and Broadcasting; processes applied with women. An example is a report by the International labour Organization on a project to educate 80,000 industrial sector couples in FP. Sub-project level workshop reports follow for 3 workshops in Comilla, Mymensing, and Bogra. Progress reports, discussing village-level advances such as latrine digging; night schools; and contraceptive prevalence follow, for several villages. The format was 2 review workshops held several months after projects began, in Comilla.
Bangladesh Contraceptive Survey--1983, special topics.
The studies presented in this volume are based on data collected by the 1983 Contraceptive Prevalence Survey (CPS) of Bangladesh. 2 volumes analyzing these data have already been published--the June 1984 "Key Results" report and a final report in March 1985. This volume presents a collection of papers, each of which focuses on a special topic related to population and family planning issues in Bangladesh. The current use of contraception is still relatively low, as Chapter 2, a study of unment need among CPS respondents, shows. A study of contraceptive availability (Chapter 3) considers 3 measures of availability--number of methods mentioned spontaneously, number of methods mentioned for which the source was known, and whether a respndent received a field worker visit in the past 6 months--and their relationship to socioeconomic factors. Chapter 4 analyzes both reasons for nonuse of contraception and sociodemographic characteristics of the respondents for their impact on reasons for nonuse. Fertility levels, trends, and differentials by socioeconomic variables were analyzed in Chapter 5; fertility declined about 18% from 1975. In Chapter 6, Brass techniques were applied to the CPS data to estimate levels of infant and child morality. No evidence of nay substantial decline in infant mortality inrecent years was found. Chapter 7 disucusses the nature of contraceptive choice and evaluates the impact of multiple factors on the probability that a woman will have ever made the decision to use contraception. The final chapter summarizes the major findings and policy implications. The details of the CPS sampling procedure are presented in Appendix 1 and the questionnaire is presented in Appendix 2. It is hoped that the research presented here will contribute to an improved understanding of the family planning program performance and potential for improvement.
Final report on teacher training in population education.
Korea's Teacher Training in Population Education in Elementary and Secondary Schools in Islands and Remote Rural Areas Project was implemented between 1983 and 1985. Teachers from these regions are underrepresented in such training programs, and training is needed because they are often community leaders knowledgeable about local culture, who teach many subjects to students usually not receiving other education. 500 copies of the teacher's guide, (which dealt with population education needs, the concepts and process of population; the nature, causes and seriousness of population problems; institutional reform; and population policy) were distributed in 1983, and 1,700 of a revised copy in 1984. The guide was for training as well as ongoing reference. 2,577 teachers were trained over a 3-year period, in 10 seminars in a diversity of locations. Lecturers included college proffessors; researchers; and education ministry population education experts. Teacher origin is broken down by province (total, 9 provinces). A questionnaire administered to 600 of the initial seminar participants influenced the content of a Population Education Guidebook for teachers, which emphasized rural problems. The book was published in 4 volumes, adjusting its content to grade levels. 17,000 of the 1st volume (for elementary and 2ndary school) and a total of 34,000 of all volumes was distributed. A research report on the interaction of population and education was published in 1986, and distributed to educational institutes and involved personnel. The program is evaluated. The use of teacher feedback was effective. There are not enough guidebooks, and publishing of a workbook would be useful. Population education can have tremendous impact on the large school-age population. Teacher education should be strengthened and there should be follow-up research. The appendices contain a summary of the teachers' guide; the evaluation and teacher background questionnaires; and a summary of the Guidebook.
Effects of marital status change on residential mobility.
The authors examine the relationship between residential mobility and various stages of the family life cycle using data for 2,058 Rhode Island adults, originally interviewed between 1967 and 1969 and followed through 1979. "This research uses detailed mobility data, collected prospectively over 12 years, which has been integrated with complete information on dates of marriage, divorce, and widowhood to create linked life-cycle segments. An extensive body of information is also available on characteristics of these households to control the effects of other factors that relate both to marital status and to mobility, such as home ownership and income. The probability of mobility is modeled as a function that varied both with the time since the last change in marital status and various characteristics. The effects of marriage, divorce, and widowhood both on immediate relocation and on subsequent mobility patterns are assessed." (EXCERPT)
Patterns of population growth in Africa.
This paper discusses past, present, and future trends in Africa's population growth, stressing problems associated with overpopulation and discussing measures for reducing the population growth rate. Between 1950 and 1980, sudden declines in death rates coupled with high birth rates increased the African population dramatically despite poor economic growth and widespread political instability. The urban population has increased more than 300% since 1950, reaching 136 million by 1980. 70% of Africans still reside in rural areas however, and this population continues to grow at a rate almost as astounding as that in urban areas. As a result, by 2025, the urban population is expected to reach 1.5 billion with 900 million people in urban areas and 650 million in rural. In addition, the age structure has shifted so that Africa now has the world's highest percentage of children relative to adults which places a greater burden on a smaller workforce to provide for a growing dependent population. As a result, the present and future populations are likely to face declining standards of living. The author argues that economic and social development supported by strong educational systems, along with government supported family planning programs, are necessary to decrease Africa's population growth. Specifically, higher education and employment for females could help reduce the fertility rate. Yet, in general, the bureaucratic nature of African governments has stalled the implementation of such programs. Unless systematic programs for dealing with the population crisis are enacted, the future for African people promises to be bleak as per capita income and standards of living drop below the subsistence levels of today.
The epidemiological situation in the Asia-Pacific region: facts, fallacies and implications.
This paper demonstrates that in contrast to the significant advances in the control of mortality in the Asia-Pacific region, the morbidity situation has either stagnated or failed to match the gains in longevity. There have been impressive advances in some developing countries and areas with grave setbacks in others. On the whole, the diversity of national health conditions has increased, with some countries approaching a "modern" epidemiological scenario; others are lagging behind while another group is tackling old and new disease problems concurrently. Within countries, similar differences exist or gradually emerge between urban and rural populations. Malnutrition, in synergistic action with diarrheal diseases and acute respiratory infections, as well as malaria, are the main challenges in the Asia-Pacific region, particularly for the countries of South Asia. Successful agricultural policies have laid the foundation for overcoming the age-old threat of malnutrition and undernutrition. However, only time will show whether, and how quickly, these gains will be passed on to the population at large, particularly the masses of the rural poor and slum dwellers. However, even in the event of malaria vaccines and better pharmaceuticals, it would take years for a full benefit to be reaped by the populations concerned. In the developed countries of the region, the common causes of illness are cardiovascular diseases, cancer, and accidents. Communicable diseases are of such low incidence that they are not considered a major health problem. Environmental pollution, health problems of the elderly, mental health, and drug and alcohol-related problems are all major concerns in the developed countries and are gradually emerging as a major threat in developing countries. (author's modified)
This paper discusses the impact that the aging of the population and the extension of life will eventually have on various Asian countries. Currently, Japan is the only country in the Asia-Pacific region that has a large elderly population (those 65 years of age and over). During the 1st quarter of the next century, however, several countries in the region will have 10% or more of their populations in the elderly age group. While the problem of aging is not imminent for this region, within the next 13 or 14 years, the steadily growing proportion of the aged in the population is expected to modify the savings, consumption, and investment patterns of the people concerned and alter the region's economies. The statistics on aging for the period until the year 2000 may mask the problem. In many Asian countries there are only slight increases projected between 1980 and 2000 in the proportions of the elderly; however, large jumps of about 40% or more are projected between the yaers 2000 and 2025. In this context, the governments of the region must face the following issues or else risk being caught by suprise by new population problems in the future: 1) their ability to sustain the cost of an increasing proportion of elderly dependents as the nature of dependency shifts from the young to the old; 2) the maintanance of the traditional veneration of the elderly and the integration of the age group into the 3-generational family as families increasingly become 4-generational; and 3) the implications of aging trends with regard to retirement and pension schemes and those related to the swelling ranks of the labor force employed in the fornal sector in urban areas. (author's modified)
[Institutes for Population Studies (RIPS and IFORD)]
The 9 year old Regional Institutes for Population Studies in Accra, Ghana for the English-speaking African countries and in Yaounde, Cameroon for the French-speaking countries were established in response to the growing demand for regional facilities for demographic research and training in Africa. The Institutes: 1) provide training courses on population and related fields; 2) organize and undertake research on all aspect of population and related fields both at the headquarters and in the countries served by the Institutes; 3) organize, in cooperation with appropriate national services and specialized agencies concerned in other African countries, workshops, seminars and meetings on national, subregional and regional population problems; 4) provide at the request of the governments of the countries such advisory services as may be within their competence and resources; 5) grant degrees, diplomas, certificates or other awards to persons in respect of courses of study provided by the Institutes and subject to the approval of the Governing Council, established for the purpose such relationships with national universities or similar institutions; 6) provide documentation in the various fields of population with respect to Africa, to research workers of national, subregional and regional organizations. Information pertaining to admission requirements, fellowships, application forms, and training activities, is also provided.
[International Conference: population and the urban future]
An International Conference on Population and the Urban Future sponsored by the UN Fund for Population Activities took place in Rome, Italy from 1-4 September 1980. The objectives of the Conference were: 1) to increase the awareness and understanding of population factors in urban planning at local and national levels; 2) to bring to the attention of planners, policymakers and administrators the results of recent research and experience on urban issues and problems; and 3) to provide a forum where all the parties involved in urban management may share problems and possible solutions, identify areas which have hitherto been neglected and formulate ideas and proposals for future action. The Conference is part of a continuous process in which the UN Fund for Population Activities is trying to focus attention on different aspects of the population question and to involve different groups of important people in discussion of those questions.
[The migratory process in Mendoza in recent decades]
The author analyzes the migratory process in the province of Mendoza, Argentina, for the period 1947-1980. An introduction provides a brief review of migration concepts and analysis and of regional economic trends during the period studied. Chapter 1 is concerned with interprovincial migration before and after 1970. The focus of Chapter 2 is on interdepartmental migration and includes examinations of population redistribution between provinces and between departments, types of migrants, migration flows and net migration, and differences in migration behavior among natives and foreigners.
[The myth of the north. Bibliography on clandestine migration]
A bibliography of works on illegal migration is presented. The bibliography is based on the collections of three major institutions concerned with the study of migration in New York, Paris, and Rome, and focuses on the situation in Europe and the United States. The bibliography is organized alphabetically by author, and a selection of the entries is provided with abstracts in Italian. No subject or geographical index is provided. (ANNOTATION)
A review of the current status of population projections is presented on the occasion of the Eighth National Demographic Conference held in Grenoble, France, in May 1987. Consideration is given to the current situation concerning projections for the world in general as well as those for France. (ANNOTATION)
Some problems concerning data collection in multistage surveys are examined using the example of the EMIS survey on infant mortality in the Sahel, carried out between 1981 and 1984 in the region of Bobo-Dioulasso, Burkina Faso. The emphasis is on the problem of nonresponse for unknown reasons. The reasons for error sources include the determination of place of delivery, especially for women undergoing cesarean sections who were moved from outlying health centers, and for deliveries where the child subsequently died. The evidence also indicates that some women, particularly those in vulnerable categories, were not included in subsequent phases of the survey. (SUMMARY IN ENG AND SPA)
A three-sector, time-series model of the labor market in India.
This paper presents a 3-sector time-series (1959-1979) model of the labor market in India. The paper estimates a rural labor absorption equation, a rural wage rate determination equation, and a rural-urban migration equation for 3 sectors, as interdependent parts of a 7-equation system. The 3 sectors are 1) the agricultural or farm sector, 2) the organized nonagricultural or formal sector, and 3) the unorganized nonagricultural or informal sector. The estimated model shows that in India the determination of both farm employment and formal employment conforms to neo-classical organization, but the behavior of real wages in the 2 main sectors is consistent with the dualist/institutionalist hypothesis of wages being determined by the average product, though the relevant average products and the institutional mechanics which produce this outcome differ as between the 2 main sectors. The behavior of earnings in the informal sector, which absorbs the whole labor force not employed in the main sectors confirms the "disequalibrium" hypothesis that average earnings are passively, negatively related to the size of the labor force unabsorbed in the main sectors, and positively to informal output. In the last section of the paper the reduced form of the estimated model is used to project sectoral employment and wages and rural-urban migration over the next 2 decades--assuming 3 alternative sets of growth rates of industrial output.
Methods for the analysis of event history data.
This paper aims to be a useful guide for those interested in the application of methods of event history analysis. It 1st sets up the fundamental language and objectives of event history analysis and shows its connection with the demographic life table approach for a simple death process, introduces the rudiments of estimation technics, and presents generalizations of the simple model. The paper then reviews estimation problems and technics. Methods for the analysis of event history address and resolve 4 fundamental problems: 1) the possibly incomplete observation of the entire event history generated by a single underlying process, 2) the requisite translation of an underlying continuous time process into one where changes are observed to occur at discrete times, 3) the incorporation of possibly variable characteristics that affect the path of events followed by individuals, and 4) the correct identification and separation of 3 components defining the process, namely: the duration structure (the nature of the time dependence), the structure of effects of determinants of covariates, and the residual component of unmeasured heterogeneity. The paper closes with a summary of available software to implement estimation technics.
Change in the structure and size of American households: 1970 to 1985.
Although the average size of households in the US fell steadily throughout the 1970s, the relative weight of the forces leading to smaller households shifted over the decade. In the 1st half of the 1970s, changes in type-specific household size, attributable to the cumulative impact of fertility declines beginning in the early 1960s, were responsible for the bulk of the decrease in the average size of households. During the 2nd half of the decade, fertility rates leveled off and changes in the living arrangements of adults began to exert a greater impact on the downward trend in the size of households. Of particular importance in this context were high levels of divorce, increasing age at first marriage, and increases in the tendency of both young and old persons to live in independent households. The slower rate of decline in household size observed during the 1st half of the 1980s represents a continuation of these underlying dynamics, according to which the living arrangements of adults seem to be exerting an increasing impact on the average size of households. Post-1970 changes in household size constitute a microcosmic representation of long-term trends; decreases in the average size for households have less to do with decreasing fertility and more to do with changes in the living arrangements of adults. The post-war baby boom temporarily interrupted these long-run trends, but they appear to have resumed in the decade and a half since 1970.
Changing family structure: who cares for America's dependents?
This note reviews several ongoing demographic changes in families and considers their implications for legislation. Those changes include 1) the growing instability of contemporary families; 2) their increasingly diverse, often nontraditional, forms; 3) the altered social settings and economic circumstances affecting children; and 4) the lengthening of life expectancy among older Americans. In view of these changing demographic realities, it is essential that future social legislation recognize the growing diversity of families and incorporate technically sound demographic assumptions about the future. The family structures through which much social legislation operates will become increasingly varied and complex in the future. Nontraditional (single-parent) families are becoming more common, and traditional families are not enduring as long as they once did. To be workable, future legislation intended to enforce "family responsibility" will need to accommodate that diversity and complexity. Filial, parental, and grandparental responsibilities will become more complex and open to legal dispute as blended families become more prevalent. Through population aging, the income security and health care needs of the elderly may increase more than federal planners now envision. To remain solvent in the next century, the Social Security system will have to squeeze more dollars out of a slowly growing or possibly shrinking work force to pay benefits to a swelling number of retirees who were born during the baby boom. Future fertility levels will influence the size of the work force; future life expectancy will affect how long retirees continue to receive Social Security benefits. The long-range demographic assumptions on which legislation is premised need careful and impartial scrutiny because they can invite a false sense of security.
Pearson Type I approximation of human mortality curve.
The human mortality curve has the bathtub pattern, and very few satisfactory approximations of this curve are available. Mitra, Mitra and Romaniuk, Loh and others have fitted the Type I curve to fertility rates. Since the Type I distribution has the U-pattern under certain conditions, the human mortality curve is subject to that approximation. Mortality data from Canada, India, and Taiwan are utilized for fitting the curve by the method of moments. The fits are seen as satisfactory. (author's)
[International Seminar on Islam and Family Planning, final report]
This Conference reviews the religious ramifications of family planning (FP) in this overwhelmingly Moslem Island nation of 350,000 inhabitants. An economic imperative exists for FP, since the population growth rate is 3.6%/year, and the economy is largely agricultural with little potential for increased growth. However, any national FP program not taking into account the teachings of Islam would be likely to meet with resistance. Theological bases for FP policy were reviewed: the emphasis must be on the spacing of births, rather than on strict birth limiting, in order to ensure the health of the mother and children and a decent upbringing for the children. Parents therefore have duty to plan families, since they will be accountable in heaven for the upbringing of their children. Parental duty is, however, accompanied by parental authority: government-imposed limits on the number of children per family were cautioned against. Sterilization and abortion were considered generally indefensible, except as a safeguard for the mother's health. Extra-marital contraception was considered anti-Islamic, and the distribution of contraceptives to adolescents and unmarried persons was forbidden, as was the teaching of sexual education in primary and 2ndary schools. The abuse of divorce and polygamy beyond the economic capabilities of the husband were also condemned. The use of contraceptives by men was considered permissible. An emphasis on birth spacing would prevent a rapid drop in population growth a resultant burden of older people. The problem of a large population <20 years old, in need of schoolling and employment, was underlined.
Attempting to build on Rwanda's 1983 National Fertility Survey, which included a partial analysis of contraceptive knowledge, attitude, and practice, a separate and detailed questionnaire directed at men and women was developed. Family planning (FP) support has recently become a societal policy. Contraceptive knowledge is relatively high: 66.6% of women surveyed are familiar with some form of contraception, but only 1% of women have been found to use modern contraceptive methods. The women's questionnaire (57 questions) examined socioeconomic situations (e.g, educational level, religion), as well as information on past and present contraceptive usage, motives, contraception side effects, and other issues. The men's questionnaire was shorter (27 questions), and examined issues such as information sources, reasons for choosing or refusing to choose contraceptive methods, and general attitudes. The questionnaire was tested on a population of 60. All individuals studied were married, and between the ages of 20 and 60. Practical aspects of choice of a study population are reviewed: cost, availability, and general characteristics of the survey personnel are taken into account in the presentation of alternatives, along with study accuracy. Questionnaire samples are provided.
Contrasts in the self-esteem of unwed teenage mothers.
The self-esteem of 93 unmarried US females between the ages of 14 and 19, was measured upon entry into several state-sponsored training programs. The Test of Adult Basic Education (TABE) was administered to determine reading and mathematics levels of cognitive ability. Some signifcant differences were discovered concerning the impact of early motherhood on these individuals. Even though 40% of the teen mothers responded "I am nice" as compared to only 30% of those without children, no significant difference was found between their Coopersmith and Rosenberg self-esteem measurements. Among the unwed mothers the effect of age group showed no significant impact on any of the variables. The absence of significant correlations between academic skills and self-esteem is underscored by the negative relationship between the TABE scores and the Dean alienation measures. 1 consequence of young motherhood is a change in social interaction. Membership in a network of support also may be a consequence of unwed teenage pregnancy. The symbolic importance of motherhood, as a passage into adult status, and the intervening effects of normative group anchorage may mediate between individuals' cognitive ability and their level of self-esteem.
Mother and daughter perceptions of their relationship: the influence of adolescent pregnancy status.
The perceived relationships between 95 mothers and their adolescent daughters were explored to determine if there was a significant difference in the mother-daughter relationship as perceived by pregnant vs. nonpregnant adolescents, and whether mothers of these 2 groups, when compared to each other, differed in their feelings for their daughters. Female high school students and their mothers in an urban area of the American southwest were surveyed at 3 regular high schools and in-school program for pregnant teenagers. In contrast to other investigations, no striking differences between the groups in intimacy, attachments, and strength of feeling as indicated by a questionnaire were found, though results were generally in the predicted direction, that is, in favor of mothers and daughters in the nonpregnant groups. The ratings by both mothers and daughters were overwhelmingly positive toward each other. In summary, although the mother is a significant source of inspiration and help to her daughter, at least as determined by this study, the quality of their relationship does not strongly relate to the pregnancy status of the daughter.
Primary health care is not cheap: a case study from Guinea Bissau.
In 1977 the Ministry of Health in Guinea Bissau started 2 regional community health projects. In this article the progress of the Tombali project is described. 3 aspects are discussed: the "Learning Process Approach" used in the project; measurement of the effectiveness of the project and the problems of collecting and interpreting these data; and the ratio of investment to recurrent cost and the proportions borne by government and by villagers. Primary health care projects evolve slowly, and the importance of the willingness of project workers, donor agencies, and the national government to work without a blueprint plan is emphasized. This paper discusses ways of evaluating the success of primary health care schemes; the measurement of any change in health status is difficult and discounts other benefits that may result, such as encouraging community participation and involving villagers in government activities. Both government and villagers contribute significantly to the scheme, the government and donors bearing most of the investment costs, while most of the recurrent costs fall on the villagers. The data show that for neither government nor villagers is the scheme a cheap option to secure health care for rural populations. Finally, the lessons to be leaned by national governments, donor agencies, and health workers from this attempt to implement a primary health care program are discussed. (author's modified)
This report describes the 8th annual intensive workshop in "Management and Training for Family Planning and Primary Health Care in Africa," conducted in New York City, June 1 through June 26, 1987. The workshop was designed to teach managers, evaluators, trainers, and researchers the underlying principles, practical techniques and tools for designing, implementing, managing and evaluating family planning and related primary health care programs. Special attention was given to increasing the level of epidemiologic, demographic and management skills required for the provision of services to lower income groups living in rural and urban slum areas in Africa. A completely revised curriculum was prepared, focussed on Family Planning Programs. New material included sessions on Service Delivery Strategies, Financing, Logistics, Management Audit, and AIDS. The newly structured sequence of workgroup exercises enabled participants to apply concepts and skills to key aspects of the management process including: strategic planning, assessing needs and resources, setting objectives, designing organization structures, writing job descriptions, developing management information systems, monitoring and supervision, scheduling, financing, scheduling and designing systems of logistics and supply, training, evaluation, operations research, and the management audit. The report contains a list of participants and faculty; facilities and resources used; evaluations based on pre-and post-testing, rapid feedback analysis of specific sessions, participants' qualitative appraisals in response to open-ended questions, and verbal feedback; the workshop curriculum; participant needs assessment questionnaire, and a supplement on AIDS Module.
Antenatal care in a district hospital.
Antenatal care at a district hospital should start with an understanding of the problems peculiar to that district, followed by an inventory of resources available. On this basis a rational approach can be made to the level of care that is possible and appropriate within the constraints of manpower, money, and infrastructure. Health for all by the year 2000 can never mean the same thing to every country. Priorities in each country have to be identified and steps taken to provide services that will address those priorities. For these reasons this article dwells more on the administrative and organizational aspects than on the routine aspects of antenatal care. The details of antenatal care discussed in this article include: 1) inventory of resources; 2) at-risk approach; 3) action oriented antenatal card; 4) assessment of fetal growth; 5) data to be recorded on antenatal card; 6) medication during pregnancy; 7) place of delivery; and 8) waiting mothers' area at district hospitals.
Modifications to the AHRTAG child length measurer.
Great accuracy is needed in measuring a child's length, both for individual assessment of growth and for studies of groups to monitor their nutritional status. A small error in length measurement has greater effect than a similar error in weight. This is because a child in its 1st 2 years puts on a much greater % of weight than length. A precise length measurement is also more difficult to obtain because of the crucial element of the child's posture. Good technique is of paramount importance, and the more accurate the equipment the better. Working with a carpenter, it was found that simple changes could be made on the basic AHRTAG (Appropriate Health Resources and Technology Action Group) design which improved precision. These changes also made for greater durability and a more readily transportable measurer. The degree of precision achieved with the modified measurer was demonstrably better than for the original form and is acceptable for field conditions compared with standards achieved elsewhere. Plans are provided for local construction of the measurer.
Problems with home ORS: lessons from Africa.
The home-available solution for diarrheal disease control most thoroughly investigated in Africa is sugar-salt solution (SSS). Sugar and water can sometimes be expensive, and sugar is not always readily available. Standard container sizes do not always exist, and it has been shown that many women prepare SSS for their children with sodium concentrations above recommended levels. However, SSS should not be discarded. While it is still being used, improved training and health education techniques need to be tested, including perhaps the development of a simple color test for sodium concentration. If appropriate traditional remedies can be identified, they should be promoted with particular attention paid to the amount of fluid administered. Families should be encouraged to give any available fluid in adequate quantities to prevent dehydration. They should be taught to recognize signs of dehydration and when to seek treatment at facilities offering case management with oral rehydration salt (ORS) packets. More work is necessary in social marketing and involving the private sector, especially pharmacists and merchants, to improve access to packaged ORS and to information about appropriate usage.
The human immunodeficiency virus (HIV) epidemic is an international health problem of great scope and urgency. By May 15, 1987, 49330 cases had been reported to WHO from 109 countries. By region, the largest number of reported cases of acquired immunodeficiency syndrome (AIDS), 35219, were from the Americas with 90% of these from the US. Europe has reported 3858 cases from 23 countries, while HIV has only started to appear in Asia. All but 1 case so far reported from Oceania are from Australia and New Zealand. In terms of the proportion of the healthy population already infected and probable numbers of AIDS cases, no area of the world is more affected by HIV than Africa. WHO estimates that there have been at least 100,000 AIDS cases worldwide since the beginning of the epidemic and that 5-10 million persons are infected with HIV. Between 500,000 and 3 million AIDS cases are likely to emerge during the next 5 years, along with 1-5 million cases of AIDS-related illnesses and an unknown number of neurological illnesses. The personal, social and economic costs are very high. In the US, it is estimated that the total cost of direct medical care for AIDS patients in 1991 will reach US $16 billion. Neither vaccine nor therapy for widespread use is likely to become available for several years, and the HIV global control effort will be long-term and likely to go on for several decades. The WHO Special Program on AIDS includes 5 major components: national program support; health promotion; research and development; surveillance, forecasting and impact assessment; and administrative services. The HIV pandemic represents an unprecedented challenge to public health and mandates a response of exceptional creativity, energy and resources.
The effects of life cycle and family formation variables on pregnancy outcome.
Out of a total of 6992 pregnancies which occurred among the 1616 Malaysian women at their various stages of reproductive cycles in 1982. 1.1% ended in stillbirths, 6.1% in spontaneous abortions, an 2.2% in induced abortions. Life cycle and family formation variables provided far sharper differentials in pregnancy wasstage as compared to the ethnic and educational variables. Pregnancy wastage rate varied from 5% at maternal age below 20, to 24% at maternal age 40-44, and from about 7.5% at the 1st 2 pregnancy orders to 13.8% at the 7th and higher orders. Intervals of 1 year or less had a wastage of 29.4%. Pregnancy outcome was strongly associated with the outcome of the preceding pregnancy. Data is based on analysis of the 1982 Survey on Health and Family Planning in Johore an Perak. (author's modified)
The trained traditional birth attendant and neonatal tetanus.
One of the most compelling reasons for giving medical training to developing country traditional birth attendants (TBAs) is the high number of annual deaths from neonatal tetanus (estimated in the 100s of 1000s), resulting from poor care of the cut umbilical cord. While neonatal tetanus is almost nonexistant in developed countries, its mortality rate has been measured at 72/1,000 live births in Sierra Leone in 1979-80, and 78/1,000 in Colombia in 1961-66. Neonatal tetanus has developing-country case-fatality rates of between 40% and 90%. The umbilical cord is considered a frequent infection route, and many of the TBAs (who perform 2/3 of developing country deliveries) not only are not trained in aseptic technics, but increase the dangers of infection by applying cow dung or other substances to the severed umbilical cord. Programs to train TBAs in aseptic technics as well as in giving tetanus toxoid injections showed significant positive results in a group of 11 villages in Sierra Leone, where neonatal tetanus mortality dropped from 72 to 11/1,000 live births, and total infant mortality from 305/1,000 to 172 between 1979-80 and 1980-81. Less dramatic results are reported for studies performed on Filipino programs. Even in the absence of tetanus toxoid administration, the training of TBAs in Haiti showed measurable results. Studies in Senegal, the Punjab, India, Malaysia, and Bangladesh are reviewed. Despite possible confounding factors, the results appear to indicate that TBA training is an effective way to reduce infant mortality, especially through the reduction of neonatal tetanus. Combination of training with effective immunization programs would probably have considerable impact.
An evaluation of dai training in Andhra Pradesh.
India's medically-trained and equipped traditional birth attendants' (dais) duties include registering and educating pregnant women regarding proper health behaviors, small family norms, infant care, and other issues, coordinating their care and referring them to health centers for complicated medical treatments, and other maternal-child health duties. The program was evaluated in 16 Indian states, including Andhra Pradesh, examined here. Trained/untrained dai from headquarter villages, villages with subcenters, and remote villages (a total of 67 trained and 67 untrained) were interviewed. Also intervewed were health personnel and mothers (total 637). Most dais considered midwifery to be their main occupation. 59% reported landless agricultural labor as their 2ndary occupation. Tabular data give information on dai characteristics and dai training targets versus achievements. Trainers noticed several sets of negative practices and beliefs among dais before training, e.g. using unsterile implements to cut the umbilical chord, and believing birth aversion to be a sin. The training evaluation revealed that only 3% of the dais reported not being instructed in check-up procedures and 1.5% in family planning methods, but 33% missed being trained in urine sample testing. A lack of participatory training and lesson preparation was noted. Performance assessment should the proportion of trained dais that reported the presence of a health worker at deliveries was 20% against 9.5% of untrained workers. The figures for boil-sterilization of equipment were 74% and 34% respectively. 16% of trained and only 10% of untrained dais sought help with a difficult labor. Dais were generally available when needed, and were perceived by most to be very helpful.
A 3-week training program for training Sierra Leone traditional birth attendants (TBAs), which took place in 1974, is evaluated. 313 of 631 TBAs originally trained were followed up, using questionnaires directed at the TBAs themselves, community leaders, mothers, trainers, and supervisors. 70% of the study population were over 50 years of age, 51% had practised between 10 and 25 years, and 21% for >25 years. In the last 3 months, the majority (118) had assisted with only 1-5 births, while 21 had not attended any births at all. 125 were inclined to attempt to assist with breech deliveries, rather than refer mothers to the hospital immediately. 177 would send a breech delivery, and, 167, a case of a retained placenta to a hospital. While 121 of the TBAs reported giving no medication at all postnatally, 97 would administer native herbs, and 77, pharmaceutical industry painkillers. 117 were aware that prolonged breastfeeding had a pregnancy-prevention effect, while 212 were aware of the female oral contraceptive, 78 of the condom, 102 of spermicide. 20% of all TBAs interviewed had not been supplied with UNICEF midwifery kits. Generally, those having kits were knowledgeable in their use. 45% would have liked drugs like ergometrine and pain-killers to be included. that hospital based staff (dispenser, physician) had poor working relationships with TBAs, while field staff (primary health workers, health service sisters) had good relationships. Recommendations for improvement deal with the reinforcement of postnatal care, recordkeeping, the need for more training on items such as mucus extractors and drugs, and the problem of replenishment of midwifery kits.
Evaluation of a programme to train traditional birth attendants in Ghana.
A 4-year evaluation of a program to train traditional birth attendants (TBAs) in Danfa, Ghana covered a district containing about 60,000 people living in 307 villages. The fertility rate was 220/1,000 women aged 15-44, and the population growth rate was about 3.2% annually. In the 3 study areas of the project, 237 TBAs and 26 assistants were registered in 1972; they were about 1/2 male, had a mean age of 62, and averaged 6 deliveries/year. TBAs were to acquire, over 8 3-hour sessions held every 2 weeks, knowledge of pregnancy and its care and monitoring, referral of high-risk patients to skilled care, safe deliveries, umbilical cord care, and improved maternal and child health practices and family planning. Community education and program promotion were carried on at the same time. Where before the training 75% of TBAs almost never referred pregnant females for prenatal visits, after the training program, 91% were referred for at least 1 prenatal visit during the pregnancy. An increase was reported in the use of sterile blades provided in midwifery kits, for umbilical cord cutting: from 42% in 1974 to 68% in 1976. In other childbirth practice evaluations, female generally scored higher than male TBAs; there was no correlation between quality of care and age. The program was estimated to have have had a cost of US$6.07/birth in this area, including the cost of promoting contraception. It may be cost effective to concentrate resources on the most active TBAs in future. Keeping villagers informed of the training program made them aware of the value being built into the TBAs' services and more willing to pay for services perceived as better-quality.
An evaluation of the training of let-thes in Burma.
In 1978, a pilot program for the training of traditional birth attendants (TBAs) was begun in 2 townships in the Rangoon Division of Burma. By 1980-82, the program was extended to 19 townships, and they are now being trained at a rate of 3000/year in 147 townships. Changes in the TBAs' knowledge after a 6-day intensive course followed by a once-a-week, 24 week long course, were analyzed using a questionnaire. The study area was a township containing 59 TBAs, 6 auxiliary midwives, and 12 health service midwives. The reports of mothers using the services were taken into account. The training course appeared to have a considerable positive effect on TBA knowledge of risk factors. Before training, 30.5% of TBAs correctly identified maternal age <16 years or >35 years as a risk factor; post-training, 91% identified correctly. The figures for agnormal presentation of the fetus during delivery were 25.4% pre-training and 83.1% post-training. Surveys of mothers in the area showed that trained TBAs were more inclined to refer mothers for skilled care as a reaction to these risk factors. Training also had considerable effect on TBA knowledge concerning subjects such as resuscitation of a newborn, advisability of breastfeeding, and necessary immunizations. Since the evaluation was undertaken 15 months after the end of the training period, it seems clear that TBAs retained considerable knowledge acquired during training.
Birth and tradition in the Philippines.
Filipino traditional birth attendants (TBAs) are very important figures in the process of childbirth. They tend to be married women in their middle 50s; 1 study shows that 39% claim to have 31+ years' experience, but TBAs tend not to be well-educated (32% never went to school; only 2% attended high school). TBAs are respected and carry authority, to the point of claiming religious powers, and are generally preferred by rural women over expensive and inconvenient official medical services. Common Filipino and Western Pacific pregnancy-related practices are reviewed and evaluated: practices such as prenatal care by the TBA early in the pregnancy are beneficial, and should be encouraged. Others such as abdominal massage are accepted with reservations. Several intricate and sometimes confusing practices are connected with activities such as the disposal of the placenta, diet, and delivery position. Often they are harmless (the taboo against sitting in doorways) but can cause anxiety. Poor care of the umbilical cord is believed to be the cause of high mortality from neonatal tetanus. Postpartum, the woman is the object of considerable attention. Certain dietary taboos (e.g. against high-protein chicken or fish among Tinguan mothers) can be harmful if nutrition is generally poor. The use of sitz baths and the application of dry heat are common, as are abdominal binders (which can be beneficial if they do not restrict circulation). Prolonged breastfeeding is widespread, and is effective in the spacing of births. Postpartum abstinence, coitus interruptus, and a variety of more or less effective abortifacients are known in the region. The increased use of trained TBAs in the fight against mortality is recommended.
Traditional birth practices and pregnancy avoidance in the Americas.
In Latin America, childbirth is perceived as a time of stress, when there is a need to restore balance. Concepts of the body and its anatomy can influence the acceptance of innovations such as contraception. For example, among Yucatan Maya, fear of disrupting the functioning of an organ believed to be located near the navel can prevent the adoption of contraceptives. In Latin America, the traditional birth attendant (TBA) is often an older woman who has practiced part time for a number of years, and who enjoys considerable status and respect in the community. Often she is believed to have been called to the profession by God and to have spiritual powers. She enjoys the trust of the mother, and is often more respectful of the mother's sense of decency and modesty than the educated health professional. At the birth, adult family members, even the husband, are often present. The supine position is not the only birthing position used. More study is required of the use of traditional herbs. A variety of traditions connected with demonic agents, taboos against coitus during pregnancy, disposal of the placenta, and others are noted. Often they can cause anxiety, which the TBA through ritual control can help alleviate. Often infants are not fed colostrum or breast milk for hours or days postpartum. Traditional practices such as sweat baths, herbs, and massages for the mother should not be condemned without full knowledge of their possible beneficial effects. Many groups believe pregnancy should be avoided when there is a small child, through postpartum abstinence, abortion, or herbal contraceptives. Legitimation of both TBAs and some traditional practices should be considered.
Can literacy instruction contribute to the training of traditional birth attendants?
Cooperation between the UN Educational, Scientific, and Cultural Organization (UNESCO) and the World Health Organization (WHO) has been focuses on, among other things, programs to train traditional birth attendants (TBAs), who play a dominant role in developing countries in safe maternal-child health (MCH) care. Such programs now exist in 52 countries; they have been successful for the most part, despite barriers to training presented by factors such as generalized illiteracy among TBAs, and the problems presented by developing appropriate educational media. "Literacy" is a relative term, and functional literacy for a TBA could imply the ability to use charts or read a professional newsletter. Often TBAs are mature women for whom midwifery is a part-time profession: these factors affect their trainability, as well as the amount of time devoted to the training and the intervals between training sessions. Combined literacy and MCH training should follow guidelines which include making literacy itself a prime objective instead of a 2ndary component, and integrating health into literacy training, where appropriate. Literacy is considered a "perishable" skill, which must be employed regularly after training to maintain itself. A problem faced by these efforts is that of languages and dialects, which tend to vary considerably in some developing countries. A chronology of program implementation is suggested, consisting of development of materials and methodology, testing of the program in pilot areas, and assessment of relative costs and effectiveness of health training with or without a literacy program. Training might usefully be broken down into modules on specific subjects, to make the program adaptable to specific situations.
Supervising trained traditional birth attendants.
The role of supervision in programs using trained traditional birth attendants (TBAs) is reviewed. Supervision help to establish TBA recognition and status in the community, motivates the TBA to practice what he/she has been taught, provides continuing training and technical assistance, reinforces the use of referral services, and monitors and evaluates records and performance. The degree of supervision can vary: in some cases governments do not follow TBAs at all after training, for reasons varying from lack of resources to not wanting TBAs to appear to be part of the health care system. Thorough training has been shown in some cases to offset a subsequent lack of supervision. Supervision can be by the community, which in Africa has taken the form of TBA participation in a village health committee. In the Philippines there has been a limited effort to train outstanding individuals from among the TBAs themselves as supervisory staff, while in Brazil and to an extent in Senegal, literate TBAs staff maternity centers. The more common supervision type is by educated health professionals. Some governments require TBAs to be licensed, either a single time or periodically. Supervision can fail, either through poor planning, a lack of clarity about whose role it is to supervise, or logistic problems such as physical distance. Supervision efforts should provide meaningful objectives and training for supervisors and stress support of TBAs over control, and can make use of community resources such as teachers, follow-up workshops and meetings.
Risking the future: a symposium on the National Academy of Sciences report on teenage pregnancy.
More than 1 million teenage girls in the US become pregnant each year. Just over 400,000 obtain abortions, and nearly 470,000 give birth. The majority of these births are to unmarried mothers, nearly 1/2 of whom are not yet 18. Prevention of teenage pregnancy should have the highest priority. Sexually active teenagers need the ability to avoid pregnancy and the motivation to do so, and our concept of the high-risk population must include boys and girls. Responsibility for addressing the problems of adolescent pregnancy and childbearing should be shared among individuals, families, voluntary organizations, communities, and governments. Public policy goals should include: reduction in the rate and incidence of unintended pregnancy among teenagers through the use of education and training and the encouragement of diligent contraceptive use by males and females, especially use of the contraceptive pill and condom; provision for comprehensive care in the alternatives of adoption or abortion; and the promotion of positive social, economic, health and developmental outcomes for adolescent parents and their children.
The 1985 intercensal survey of Indonesia.
Caution must be exercised in using the 1985 Inter-Censal Survey (Supas) labor force results to analyze trends in labor force participation or in employment since either the 1976 Supas or the 1980 Population Census. The problems in comparing Supas 1985 with either of the above sources arise for 2 reasons: there is a tendency for unpaid family workers, especially females, to be "overrecorded" in both Supases, but to a greater extent in 1976 than in 1985; there is some difficulty in allocating workers between employment status groups, the definitions of which changed in 1980, and remained the same in 1985, in a consistent way. The question remains as to why the participation rates recorded by the 1985 Supas were not as high as those recorded in the 1976 Supas. The main reason could be a seasonal one, since the 1976 Supas was held in March (a busy season in agriculture in much of Indonesia) whereas both the 1980 Census and the 1985 Supas were conducted in October, a relatively slack time in agriculture. The Supas uses as interviewers, the mantri statistik, permanent employees of the Central Bureau of Statistics who are assigned in the regions, and who are familiar with survey procedures and the application of definitions, whereas the Census uses a larger group of interviewers, mostly public servants who are temporarily recruited for the purpose.
Epidemiology of AIDS in women in the United States, 1981 through 1986.
As of November 7, 1986, a total of 27,140 cases if acquired immunodeficiency syndrome (AIDS) in adults had been reported, 1819 (6.7%) of whom were women. Between 1982 and 1986, the proportion of adult women with AIDS has not changed significantly. Women with AIDS are significantly younger than non-homosexual/bisexual men with AIDS. A larger proportion of women compared to men with AIDS are in the 20-29 year age group, (32% vs. 20%, P<.001), and a lower proportion are in the 40-49 year age group (11% vs. 18%, P<.01). The vast majority of women with AIDS are of reproductive age, with 79% between ages 13-39 years. Over 1/2 of the women with AIDS are black. New York has the highest number of men (7727) as well as women (855) with AIDS. The major transmission category for women with AIDS is intravenous drug use (52%), and the 2nd largest category is heterosexual contact with a person at risk for AIDS (21%). The proportion of women with AIDS in the intravenous drug use group decreased between 1983 and 1986. The proportion of women with AIDS in the heterosexual contact category increased from 12% to 26% between 1982 and 1986, (P<.0001). Between 1982 and 1986, there was an increase in pediatric patients with AIDS whose mothers were in the above risk groups. Since the majority of childhood AIDS cases are a result of perinatal transmission from the mother, trends in AIDS cases in women may also predict future trends for AIDS in children.
Developments in HIV screening tests.
Work during 1983-1984 enabling researchers to culture human immunodeficiency virus (HIV) in vitro, paved the way for development of the 1st HIV screening tests. The current generation of antibody tests are relatively expensive and require laboratory equipment not available in many developing countries. Less expensive tests that do not require sophisticated equipment and yet have high accuracy, are needed. Several rapid antibody tests that meet these specifications are being developed of field tested. These tests are not yet commercially available. The most widely used test for detection of antibodies to HIV is the enzyme-linked immunoabsorbent assay (ELISA). Immunoflourescence and Western blot assays are used less frequently, primarily to confirm the prescence of antibodies in individuals who have repeatedly tested positive by ELISA. Most currently available ELISA tests are "1st generation" tests for which viral antigens are derived from infected cell lines. Viral antigens produced in this manner may be contaminated with proteins from the cell line in which the virus was grown. In an effort to improve the assay's specificity, "2nd generation" assays that use synthetic viral proteins produced by recombinant DNA methods have been used with HIV, but have not yet produced antibodies to the virus. Although these may be capable of tranmitting HIV, these people will test negative by ELISA, immunoflourescence and Western blot. Researchers are developing a 3rd generation of AIDS test that will rely on detection of the HIV virus rather than on detection of antibodies to the virus. These tests may help to identify people who are infected but who have not yet seroconverted. Antigen detection tests are currently available for research use only.
Between January 1st and December 31st, 1986, 150 health workers were accidentally exposed to the human immunodeficiency virus in the United Kingdom. Altogether 95 (63%) of these occurred in hospitals in the 4 Thames health regions. Exposures were reported in 41 male and 109 female health care workers. There were 91 (61%) nurses, 32 (21%) doctors, 8 (5%) laboratory workers, and 19 (13%) others. There were 76 needlestick and other injuries from sharp instruments. In 67% of the injuries there was exposure to blood and in 16%, to urine. 109 health care workers were followed for more than 1 year, and 41 for between 1 and 12 months, median 9 months. No seroconversions were observed in these health care workers. Larger studies in the US and anecdotal accounts in publications from other countries confirm that the risk of occupational infection is very low. Health care workers must adopt safe procedures at all times, however, to avoid exposure to infection.
Anti-HIV appears 3 weeks to 3 months after exposure to HIV and thereafter is almost invariably detectable in spite of any detrimental effect the virus might have on lymphocyte function and antibody production. The proportion of true to false results of the anti-HIV tests depends on the population studied, but even in low risk groups such as blood donors, it is now relatively high. In many countries, including the United Kingdom, procedures have been introduced to ensure accurate testing. Viral antigens are present in the serum, in particular the main HIV core antigen, (p24). Viremia, recognized by isolation of HIV from lymphocytes, is demonstrable even in the presence of high titers of anti-p24 and antibodies to other HIV proteins. However, virus isolation is time consuming, and a more important element in the successful laboratory diagnosis of HIV infection with little or no antibody is access to follow up specimens. Tests for anti-HIV, though not those for antigen or HIV culture, are now widely available in the United Kingdom. New anti-HIV test kits may also detect antibody to related retroviruses such as HIV-II. In conducting the tests, certain precautions should be taken in transporting the specimen. All positive results should be checked again on a freshly drawn specimen.
Abdominal swelling in the newborn: in Zaria, northern Nigeria.
5 females and 16 males with ages ranging from 1-28 days, presented with abdominal swellings. In 5 cases there was history of obstructed labor with 4 requiring cesarian section. The causes of abdominal swelling in the neonates were as follows: renal masses (10), both bladder and renal masses (5), ascites (5), and ectopic kidney (1). Ascites was due to renal disease in 2 and posterior urethral valves in 3. The causes of renal mass were hydronephrosis 2ndary to posterior urethral valves (9), renal dysplasia (2), and congenital mesoblastic nephroma (1). In this series the longest follow up was for 7 months in 4 patients: all the rest defaulted and were lost to follow up. The causes of abdominal distention in the 1st month of life can be divided into 3 groups: surgical conditions (15), medical disorders (2), and severe anatomical malformations for which neither surgery nor medical treatment offers a long-term benefit, (4).
Early mother-infant interaction: global perspectives and developing country concerns.
The reported influences on the bonding phenomenon and attendant controversies in affluent societies regarding the importance of mother-infant interaction are reviewed. In the 3rd world countries, where the concept of a mother with a high risk infant is not new, an extension of the hospital neonatal special care unit (NSCU), in which mothers stay with high risk infants, has been reserved for years. Some advantages of the NSCU maternal extension include more personal attention and emotional support, as well as the method of supplying human milk to the high risk around the clock. The main identified advantage relate to non-emotional aspects, namely, maternal education on the care of the infant, provision of human milk and promotion of breastfeeding as well as aid to inadequate healt staff. However inadvertant entry of mothers with major infections may result in problems in babies. Maintenance of cleanliness may be hampered. 7 brief guidelines are given regarding the practical organization of the maternal extension of the NSCU. The need to establish early mother-infant interaction is indisputable, even on a worldwide basis. The influencing factors, priorities for intervention and short and long-term outcome and benefits, however, may vary in advanced industrialized centers and in developing countries.
Neonatal sepsis: a review with a study of 50 cases.
Neonatal spesis data is presented on 50 cases of this condition admitted to Mayo Hospital in the 2nd 1/2 of 1983. Escherichia coli and group B Streptococci together account for 50-70% of cases at most medical centers in the US. Of the 50 cases in Lahore, India the bacterial pathogen was Escherichia coli in 12 cases (24%) leading to 100% mortality. Klebsiella was the pathogen in 6 cases (12%), leading to 50% mortality. Other causes cited, such as Pseudomonas, Salmonella and Citro Bacter, all caused 100% mortality. Traditional birth attendants or others in the house may transmitt pathogens from their own or the mother's person to the newborn. Urinary tract infection, coitus within 2 weeks before delivery, delay after rupture of membranes, premature delivery, and absence of specific humoral antibody against pathogens in the mother are factors which increase the risk of infection of the amniotic fluid. In neonates, the deficient supply of neutrophils, decrease in bactericidal activities of leukocytes, impairment of chemotaxis of neutrophils and monocytes and deficiency of complement (C3) in low birth weight infants, all constitute a generally inadequate host defense mechanism. For diagnosis, cultures of blood and cerebrospinal fluid (CSF) are carried out. Antimicrobial therapy for neonatal sepsis should be continued for 10-14 days or 5-7 days after symptoms have subsided. In meningitis the duration of therapy is 3 weeks. Mortality for neonatal sepsis is 10-40% and for meningitis 15-50%.
Recent trends in child health and survival in Zimbabwe.
According to the 1982 population census, 92,000 persons died in Zimbabwe that year. 39% were children below 15 years of age, 34% were under 5 years old, and 26% were under 1 year. Reliable information on child mortality (1-4 years) is difficult to obtain and estimates range from 7.4-11/1000. In 1979, pre-independence, this was estimated at 12-15/1000. The main causes for infant and child mortality include low birth-weight and associated perinatal problems, diarrheal diseases, nutrition-related diseases, pneumonia, measles, tetanus, and meningitis. In 1982, only 25% of 1 year old children outside the 3 major cities were fully immunized in Zimbabwe. By 1984, immunization coverage was raised to 42% of 1 year olds in non-urban communities. The survey of 1982 showed that 8.2% of urban and 17.7% of rural children suffered from moderate to severe malnutrition. Recent preliminary results of the Nutrition Survey of 1984 reveal that 23.8% of children under 5 years suffered from moderate to severe malnutrition. In 1984, 89% of mothers in a sample had received antenatal care (against 73% in 1982) and 67% had delivered their babies in a health facility (as against 49% in 1982). Diarrheal diseases constitute a major cause of childhood morbidity and mortality in Zimbabwe. Incidence rate is estimated at 4.38episodes/year for each child under 5 years, with an associated estimated mortality of 4.23/1000, representing 27% of all deaths of children under 5 years. 84% of sampled mothers in 1984 knew of oral rehydration therapy (ORT), as compared to 45% in 1982, however only 59% had actually used oral rehydration solution. Significant progress has been acheived in 5 years since independence in addressing some major health problems that affect the survival of children in Zimbabwe.
Race differentials in the timing of adolescent intercourse.
Researchers have long been aware of sizeable racial differences in the prevalence and timing of premarital sexual behavior. In a national US sample of youth aged 15-16, blacks are shown about 4 times more likely than whites to report ever having intercourse. Various explanations are hypothesized: a demographic composotion explanation that stresses differential socioeconomic position; an explanation that focuses on the consequences of low socioeconomic position, a higher incidence of female-headed households, or differences in school performance or educational aspirations; and a contextual explanation based on differences in subgroup attitudes or norms. Results provide limited support for the demographic composition argument and stronger support for a contextual subgroup explanation. Blacks in predominately black classrooms are much more likely to report ever having intercourse. For whites, attending a class that is mostly white lowers the odds of having several sexually active friends. Youths reporting several or more friends having had intercourse are over 3 times more likely to report that they have had intercourse. In racially isolated and mixed classrooms, blacks are 18.6 and 2.1 times more likely than whites to expect parenthood to occur before or at the same time as marriage. Perhaps, adequate treatment of social context will push us further toward understanding teenage sexual behavior than will more refined analyses of individual characteristics.
Research into heterosexual behaviour with implications for the spread of AIDS.
The acquired immunodeficiency syndrome (AIDS) crisis creates a powerful impetus for research into the patterns and dynamics of heterosexual behavior. This review paper summarizes some of the basic empirical findings on indicators of heterosexual behavior and highlights a body of research literature which focuses upon heterosexual activity in terms of the development of interpersonal relationships and underlying sexual philosophies. 3 basic sexual ideologies may be discerned: the traditional-reproductive in which sex is for childbearing to the exclusion of premarital sex; the liberal-romantic in which sex is primarily for pleasure but should be exclusively contained within a committed, if not married, relationship; and the radical-recreational in which sex is seen as a source of pleasure in itself untrammelled by any constraints resulting from commitments to a relationship. Such typologies afford the opportunity to develop a more fundamental and pertinent understanding of the processes underlying heterosexual behavior, from which practical initiatives to control the spread of AIDS can be developed.
Infant immunisation: do we need a media campaign?
Research conducted on behalf of the Scottish Health Education Group suggests that mass media campaigns have a valuable role to play in dealing with the problem of low infant immunization levels. The data sample consisted of mothers of young children, all of whom were directly involved in decisions about both whooping cough and measles immunization. 4 factors appeared influential in decision-making about immunization: parental inclination and confidence; communication with the doctor or health professional; consumer perceptions of immunization and the particular diseases and vaccines involved and the timing of the injections, that is, the stage in the child's life when vaccination is required. Certain basic ground rules need to be followed if the use of mass media is to be effective, otherwise campaigns can be counterproductive. For example, publicity that confirms perceptions that measles is an unpleasant but essentially trivial illness is as likely to reduce the inclination toward immunization as to increase it. There is always a need to research individual mass media campaigns, to check that the message sent is the message received.
The present state of health in Africa.
An examination of Africa reveals disease processes which conventional methods of community health and development economics offer little hope of cure. There are several possible scenarios for Africa in the coming century: rapid demographic transition ending up with sustainable development; a massive population crash; perpetuation of a chronic misery; a continuing and worsening epidemic of acquired immunodeficiency syndrome (AIDS); some miracle or combination of miracles; a nuclear winter. There is no substantial sign of a demographic transition even starting to occur in Africa, and even the most optimistic projections don't lead to populations of sustainable size. Nevertheless, it is the view of the World Bank and UNICEF that such a transition will occur. The ecological prognosis supports the scenarios of population crash and chronic misery in their extreme forms. It is highly critical of the massive transfer of technology to Africa and observes that there is a vicious cycle between poverty and population growth and that both are environmental threats.
Using the Infant Mortality Rate (IMR) and a target level of 50/1000 live births as the indicator of health, this paper provides estimates of the resources needed to raise levels of health care and other health-related social services in the developing countries. Estimates suggest that, at a minimum, recurrent spending on health, sanitation, and education in the low-income developing countries will need to increase by US$38 billion annually by the year 2000, and over the period to 2000 additional capital expenditure US$79 billion will be required. For certain regions, estimates suggest that present trends in health will bring the IMR down to the target level by the year 2000 without special external assistance, but, for the poorest regions, the outlook is gloomier. Greater emphasis will have to be placed on primary health care. Estimates include a minimum of US$22 billion capital expenditure for water supply and sanitation, US$18 billion (capital) plus US$11 billion (recurrent) for general education, and US$39 billion (capital) and US$28 billion (recurrent) for health care. Developed countries can contribute to better health in the poorest countries at 3 levels: assistance on a short-term basis in crisis situations; expansion of existing activities under the broad heading of health assistance; and the redesigning of international institutions to make it possible for developing countries to receive assistance without loss of sovereignty.
Resource transfer from defence to health care: problems and possibilities.
Vast resources are spent worldwide on military and defense while poverty and deprivation continue inexorably. In 1980, the non-oil developing countries spent over US$51 billion on military expenditures. Given the state of international relations, a modest estimate of 1-2% of global defense expenditures might be transferred to health care. A selective program for an integrated scheme of simple health care, immunization, supplementary feeding, nutritional education, and family planning would do a great deal to improve the quality of life of the poor in developing countries, and the costs would not be prohibitive. This emphasis on doing a few things is possible within the budget constraints. There should be a conscious attempt to secure the participation of the domestic military itself. Also, professional specialist organizations, in developed countries as well as the host developing one, should get involved in projects that are to be funded. An International Disarmament for Development Fund (IDDF) has been proposed. Most of the money would come from developed countries (80% of world defense expenditures) and all would be spent in the Third World. The ultimate decision regarding such a fund must be political.
Finding the right road to health.
Like other developing countries, Nigeria has learned that large hospitals and sophisticated equipment are not the most effective means of looking after the people's health, and that a nationwide system of primary care is essential. Medical students at Lagos University, in Nigeria, now spend their entire 5th year of education on this subject. Programs such as the expanded program on immunization are bringing immense benefits. The medical students at Lagos devote their 5th year to health management, health education, medical jurisprudence, medical ethics, maternal and child health, and diagnosis and treatment of common diseases. Developing countries must learn the meaning of self reliance and put it to practice.
Health for all: from words to deeds.
WHO's Member states have been surveyed on progress toward the goal of health for all by the year 2000. The results, published in the 7th report on the world health situation, are summarized. Extracts from the evaluation reports of several countries are also included. The majority of countries in the African, Eastern Mediterranean, and South-East Asian regions still have infant mortality rates far above 50/1000 live births. Poor health of women, complications of pregnancy and childbirth, and low birth weight of babies due to malnutrition and infection are responsible for many cases of illness and death among newborns, children, and their mothers. Malaria remains the major public health problem in many countries, setbacks being caused by chloroquine resistance. As a result of a collaborative effort involving 7 African countries, transmission and risk of onchocerciasis have been reduced to nearly 0 in 90% of the originally infected program areas. A reduction in cardiovascular disease mortality has recently been noted in few developed countries as a result of a combination of factors including healthier life styles. The effectiveness of community involvement has been directly related to progress in decentralization and intersectoral coordination. In a few countries, federations of nongovernmental organizations collaborate in official programs. The 1st contact of an individual with the health care system is where the major increase in activities has been reported over the past decade, with particular emphasis on reaching rural and scattered populations. In most developing countries, the immediate level of health care, provided by a district hospital which serves as the 1st referral level, needs to be strengthened. Many countries are worried about the poor utilization and low productivity of their health personnel.
Community health practitioners in the Republic of Korea.
The Korea Institute for Population Health, formed in 1981, was given the task of developing and implementing training programs for community health practitioners. By the end of 1986, 2000 community health workers had been trained and assigned to remote villages, and were assisted by village health volunteers. Community health practitioners are registered professional nurses and/or midwives aged 20-55 who have completed a special 6 month training course in an institute designed by the government. They are preferably selected by the communities or provinces where they serve. Their responsibilities include organization and development of comunity, program planning, implementation and management, maternal and child health care, management of common and minor ailments, and training of village health volunteers. Each primary health post with its community health practitioner is established by the chief of the county, and is located so that most residents of the area can reach it within 30 minutes. The population served can range from 1000 to 5000. The community health training program lasts 24 weeks, with 8 weeks spent on class work, 12 on clinical practice, and 4 on field practice. The training is imparted at 8 regional medical or nursing facilities. Work for village health volunteers includes home visiting, advice on health matters, referring cases to primary health posts, and collecting data. Community health practitioners play an important role in the delivery of primary health care in rural areas.
Revitalizing primary health care.
Primary health care was started in the Isoka District of Zambia in 1981, and the program was significantly modified in 1984 to make it more effective. Government support was given to local communities, illiterate community health workers were admitted to the service, course content was simplified, training was transferred from the district hospital to the health centers, and local communities and local health center staff were given an increased part in the training and regular supervision of community health workers. 1 community health worker from each village was selected for a 2 week training session at a rural health center. The training is largely of a practical kind, and conducted in the local language of Chinamwanga. A reference text with color coded pictures, describing clinical diseases and treatment, was provided to the health workers. Traditional birth attendants and school first-aiders were then introduced to work with the village health workers in caring for children and expectant mothers. The present trend suggests that there is an encouraging degree of public participation in the program through material, moral and financial support for the community health workers. The cost per worker is estimated at US $51, which compares favorably to the US $140 of an earlier scheme.
Speeding up child immunization.
Ways in which it has been possible to improve immunization coverage are outlined. Accelerated campaigns on a national level require careful planning at an early stage, if potential benefits are to be fully realized. Existing health posts, clinics and personnel can be used to provide immunization services. Success of outreach components, whereby teams of health workers make regular visits to remote communities depends on reliable and affordable transport, supplies of fuel and willingness on the part of the health workers. Immunization via mobile units can be relatively expensive, if they provide only this intervention. The enumeration and registering of children eligible for immunization, also called channelling, may enhance the program's strategy. This strategy is labor-intensive and depends on good record-keeping and quick processing of data so that children found can be followed up. For an accelerated national campaign, there has to be good cooperation between government ministries, health services, teachers, religious leaders, the private sector and the community. Newspapers, radio and television are utilized along with other methods for communicating. National campaigns have made public health measures and the primary health care system more visible yet they are thougt to be unduly expensive if they do not contribute to the development of a permanent health service infrastructure.
Cost-effectiveness of immunization in Colombia.
The cost of Colombia's 1984 national immunization campaign is compared to that of the country's routine immunization services. Although the cost per immunization was broadly similar in the 2 cases, cost per fully immunized infant was twice as high for the campaign as for the routine services. The cost of routine services was assessed by identifying the type and quantities of human and physical resources deployed for immunization at each health post, and by apportioning a share of the immunization resources at the regional, departmental and national levels to the units. The campaign substantially boosted the number of immunizations performed. During its 3 days, 636,000 doses of DPT were given to infants, nearly 190,000 infants received a 3rd dose of the vaccine, and 98,000 began and completed DPT schedules. It cost between US$0.55 and US$11.90 to provide an immunization, the mean from the sample for routine services was US$2.54 and for the campaign the mean additional cost was US$3.56. Possible alternative delivery strategies and variations in campaign strategy are considered. Prior assessment of cost-effectiveness as an aid to option appraisal is advocated.
Traditional practioners are here to stay.
The majority of people in Nigeria use traditional rather than Western medicine for reasons of culture, cost and availability. Surveys conducted among members of the traditional and orthodox professions have revealed a large measure of support in each for the idea of integration. Questionnaires were distributed to a stratified random sample of 150 medical doctors and 150 medical students affiliated with the University of Benin Medical School, in Nigeria. A higher % of medical students than doctors disapproved of integration. 53% of the doctors and students considered no access to Western medical practice as the factor responsible for popularity of traditional medical practitioners. Interviews were conducted on 138 male and 37 female traditional medical practitioners. The traditional religion was claimed by 141 participants and the average age was 50 years. Cooperation with orthodox practitioners was favored by 161 interviewees whereas 14 wanted the status quo to continue.
Feeding practices of infants, and beliefs of mothers in western Jamaica.
An infant feeding survey was carried out in 3 parishes in Cornwall county, Jamaica, from March to August, 1984, in an attempt to determine the feeding patterns of infants and beliefs of mothers in Western Jamaica. 41 Enumeration districts (EDs), were randomly selected from 2 strata, urban and rural, in proportion to the population distribution. 614 households with children under 36 months of age were selected from 41 EDs. The results showed that the presence of breastfeeding was 98%. Despite the high frequency of breastfeeding, infant formula was introduced very early, and only about 1/2 of the mothers introduced semi-solids and solids within a month of the recommended time. The most popular foods, identified as good foods, were also popular weaning foods. There is need for adequate training of both primary and 2ndary health-care staff, and reinforcement of nutrition messages by frontline health workers. The collection of adequate baseline data in evaluating the effectiveness of nutrition education programs is also important. (author's modified)
Lack of association between spermicide use and trisomy.
It has been suggested that maternal use of spermicidal contraceptives increases the frequency of certain congenital abnormalities, including trisomy, but this issue is in dispute. The controversy led to this examination of whether the use of spermicidal contraceptives is associated with an increased risk of fetal trisomy. A questionnaire concerning contraceptive use was completed by 13,729 women undergoing prenatal fetal chromosome studies but were as yet unaware of the trisomic fetus because of their advanced age. Of 154 fetuses with trisomy, 98 had trisomy 21. For each woman (case) with an affected fetus, 4 controls were selected from among women with chromosomally normal fetuses, matched for maternal age and medical center. Cases and controls were compared by matched-sample maximum-likelihood logistic regression, to examine the association between fetal trisomy and 4 measures of spermicide use: preconceptional use, timing of last use, duration of last use, and total lifetime use. No evidence was found for an association, either when all types of trisomy were combined or when trisomy 21 alone was considered. All point estimates of odds ratios relating spermicidal exposure to trisomy were approximately 1, and an effect > a 2-fold increase was excluded with 95% confidence in the combined-trisomy group for all measures of spermicidal use. (Author's modified)
Teenage pregnancy and fertility in the United States, 1970, 1974, and 1980.
A preliminary analysis is made of changes occurring in adolescent fertility between 1970 and 1980 as well as pregnancy (live births and induced abortions) between 1974 and 1980, during which period the pregnancy rate for females 15-19 increased by 8.2%. The epidemiology of adolescent fertility, as characterized by race and marital status, is described for all females and for sexually experienced females (those who have ever had sexual intercourse) ages 15-19 within each state and US Department of Health and Human Services (HHS) region. The pregnancy rate declined 5.7% from 204.5 pregnancies/1,000 sexually experienced females to 192.8. In the same period, the fertility rate for sexually experienced 15-19-year-olds declined by 20.9%, from 146 births/1,000 to 115.5. Pregnancies among females ages 15-19 increased 10.5% from 1974 through 1980, whereas births decreased 7.3%. There was considerable variation between states. Not all births to females in this age group are unintended: the estimated intended fertility rate for females ages 15-19 decreased from 31.6 intended births/1,000 females in 1974 to 16.2 in 1980. Pregnancy rates are reported by race for all females and for sexually experienced females ages 15-19 within each state and HHS region. The pregnancy rate among females 12-14 years of age between 1974 and 1980 rose from 3.9 to 4.3/1,000 between 1974-1980, although the number of pregnancies for this age group declined from 24,128 to 23,010. This rate increased for Whites and decreased for Blacks. Between 1970 and 1980, the fertility rate for 15-year-old females decreased from 15.1 to 14.2; rates for 16 and 17-year-old females decreased from 37.4 to 30.9 and from 65.1 to 51.8 respectively, indicating some modest progress towards the 1990 Family Planning Objectives for the Nation.
Abortion surveillance, 1982-1983.