Reproduction and maternal nutrition in Madura, Indonesia.
Between late 1982 and late 1985 and early 1987 and late 1989, health workers collected anthropometric and caloric intake data on 1032 women living in a rural village on the island of Madura, East Java, Indonesia, to determine the prevalence and severity of chronic energy deficiency and the effect reproduction had on their nutritional status. These women had 2013 single births. 41.3% of all women suffered from chronic energy deficiency, defined as a body mass index (BMI) less than 18.5. Further, 2.6% of all women had severe chronic energy deficiency. This indicated that these women had suffered malnutrition during childhood. 31.6% of the women weighed less than 41 kg before pregnancy. 80% of these women had chronic energy deficiency. Caloric intake during pregnancy averaged 1550 kcal/day. Pregnancy women ate a mean of 42 g of protein/day. Their physical activity level was low. Mean total weight gained during pregnancy was a low 6.6 kg. Pregnant women used fat reserves during pregnancy, as indicated by lower upper aim circumferences and skinfold thicknesses (in 75% of cases) at the end of pregnancy compared to the first trimester. Women who weighted the least before pregnancy (<35-45 kg) gained weight (0.9-2.8 kg) during pregnancy, while those weighing at least 45 kg before pregnancy lost weight (0.3-0.6 kg). There was a very significant positive trend in mean birth weight with prepregnant weight and BMI. For example, the mean birth weight for infants of mothers whose BMI was less than 16 was 2740 g, and 3044 g for =or> 18.5 BMI. Thus, the tiniest women built up fat reserves during pregnancy at the expense of fetal growth. Postpartum women consumed just 200 kcal more during lactation than they did during pregnancy. Women who weighed less than 35 kg and had a low BMI at 4 weeks postpartum gained weight over the 12 months postpartum while those who weighed the most lost weight. These findings stress the need to put as much emphasis on maternal undernutrition as there is on malnutrition among preschoolers.
Assuring health sector policy reforms in Africa: the role of non-project assistance.
In the mid 1980s, USAID started nonproject assistance, mainly in the economic sectors, to African countries. The countries received nonproject assistance after they fulfilled conditions which influence institutional and/or policy reforms. The longest running health sector reform program in Africa was in Niger and was slated to receive portions of the funds after fulfilling 6 specific predetermined reform activities. Yet, between 1986 and 1991, Niger had implemented only 2 of them. It did accomplish the population/family planning reforms: expansion of family planning services, a national population policy, analyses and implementation of improvements in the pricing and distribution of contraceptives, and legalization of use and distribution of contraceptives. Continuing economic deterioration during the 1980s and political upheavals after 1989 somewhat explained why the other reform activities were not implemented. Other equally important factors were a very complex sector grant design (more than 20 reforms in 6 policy/institutional areas) with little incentive to realize the reforms, insufficient number of staff (limited to senior personnel) to implement the reforms, and just 1 USAID staff to monitor and facilitate activities. The nonproject assistance for the primary health care (PHC) system in Nigeria had a simpler design than that in Niger. The reform goals were shifting responsibility for PHC from curative care to preventive health services. After USAID and the Nigerian government signed an agreement, they included policy reforms promoting privatization of health services. Only 1 reform was implemented. Factors which could lead to success of nonproject assistance include host government needs to perceive it owns the objectives and building financial and institutional sustainability. In conclusion, nonproject assistance can be effective when implementing policy reforms that the host government has already adopted.
AIDS, addiction and condom use: sources of sexual risk for heterosexual women.
This paper presents an analysis of interviews with 2 women, in intravenous drug use and a sex partner of an intravenous drug user. Their discourse reveals how many women may assume different relations to traditional ideals of womanhood and heterosexual intimacy as defined by mainstream culture, and how the circumstances underlying their everyday personal experience are often in conflict with ideal gender roles. Analysis demonstrates that decisions regarding the use of condoms are constrained by this tension between the circumstances of addiction and mainstream ideals. Interview segments focus on source of ambivalence toward condoms and the way in which economics, emotions, and addictions may affect women's willingness and ability to negotiate sexual risk reduction with steady male partners. (author's)
Adolescent pregnancy prevention programs: design, monitoring, and evaluation.
Administrators tend to use their perception of adolescent pregnancy as a social problem to design and implement programs to prevent adolescent pregnancy. The first step in designing a successful program is conducting a needs assessment which requires administrators to define the problem, determine the size and scope of the problem, and understand the problem. All too often programs define teenage pregnancies as the problem, but tend to ignore related problems such as sexually transmitted diseases, abortion, poor birth outcomes, single parenthood. The scientific literature can help administrators identify who is at risk of sexual intercourse and pregnancy and how to design interventions which would help the high-risk group. Sociologists have reviewed several adolescent programs and have identified several factors which increase program effectiveness. For example, programs should be able to reach the at-risk population and realize that adolescent pregnancy prevention is complex and the message they send should ideally be able to clearly and precisely reflect this complexity without sending a mixed message. Administrators should assess programs on a routine basis and adjust them accordingly. Program assessment consists of a description of the program, including objectives and how the program hopes to meet these objectives, monitoring, process evaluation, and impact evaluation. Yet, resources and time may prevent programs from conducting impact evaluations using data. On the other hand, impact evaluations are the best means to learn whether program activities are solving the problem. Some adolescent pregnancy specialists suggest several realistic and productive steps to achieve quality and quantity assessments of adolescent pregnancy prevention programs. For example, funding sources should provide funds to conduct program assessment.
Small group sex education at school: the McMaster Teen Program.
In 1980, McMaster University in Hamilton, Ontario, developed a school program to prevent adolescent pregnancy (McMaster Teen Program). It did not provide comprehensive information about contraception (e.g., pragmatic guidance on knowing what to purchase, how to ask for it, where it can be purchased, and cost), however. It followed and compared an experimental group of 2111 11-to-16-year-old junior high school students with a matched control group (1263 students) for 4 years to evaluate the program's effectiveness. Only students who had parental consent entered the study. At post-test, a much higher percentage of males in the experimental group had sexual intercourse than those in the control group (54.1% vs. 44%; p < .05). Contraceptive use was not significantly higher in the experimental group than the control group (29.6% vs. 25.75%). Further, students in experimental group were not more likely to practice sexual abstinence than were those in the control group (49% vs. 53%). The pregnancy rate was higher for students in the experimental group than for those in the control group (4.6% vs. 2.9%), but the difference was not statistically significant. The only variable which significantly affected the likelihood of pregnancy before age 17 was a low level of internal control. Variables which contributed significantly to the likelihood of females practicing sexual abstinence before age 17 were ethnicity, educational goals beyond high school, age, living with both parents, and a high level of internal control. Educational goals beyond high school was the only variable affecting delay of first intercourse. Ethnicity, a high level of internal control, and educational goals beyond high school contributed to consistent use of contraceptives among sexually active females. As for males, age, educational goals beyond high school, attendance at a small elementary school, and part of the control group at school were significant.
Enhancing social and cognitive skills.
In California, teachers and/or researchers followed 1033 high school students (586 in a treatment group and 447 in a control group) to evaluate the impact of the Reducing the Risk (RTR) curriculum which constantly reinforced avoiding unprotected sexual intercourse and promoted discussion between parent and child. Despite strong objections by a vocal minority of parents, most parents of the children who participated in the study supported the curriculum. The RTR curriculum significantly improved communication with parents about contraception and sexual abstinence (p < .005 at 6 months and p < .05 at 18 months). Further, communication about contraception between parents and Latino youths in the treatment group increased 2-fold. Communication about abstinence also increased greatly for Latinos. Overall, the curriculum did not improve communication with parents about pregnancy and sexually transmitted diseases. It did significantly improve communication between parents and daughters about pregnancy and STDs, however. The curriculum's use of role playing to impart knowledge of pregnancy prevention increased knowledge significantly, suggesting that a cognitive behavior approach results in more knowledge gained and retained for a longer time period. Even though the RTR curriculum did not reduce the percentages of perceptions that all their age peers had had sex, it did keep these perception from increasing over time. The researchers thought it reduced bragging. The curriculum did not affect behavioral intent to abstain from intercourse by about 24% and did not increase sexual intercourse. It did not decrease frequency of intercourse, however. The curriculum did reduce unprotected intercourse by about 40% among the lower-risk students and those students who had not yet had their first sexual intercourse at pretest. These findings supported the importance of using a cognitive behavior approach in sex education before youth have their first sexual intercourse.
An information and skills approach for younger teens: postponing sexual involvement program.
In 1983, in Georgia, the Henry W. Grady Memorial Hospital outreach education program implemented its Postponing Sexual Involvement Program for low-income, mostly black, 8th grade students at Atlanta's 4 school systems. During the 1985-1986 and 1986-1987 school years, researchers collected pre-program and post-program data on at least 536 youth to compare the results of treatment group with those of the control group. 76% of all students (75% of program students) were virgins at the beginning of 8th grade. Virgins who experienced the sex education program were considerably more likely to postpone sexual intercourse than those who had not experienced the program. Further, the program's effect continued for at least 12 to 18 months. By the end of 9th grade, 33% fewer program students had experienced first intercourse than the non-program students (24% vs. 39%; p < .05). This held true for both males and females. By the end of the 9th grade, youth who began sexual activity after the program started were less involved in sexual intercourse (e.g., tried sex no more than twice, 28% vs. 43%) and more likely to not expect to have sex in the next 6 months (72% vs. 53%) than non-program youth. Fewer females in the program group had sexual intercourse; their pregnancy rate was 33% lower. The program did not affect the sexual behavior of program students who had had sexual intercourse prior to experiencing the program, however. It also did not reduce their pregnancy rate, even though many females had sometimes used a birth control method. Thus, the hospital began developing means to increase contraceptive use. These findings indicated that the program was effective for youth who had not yet experienced their first intercourse. Nevertheless, the hospital hoped to convince the schools to allow the program to be implemented also at the 7th grade level because of the relatively large proportion of 8th grade students who had had sexual intercourse.
A comprehensive age-phased approach: Girls Incorporated.
A longitudinal study evaluated the effect of Girls Incorporated's comprehensive age-phased model for pregnancy prevention on 343 females at the following sites: Dallas, Texas; Memphis, Tennessee; Omaha, Nebraska; and Wilmington, Delaware. The components were Growing Together for 12-to-14-year-old girls and their parents, Will Power/Won't Power for 12-to-14-year-old girls, Taking Care of Business for 15-to-17-year-old girls and Healthy Bridge for 15-to-17-year-olds. Youth who attended at least 2 program components were 2.7 times less likely to have sexual intercourse during the last 4 weeks without contraception than those who attended just 1 component (8.9% vs. 20.6%; p = .018). Surprisingly, none of the program participants were significantly less likely to have sexual intercourse without contraception than nonprogram participants. Nonprogram youth experience a higher percentage of pregnancies than both the 1-component and 2-or-more-component program participants (12.3% vs. 6.8% and 4.8%, respectively; p = .062; odds ratio = 2.8). Even though the 50% reduction in pregnancies between the 1-component and 2-or-more-component program participants was not significant, it indicated a possible positive program effect. Just 3.6% of the girls who attended only the Will Power/Won't Power became pregnant compared to more than 11% of the girls who attended the other components. Further, a relatively small percentage of girls who attended Will Power/Won't Power and another component became pregnant. Thus, Will Power/Won't Power was apparently the most effective component. It used role play to practice assertive skills to resist pressure to become sexually active and to avoid risky situations. Will Power/Won't Power also developed a peer network to support particpants' decisions to resist peer pressure to become sexually active. Further analysis revealed that neither Will Power/Won't Power nor any other component alone contributed to pregnancy reduction. Thus, program components for different age groups with different objectives together affect pregnancy reduction.
Life options and community service: Teen Outreach Program.
In the US, an evaluation study of the Teen Outreach program covered the period between 1985 and 1989 and compared data on 495 students who experienced the program with data on 490 students who did not. The researchers used random sampling to create only 1 control group, but the numbers were too small (6) to detect statistical significance, thereby limiting their ability to do a multivariate analysis with data on the control group. Teen Outreach students consistently had lower pregnancy rates than the comparison students (e.g., 1984-1985, 3.75% vs. 10%; 1986-1987, 3.9% vs. 5.75%; 1988-1989, >3% vs. <7%; p < .05 for 1984-1985 and 1986-1987 and p < .01 for 1988-1989). Further, they had lower rates of suspension from school in every school year except 1985-1986. The lower rates were significant in all school years following 1985-1986 (p < .01), regardless of grade, prior rates of suspension, and failing courses. In addition, Teen Outreach students were significantly more likely to have lower rates of course failures than comparison students in all but 2 school years (1985-1986 and 1986-1987). They had consistently lower dropout rates than comparison students, even when the researchers controlled for grade and pregnancy (significant for all school years except 1984-1985). These findings supported the effectiveness of the year-long program which included mentoring from a caring and supportive facilitator, skill building and build up of self-worth through a work experience, and peer support. The curriculum equally emphasized imparting knowledge on how to prevent pregnancy and developing tangible coping skills.
Comparing adolescent pregnancy prevention programs: methods and results.
Successful adolescent pregnancy prevention programs tend to emphasize value reinforcement, decision making, skill building, contraceptive services, and motivation by presenting life options. In the 1980s, the US government encouraged pregnancy prevention programs to only promote sexual abstinence until marriage ("just say no"). Orientations of programs reviewed in this book include sexual postponement ("just say not yet"); if and whenever sexual intercourse occurs, using a contraceptive ("not without using something"); and offering youth life options. The review reveals 5 basic principles of these programs which were able to bring about moderate improvements in adolescent sexual and contraceptive behavior: clear and specific goals, a relatively young target population, intensive program, comprehensive program, and providing parent and peer support. The program evaluations compare students before and after experiencing the program or program students with nonprogram students using either a true or quasi-experimental design. Not all of the evaluations pay attention to the amount of each program component each student actually experiences (dosage). The book's editor strongly encourage programs to collect dosage data (e.g., class attendance and clinic visits) so evaluators can determine their association with relevant outcomes. The editors address inherent problems of measuring adolescent sexual and contraceptive behavior and pregnancy since the data depend on the adolescents' own reports. Indeed response often consist of confusion, lies, random responses, and missing data. Accurate records (e.g., clinic records and logs) can alleviate some of the measurement problems. Some of the programs in the review clearly identify different needs and responses based on age (i.e., the classroom and volunteer work components were more effective for younger adolescents than older adolescents), thus providing insight into adolescent development.
[Pregnancy after female surgical sterilization: 38 cases]
Between January 1981 and July 30, 1987, 38 women who had earlier undergone sterilization became pregnant and sought medical care at the Maternity and Neonatology Center in La Rabta in the city of Tunis in Tunisia. 19 women had earlier undergone surgical female sterilization at the center for a failure rate of 7.1%, which corresponds to the global failure rate. There were 34 confirmed cases. Surgeons had correctly ligated the tubes of 7 (20.6%) women. 5 women had an intrauterine pregnancy. Ruptured tubes caused peritoneal flooding in the 2 women who had an ectopic pregnancy. The sterilization procedure used for these 2 women were electrocoagulation (pregnancy occurred 6 years after sterilization in West Germany) or Pomeroy technique (pregnancy occurred 14 years later). Technical error was responsible for the remaining 27 cases (80.04%, 85% of cases who underwent sterilization at the Center in Tunis). Laparoscopic sterilization comprised most sterilization failures (23 cases of error cases or 85.2%). In fact, the ring was not correctly attached on 1 tube in 13 of these women and on both tubes in the other 10 women. 28 of the 38 pregnant women (73.7%) chose to have the pregnancy terminated. The other women delivered full-term infants. Physicians performed a repeat sterilization procedure in 87% of the women.
Opportunities for CD-ROM information services in Africa.
In the more populous and wealthier region of Africa, North Africa, one library serves 26,000 people, while in sub-Saharan Africa this figure is 60,000. Only 14% of all libraries (national libraries, university libraries, and special libraries) in Africa are likely users of CD-ROM technology. Most of these libraries (68%) are in North Africa. Extrapolation shows a minimum of 282 computers in North Africa and 135 computers in sub-Saharan Africa in these libraries. 65% of Africans surveyed by UNESCO in 1991 regarding their information needs have access to IBM-compatible personal computers (PCs). Indeed, the number of PCs installed in Africa has grown considerably during the late 1980s. A 1990 AAAS survey showed that 16 out of 106 libraries have CD-ROM drives (9 university libraries, 7 research libraries). The most frequently used CD-ROM database is MEDLINE, followed by POPLINE, which is produced by the Population Information Program (PIP). PIP has provided 60 CD-ROM drives to Africa, where 71 POPLINE sites already exist in 27 countries. At least 200, maybe as many as 400-500, POPLINE sites exist throughout the developing world. Advantages of CD-ROM technology in Africa are: no need for telecommunication systems; limited on-site assistance needed; relatively easy to install and run; physical attributes suited for use in tropical environments; economical; and encourages end users to access information. Thus, CD-ROM has the potential to solve various information problems facing Africa. Africa is a growing market for CD-ROM in Africa should be aware of several obstacles, such as difficulties with indigenous human resources, language barriers, differing values of time, nonverbal communication differences, and economic constraints. In late 1992 and early 1993, several meetings on CD-ROM are scheduled in Ghana and Zimbabwe.
Gender and health in rural Egyptian households.
In Egypt, gender rules envelop all facets of daily life including word usage, roles, status, and clothing. Women in the Delta region either work on family land without receiving any wages or they work for landowners at lower wages than men. In addition to agricultural work, they also care for the children, prepare meals, and do housework. Further, their social status improves as the number of sons they bear increases. In fact, women who have only sons tend to stop childbearing while those with only daughters continue childbearing until they have s on. Adult males receive the largest share of meals and girls receive the smallest share. Indeed, malnutrition and anemia are more common among girls than boys. More rural women than men are illiterate and girls are less likely to be enrolled in school than boys. Inadequate diets and limited or no education adversely affect female health. Moreover, they have less access to biomedical care than males despite their relatively close proximity to such care, because households spend less income on female health care than on male health care. In addition, they do daily chores when feeling ill, thus hiding pain or discomfort, while males receive women's constant attention when ill. Women tend to receive home remedies, but mothers of sons are more likely to receive biomedical care than mothers of daughters. Other gender-linked health risks are septic abortion, unsafe and septic delivery techniques, sexually transmitted diseases, early marriage and subsequent adolescent pregnancy, female circumcision, domestic violence, homicide (honor killing), suicide, and exposure to occupational risks (e.g., parasitic and infectious disease, pesticides, and accidents). In Egypt, there is excess female child mortality. All these aforementioned gender disparities have resulted in the preventable death of 1,034,822 women.
AIDS and sex tourism.
Tourists traveling internationally lower their inhibitions and take greater risks than they would typically in their home cultures. Loneliness, boredom, and a sense of freedom contribute to this behavioral change. Some tourists travel internationally in search of sexual gratification. This motivation may be actively conscious or subconscious to the traveler. Billed as romantic with great natural beauty, Thailand, the Philippines, Brazil, the Dominican Republic, and Kenya are popular destinations of tourists seeking sex. The Netherlands and countries in eastern Europe are also popular. With most initial cases of HIV infection in Europe having histories of international travel, mass tourism is a major factor in the international transmission of AIDS. While abroad, tourists have sex with casual partners, sex workers, and/or other tourists. Far from all tourists, however, carry and consistently use condoms with these partners. One study found female and non white travelers to be less likely than Whites and males to carry condoms. The risk of HIV infection increases in circumstances where condoms are not readily available in the host country and/or are of poor quality. Regarding actual condom use, a study found only 34% of sex tourists from Switzerland to consistently use condoms while abroad. 28% of men in an STD clinic in Melbourne, Australia, reported consistent condom use in sexual relations while traveling in Asia; STDs were identified in 73% of men examined. The few studies of tourists suggest that a significant proportion engage in risky behavior while traveling. HIV prevalence is rapidly increasing in countries known as destinations for sex tourism. High infection rates are especially evident among teenage sex workers in Thailand. Simply documenting the prevalence of risky behavior among sex tourists will not suffice. More research is needed on travelers and AIDS with particular attention upon the motivating factors supporting persistent high-risk behavior.
Gender and health in Africa.
Marriage and divorce, sexuality and intimacy, and submission and resistance occur in an economic, social, and political context of male dominated institutions. Women's productive and reproductive labor and biological reproduction affect women's health; therefore, medical or public health based solutions are not always the answer to these problems. In Africa, women's subordination and limited opportunities for women to acquire credit and autonomy through productive work are the basis of the problem of reproductive health. Specifically, women who gain recognition only though their status as wives and mothers are often not able to use contraceptives, or they use them clandestinely and face possible risks of retaliatory abuse. Men determine how and when women have children and have rights to these children. Further, many African women pay for their lack of control over biological reproduction with their or their children's lives. Even through education and training can in theory grant them profitable work, declining economies in Africa foster few jobs. Besides, African women are overextending themselves in vain to overproduce because of the structural problems of the indenture to bankers and the lowering of the value of primary products. Female circumcision, which is often performed on infants and young girls is both a women's health problem and an issued of men's attempt to control women's sexuality. Since it is predominantly an African issue, only Africans understand it and its effects enough to address it. Female circumcision, polygyny, the age gap between spouses, and possible postpartum sexual abstinence, weaken the conjugal, emotional bond. National and international bodice should be searching for solutions to women's health problems which are affected by many political, economic, and social conditions. Women worldwide should join to put pressure on these bodies to induce change.
Conception, contraception: do Algerian women really have a choice?
In Algeria, some women do not use contraception because they, their husbands and their in-laws consider it a sin or state interference in family affairs. Women sometimes reject family planning because children are the only means of achieving respect in their husbands' families with whom they live. They may not use contraception until they have several sons. Often women want to use contraception, but their husbands refuse, thinking it would hurt their social image. Information diffusion campaigns that consider women's social realities may increase the practice of family planning such as what occurred in Algeria. Some of these realities include segregation of men and women, discussion of sexual matters only within same sex groups, uneasiness about sexuality, and ongoing transformation of women's lives (e.g., increased access to income and education). The Algerian maternal and child health/family planning (MCH/FP) program has retrained midwives to listen and respond to women. It has also conducted a study of the quality of MCH/FP care and an operations research study. It realizes the importance of having women participate in primary health care. The MCH/FP program plans to integrate literacy projects into its clinics. It wants women to feel comfortable rather than feel guilty for not following appropriate health and family planning guidelines at MCH/FP clinics. Clinics must value positive traditional practices. The MCH/FP program has examined the demand for family planning and the key role motivation plays in fertility and contraception. Abortion and adoption are illegal in Algeria, so if a single woman conceives, her only choice is to deliver away from her family and to abandon the infant at an orphanage. Since Algeria and France are historically linked, many Algerian women live in France where a different culture exists and permits certain behaviors not accepted in Algeria. This situation makes life confusing and difficult for these women.
Should the threat of HIV affect breastfeeding?
About 33% of infants born to HIV positive women acquire HIV. Since breast milk has disease-protecting antibodies and diluting infant formula with unsafe water poses sizable health hazards, it is difficult for countries to set sound policy on breast feeding and for health workers to counsel HIV infected mothers and those at high risk of HIV infection. In 1985, US and UK public health officials advised HIV infected mothers to bottle feed. They eventually amended their position by claiming the guidelines only applied to the US and the UK where safe water is exists. WHO recommends that the only HIV infected women who should use a breast milk substitute are those in countries where infectious diseases are not the leading causes of infant death or those in countries with widespread malnutrition and infectious diseases which do cause infant death, but whose conditions would allow an appropriate alternative. In Rwanda, a study on HIV transmission via breast milk shows infants seroconvert during the same month as do the mothers. So the researchers advise mothers at high risk for seroconversion to not breast feed; yet all women in Rwanda are at high risk. In Haiti, where all women are also at such risk and have no breast milk substitutes, the HIV transmission rate among breast fed infants is 25%, equalling that of non breast fed infants in the US and Europe. A European and Australian study also reveals a higher risk of HIV transmission via breast milk in mothers who acquired HIV postpartum than in those who acquired it prenatally. Some research shows that 24% of the colostrum of HIV infected mothers has P24 antigen, while there is no P24 antigen in 4-day postpartum breast milk. Policymakers should develop an algorithm for health providers to use to advise mothers about the relative benefits and risks of breast feeding concerning HIV transmission.
Benefits and risks of oral contraceptive use.
The effectiveness of monophasic and multiphasic oral contraceptives (OCs) depends on their ability to suppress ovulation, change endometrial growth and ovum receptivity, and reduce cervical mucus receptivity to sperm. They are all more than 99% effective, but, depending on the type and dose of hormone components, they have different side effects. The estrogen component (ethinyl estradiol) of most new OCs is between 30 and 35 mcg, which reduces the risk of estrogen side effects, especially thromboembolism and hypertension. The Food and Drug Administration does not recommend use of an OC with an estrogen component for lactating mothers, while the American College of Obstetrics and Gynecology and the American Academy of Pediatrics believe it is fine. Estrogen may protect against coronary artery disease, yet the estrogen component of today's OCs is so low that the progestin component may cancels this beneficial effect. It also prevents breakthrough bleeding. The most frequently used progestins in OCs are norethindrone and norgestrel. They prevent ovum implantation, sperm penetration through the cervical mucus, and ovulation. Progestins, especially norgestrel, increase the risk of coronary artery disease. Other side effects include acne and weight gain. Progestin benefits are reduced menstrual blood loss, pain during menstruation, premenstrual tension, and endometrial cancer risk. The ideal estrogen-progestin balance depends on the individual, but the estrogen component should be between 30 and 35 mcg, and the progestin component should be the lowest possible dose to reduce metabolic side effects. If an OC user with a well stabilized cycle who takes another recently prescribed drug experiences unexpected breakthrough bleeding or spotting, this change may indicate a drug interaction. Absolute and/or possible contraindications of OC use are smoking after age 35, history of breast or endometrial cancer, liver disease or impaired liver function, cardiovascular risk factors, and diabetes mellitus.
AIDS prevention programs for men: workplace interventions in developing countries.
If is neither easy to identify nor communicate with clients of commercial sex workers, yet they are key targets for HIV/AIDS prevention programs. Active cooperation from management and employer organizations contribute to the success of these programs. Employment-based HIV/AIDS programs in developing countries help reach this population. The Ghana Armed Forces provides health education and educational materials using military themes (e.g., posters, T shirts, comic books, and a film). Its program stresses condom use. Over 8 months, soldiers purchase more than 34,000 condoms with figures rising monthly. Logistics problems prevent stores, mess halls, and canteens from meeting condom demand, however. AIDS/HIV prevention messages are part of monthly presentations, social gatherings, daily pep talks, and mandatory health education sessions. The Commercial Farmer's Union in Zimbabwe (300,000 members) distributes condoms free of charge through farm stores, beer halls, pay desks, and village health workers (<1.3 million at almost 1000 outlets in 21 months). Motivated by branch managers, condom promoters at farm stores hand out condoms to customers to distribute on the farms. Some farmers encourage farmhands to organize AIDS committees. The Committee for Surveillance and Control of AIDS uses 17 peer educators to conduct onsite AIDS education for 700 employees at 17 resort hotels in Puerto Plata, Dominican Republic. The program also includes condom distribution. Some hotel owners realize that healthy employees increase productivity and decrease absenteeism and turnover and that a reputation of having safe, educated employees increases profits. Not all managers cooperate with the program in the same manner, however, which stresses the need to gain strong manager support at each worksite. An AIDS prevention program in Thailand uses 300 peer educators from 300 businesses. Brochures, slides, videos, and cassette tapes help them spread the message. Businesses with just short-term employees not to participate, however.
The Latin American trial of psychosocial support during pregnancy: a social intervention evaluated through an experimental design.
2236 pregnant women at high psychosocial risk participated in a randomized controlled trial conducted at obstetric hospitals in Rosario, Argentina; Pelotas, Brazil; La Habana, Cuba; and Mexico City, Mexico, to evaluate a social support and health education program. First, the health professionals used an ethnographic study to pinpoint stress-producing situations and needs for support during pregnancy. They used the results to design the program. Each center used the same manual with a decision making flow chart to standardize the program. They hoped the program would correct stressful situations and negative health related behaviors. Interventions to achieve reinforcement of social support network were 4 to 6 home visits beginning at the 20th week of gestation (patient, support person, and home visitor), discussion about woman's natural social support network and needs, and involvement of this network in actual and helpful tasks. Activities generating emotional support included the home visitor's empathy, interest, and being a liaison between material, and discussions about specific health topics were intervention activities to increase knowledge about pregnancy and delivery. Activities to reinforce adequate health service utilization included providing information about hospital characteristics and rules, a telephone hotline, a guided tour of the hospital, and a consultation service. The multicenter study showed that program implementation was strongly associated with what was planned and taught during the training course. It also supported the need for an interdisciplinary approach to investigate child survival. The researchers concluded that comprehensive conceptual models, designs, and methodologies are essential to propose effective responses to complex problems.
Oral rehydration therapy -- qualitative studies of balance between pragmatism and scientific rigour in managing diarrhoea.
In the experience of the author, oral rehydration therapy has proven effective at home, in the ambulatory and in the institutional care setting. A series of anecdotal reports on the successful use of oral rehydration on refugees, in famine and poverty, on medical students, prisoners, and the well-off people of Western countries, is presented. The essential principles of oral rehydration are identified and the authors show how these can be adapted to a particular health care setting. A clear understanding of local attitudes and beliefs about diarrhea is essential to professional health workers if they are to act as agents of change. (author's)
School-linked reproductive health services: the Johns Hopkins Program.
In Baltimore, Maryland, staff at John Hopkins School of Medicine evaluated its 28-to-30-month primary prevention of adolescent pregnancy (Self Center) program at urban junior and senior high schools. Baseline data revealed that about 92% of boys in both junior and senior high school and 54% of 9th grade girls and 79% of girls in senior high school had had sexual intercourse. The program resulted in about a 7-month postponement of first intercourse (15 years 7 months for youth who have already had sex vs. 16 years 2 months for virgins). Further, coital frequency of youth who initiated sex after the program was lower than those who did beforehand. The pregnancy rate among the control schools increased throughout the study period, while it increased slowly up to 16 months for treatment schools, then fell 22.5% by 20 months and 30.1% by 28 months. Moreover, the abortion rate among treatment schools fell before the pregnancy rate. The magnitude of change in the pregnancy rate brought about by the program was greater than expected among the younger youth. In fact, it had the most dramatic effects on unprotected coitus, clinic attendance, and contraceptive use for the younger youth. At least 2 years exposure to the program increased family planning clinic attendance by more than 70%. In fact, the same or a greater proportion of junior high school students attended the clinic compared to their female counterparts. Thus, the program also influenced boys. The level of contraceptive use among all girls increase significantly after exposure to the program (25-49% before vs. 39-61% after). The program's mean cost per student was $122 (range $3-$3052). These findings demonstrated that the Self Center program had a positive effect even on students who did not use all components of the program (contraceptive services, class room sex education, and individual counseling and education). Indeed, it confirmed that youth do respond to a well-conceived program which offers them supportive services, education, and the means to behave responsibly and build their self-esteem.
School-based clinics.
In 1984-1985, the Center for Population Options began to evaluate 6 high school based comprehensive care clinics. The students tended to be poor minorities, especially Blacks. The clinics did not increase the frequency of sexual intercourse or precipitate the onset of sexual activity. In fact, in those cases where there was a significant difference between students at schools with a clinic and those at schools with no clinic (p < .01), sexual activity was delayed for clinic students. The Gary, Indiana, clinic did not provide contraceptives and rarely did it counsel students about them or refer the students for contraceptives. Thus, contraceptive use did not improve. The San Francisco, California, clinic had a strong AIDS education program and peer education program encouraging condom use, but did not prescribe or dispense contraceptives. Yet, condom use increased considerably (29-56% for males and 22-38% for females; p < .001). The main thrust of the Muskegon, Michigan, clinic was pregnancy prevention. Further, the health education teacher and clinic staff addressed human sexuality. Thus, its male and female students were the only group with a significant increase in use of any contraceptive (61-78% for males and 60-75% for females; p < .001). Condom use made up most of the increase for males (41-61%; p < .001) and oral contraceptives (OCs) did for females (27-36%; p < .01). The highest percentage of sexually experienced females who used OCs was in Jackson, Mississippi (46%). Further, it was much higher than that at the school with no clinic (30%; p < .05). The Dallas, Texas, clinic did not stress pregnancy prevention (just 14% of visits were for family planning). Yet, 40% of sexually experienced females obtained their OCs from the clinic. They were not necessarily more likely to have used OCs during the last intercourse, however. Even though the Quincy, Florida, clinic stressed pregnancy prevention, OC use only increased 7%. High staff turnover and already reasonable access to another clinic may account for this low increase. None of the clinics affected the pregnancy rate.
A health beliefs field experiment: Teen Talk.
A randomized field trial evaluated the Teen Talk sex education program based on the Health Belief Model and Social Learning Theory (HBM-SLT) at 7b agencies providing family planning services in Texas and 1 school district in the San Francisco Bay Area in California. Male virgins who experienced the HBM-SLT curriculum were significantly more likely to continue to abstain from sexual intercourse during the following year than those who did not (64% vs. 56%; p < .05). This was not the case for female virgins, however. Further, female virgins at time 1 who experienced comparison programs were more likely to have used an effective contraceptive during their last intercourse and consistently use an effective method than their HBM-SLT program counterparts (65% vs. 35% and 12 vs. 6.95; p < .01). The HBM-SLT and comparison programs equally affected male virgins at time 1. In addition, both programs significantly improved contraceptive efficiency for sexually active youth. The HBM-SLT program had a considerably longer effect on contraceptive efficiency for sexually active males than the comparison program did (p < .05). In fact, it was more successful for black and white males than it was for Hispanic males (p < .01). Both programs led to equal improvement in contraceptive efficiency for females. Students who had had sexuality education before this study showed higher contraceptive efficiency at the end of the study than those who had none, regardless of the present sexuality education program (p < .05). The pregnancy of pregnancy involvement rate for the HBM-SLT program was not significantly different than that of the comparison program. The HBM-SLT program's greater success with males may be due to the role playing and interpersonal interaction components which made them examine and reflect on sexual interactions with females in new and unsettling ways.
Twinning and the r/K reproductive strategy: a critique of Rushton's theory.
"The theory of r selection, favoring population growth, as opposed to K selection, favoring more efficient utilization of resources, has in recent years been applied by [J.P.] Rushton to contrast human ethnic groups in terms of their r/K reproductive strategies, suggesting the existence of a continuum from r groups, producing many offspring but providing little parental care, to K groups, producing few offspring but providing much parental care. Rushton's theory, which is largely based on ethnic differences in twinning rates, is here critically examined. It is pointed out that twinning rate differences are not necessarily genetic in origin since various environmental factors clearly play a role, and also that twinning, as a mode of reproduction, is not necessarily an r strategy, considering the high prenatal and perinatal selection to which it has been, and still is, associated....The claim that ethnic differences in twinning rates provide evidence for an r/K typology in human populations with respect to reproductive strategies does not appear to be warranted." (EXCERPT)
Projection of Indonesian population: 1990-2020.
Population projections for Indonesia are presented in tabular format up to 2020 by age and sex. (ANNOTATION)
[Demography and differences: the international conference in Montreal (June 7-10, 1988)]
These are the proceedings of the fourth international conference organized by the International Association of French-Speaking Demographers, which was held in Montreal, Canada, in June 1988. The 72 papers are organized under three general topics, all of which are concerned with both theory and methods. The first session presents a general review of what has been learned about the study of differences in demography, including differential fertility and mortality. The second session looks at methods used to analyze such differences. The third session goes beyond the description of the methodology to focus on epistemological aspects. The geographical scope is worldwide.
Canada's immigrants: recent trends.
Recent trends in immigration to Canada are analyzed. The author notes that immigrants are concentrated in the major urban areas, particularly Toronto, Vancouver, and Montreal. An increasing proportion are Asian-born, although over half of all immigrants living in Canada in 1991 were born in Europe. (ANNOTATION)
[Population census, March 1, 1991. A listing of professions]
This publication lists the professions and occupations for which data were collected in the 1991 Belgian census. (ANNOTATION)
Population aging, social security design, and early retirement.
"The aging of the industrialized countries will dramatically strain their social security systems. In Germany, for example, 100 employed persons now support about 40 elderly, but 85 elderly will have to be sustained by the same number of employed persons in the year 2030. This pressure is exacerbated by the observed trend towards earlier retirement ages. This paper presents cross-national evidence and an option value analysis of the retirement decision to argue that the distortions created by the actuarially unfair design of the social security systems in the United States and particularly in Germany have significantly contributed in this trend." (SUMMARY IN GER) (EXCERPT)
Changes in size and structure of households--an analysis of the past 150 years.
The author examines changes in household size and structure in Germany from 1840 to the present. Data are from official sources. (ANNOTATION)
Revising the conquest of Mexico: smallpox, sources, and populations.
The author questions some estimates of the size of central Mexico's population in the early sixteenth century, at the time of the Spanish conquest. He also examines the available data concerning the decline of the indigenous population following the conquest, with a focus on the role that smallpox may have played. He concludes that there is no reliable evidence for a massive pandemic of smallpox in Mexico that would have had a significant effect on Aztec mortality. (ANNOTATION)
The determinants of East-West German migration: some first results.
Determinants of the propensity to migrate are explored using data collected in a survey of East German residents following German reunification in 1991. The author notes that in the period 1989-1992, some 870,000 individuals migrated to West Germany, representing about 5% of the total East German population and 10% of the work force. He suggests that "recent developments in the literature on the option value of waiting may yield important insights into these determinants." (EXCERPT)
Sexual networking and HIV/AIDS in west Africa.
"This supplement to Health Transition Review provides a record of early behavioural research in West Africa on sexual networking (relations with multiple sexual partners) that has been catalysed by the outbreak of the AIDS epidemic in parts of the region. Most of the authors belong to the West African Research Group on Sexual Networking (WARGSN)...." Topics considered include families and AIDS, social and economic choices available to divorced or married women and prostitutes, sexual networking, migration and AIDS, women's control of their sexuality and the spread of STDs and HIV/AIDS, HIV/AIDS counseling programs, the role of religious leaders in changing sexual behavior, changes in adolescent sexuality and the perception of virginity, female reproductive tract infections, and incidence of antibodies to HIV in seropositive cases. The individual studies are concerned with Gambia, Ghana, Nigeria, or Uganda. (EXCERPT)
1991 census of Canada. Labour force activity.
Statistics from the 1991 census of Canada are presented on labor force activity. The data are a 20 percent sample and concern the population over age 15 by age, marital status, labor force activity, and sex for Canada, provinces, and territories. (ANNOTATION)
1991 census of Canada. Mother tongue.
This is one of 23 reports in the series entitled The Nation, which presents basic information on a broad range of topics from the 1991 census of Canada. This report contains data on language. The statistics concern mother tongue and sex for Canada, its provinces, territories, and census metropolitan areas. Some detailed household-level data on language are also included. (ANNOTATION)
1991 census of Canada. Occupation.
This report presents 20 percent sample data on the labor force from the 1991 Canadian census. Statistics enumerate those 15 years of age and over by occupation and sex for Canada, provinces, and territories for 1986 and 1991. (ANNOTATION)
[The Ukrainian population of Russia and the USSR beyond Ukraine (from the eighteenth to the twentieth century): population size and distribution]
The author provides a detailed historical overview and analysis of the distribution and size of the Ukrainian population within Russia and the USSR but outside the borders of what constitutes modern Ukraine. Determinants of variations in the size of this population from the eighteenth to the twentieth centuries are examined. Assimilation, bilingual trends, and retention of ethnic identity are discussed. Data are from censuses conducted between 1887 and 1989 and from church, police, and other archival records for the earlier period. (SUMMARY IN ENG) (ANNOTATION)
Mortality Surveillance System: models from the first year.
"This report presents the statistical charts and text from the first year of the Mortality Surveillance System (MSS), as published in 12 issues of the Monthly Vital Statistics Report (MVSR)...and briefly describes the methodology that was used. Also presented are the monthly data used in fitting the models depicted in the published charts and the model statistics for the fitted curves....The MSS consists of a series of charts and text published each month in the MVSR, depicting trends in provisional mortality data for selected causes of death and population groups. Emphasis is given to graphic presentation that permits timely identification of departures from mortality trends observed in the recent past." (EXCERPT)
[Regional differences in mortality in Italy]
"Following the recent publication of 1990 mortality tables for the Italian regions by the 'Istituto di Ricerche sulla Popolazione', the authors have surveyed the 1990 mortality differences by regions in Italy as well as the regional changes...in mortality levels from 1970-72...to 1990. In particular, the authors focused on the levels of life expectancy at birth in the Italian regions as well as on their trend over the 20 year period; male [excess] mortality; the regional differences in the probability of death for specific age groups and their trends over the period under study; [and] the mortality risk in the different regions." (SUMMARY IN ENG) (EXCERPT)
Moderate drinking and coronary heart disease mortality: evidence from NHANES I and the NHANES I Follow-up.
"Data from the [U.S.] National Health and Nutrition Examination Survey, conducted from 1971 through 1974, and the National Health and Nutrition Examination Survey Follow-up, conducted from 1982 through 1984, were used to test for a beneficial effect of moderate alcohol consumption on coronary heart disease mortality among White men and women. Evidence of such an effect was found for White men; accelerated time-to-failure models showed 3% to 4% longer life spans for moderate drinkers than for nondrinkers or light drinkers." (EXCERPT)
The emergence of modern retirement: Germany in an international comparison (1850-1960).
The author compares the retirement situation in Germany with that in Britain, France, and the United States over the period 1850-1960. (ANNOTATION)
The event history approach in demography.
"In the present paper, we shall examine...changes in the field of demography, by following the progression from period analysis to cohort analysis. We shall discuss the hypotheses underlying each of these approaches and show how their distance from actual human behaviour could lead to mistaken or incomplete conclusions. We shall then show how event history analysis can solve these problems and we shall define the hypotheses implied by this new approach. Finally, we shall come back to the complimentarity of the different social sciences." (EXCERPT)
[Census of population, houses, and dwellings, 1991. Population, houses, dwellings, and households. Republic of Czechoslovakia]
Selected results from the 1991 census of Czechoslovakia are presented on total population, households, and housing. The data concern both the Czech and Slovak republics. (ANNOTATION)
Premarital cohabitation and marital instability: a test of the unconventionality hypothesis.
"This study examines whether the greater instability of marriages begun by premarital cohabitation can be accounted for by cohabitors' greater unconventionality in family ideology. The hypothesis was largely unsupported. Although family attitudes and beliefs tend to predict the attractiveness of a cohabiting lifestyle, they do not account for differences between cohabitors and noncohabitors in instability. Moreover, controlling for background differences, only serial cohabitation is associated with greater instability among intact first marriages of up to 10 years duration....Data for this study come from the [U.S.] National Survey of Families and Households 1987-88...." (EXCERPT)
The famille souche and its interpreters.
"This article examines the differing approaches of French and Spanish investigators to the study of the Pyrenean stem family household. In the French view it is either a bastion of social stability and harmony...or a pernicious, inegalitarian institution in which some members exploit others....In the Spanish view the stem family household is a model of agrarian economic rationality...and a refuge of cultural distinctiveness....These differing approaches to and interpretations of the same social institution are analyzed as functions of Spanish and French history as well as the distinctive historiographic traditions of the two nations." (SUMMARY IN FRE AND GER) (EXCERPT)
Impact of in-migration on industrial development in a middle-sized town of Gujarat.
This study examines two issues: "How has in-migration affected the process of industrialization in [Jetpur, India], and what specific role has commuting played? How have in-migration and/or absorption into the industrial sector affected the economic status of the migrants or commuters themselves?" Data are from fieldwork carried out during the period 1987-1989. (EXCERPT)
Migration regions and interstate labor flows by occupation in the United States.
"This paper investigates the migration patterns of occupational groups [in the United States]. The results confirm previous analyses of the differences in movement behavior between occupations but, in addition, show that this variation is a function of the industrial sector of employment. The chief aim of the paper, however, is to uncover the geography of labor flows for different occupational groups using a principal components analysis of interstate flow matrices....Results indicate that migration regions vary by occupation and industry and we argue that these differences reflect job information flows and regional employment structure for various classes of labor." Data are from the Public Use Microdata Sample A taken from the 1980 census. (EXCERPT)
Trade, aid and migrations: some basic policy issues.
The link between trade policy and international migration is explored using data from the United States and Europe. "We conclude that restrictive trade policies in industrialised countries have most likely added to migration pressures. We then turn to the broader question of the effects of income growth in the sending countries on the propensity to migrate. We argue that, in relatively poor countries, an increase in income will be associated with higher migration flows. For middle income countries, however, income growth will lead to lower migrations. In the medium run, therefore, the relationship between development levels, as measured by GDP per capita, and the propensity to migrate follows an inverse-U pattern. Econometric analysis of aggregate migration flows from Southern Europe provides considerable support for such conjecture." (EXCERPT)
Biometric analysis of the multiple maternities in Finland, 1881-1990, and in Sweden since 1751.
"In this study the inaccuracy of Hellin's law [on multiple maternities] is studied and the discrepancies are explained mathematically....We consider secular data from Finland for 1881-1990 and from Sweden since 1751. Using Hellin's law, we compare the triplet rates and the twinning rates and study the time trends of the observed twinning and triplet rates. The data are standardized. Our theoretical results are applied to multiple maternity data for Finland....This analysis shows a decreasing linear time trend in the triplet series for the period 1881-1950 but not in the twinning series. The triplet rate has an increasing trend after 1960, which seems to be mainly caused by artificial induction of ovulation." (EXCERPT)
Going to town.
The author examines intercounty commuting patterns and their impact on business practices in the United States. He finds that "although job growth has been rapid in America's suburbs, these urban frontiers will continue to depend on central cities for jobs well into the 21st century." (EXCERPT)
Mate availability and family structure among African Americans in U.S. metropolitan areas.
"Census and vital statistics data for U.S. metropolitan areas in 1980 were analyzed to investigate the effects of mate availability, men's and women's levels of socioeconomic status and employment, level of public assistance, population size, and region on several aspects of family formation and family structure among African Americans. As predicted by theory, mate availability as measured by the sex ratio had a positive effect on marriage prevalence for women and a negative effect on marriage prevalence for men....Men's socioeconomic status had positive effects on men's and women's marriage prevalence, the prevalence of husband-wife families, the percentage of children residing in husband-wife families, and the percentage of marital births. Women's socioeconomic status and level of public assistance had negative effects on these variables. We conclude that mate availability, men's socioeconomic status, women's status and economic independence are important determinants of African American family formation and family structure." (EXCERPT)
Immigration from poor to wealthy countries: experience of the United States.
The U.S. experience with immigration from poor countries is examined using the results of two projects carried out by the National Bureau of Economic Research. Questions considered include what determines the supply of immigrants, how such immigrants fare in the U.S. job market, and how this immigration affects the prospects of native-born workers. (ANNOTATION)
Some laws of mortality: how well do they fit?
"The goodnesses of fit over the entire life span of four models of mortality are compared using life tables from Australia and the United States. The results indicate that the five-parameter Siler model fits considerably better than the more complex eight-parameter Heligman-Pollard and Mode-Busby models. On the other hand, the ten-parameter model proposed by Mode and Jacobson fits human mortality patterns better than the Siler model. We conclude that the Heligman-Pollard and Mode-Busby models are probably misspecified. Additional research is necessary to determine (1) whether the Heligman-Pollard model can be improved by specifying it as a true hazard model and (2) whether the respecified Heligman-Pollard and Mode-Jacobson models are statistically robust, particularly with abridged life tables." (EXCERPT)
[Population of the USSR over the last 50 years (1941-1990): a statistical factbook]
This book presents selected demographic data for the USSR for the period 1941-1990 by individual year. Statistics are provided on age and sex distribution, birth and death rates by age and sex, and life expectancy. A brief analysis of the data and a description of the methodology used to extrapolate them are included. (ANNOTATION)
Regional differences in cancer incidence and mortality in Israel: possible leads to occupational causes.
"This study provides a regional analysis of cancer incidence and mortality as a method of identifying localizing factors in cancer that can be followed by more specific epidemiologic investigation. In this study we analyze the regional standardized mortality ratios (SMRs) for site-specific cancers, by age, sex and continent of birth for the years 1983-86, for the Jewish population of Israel." The possible impact of occupational, environmental, topographical, and health service factors is considered. (EXCERPT)
Standardized mortality ratios for Israel, 1983-86.
"This article presents regional SMRs [standardized mortality ratios] for the Israeli population (both Jews and non-Jews) for the years 1983-86. These rates were standardized not only for age and sex but also by continent of birth and religion in an attempt to take into account any ethnic component that could be the cause of regional differences. The research also investigates whether or not there have been changes in regional SMRs over the past decade." (EXCERPT)
Vietnamese refugees and blocked mobility.
"This paper examines data from published sources and ethnographic studies conducted by the authors in Oakland, California and Philadelphia [Pennsylvania] to assess the economic situation of Vietnamese refugees in the United States. Evidence suggests that in strong contrast to being a 'success story,' the economic status of many recently arrived Vietnamese refugees is characterized by unstable, minimum-wage employment, welfare dependency and participation in the informal economy. The paper suggests that the group's economic opportunities have been limited by the configuration of circumstances that have surrounded their entry and settlement into the United States as refugees, as well as by the demographic structure of the group." (EXCERPT)
The role of equilibrium and disequilibrium in modeling regional growth and decline: a critical reassessment.
The authors critically examine a 1990 study by Alan W. Evans concerning the assumption of interregional equilibrium in recent migration research. "We here argue that Evans is unconvincing in his primary substantive argument; we provide an alternative reading of the literature that supports this assertion....[We then illustrate] the substantive issues in terms of a simple formal model that allows for both equilibrium and disequilibrium migration." The geographical focus is on the United States. A reply by Evans is included (pp. 89-97). (EXCERPT)
[Urban growth, migration, and population in Benin].
This is the first study to be published from a project jointly funded by the International Development Research Centre in Ottawa, Canada, and the Ford Foundation to promote research on population in Africa. The primary purpose of the present volume is to analyze the causes and consequences of urban population growth in Benin, concentrating on the city of Cotonou. Data are mainly from the 1979 census and a 1988 survey on migration to Cotonou. The study includes chapters on the urban system in Benin and on the characteristics of rural-urban migration. (ANNOTATION)
Living arrangements of the elderly in a changing society: the case of Iceland, 1880-1930.
"This article examines how urbanization and the introduction of welfare legislation affected the household position of the elderly in Iceland during the period 1880-1930. Using a life-course perspective it is shown that urbanization created a new form of kinship network during the period. This enabled the elderly to rely on the assistance of offspring although increasingly heading households of their own. In the countryside the growth of owner-occupancy, and a decline in the institution of service, led to a higher age at leaving home and better possibilities for the elderly to continue running a farm at an advanced age with the assistance of grown-up offspring." (SUMMARY IN FRE AND GER) (EXCERPT)
Rural-urban migration, informal sector and development policies: a theoretical analysis.
"A theoretical model of rural-urban migration has been developed with special reference to the informal sector. The wage rate and employment in the informal sector are determined endogenously. The paper shows the simultaneous existence of open unemployment and informal sector in the urban area in migration equilibrium. The effects of alternative subsidy policies on unemployment and welfare of the workers are studied." The model is intended primarily for use in analyzing trends and policies in developing countries. (EXCERPT)
Population projections in Hungary: methods, assumptions and results.
The author examines and compares population projections prepared for Hungary since the 1960s, some of which cover the period up to 2051. (ANNOTATION)
Proceedings of the Twenty-Fourth Annual Conference, Association for Population/Family Planning Libraries and Information Centers--International: accessing public information.
These are the proceedings of the twenty-fourth APLIC annual conference, held in Washington, D.C., March 19-21, 1991. Papers are included on accessing various information sources, including the international census collection at the University of Texas's Population Research Center, the Congressional Information Service Index to Health Information, the Social Science Research Council's Urban Underclass database, U.S. AID's Development Information Center, and the China Population Information Retrieval System in Shanghai, China. (ANNOTATION)
A parametric method for census based estimation of child mortality.
"A parametric method for estimating child mortality from reports concerning children ever born and surviving children is presented. In contrast with previously proposed methods, it facilitates use of single-year age reports by mothers on the survival of their children. In addition, the new method makes it possible to incorporate a priori knowledge of child mortality and fertility in the estimation process. The new method is illustrated by means of an application to data from the 1976 Western Samoa census." (EXCERPT)
The entropy of the survival curve: an alternative measure.
"The 'entropy' of a life table, [Keyfitz's H] was introduced by Keyfitz as the elasticity of the expectation of life, E, with respect to uniform change in age-specific mortality rates. [Keyfitz's H] is not a true measure of entropy in the probability sense....A more direct measure is...the entropy of the distribution of age at death. The mathematical relationships between these indexes are reviewed, and their behaviour compared using historical cohort life tables from various countries, with Gompertz functions being fitted to survival from age 30 to age 85 for each sex." Data from Canada, England, France, the United States, and Wales are used in the study. (SUMMARY IN FRE) (EXCERPT)
[Nuptiality and divorce in Japan: 1991].
The authors present nuptiality and divorce data for Japan. The focus is on the years 1990-1991, with retrospective data included to 1965. (ANNOTATION)
Recent changes in gender roles and multigenerational living arrangements in Japan.
The author discusses "changes in the relationship between living arrangements and gender roles in Japan using newly published survey data and works; first, living arrangements of the elderly, second, that of younger generation including just married couples, and third, effects of living arrangements [are considered]." (EXCERPT)
Population projections for the countries of the European Community.
"Methods and results of different population projections for the countries of the European Community [EC] are...presented. First of all the aims and contents of population projections are discussed. Secondly the methods and assumptions of different population projections for the countries of the EC are compared. Finally the results of such projections are shown and discussed." (EXCERPT)
U.S. population estimates, by age, sex, race, and Hispanic origin: 1980 to 1991.
"This report presents annual estimates of the resident population of the United States by single years of age (to 64, with 5-year groups to 100), sex, race, and Hispanic origin....All estimates are consistent with the national population as enumerated on these dates, and are not adjusted for net underenumeration. Included in this report is a distribution of the year-to-year change in the resident population from April 1, 1980, to January 1, 1992, by its major components: births, deaths, and net immigration." (EXCERPT)
[Life tables, 1986-90]
Life tables for Finland for the period 1986-1990 are presented and briefly discussed. Among the findings, it is noted that "life expectancy at birth in Finland during the 1986-1990 period was 70.7 years for males and 78.8 years for females....The mortality of young and middle-aged people rose from the previous five-year period....Excluding the oldest five-year age group, mortality was lower among married people than among people in the other marital status groups." (SUMMARY IN ENG AND SWE) (EXCERPT)
[The population of Dagestan in the twentieth century (ethno-demographic problems)]
The author presents a historical analysis of the ethnic composition of Russia's Dagestan Autonomous Republic during the twentieth century. Factors considered include the geographic distribution of more than 50 ethnic groups; growth of the total, urban, and rural population; and major ethnic groups. Data are for years 1926, 1939, 1959, 1970, 1979, and 1989. (SUMMARY IN ENG) (ANNOTATION)
Fertility in China. Proceedings of the International Seminar on China's In-Depth Fertility Survey, Beijing, February 13-17, 1990.
"This book consists of 35 papers presented at the International Seminar on China's In-Depth Fertility Survey, held in Beijing, People's Republic of China from February 13-17, 1990....[Paper topics cover survey] design, preparation,...methodology, theory, [and] modelling...[as well as] fertility and infant mortality, contraception and abortion, infant feeding, [and] social life and marriage...." The survey was conducted in two phases in 1985 and 1987 A Chinese version of the proceedings will also be published. (EXCERPT)
The statistics of population in Liberal Italy.
"In this paper I shall deal with the...official collection of demographic data in Liberal Italy, [with a focus on the]...political and theoretical aspects of the Italian statistics of the period." The study covers the nineteenth and early twentieth centuries. (EXCERPT)
[The 45th abridged life tables (April 1, 1991-March 31, 1992)].
Life tables for Japan are presented by sex for the period 1991-1992 by five-year age groups and by single years of age. Trends in life expectancy at birth are summarized. (SUMMARY IN ENG) (ANNOTATION)
[AIDS mortality variation characteristics in France, 1983-1990]
Trends and characteristics of the increase in mortality from AIDS in France are analyzed. The authors conclude that "from 1983 to 1990, the number of AIDS deaths in France (8,119 deaths overall), increased substantially but the annual rate of progression has fallen since 1987....In 1990, AIDS represents for the 25-34 years old group, 12 deaths out of 100 for males and 7 deaths out of 100 for females and for the 25-44 years old group, 15 deaths out of 100 for nonmarried males and 4 deaths out of 10 for males working in an information or artistic profession. Furthermore, it accounts, in 1989, for the [one] third of the deaths of males between 25 and 44 years living in Paris." (SUMMARY IN ENG) (EXCERPT)
Demographic prospects of Poland according to different projection assumptions.
The author examines population projections prepared in the 1980s for Poland. "The aim of the paper is to present and compare the assumptions of these projections and to discuss some of the resulting differences and similarities in [the] predicted demographic future of [the] population of Poland." (EXCERPT)
Determinants of infant mortality in Malawi: a spatial perspective.
"This paper examines the spatial variation of infant mortality in Malawi between 1977 and 1987. Data from the 1977 and 1987 censuses are used in simple correlation and forward stepwise regression analysis to explain and/or predict the variation and change of infant mortality at district (county) level. The results indicate that, at the macro-level, the variation of infant mortality is strongly associated with a number of demographic and socioeconomic variables. Region in which a district finds itself also matters as far as levels of infant mortality are concerned." (EXCERPT)
[Population projections by prefecture: 1990-2010].
Population projections for Japan are presented to the year 2010. Data are included by prefecture and for five-year increments by age group from 1990-2010. (ANNOTATION)
[Population dynamics of ethnic groups in Estonia in the twentieth century]
The author describes and analyzes changes in the ethnic composition of Estonia during the twentieth century. "The paper points out that ethnic composition of the urban population was changing in the period under consideration much more rapidly than the ethnic structure of the rural population." Data are from censuses conducted between 1897 and 1989. (SUMMARY IN ENG) (EXCERPT)
Mortality rates and risk factors for coronary disease in black as compared with white men and women.
"Data collected over a 30-year period in the Charleston Heart Study were used to estimate mortality rates and quantify associations with risk factors assessed at the base-line examination in 1960 and 1961 of 653 white men, 333 black men, 741 white women, and 454 black women [in the United States]. There were no significant racial differences in the rate ratios for death from coronary disease; however, women had significantly lower death rates than men." (EXCERPT)
Alcohol and mortality.
The authors "study the relation between alcohol intake and mortality in a large ambulatory [U.S.] population with attention to causes of death and differences related to age, sex, race, and baseline risk....[They find that] women and younger persons appear more susceptible to the increased mortality risk of heavy drinking. The reduced cardiovascular risk of lighter drinkers is more pronounced in older persons. Lower coronary disease prevalence may reduce the noncardiovascular mortality risk of lighter drinkers." Data are from 128,934 adults who received health evaluations in California between 1978 and 1985. (EXCERPT)
[Remarriage in Poland]
Trends in remarriage in Poland since 1960 are analyzed "by age, sex, marital status and place of residence of remarrying persons....In the period under investigation the proportion of remarriages in total number of marriages contracted increased. Remarriages are more frequent in urban than in rural areas and among males than females. The most common are marriages of divorced males and single women; remarriages of widowed persons occur the most seldom....Marriages [between] single-divorced persons have the highest reproductive potential; marriages [between] widowers-widows have the lowest one." (SUMMARY IN ENG) (EXCERPT)
Sibling configuration and marriage timing in Japan.
"This study aims to clarify the effects of sibling configuration...on the probability of first marriage by...three types of postnuptial residence in Japan...." The types are living with husband's parents, living with wife's parents, and living independently. (EXCERPT)
[The Bulgarian population censuses of 1878, 1912, 1928, and 1968]
"Having studied a number of original sources and statistical data, the author reviews the Bulgarian population censuses in 1878, 1912, 1928 and 1968. He analyses the causes for the population's small number which does not correspond to the long historical existence of the Bulgarian nationality. The author finds its basic cause in the long Ottoman domination which was connected with physical destruction, purposeful Islamisation and assimilation, and mass deportation of large groups of Bulgarians." (SUMMARY IN ENG AND RUS) (EXCERPT)
[Situation of small towns in Ciechanow Province in the settlement system, and permanent migration of the population (directions, structures, and effects)]
This is an analysis of migration to and from seven small towns in Ciechanow Province, Poland, during the period 1976-1987. (SUMMARY IN ENG AND RUS) (ANNOTATION)
On the improvement of demographic forecasting in Poland.
"In the paper attempts at improving demographic projections, undertaken in Poland in the late 1980s, are discussed." The focus is on the use of the LIPRO (LIfe-style PROjections) model, developed by the Netherlands Interdisciplinary Demographic Institute. The model is used "to project changes in marital composition of Poland's population by place of residence (urban/rural areas) till 2050....In the paper, the brief description of the marital status version of the LIPRO model is given and the selected results of projections for the period 1985-2050 are discussed to illustrate the usefulness of that approach." (EXCERPT)
Mortality modelling with order statistics.
"The parameters of the distribution of age at death are estimated with the help of several order statistics." Some Canadian data are used as illustrations. (EXCERPT)
[Determinants of migration to Warsaw]
The authors examine trends and determinants of internal migration to Warsaw, Poland. Consideration is given to occupational and socioeconomic status of migrants, rural-urban migration, and effects of migration on marriage. (SUMMARY IN ENG AND RUS) (ANNOTATION)
[The population of France in 1992]
Population estimates are provided for France for January 1, 1993. They show a steady level of growth of about 0.5 percent for the year, but one that is increasingly the result of immigration rather than natural increase. (ANNOTATION)
Migration networks: a case study in the Philippines.
"In an attempt to consider contract labor and other forms of temporary migration from the Philippines within the context of several interacting processes, I will first examine aspects of the international economy and government policy that set the stage for labor movement. It will then be argued that international migration flows emerge as a complex set of links that connect individuals and communities to the national capital region and ultimately to places abroad. This approach acknowledges that structural imbalances provide conditions for potential movement, but that this potential is translated into movement flows only when links between various people, places and mediating structures are actually activated through social networks. Once these links are established, a cascading system of migration emerges that is held together by a series of interpersonal relationships." (EXCERPT)
Early English mortality.
The authors review available literature on mortality in England before 1500. They conclude that mortality probably fell significantly at some time during the late fifteenth and early sixteenth centuries. (ANNOTATION)
Households, families, and children: a 30-year perspective.
"This chartbook presents a series of graphs intended to illustrate important trends of the past several decades that have influenced household and family circumstances and the living arrangements of all persons [in the United States], with a special emphasis on children. The charts are presented in four sections. The first section shows basic demographic trends. The second section focuses on household and family composition. The social and economic circumstances of families are featured in the third section. The final section concentrates on children and their families." The charts were compiled from various census publications. (EXCERPT)
Chain migration reconsidered.
Aspects of migration, particularly chain migration, from Italy to Australia, Latin America, and the United States during the period 1850-1960 are analyzed and compared with migration to countries of the European Community since 1960. Consideration is given to occupational status and other migrant characteristics and to effects on the sending countries. (ANNOTATION)
Air pollution, lagged effects of temperature, and mortality: the Netherlands 1979-87.
The authors "explore whether the apparent low threshold for the mortality effects of air pollution could be the result of confounding....The number of deaths listed by the day on which the death occurred and by the cause of death were obtained from the Netherlands Central Bureau of Statistics. Mortality from all causes and mortality from four large groups of causes (neoplasms, cardiovascular diseases, respiratory diseases, and external causes) were related to the daily levels of [sulphur dioxide] air pollution and potential confounders (available from various sources) using log-linear regression analysis....Results were similar for separate causes of death. While univariate associations suggest an effect of air pollution on mortality in all four cause of death groups, multivariate analyses show these effects, including that on mortality from respiratory diseases, are a result of confounding." (EXCERPT)
Reconstruction of Indian life tables for 1901-1981 and projections for 1981-2001.
"An attempt has been made to reconstruct life tables for India from 1901-11 to 1971-81 and to project for the decades 1981-91 and 1991-2001 by adopting a Brass relational model. The earlier actuarial life tables seem to have been based on a British model of sex differentials in mortality leading to higher life expectancies for females--not in tune with Indian experience. Consistency has been attained in this study by taking recourse to mortality patterns obtained from the Sample Registration System." (EXCERPT)
Mother and child health in Bangladesh: evidence from field data.
This is a general review of maternal and child mortality in Bangladesh, the causes of such mortality, and ways in which improvement might be achieved. Data are primarily from the Bangladesh Health Finance and Expenditure Study Project of 1987-1988. (ANNOTATION)
First results of the Aussiedler survey of the Federal Institute
Results are presented from the first survey, conducted in 1991, of Aussiedler, or ethnic Germans who have returned to Germany. The survey concentrated on migrants from Poland, Romania, and the former Soviet Union and their living situation, employment, acculturation, demographic structure, and future plans. (ANNOTATION)
Population aging: baby boomers into the 21st century.
The author summarizes probable changes in the age composition of Canada's population up to the year 2036. (ANNOTATION)
Reconstitution of annual life tables for nineteenth-century France.
"The nineteenth century was not one of runaway health progress, but it marked a deep transformation of mortality conditions [in France]. The reconstitution of mortality tables by single years of age and calendar years makes it possible to study this transformation in detail, and to distinguish between period fluctuations and structural changes. In the present article, we have given preference to graphic representation, and purposely limited the statistics....We have also given preference to the period approach." Consideration is given to annual mortality trends, life expectancy, age-specific probability of dying, the war-related crisis years of 1813, 1871, and 1915, and differentials in mortality by sex. Data generally concern the period 1806-1898. (EXCERPT)
Redefining the concept of immigration in Canada.
"In Canada, temporary movements of foreigners have so far been excluded from the system of international migration statistics, and consequently, from any demographic and socio-economic analysis of the impact of these movements on the socio-economic situation in the country....The purpose of this paper is to analyze the trends and selectivity among foreign temporary residents in Canada. The study covers the period between 1981 and 1990, and is confined to the following characteristics: sex, age, marital status, occupation, place of destination, length of stay, and type of authorization to remain in Canada." (SUMMARY IN FRE) (EXCERPT)
[Introduction to life event history analysis]
"The paper presents basic features of...life event history analysis....Discrete time method, continuous time data methods and the proportional risk models are presented. An attempt is made at distinguishing the censoring-related problems from those of the time-varying explanatory variables. The method proposed is that of...maximum likelihood. The final chapter deals with the PC software applicable for such analysis...." (SUMMARY IN ENG) (EXCERPT)
The demographic situation of Europe and the developed countries overseas: an annual report.
Current levels and trends in population growth and characteristics for Europe during 1989 and 1990 are estimated. Births, deaths, fertility, nuptiality, divorce, abortion, and life expectancy data are presented in tabular format. Selected statistics for other developed countries are included. (ANNOTATION)
How to use local census data.
"This article shows you how [U.S.] census data are packaged into computer files, when to use each file, and...simple techniques of data analysis...." (EXCERPT)
Validation and adjustment of the 1991 population as counted.
This is the report of a committee set up to validate the results of the 1991 census of South Africa. "This report is intended to answer two questions: How complete was the population count in 1991 in each district and, second, how accurate are the statistics collected for population groups by sex and age?...Chapter 2 is concerned with the methods of validation applied in the study and Chapter 4 deals with the actual validation. Chapter 3 discusses the post-enumeration survey conducted among the black and white populations. The adjustment of the population as counted in each district is explained in Chapter 5." Data on the major ethnic groups are considered separately. (EXCERPT)
The benefits and costs of immigration.
This is a collection of five articles on the costs and benefits of immigration to Australia. Topics discussed include the macroeconomic impact of migration on development, the incompatibility between current economic and immigration policies, and the relative contribution of natural increase and immigration to population growth. (ANNOTATION)
Poverty, ethnicity and migration potentials in Eastern Europe.
"This paper analyzes migration streams within and out of the former USSR, here called Eastern Europe. It also discusses potential streams during the coming decades. The main part of the paper, however, is descriptive and builds on information from census data." (EXCERPT)
[The day the Albanians will invade Italy...Attitudes of public opinion and of the Italian press on the question of migration from Albania]
The authors analyze some 400 articles published in Italian newspapers in 1991 concerning two waves of Albanian refugees arriving that year in Italy. The relationship of press reports to attitudes toward such migrants is examined. (SUMMARY IN ENG AND FRE AND SPA) (ANNOTATION)
The household structure of Status Indians in Regina and Saskatoon, 1982.
"This paper [examines]...patterns of co-residence and financial support among Canadian Indians living in the cities of Regina and Saskatoon, Saskatchewan in 1982. The first section situates urban Indians by describing their socio-economic status and household structure compared to the total population of Regina and Saskatoon. Secondly, additional persons in Indian family households are described in terms of demographic and labour force characteristics, relationship to other household members, and evidence of need for assistance with accommodation. Finally, the conclusion focussed on which households are more or less likely to house additional persons." (SUMMARY IN FRE) (EXCERPT)
Postponement of death until symbolically meaningful occasions.
"This study shows that mortality dips before a symbolically meaningful occasion and peaks just afterward. Mortality among Chinese [in California]...dips by 35.1% in the week before the Harvest Moon Festival and peaks by the same amount (34.6%) in the week after....In terms of percentage, cerebrovascular diseases displayed the largest dip/peak pattern, followed by diseases of the heart, and then malignant neoplasms. The dip/peak mortality pattern does not appear in various non-Chinese control groups....After testing alternative explanations for the findings, we concluded that the dip/peak pattern occurs because death can be briefly postponed until after the occurrence of a significant occasion." Comparisons with an earlier study of mortality among Jews around the time of Passover are made. Data concern all Chinese deaths from natural causes in California from 1960 through 1984. (EXCERPT)
Requiem for the fixed-transition-probability migrant.
"In a recent paper...Andrei Rogers persuasively argues for the use of a multiregional perspective rather than a uniregional one in measuring and projecting the dynamics of internal migration. In particular, he highlights the deficiencies of using net migration rates in population projections, giving illustrations of the very large differences that can occur if constant net migration rates are assumed versus fixed interregional transition probabilities....This paper explores alternative, more behaviorally pleasing interregional models that posit a role for shifting destination populations in altering the attractiveness of migration alternatives. Density-dampened, destination-population-weighted transition probability structures are explored. The importance of modeling intraregional migration separately from nonmovement is stressed." (EXCERPT)
[Permanent migration of the population of Ciechanow during the period 1976-1987]
Trends in migration to the city of Ciechanow, Poland, from 1976 to 1987 are analyzed. The author finds that a "majority of population settling in this centre came from rural areas, and the percent share of this subpopulation in the total number of migrants grew from 62.8% in 1976 to over 80% in 1987." Consideration is given to changes in age distribution and family characteristics among migrants. (SUMMARY IN ENG AND RUS) (EXCERPT)
Cameroon 1991: Results from the Demographic and Health Survey.
Summary statistics from the 1991 Cameroon Demographic and Health Survey are presented in tabular format. They concern general and socioeconomic characteristics, fertility, fertility preferences, contraceptive usage, contraception, marital status, postpartum variables, infant mortality, health, and nutrition. (ANNOTATION)
[Migration and critical times]
Current trends in internal migration in France are briefly analyzed for the period 1982-1990 using 1990 census data. The authors attribute the decline in mobility to worsening economic conditions. (ANNOTATION)
[Spatial and socio-demographic characteristics of permanent migrants in towns of medium size, illustrated by the example of Mlawa]
The spatial distribution and socioeconomic characteristics of migrants in the city of Mlawa, Poland, are examined for the period 1976-1987. Consideration is given to changes in the proportion of migrants from rural and urban areas, sex and age distribution, and educational and socioeconomic status. (SUMMARY IN ENG AND RUS) (ANNOTATION)
Demography and retirement: the twenty-first century.
"This book presents the papers and comments from the Pension Research Council's Spring 1991 Symposium. It focuses on those issues related to the age structure of the [U.S.] population and patterns of retirement as well as our ability to anticipate how these might change in the future....The participants in the symposium included academicians from a variety of disciplines including economics, gerontology, demography, etc.; government representatives; plan sponsors; and advisors to plan sponsors....The symposium focused on demographics, the work behavior of older people, retirement, and the benefits provided for retirement. The scope of the benefits covered encompassed both social insurance and private benefits, including pension plans of all types and retiree health programs. Long-term care was identified several times as a potentially important issue, but was not discussed in depth. The international perspective was presented by comparing the United States with five other countries." (EXCERPT)
Disability and mortality among middle-aged males in counties of Finland in 1975-1988.
"This study compares trends and differentials in disability retirement among counties of Finland using mortality as an approximation of morbidity." (EXCERPT)
Cross-cultural analysis of migration rates: effects of geographic distance and population size.
"A model is developed that treats migration rates among populations as a function of the geographic distance between them and the size of both sources and recipient population....Methods of parameter estimation and hypothesis testing using maximum likelihood are outlined. These methods are applied to migration matrix data from 13 samples obtained from the literature representing a wide range of ecological settings. All samples show a significant effect of geographic distance on migration, and all but one show a significant effect of differential population size. All but one sample show an overall tendency for migration to be negative density-dependent; that is, the relative migration rate is greater from larger populations to smaller populations than the reverse." (EXCERPT)
[Analysis of migration in Bolivia]
Levels, trends, and causes of internal migration in Bolivia are examined. Consideration is given to historical precedents, including agrarian reform; the drought of the 1980s; the impact of political factors; socioeconomic incentives to migrate; migrant characteristics and the informal sector; and access to basic health services for the migrant population. The focus is on the role of the Episcopal Church as a provider of social services. (ANNOTATION)
A mortality study of 1.3 million persons by demographic, social, and economic factors: 1979-1985 follow-up. U.S. National Longitudinal Mortality Study.
"The U.S. National Longitudinal Mortality Study (NLMS) is a long-term prospective study of mortality in the United States....The basic objective of the study is to investigate socioeconomic, demographic and occupational differentials in mortality within the United States. This is the second in a series of data books from the NLMS. In this report, standardized mortality ratios (SMRs) are presented for selected characteristics [such as age, sex, and race for the leading causes of death] based on matching individual records from Census Bureau samples for 1,281,475 persons to the National Death Index (NDI) for years 1979-1985." (EXCERPT)
The prevalence of alcohol-related mortality in both sexes: variation between indicators, Stockholm, 1987.
Alcohol-related mortality is analyzed by sex using data on 668 persons aged 15-54 who died in Stockholm, Sweden, in 1987. The data are from a variety of sources, including death certificates, autopsy reports, and police records. The results suggest "the serious underdiagnosis of alcohol involvement in death certificates and the misclassification of important causes of death (i.e., liver cirrhosis and cardiac disease)...." (EXCERPT)
A projection of the South African population, 1991-2011.
"This report contains projections of the population [of South Africa] by population group, gender and age at five-year intervals until the year 2011." (EXCERPT)
Socio-economic and cultural correlates of infant mortality: a demographic appraisal.
This is an analysis of the factors affecting infant mortality in India. It is primarily based on data from a 1981 survey of some 600 households, half from an economically developed district and half from an underdeveloped district of Andhra Pradesh, India. Equal consideration is given to sociocultural and economic correlates of infant mortality and to environmental and infrastructural correlates. (ANNOTATION)
Partner choice in marriages and cohabitations.
"This paper examines the extent to which cohabitation resembles marriage by comparing patterns of partner choice in the formation of married and cohabiting couples....On the assumption that cohabitations are not 'informal marriages' but relationships formed by a 'looser bond,' we use exchange theory to predict differences in partner choice. Since cohabitations are less permanent than marriages, we hypothesize that choices of a cohabitation partner give greater weight than choices of a marriage partner to achieved characteristics (such as education) which can reflect a short-term ability to contribute to the relationship. In turn, we expect that choices of a cohabitation partner give less weight to ascribed characteristics (such as age, race, and religion) that reflect long-term considerations. That study hypothesis is tested using propensities to marry and to cohabit calculated from the [U.S.] National Survey of Families and Households." (EXCERPT)
Inverse association between serum total cholesterol and cancer mortality in Dutch civil servants.
"The association between serum total cholesterol and cancer mortality was investigated in a 28-year follow-up study of 3,091 Dutch civil servants aged 40-65 years and their spouses. After adjustment for age, body mass index, and smoking, an inverse association between serum total cholesterol and all-cancer mortality was observed in men during the first 15 years of follow-up, excluding the first 2 years....In women, no consistent association between serum total cholesterol and cancer was observed. After the first 5 years of follow-up were excluded, the significant inverse association in men still persisted. These results suggest that in this study population, low serum cholesterol seems not to be attributable to undetected cancer, but might be a risk factor for cancer mortality in men." (EXCERPT)
A guide to historical datafiles held in machine-readable form.
"This publication provides information on over 650 data collections compiled from a wide variety of historical source material. As such, it is an invaluable aid for any computer-using historian undertaking research or teaching. The volume is divided into three parts: an introduction outlining the nature and scope of the project of which the book is a product; an inventory of datafiles generated by historians located principally in the U.K.; a summary of historical datafiles held overseas; and a set of six indexes, providing quick and easy searching of the text." The primary geographical focus is on the United Kingdom, although some of the data files concern other countries. (EXCERPT)
Surveying the people: the interpretation and use of document sources for the study of population in the later seventeenth century.
The authors examine "four key sources for the study of population [of England] in the later seventeenth century: the assessments and/or returns for the Hearth tax, Compton census, Poll taxes and Marriage Duty Act. It provides details of the legislative background and administrative framework for these important sources and discusses some of the main problems involved in their use and interpretation. Subsequent chapters illustrate how the surviving documents can be applied to illuminate various research issues. These include the social structure of the City of London, the household composition of King's Lynn, the distribution of nonconformity in Devon, some regional variations in household structure and critiques of the work of Gregory King." (EXCERPT)
Air pollution and daily mortality in Birmingham, Alabama.
This study examines the relationship between levels of particulate air pollution and mortality using data for Birmingham, Alabama, for the period 1985-1988, taking different weather patterns into account and using different methods of analysis and covariate control. The results indicate a significant association between inhalable particles and daily mortality. (ANNOTATION)
Development, methods, and response characteristics of the 1986 National Mortality Followback Survey.
"This report describes the development process, the methods employed, and the response characteristics for the 1986 [U.S.] National Mortality Followback Survey (NMFS). This introduction provides a brief overview of the origin, purposes, nature, and contents of the survey. The next section describes the process used in the development of the survey and significant aspects of the results of the pretest. The third section describes the main survey: sampling of death certificates, the collection and processing of survey data, the production of national estimates, the approximation of sampling errors, the nature of nonsampling errors, and quality control measures employed. The fourth section examines response rates for informants and for facilities, by relevant characteristics." (EXCERPT)
Migratory work today as a sociocultural phenomenon.
The author analyzes seasonal labor migration patterns within the former USSR. She notes that much of this movement is officially illegal, involves long working hours, and has in part developed in response to supply and demand factors. The government has tolerated these migrations on the grounds that they help close the gap between the demand for labor and the supply of workers. Migrant characteristics and motives for migrating are considered. (ANNOTATION)
Rural population change in Crete.
Trends in rural population change and rural-urban migration on the Greek island of Crete over the course of the twentieth century are analyzed using data from 42 communes in the western Mesara valley. (ANNOTATION)
Consideration of alternatives to censuses and census-type statistics. The case of Germany.
The author critically examines the 1987 census conducted in West Germany and proposes changes to the questionnaire, the way it is administered, and the tabulation and publication of census results. (ANNOTATION)
Topical bibliography of demographic publications concerning Albania.
This bibliography of publications concerning Albania is based on a search of POPLINE. It includes English abstracts for most citations, supplemented by materials located in Italy. The information is organized by subject, the main ones of which are general demography, family planning and women's emancipation, rural and urban differences, and mortality. (ANNOTATION)
Population growth, environment and development: issues, impacts and responses.
This is a collection of papers presented at two interdisciplinary conferences held at the Banaras Hindu University in India in April 1988 and February-March 1989, on problems related to the rapid rate of population growth in developing countries. Section 1 examines population growth in India and other developing countries. Section 2 focuses on population growth and environmental issues, including climatic changes, and contains papers on Nepal, Bangladesh, and India. Section 3 examines population projections and characteristics, with the primary focus on India. Section 4 looks at policy responses to these issues, with a focus on India.
People of India: an introduction.
This book is a product of the People of India Project, begun in 1985, which attempted to generate a brief, descriptive anthropological profile of all the communities of India. Some 4,635 ethnic groups or communities were identified during the project. This introductory volume describes the project as a whole and the publications generated by it. The information collected for each population includes current size according to the census; language; demographic characteristics, including fertility and mortality; marriage patterns; family characteristics; economic activities; and religion.
[Emigration from Poland in the 1980s to main overseas and continental countries of immigration: demographic and social aspects]
The author examines migration from Poland using data from receiving countries, including Australia, Austria, Canada, Sweden, the United States, and West Germany. "The image of the Polish Diaspora of the 1980s is viewed in the light of other significant demographic and social features of immigrants such as their age, sex, social and professional groups to which they belong, [and] the place where they have settled down in their country of immigration. The author has also paid some attention to the causes of emigration, and in particular, to the size of political emigration...." (SUMMARY IN ENG) (EXCERPT)
Some myths concerning the demographic status of girls.
"The purpose of this paper is to draw attention to the disadvantaged demographic status of girls from the ages of 0 to 19, compared with (1) boys in the same age groups and (2) women." The geographical scope is worldwide. (EXCERPT)
[Changes in the level of urbanization of major European cities]
The author examines urbanization levels in major European cities over the period 1910-1985. It is found that "the number of cities with over 100,000 inhabitants tripled (to 459) by 1985 comprising one third of the European population while the number of cities with over one million inhabitants rose [from 5 in 1910] to 32." (SUMMARY IN ENG) (EXCERPT)
Alcohol-related mortality in California, 1980 to 1989.
The impact of alcohol drinking on mortality in California over the course of the 1980s is analyzed using state vital statistics data. "An estimated 6.2% of all deaths for California residents during 1989 were related to alcohol, making it one of the top 10 leading causes of death. Injury diagnoses were major contributors to the total estimated number of alcohol-related deaths and years of potential life lost before age 65. Alcohol-related mortality rates were significantly higher for men and for Blacks. However, age-adjusted death rates for alcohol-defined diagnoses declined significantly from 1980 to 1989." (EXCERPT)
[Future life expectancy and causes of death in Japan].
The author examines projected trends in life expectancy and mortality by cause in Japan to the year 2025. (SUMMARY IN ENG) (ANNOTATION)
Balkan family structure and the European pattern: demographic developments in Ottoman Bulgaria.
The author reassesses the traditional stereotype of the place of the Balkans in the nineteenth-century European family model by providing a synthesis of existing sources and research. She discusses population structure, marriage patterns, fertility, mortality, family and household size and structure, and the problem of the south Slav zadruga, or extended family. Data concern Bulgaria and are primarily from Ottoman registers, church records, and other archival sources. (ANNOTATION)
The dynamics of U.S. internal migration.
"In this paper we have theoretically derived a net migration equation and estimated it using time-series data for 51 [U.S.] regions over the period 1971-1988. The results indicate that the dynamic response of net migration is stable and is significantly related to stock equilibrium changes induced by amenity differentials, relative employment opportunities, relative real wages, and industry composition." (EXCERPT)
The social effects and institutional structure of immigration in New Zealand in the 1980s.
"The aim of this paper is to facilitate an understanding and explanation of the social effects of immigration in New Zealand during the 1980s. Working within the framework of social demography...this objective will be pursued in two stages. First, a concise overview will be given of some of the more commonly known social effects that can be related to the composition and volume of immigration. Second, to gain a deeper appreciation of the causes of change, attention will be directed to the nature and operation of what has been described as the 'institutional structure of immigration'...." (EXCERPT)
Women's lives and public policy. The international experience.
"This book considers the impact of public policy on various aspects of women's lives, including sex and birth, marriage and death, work and child rearing, and women's responses to those policies. Written by scholars who have lived on five continents, the work spans the First and Third Worlds, with several chapters providing case illustrations from Latin America, Asia, and Africa. Interdisciplinary in scope, the volume includes the fields of economics, politics, planning, and literature. The work is divided into two sections, with chapters in the first part considering the impact of economic and demographic policies on women and those in the second part considering policies relating to women's interpersonal relationships. Urban culture is considered in an epilogue." (EXCERPT)
1991 census. County report. West Midlands.
This report, which is in two separate volumes, is one in a series presenting results for England from the 1991 United Kingdom census at the county level and concerns the West Midlands. "Part 1 includes the results based on processing all Census returns, prefaced by a summary of the main results. Part 2 includes results based on the subsequent processing of a one in ten sample of the returns, and is published separately and later. Each of the main tables is presented for the county as a whole and for each local authority district within the county." (EXCERPT)
Small town and rural human resources development to reduce migration to large cities: China, India, Indonesia, Nepal, Papua New Guinea.
This publication contains five studies prepared as part of a UN project to develop small towns in order to reduce migration to larger cities in developing countries. "The purpose of the present study was to examine the effect of human resources development policies on urbanization and rural-urban migration and to develop policy guidelines for improving such policies and their implementation. The policies recommended are intended to reduce rural-urban migration and to improve human resources and their utilization, particularly in small towns and rural areas." The five case studies concern China, India, Indonesia, Nepal, and Papua New Guinea. (EXCERPT)
1990 census of population: general population characteristics. Puerto Rico.
This report contains results from the 1990 U.S. census on population and housing in Puerto Rico. The demographic data concern age distribution, family characteristics, households, population density, sex distribution, and marital status. The data are provided by municipio, place, and municipio subdivision. (ANNOTATION)
Problems of demographic ageing in new light.
The author analyzes demographic aging in Hungary over the period 1973-1989, then makes projections to the year 2010. The formulas used are included. (ANNOTATION)
[Mortality in the Netherlands population forecasts]
Trends in life expectancy in the Netherlands are reviewed, using mortality data from the 1992 official Netherlands population forecasts. Data are presented by age and sex. "A main conclusion is that mortality in recent years has developed more favourably for men than for women." (SUMMARY IN ENG) (EXCERPT)
Common beliefs about the rural elderly: what do national data tell us?
"National data from various sources are presented to support or debunk 10 commonly held beliefs about the elderly living in rural America. Topics include: health, income, housing, social networks, population size and distribution, and access to care. Most comparisons are between nonmetropolitan and metropolitan data." (EXCERPT)
Assessment of trends in geographical inequalities in infant mortality.
"The aim of this paper is two-fold: (a) to propose an overall measure by which geographical inequality in infant death can be quantified, and (b) to suggest a methodology for assessing time-trends and percentage-changes that such geographical inequality might undergo. With this purpose in mind, we present the evolution of four indicators based on infant death--Infant, Neonatal, Postneonatal and Perinatal Mortality--between 1975 and 1986 [in Spain]." Official vital statistics data are used in the analysis. (EXCERPT)
From marriage to informal union: recent changes in the behaviour of French couples.
The author uses data from the 1986 Family History Survey conducted in France to examine patterns of entry into marriage and the range of informal unions that exist. "Since unmarried cohabitation is only recent for first unions, we shall confine our analysis to first unions and, for homogeneity, to those begun before the 30th birthday." She examines the effects of occupational status and social background on marriage decisions. (EXCERPT)
Waves of migration: a new situation.
An attempt is made to forecast migration trends affecting those countries that were formerly part of the Soviet Union. "The new migratory trends are characterized by at least three fundamentally important elements: the ouster of the newly arrived population from the social niche that it had recently occupied, emigration from overpopulated regions, and growing emigration beyond the borders of the former Union." (EXCERPT)
The demographics of decision makers.
Demographic characteristics of company managers in the United States are analyzed using 1992 data from the Bureau of the Census. The author concludes that "middle management's profile is middle-aged and middle-class, and the share of women is growing. Since 1987, the number of part-time managers increased, and the salaries of full-timers stagnated." (EXCERPT)
The census, demography and Quebec: some milestones.
"1991 was a very important year in the history of the Canadian Census: it was the year of the last decennial enumeration of this century, and it marked the 325th anniversary of Canada's first Census,...taken by Jean Talon in 1665-66....This brief summary links 1666 with 1991, by focussing attention on selected milestones in the history of Canada's federal census, noting, along the way, some related developments in the teaching of demography and in demographic research. Although the contributions of Quebec and Quebeckers are also highlighted, they are presented in...national context." (SUMMARY IN FRE) (EXCERPT)
Parental consumption decisions and child health during the early French fertility decline, 1790-1914.
The author uses height at adulthood to measure the intergenerational distribution of nutritional resources within households in France during the fertility decline of 1790-1914. "The intrahousehold distribution of resources was influenced by the level of income and by the calorie demands of working adults. Results show that the early decline of marital fertility in France was accompanied by a small but significant increase in expenditures on child quality as measured by heights. Reductions in mortality, independent of the level of food intake, also contributed to improved heights." Data are mainly from records of conscripts into the French army. (EXCERPT)
The effects of rural-to-urban migration on the poverty status of youth in the 1980s.
"The effects of rural-to-urban migration on the poverty status of migrants have not been adequately explored. Using data from the [U.S.] National Longitudinal Survey of Youth to examine poverty status before and after a rural-to-urban migration, a proportional hazards model of time spent in poverty that begins in rural areas is estimated to determine whether moving to an urban area reduces the time spent in poverty while controlling for individual educational and family characteristics. Results indicate that moving from a rural to an urban area reduces time spent in poverty for white and black women but the effects are not statistically significant for men. Further, to adequately understand the relationship between moving to an urban area and poverty, the analysis examines the effects of moving on the length of time spent not employed." (EXCERPT)
Famine mortality.
The author uses official data from the British colonial government to analyze famine mortality in late nineteenth-century India. She notes that "the giant misery of starvation caused by the alarming incidence of famine...was compounded by the appalling conditions of migration and over-crowding into which the starving poor were driven, often literally to death, conditions exacerbated by the official measures devised for famine relief. Worse, in the great famine years..., rain which might have been expected to bring respite to the survivors of the drought instead intensified their suffering: epidemic malaria took its colossal toll. In other years drought, where it persisted, ironically limited mortality." (EXCERPT)
The effect of polygyny on sex ratio at birth.
"This report presents ethnographic evidence that the secondary sex ratio (sex ratio at birth) varies with the form of marriage. Owing to the effect of the form of marriage on the frequency and timing of coitus, more females are born to polygynously married mothers than would be expected from norms based on children born to monogamous mothers." The data are primarily from Kenya and were collected over the period 1966-1973. (EXCERPT)
Recent studies on migration in Poland.
The author reviews studies conducted between 1985 and 1990 concerning the impact of migration on socioeconomic development in Poland. The focus is on the consequences of rural-urban movement. "According to the results of [the] analysis, the demographic consequences of migration are...significant for rural areas, especially the ones showing large and long-term population outflow. The consequences of this stream of migration are not significant for the population situation on a nation-wide scale." (EXCERPT)
Slow growth will turn to decline of the Japanese population.
Trends in population size and growth in Japan since 1930 are analyzed and projections to 2090 are made. A decline in population size is projected. (ANNOTATION)
Will the earth's land and water resources be sufficient for future populations?
One hectare of corn planted with technology available to an Iowa farmer can provide enough food energy for 24 human beings, i.e., 260 kg or about 570 lbs of corn/year/person. World cultivation of land is 1.4 billion hectares to provide food, fiber, and agriculture products for 3.5 billion people in 1974. Actual cultivated land requirements are nearly 10 times this calculated minimum. The reasons are harvests come from only 50-66% of the total cultivated land. 10% of land is devoted to nonfood crops and another fraction is devoted to livestock. 10-20% of crops are destroyed by pests. Agricultural technology is not used evenly throughout the world, i.e., yields are just over a ton/per cropped hectare in Pakistan or India. Discussion focuses on potential arable land, potential gross cropped area, potential water supply, and obstacles to the potential expansion of cultivated areas. The obstacles are identified as the poor quality of potentially available arable land, the large capital investment required, uneven distribution of population and potentially arable land, and the necessity to improve the level of agricultural technology. The approximately 2.43 billion of net potential arable land and the 4.06 billion hectares of gross cropped land are estimated with currently available technology to feed 38-48 billion people, or 10-13 times the current world population in 1974. The potential, however, is quite different from the reality. The Food and Agriculture Organization has recommended that less developed countries increase both multiple cropping and total cultivated area by 1985 in order to keep pace with population growth. The assumption is that all available river water available for human use could be diverted for irrigation agriculture. Dams and tube wells may be required. Conflicts may occur in land and water use. Examples of agricultural productivity are given in India, Bangladesh, and sub-Saharan Africa. Modernization is required in order to maintain carrying capacity for all human beings. Expansion into sensitive environments will most likely entail ecological destruction. Declines in population growth are dependent on increases in income and its equal distribution.
Among those wary of abortion pill is maker's parent firm.
The German pharmaceutical company Hoechst, which developed RU-486 originally as a cancer pill, is stuck with a product that it does not want to sell. Pressure on the company has led to distribution through its French subsidiary Roussel-Uclaf SA in France, Britain, and Sweden. China has already copied the compound without permission and is distributing it. Distribution in the US would be profitable, but former Presidents Bush and Reagan communicated firm opposition to it. Hoechst never applied for a licence from the US Food and Drug Administration. The current administration of President Clinton initiated a directive to the Health and Human Services Secretary to open channels for testing, licensing, and manufacturing RU-486. Hoechst is not caught in the dilemma of having strong pressure from the US to release the pill when America's antiabortion lobby considers RU-486 the equilavent of an "antihuman pesticide." Many small drug companies are ready to distribute RU-486. Hoechst's position is that the companies are too small, and the fear is that distribution through US physicians would amount to another form of widespread use of birth control. Hoechst's options are to withhold RU-486, sell it, license another company to sell it, or sell the patent. Hoechst's chairman Wolfgang Hilger, a devout Roman Catholic, had stated formally to the International Federation of Gynecology and Obstetrics that Hoechst's corporate credo is against the commercialization of a drug "facilitating and easing" abortion. Another obstacle is the historical record of the former parent company's subsidiary Degesch, which produced the chemicals used in the gas chambers of Nazi Germany. The French government which owns 36% of Roussel considers RU-486 the "moral property of women" and urged Roussel to begin marketing the pill in France. Hoechst's sensitivity to antiabortion pressure led to the formation of a distribution policy paper on "strictly controlled distribution," and commitment to Hoechst that there is public consensus that pregnancy termination is tolerated by society. The WHO is responsible for testing and distribution to Third World countries and has been inactive. Discussion is not centered on how to control distribution.
Subjective norms about condoms are better predictors of use and intention to use than attitudes.
The aim of this research on change in condom use patterns among homosexuals was to test the Theory of Reasoned Action (Ajzen and Fishbein) on behavioral beliefs and the intention to use condoms. The goal was to determine the relationships between attitudes, beliefs, intentions, and behavior of homosexual men regarding condom. A sample of 178 homosexually active men 18-71 years old in Adelaide, Australia, was drawn in 1988 from bars or gay organizations (60%), bath houses (27%), outdoor cruising areas (3%), and other areas (10%). Time and date at each site were randomly selected over a 2-week period. 173 questionnaires were completed and involved in the regression analysis. Likert scales (4 points) were used to assess condom use or not during insertive and receptive anal sex. Attitudes toward condoms were considered as favorable or unfavorable. Behavioral intention was measured as likelihood or unlikelihood of using condoms in the next 2 months of unsafe sex. Behavioral beliefs about use of condoms were based on 5 dimensions of attitudes by Ross multiplied by the certainity with which the belief was held and summing the products (the Ajzen and Fishbein method). Normative and subjective beliefs were also assessed. Kolmogorov tests were run to determine whether distributions were significantly different from normal (p < .05). Not normal distributions were log transformed. The findings were that sexual partners are the strongest determinants of intentions to use condoms. Gay peers exert a stronger influence than family or people in the community. Subjective norms rather than attitude are the strongest influence on intention to use condoms: 4 times that of attitude measures and behavioral beliefs. There was some evidence that perception of condoms as unerotic or interrupting sex had a minor effect, which could be addressed in educational programs. The implication is that educational campaigns need to be directed to gay organizations. Intention was significantly associated with anal and not oral sex. Insertive condom use is more closely associated with intention. 20% of the variance was accounted for. Confirmation of findings and age-specific analysis is necessary before generalization to other homosexually active men is possible.
Seropositive women and discrimination in Mexico.
In the course of examining the legal problems Mexican women with AIDS encounter, women from GIS-SIDA collected interviews from 50 women. Respondents were approached on the streets, in clinics, and in hospitals. A profile of these AIDS women shows the average age to be 30 years and ranging from 5 to 50 years. 30% of the respondents have since died. 34% were housewives, 18% were secretaries, 12% were professionals, 10% were prostitutes, 8% were employees, and 21% were involved in other activities. 22% were unmarried, 12% were widows, 50% were married, and 16% were in consenual unions. 40% reported that the spouse or husband "lived with HIV/AIDS", and 38% were unaffected. The mode of transmission for 36% was through contaminated blood from transfusions, for 24% through heterosexual relations, for 20% through bisexual relations, for 12% through multiple partners, for 4% through sexual relations with professional blood donors, for 2% through sexual relations with hemophiliacs, for 4% through lesbian relations, and for 2% perinatally. Medical attention was received by 56% at the Mexican Institute of Social Security, by 6% at the ISSSTE, by 10% at the SSA, by 8% at the PEMEX, by 14% from private physicians, and 5% did not receive any medical attention. Discrimination was reported as 36% of the "medical type", 30% the "social type", 20% the "family type", and 14% in the work place. Only 2 women were involved with organizations fighting AIDS. The conclusions reached were that AIDS affects women of all ages. Housewives and secretaries were the primary groups affected. Those who were widows had husbands who died from AIDS. Intolerance was evident in all areas; of particular concern was mistreatment within the family. Women are already victims of discrimination and the victimization from AIDS further exacerbates the problems. AIDS information for women is lacking. Hospital care is limited by the slow response to testing for HIV infection, and medication is not provided efficiently or effectively. Many are denied medical care. Blood transfusions are not completely controlled, which places women who tend to receive more transfusions at a disadvantage. Women complained of "inhuman treatment" and lack of professionalism.
Knowledge and use of secondary contraception among patients requesting termination of pregnancy.
The results of a survey of 769 patients attending the St. James's University Fertility Control Clinic, England, for abortion services showed that patients seeing general practitioners were less knowledgeable than those attending specialist clinics. There was a demonstrated need for counseling on pill and condom use and protection against sexually transmitted diseases. Knowledge of postcoital methods was also found to be lacking. The survey was conducted between April 1, 1991, and January 31, 1992. Respondents included minorities such as Afro-Caribbean (8%) and Asian (9%). 307 of the cases were using a less effective form of contraception at the time of conception, usually a change from the pill to condoms. Of the 171 people reporting failure of contraception, 93 noted a split or leaking condom; 13, a condom falling off during intercourse; 32, inconsistent use of condoms;l 32, forgetting to take contraceptive pills or using antibiotics with the pill; and 1, a late injection of medroxyprogesterone acetate. 45 of the 309 people who had conceived while using condoms recognized a potential condom failure, and only 20 attempted any emergency contraceptive method such as the postcoital pill. Only 30% of the 171 patients with recognized condom failure and 12% of the 210 who had not used any contraception had adequate knowledge of the existence, timing, and source of postcoital pills; i.e., 20% of 381. Only 2% of the 171 nd 2% of the 381 patients, had knowledge of postcoital insertion of an intrauterine contraceptive device. Given the choice between and unplanned pregnancy and postcoital contraceptive, most (718 out of 769) preferred using postcoital contraception. Contraceptive information was given to 501 by a general practitioner, to 102 by a community family planning clinic, and 163 had no medical advice. There was a range of knowledge of postcoital contraceptive methods. Knowledge of how to deal with forgotten pills, severe vomiting, severe diarrhea, and concurrent antibiotic treatment among the 422 patients who had ever used the combined pill also was variable. 19% of the 372 patients treated by general practitioners knew 4 correct answers, but 50% of the 50 patients in community family planning clinics answered correctly 4 times. Differences could not be explained by other demographic characteristics.
Financing systems and resource use.
The call for user fees as a solution to the fiscal crisis of the health sector in developing countries fails to address the salient issues of resource shortages, resource inefficiencies, and equity. Although fees may encourage more efficient use of service levels by patients, they cannot remediate the lack of management skills and political influence over resource allocation decisions that underlie the current crisis. Potential changes in health financing systems must both provide increased resources for primary health care and promote the principles of equity and community participation. Even sliding scale fee systems are likely to accentuate inequities in access to health services between vulnerable income groups and geographic areas and the rest of the population. Moreover, the introduction of national fee structures undertimes the community's role in health care decision making. Calls for user charges reflect an approach to economic policy making aimed at freeing the market from government intervention, thereby enhancing efficiency. Need instead is an approach that is based on an assessment of the equity goal of the primary health care system. Such an assessment requires more information about traditional financing schemes and the likely impact of newly introduced schemes. Promising is the Zairian experience, which established a minimum package of health care (a combination of preventive, curative, and referral services) that must be provided in all regions of the country and is financed by both government and community funds.
An adequate interface with the community: the contribution of the basic health services.
When developed simultaneously at the interface between health services and communities, participation and rationalization have the potential to bring equity and self-reliance into balance with effectiveness and efficiency. In many cases, however, the effort to make health care universally accessible has superceded considerations of efficacy, sustainability, community values and demands, and the capacity of the health services to meet expectations. An optimal mix of top-down and bottom-up planning must be identified to prevent competition between the professional and community to prevent competition between the professional and community rationales of the system, and this can be achieved only through flexible communication channels at different levels. Dialogue between health workers and the people can occur on the individual level, in small groups, in regular meetings with a health committee, and at the district level. The overall aim should be the development of a healthy relationship between the health services and the people, based on mutual confidence. Part of this capacity to communicate is the active follow up of chronic patients and high risk groups. Special activities such as health education, environmental sanitation, and immunization campaigns should develop gradually out of this communication process and should not be planned until real needs have been identified. If the health center is staffed by a small integrated team of polyvalent health workers, the optimal conditions for active interaction with the community are created.
Sex and respectability in an age of fertility decline: a Sicilian case study.
Religious conservatism has long regarded premarital sex and sex for reasons other than conception to be sacrilegious. Accordingly, many in countries throughout the world, both presently and in the past, have engaged in sexual activity without taking contraceptive measures out of fear for retribution from religious institutions or because religious influences have effectively made preventive methods unavailable to the public. Despite these oft-accepted doctrine-based preconditions for engaging in sexual relations, people have used condoms since before the nineteenth century to protect themselves against sexually transmitted diseases. Coitus interruptus, however, supplemented by abortion and abstinence, was the main mode of preventing unwanted pregnancies until the spread of estrogen pills in the 1960s. Together, they helped reduce total fertility in western Europe from 7-8 to 2-3 over the period 1870-1960. This paper discusses how the practice of coitus interruptus was reinterpreted in the late nineteenth century to represent virtue and restraint instead of licentiousness and encouraging of sexuality. Further, it explains how these ideological and practical transitions occurred in a socially-stratified birth-controlling population in West Central rural Sicily over the period 1900-70. The gentry and artisans were first to embrace coitus interruptus and were followed by the peasants. This sequential pattern and the transition from high to low fertility are consistent with late twentieth century interpretations of coitus interruptus by Foucault and others as sexually restraining yet empowering. Adopting the practice enhanced access to respectability in a context of economic and cultural change. Moreover, those who adopted the practice increasingly stigmatized other high-parity couples as being out of control of their sexual instincts and unworthy of respect.
Sexual behavior and the spread of HIV.
Attention should be placed upon reducing the incidence of behavioral practices which are known to place individuals at high risk of HIV infection. Among gay males, receptive anal intercourse, fisting, other practices which cause rectal bleeding, and having sex with many partners have been identified as high-risk activities for HIV infection. While research indicates that minimal risk exists from oral sex, one study in Paris found 5 HIV-seropositive cases in gay males who had engaged in neither anal sex nor other traumatic sex practices. These results therefore suggest that HIV can be transmitted sexually outside of anal sex. Studies of homosexual populations further support these findings and leave no doubt that HIV may be contracted through routine heterosexual relations. Partner studies have shown infection rates to range 7-80%. Moreover, while male:female HIV/AIDS rates in Africa, the Caribbean, and other Third World areas are 1:1 compared to 13:1 in the US, we know little of current heterosexual infection rates in the US. Given the long latency of HIV, present HIV rates reflect transmission patterns several to many years old. Condoms do not offer absolute protection against HIV, but their consistent use may educe the risk of infection by 80%. The effectiveness of Nonoxynol-9 is also questioned. Nonetheless, consistent condom users seem to be much less likely to contract HIV than those who use them infrequently or not at all. Little is known about current adult US sexual behavior. Most data are 2 decades old and based upon small samples. Kinsey studies indicate that 85% of American men may have never engaged in homosexual experiences. Study figures therefore suggest that a significant proportion of US males are either exclusively homosexual or frequently or occasionally engage in homosexual activity. Studies of male homosexual populations from especially San Francisco and New York reveal widespread reductions in risky sexual behavior. Condom use has increased and the incidence of anal intercourse and the number of sex partners have declined. These changes have certainly taken place within the larger, more organized gay communities, but have yet to occur in smaller communities and cities. Unfortunately, it is in these later communities where the majority of homosexuals reside. As for heterosexuals, millions are having sex with large numbers of partners, engaging in anal intercourse, and not using condoms. The incidence of syphilis and gonorrhea actually increased among heterosexually over the period 1985-87, yet declined among gay men. A 1986 survey of heterosexuals in San Francisco found 73% of respondents to have engaged in vaginal intercourse without condoms; 70% of sexually active California youth has sexual intercourse at least once without using a condom. On the East Coast, 15% of 860 youths surveyed in Massachusetts claimed to have changed sexual behavior because of AIDS, yet only 1/5 had adopted an effective method of preventing HIV transmission. Despite generally widespread and accurate knowledge of the risks of AIDS, heterosexuals tend to perceive a lower sense of personal risk than homosexuals. Historically, people continue to have sex despite health risks. It may therefore be ineffective to cite health risks in the context of our relatively sexually-liberated culture. In closing, heterosexuals have modified their sexual behavior less extensively and less effectively than homosexuals and continue to freely engage in risky sex.
There's a bonanza in nature for Costa Rica, but its forests too are besieged.
The partnership between Costa Rica and the developed world in conservation of tropical forests has been possible due to local institutions, national leadership such as that provided by Dr. Gamez, a scientist with the National Institute of Biodiversity, and foreign scientists and interest groups. Costa Rica appears to be an example of a developing country which is aware of and has the means to deal with environmental concerns. Controversy has come with the development of ecotourism, which affords nature tourists access to its parks and preserves. $300 million/year is gleaned from ecotourism, which is comparable to earners such as coffee and bananas. 25-30% of the 19,575 square miles of land are constitutes protected areas of national parks, wildlife refuges, and privately operated and Indian reserves. 3.7 million areas of land in the 1970s were protected, and 2.4 million acres have been deforested in unprotected areas. 5% of the world's total of plant species can be found in the tropical rainforests of Costa Rica, of which only 16% is classified. Dr. Gamez's institute plans to classify the remaining species. Merck and Company has agreed to share profits from medically useful products that might be obtained from species identification. Encroachment on protected areas is occurring despite efforts by authorities to control the vast region. The reasons are: gathering firewood, increasing planted areas, and infringement by large banana companies. There is no old growth forest left outside the protected areas. Land that had been cleared for planting or grazing is now no longer even good for pasture. Cattle grazing as a problem is being handled by the Monteverde Cloud Forest Preserve. Dr. Tosi, President of the Tropical Science Center, says protection must be compatible with social viability and acceptability.
In Rwanda, births increase and the problems do, too.
The problems of fertility control in Rwanda are dealt with in the context of the inadequacies of the Earth Summit. This Rio de Janeiro conference declaration only mildly refers to "appropriate demographic policies," when there are dire warnings of the threat of overpopulation. The pope is attributed to having lobbied successfully in having stricken from the action plan any mention of access to contraceptives or family planning. The example is given of Rwandan women's lack of acceptance of family planning (FP) and the bearing of 8 children/family; the objections to FP are espoused by men, who feel their masculinity is threatened and their wives ability to work in the fields may be weakened if pills are taken. A nurse in charge of a rural health center finds that the cause is the subservient status of women. The director of population sciences at the Rockefeller Foundation reports that the most important reason is the education and status of women amidst other factors such as infant mortality, nutritional levels, and social security. Rwanda's Department of the Environment estimates population growth to 15.6 million by 2010. Population density is 720 people/square mile. The birth rate in 1989 was 8.5 children/woman and is the highest in the world. The environmental-population growth cycle is characterized as women's lower status leading to increased population, which leads to overuse of land; overuse of land produces poorer crops, which means more effort is required to produce food; more effort means that women will produce more children to help with their agricultural labor. Malnutrition is growing amongst children. Family planning was introduced into government health clinics in 1981. Contraception is used by 10% of married women. The Rwanda President in several speeches proposed a 4-child family, although he himself has the customary 8 children. The founder of the new women's group Haguruka, which means "stand up", says that the male-dominated culture, which deprives women of the rights to inherit property, forces women to use children to improve their status.
The message on safe sex just isn't getting through and the experts aren't sure what to do next.
The trends in condom use have remained stable since 1988 when 56.7% of adolescent urban males reported use of a condom at last intercourse. There is public health concern that the message of safer sex is not reaching a wide enough audience, and that not enough is know about the at-risk population with limited condom use. Knowledge about the best approach to reach this population is unavailable. The intimate etiquette of sexual practices is not known to sufficient detail to help people overcome their embarrassment about condom use. The most sexually active adolescents use condoms the least, i.e., 35% among the group with 4 or more partners a year versus 56% among those with 2 partners a year. Adults use condoms less often; i.e., 6-12% use a condom all the time among men aged 18-45 years with 2 or more partners and 40% did not use one at all. Condom use is high among homosexual males, as high as 70% Condom failure adds to the concern about low use patterns. One study of 70 couples who used condoms on 405 sexual occasions reported condom slippage or breakage of 14.6%. An additional concern is the sporadic use of condoms due to lack of immediate availability, when under the influence of drugs or alcohol, or due to partner objections. People delude themselves into thinking safer sex means second guessing whether their partner might be infected with AIDS or a sexually transmitted diseases. The best record of condom use was for women over the age of 30 years and 200% above the poverty level, with a 6.4% failure rate. The worst record was for women who were <30 years old and 200 under the poverty line, with a failure rate of 27-31%. There is some evidence that there is a correlation between unprotected sexual behavior and other risk behaviors. There is the suggestion that knowledge may not be enough and that interpersonal decision making is more to the point.
Homesteaders gnaw at Brazil rain forest.
The Brazilian Amazon stretches over a land area equal to the entire US east of the Mississippi River or 1.6 million square miles. Brazil has 60% of the total Amazon area. In May 1992, in the Brazilian rainforest, there is still mixed opinion on the merits of establishing roads linking remote areas to urbanized ones. Amazon deforestation continues due to logging, economic development, and land desires of the poverty class. New statistics reveal that deforestation has dropped 63% annually since 1985, i.e, dropped from 11,580 square miles in 1985 to 4299 square miles in 1991. The deforestation rate, if continued into the future, would deplete the rainforest in 330 years. The National Institute for Space Research is known for its documentation of these deforestation rates and is training research teams for several other nations of the Amazon basin. Declines in deforestation are attributed by scientists from the US and Brazil to the suspension of tax incentives for ranchers and loggers, a drop in the Brazilian economy, a public campaign against violators of forest laws, fines levied against violators, and rainfall during the season when forests tend to be burned. An American ecologist suggested that the major reasons for the decline was the Brazilian economy. His calculation are that 10% of forest cover in Brazil has already been removed, an area 2 times the size of Delaware. The fringe areas of the forest are the most vulnerable. Amapa state is typical of some of the problems. A large timber company wants to expand operations and bring a new road in. A forest preserve larger than Rhode Island is being defended by local unionists and US and European environmentalists, 35% of the state is protected as a state park or Indian reserve. Amapa state has the third highest population growth rate (4.5%). THe opinions of homesteaders, an Amapa senator and owner of a construction company, and the former President of Brazil are given in support of road development. Opposition is met with violence. The road runs through the Cajari reserve, which was established by a US investor in 1967. The concern is that rural poor will migrate, maintain high fertility levels, and want more land.
1990 report of activities.
In 1990, the Population Crisis Committee helped leverage over $75 million is extra funding for international family planning programs from the US Congress and the World Bank and charted a global plan of action to achieve universal access to family planning services; provided the media with stories about population, contraception, the environment, child survival, and related issues to 500 million people worldwide; led activism on environmental issues; conducted its Cities project on urbanization; pressured the US to resume funding to the UN Population Fund and to relax the Mexico City policy; analyzed USAID strengths and weaknesses in providing 25 years of population assistance; produced and disseminated its Report of World Progress Towards Population Stabilization; distributed population policy information kits to 3500 politicians and program managers in over 116 countries; worked on the Policymakers' Chart Book on world population issues for distribution to international government leaders; supported improved contraceptive technology such as RU-486, Depo-Provera, and NORPLANT; demonstrated that family planning is a powerful and cost-effective means of enhancing child survival; demonstrated the effects of rapid population growth overseas on vital US interests to help overcome complacency about population problems among US leaders; and supported over 2 dozen pioneering family planning initiatives in developing countries through its independent Special Projects Fund. The report also includes statistics on selected achievements, a financial report, a message from the president, a list of officers and directors, and a memorial to board members John M. Musser and Louis M. Hellman who died in 1990. The committee notes its achievements and failures in the 1980s and looks forward to 1991 and beyond as it works to ensure the availability of safe and effective birth control for all by the end of the decade.
When the shouting has to stop.
While the landmark case Roe v. Wade (1973) has been hailed as a great emancipator of women in fact it has been a disaster, the root cause of the turmoil surrounding abortion. Its demise cannot come soon enough. For, how is it the business of a Supreme Court to say when a person is or is not a person, or to divide up a pregnancy into 3 parts? In a democracy, laws are made by representatives of the people elected for that purpose who are rightly subject to popular pressure. The narrowly defined job of the Supreme Court is to determine rights under the constitution. By deciding the abortion was such a right, the justices seemed to set a highly contentious moral and political issue in stone, polarizing and poisoning the abortion debate in America. The antidote to the poison lies in legislation, not court decisions, and in politicians rather than judges. The erosion of protections from Roe over the past few years has begun to shift the burden of abortion low back to the individual states with, so far, very negative results for women seeking abortions. A patchwork of different practices will hopefully yield to national legislation from Congress, the rightful arbiter of abortion. Many argue that abortion legislation is too controversial, and even if enacted, would return to the courts anyway. But the signs indicate that is a consensus could be found, the moment might be ripe for devising national legislation of the sort that has served Western Europe democratically and effectively for the past 20 years.
1992 world population data sheet of the Population Reference Bureau, Inc.
The World Population Data Sheet for 1992 provides statistical charts for countries and regions of the World on the following variables: population estimates, birth rate, death rate, natural increase, population doubling time, projections to 2010, projection to 2025, infant mortality rate, total fertility rate, life expectancy, urban population, contraceptive use among married women, government view of fertility levels, and gross national product/capita. Separate data are available for the total area of the country in square miles and population/per square mile and the capital city. All countries included in the charts are members of the UN and have populations of 150,000 or more. The republics of the former USSR and Yugoslavia are shown separately. Regional population totals include countries not included in the country-specific data. These data sheets are not suitable for time series analysis, because fluctuations are not immune from reestimation or revision of methodology. Ranking also reflects different years and varying reliability. Data sources are official yearbooks and statistical publications of countries and UN documents. Definitions of variables are provided.
Regulation of abortion in the European Community -- Society for the Protection of Unborn Children Ireland Ltd. v. Grogan, judgment of the European Court of Justice of 4 October 1991 in Case C-159/90 (1991).
Ireland's 1983 constitutional amendment banning abortion has exacerbated tension between Ireland's identity as a sovereign state and its role as a member of the European Economic Community, (EEC), where only Ireland extensively prohibits abortion. The Grogan case arose when Irish anti abortion groups, using the Irish constitution, argued that providing information in Ireland about the availability of abortion in other EEC member states should be prohibited, and initiated Irish High Court proceedings in 1989 against the representative officers of 3 student associations. The Irish High Court determined that any adjudication required the application of community law, and referred 3 questions to the European Court of Justice (ECJ) to rule in accordance with the European Economic Community Treaty. The ECJ determined that it had appropriate jurisdiction over the questions, that the activities in question constituted a service within the meaning of the Treaty, but that the Treaty did not apply to the students because they were not providing the abortion services and were in no way affiliated with the providers of such services, making them unprotected under the Treaty; no community-law issues was involved. The Advocate General's analysis diverged from the ECJ's and concluded that in order to obtain economic equality for providers of services, potential recipients must have equal freedom of access to services regardless of nationality, place of establishment, or origin of the information. In Grogan, the ECJ accepted Ireland's infringement on the freedom to provide services within the EEC because it did not reach the substantive issues where the balancing of domestic and ECC concerns becomes crucial.
The third revolution: environment, population and a sustainable world.
Crisis sometimes spurs revolutions. The revolution that needs impetus is sustainable development. The issues of rapid population growth, consumption and technology, and environmental destruction are complex. Overstating the importance of population growth is no better than ignoring it as an important factor. Five village case studies reflect empirical evidence of the nature of the problems: Musoh, Malaysia; Ranomafana, Madagascar; Abidjan, Cote d'Ivoire; Kalsaka, Burkina Faso; and Hatia Island, Bangladesh. The example in Malaysia reflects the myth that forest people do not put pressure on the environment, which is only true when population density and consumption are low and technology is limited to sticks and blowpipes. Various theses about population are traced from Robert Wallace, William Godwin, and Thomas Malthus through critics such as William Hazlitt, Karl Marx, Henry George, and into the modern period of Ester Boserup, Paul Ehrlich, Dennis Meadows, and Paul Simon. The result is ideological chaos. The author reflects on the growth of the environmental crisis, the shortages of food, fertile land, energy, and minerals, and the state of biological diversity. The Madagascar example, illustrates past creative processes and present destructive ones. Deforestation, forest adjustments, land degradation, marginal people and areas are considered. Burkina Faso exemplifies how soil erosion can be stopped with appropriate use of technology on marginal slopes, but the balance between population and resources is lacking. In the Cote d'Ivoire example, author reflects on the growth of nonagricultural work, urbanization, the environmental impact of cities, solid waste generation and disposal, polluted waters, and atmospheric pollution. On Hatia Island population density, harsh environmental conditions, and cultural patterns which place women in inferior positions show the nature of poverty and interaction with population growth, which is exacerbated by natural disaster. A general theory of impacts is proposed based on Barry Commoner's concepts and charted. The options for action are identified. Shakespeare's Hamlet syndrome is referred to in the hope that action is not delayed until almost too late.
Is human culture carcinogenic for uncontrolled population growth and ecological destruction?
An epiecopathologic process is used as a framework for explaining the following: rapid population growth, a rapid rate of colonization, invasion and destruction of ecosystems, relative uniformity in biological characteristics of population, relative uniformity in structure and appearance of communities, and regional and global environmental changes. Malignancy is reflected in rapid, uncontrolled growth; invasion and destruction of tissues (ecosystems); metastasis (colonization and urbanization); and dedifferentiation (the ability of man to adapt to all ecosystems). Human culture is the carcinogenic agent. The global transformation is the malignancy. Objections have been made that the framework is an analogy or metaphor, does not explain or predict events, and is not a guide to action. Inductive reasoning may not apply, but the hypothesis is rigorous, is supported with data, and explains a wide variety of seemingly unrelated phenomena. Adaptation to very different ecosystems has been facilitated by cultural adaptations such as agriculture, weapons for hunting and defense against other animals, and modern medical care. Survival time has increased far beyond the evolutionary role just as cancer cells do not die on time. Urbanization had led to greater uniformity in housing, and real cultural differences are being lost. Population growth models generated by demographers explain what is happening but not why. Population growth and cultural change are linked in a positive feedback loop. Technology has been increasingly effective. The assumption of logistic thinking demographers is that stabilization of growth will occur at some point in the future. However, fertility has not decreased in many modernizing countries. The problems with the growth hypothesis are the lack of evidence of human populations stopping growth, and the Pearl-Reed logistic curve assumes a density-dependent population. Human populations have historically shown themselves to be density independent with cultural adaptation through technology. Access to and use of fertility control by the entire population is not plausible. Human population growth is reversing evolution and massively extinguishing species.
The law and planned parenthood case report.
The physician, dedicated to the preservation of health as well as the treatment of illness, must be conversant with both the immediate and the remote causes of disease. The following 1942 Connecticut case report has its origins in social, religious, economic, legal, as well as medical factors; it ends with the death of a white female, age 23. While medicine must conform itself to social regulation, medicine must also bring evidence of the unsatisfactory nature of such regulations to the immediate attention of all who influence those regulations. The patient was admitted to the hospital May 16, complaining of chills, fever, and bloody vaginal discharge. The patient had 4 children, ages 1-7 years old. The husband was a truck driver earning $20 to $325 a week. Husband and wife decided it would be wise to limit the size of their family. Contraception (condoms) were used until about 9 months before the present illness, when the druggist declined to continue to sell the patient any form of contraception. The woman's last menstrual period occurred in late January. On May 12, the patient produced by a self-induced abortion, 2 fetuses through the insertion of a catheter, sterilized by boiling, into her uterus. 2 days later she was hospitalized with a fever of 105.4 degrees Fahrenheit, a pulse rate of 130/minute, and a rebound tenderness over the lower abdomen. The uterus was enlarged to the size of about a 3-month pregnancy, and was soft and tender on motion. The cervix was enlarged, soft, and discharged a sanguinous fluid. The blood and cervical discharge culture yielded a heavy growth of beta hemolytic streptococci. Despite treatment, the blood culture remained heavily positive; the patient had a temperature spiking to 106 degrees Fahrenheit. Coma was followed by death on the 25th day of hospitalization.
A note on "conscious planning".
Explanations are given for the declines in birth rate without an increase in mortality during famine: conscious planning of marriage. Reference is made to Tim Dyson's comments on fertility responses to famine. Several points are made about the role of marriage declines during famine and abstinence from sexual relations. During the 1980-83 famine in southern Karnataka, India, which was a mild famine, conditions were such that many lost income, had less food, and low quality food was eaten; expenditures were made only for the most necessary items. Expensive marriage ceremonies or religious festivals were not held. Marriage was particularly affected because of the cost of dowries. It is estimated that 20-30% of marriages were deferred and the marriage rate fell by 25% from the pre drought level. Marriage planning also came to a halt. Those who had deferred marriage, and had been interviewed said that the reason was the cost of the dowry and wedding expenses, and not the cost of the pregnancy and raising children. The birth rate fell because of the decline in the marriage rate. The short term fertility decline was also affected slightly by a greater acceptance of family planning Mortality remained stable. Among the Indian Tamils on Sri Lanka's tea estates during the 1973-74 famine, there was an increase in infant mortality from 70 to over 100/1000. Fertility declined by 20%. In a survey conducted in 1987, the responses of women who were in the reproductive ages during the famine were that abstinence in sexual relations was practiced. The reason given was that frivolous activity was not appropriate and many were too weak or sick. Some did mention the problems associated with pregnancy, birth, or an additional family member. Some instances of illegal abortion also occurred during the famine period. The conscious planning was not fertility per se but abstinence because of other more pressing concerns. Culturally there is acceptance of the practice of sexual abstinence or permanent abstinence after childbirth. These experiences do support the Matlab finding that fertility decline was unrelated to age or parity.
MRC programme on AIDS in Uganda: a summary of programme strategy.
The MRC Program on AIDS in Uganda seeks to identify, prospectively, the determinants of HIV-1 infection and disease progression in rural Uganda and evaluate preventive strategies. The program is based at the Uganda Virus Research Institute, and initial field work has been conducted in the Kyamulibwa Subcountry in Masaka District. The research approach combines ethno demographic and epidemiologic follow-up of a clinical subcohort. A key objective of the initial phase of the study is identification of the risk behaviors associated with HIV infection and the distribution of these factors in the Ugandan population. Particular emphasis has been placed on the role of sexually transmitted diseases as a risk factor and methods to control such infection in a rural area. Also under study is the interaction between HIV and the major endemic diseases in rural Uganda-malaria and tuberculosis. The prevention component of the study has focused on assessment of the cultural determinants of sexual behavior and obstacles to behavior changes. In addition, individual and focus group discussions are providing information on how households deal with infected members and community ability to cope with increased morbidity and dependency burdens. The program's support component includes HIV testing, counseling, community-based health care, education, and water source protection. Projected is establishment of a primary laboratory for the isolation and characterization of HIV strains in Uganda and evaluation of the efficacy of HIV vaccines when available. The program'support component includes HIV testing, counseling, community-based health care, education, and water source protection. Projected is established of a primary laboratory for the isolation and characterization of HIV strains in Uganda and evaluation of the efficacy of HIV vaccines when available. The study has identified an HIV-1 seroprevalence rate of 4.9% for all ages and 8.5% for adults, with higher rates recorded among the poorest population segments.
AIDS and drug abuse: some aspects of psychiatric consultation.
The rapidly rising number of HIV-infected intravenous drug users in Buenos Aires has produced unprecedented difficulties in the physician-patient relationship and a need for greater involvement on the part of mental health specialists. At present, 35% of these drug users are HIV-positive. When hospitalized for various medical complications of the virus, drug users often manifest acting out behaviors, denial of their addiction, and other psychopathic personality traits. They are likely to be noncompliant with treatment regimens and demanding of special treatment from hospital staff. In many cases, physicians seek to protect themselves from involvement with these difficult, highly anxious patients by making a referral to a psychiatrist. Although such a referral is usually appropriate, physicians should seek to work through the crisis in the physician-patient relationship and address psychosocial as well as medical issues. Failure on the part of the physician to navigate the initial disorganizing crisis and symbiotic stages can produce serious depression in the patient, a sense of abandonment, and a worsening of the medical condition.
Female condom improves with use.
A preliminary quantitative analysis of couples' experiences with the new female condom, Femidom, suggests that the acceptability of this method improves with duration of use. The analysis, conducted by the Institution of Population Studies at UK's University of Exeter, involved a sample of 51 couples who were provided with 15 female condoms. 36 couples returned the after-1st-use questionnaire and 29 couples completed the after-10th-use form. Responses revealed substantial initial concern about the large size of the sheath and proper insertion. Although these condoms diminished after 1st use, a small number of female respondents felt that the condom's visibility during use detracted from their sexual attractiveness. In most cases, the latter perception seemed conditioned by the response of the male partner. The finding that over half of the couples in the survey used the female condom at least 10 times is a positive indicator of the method's potential acceptability in the general population. Given the female condom's ability to protect against both pregnancy and sexually transmitted diseases, it is a valuable addition to the contraceptive marketplace.
Abortion in Ireland.
Substantial legal barriers to abortion persist in both the Irish Republic and Northern Ireland, despite growing popular support for abortion under certain conditions. A 1983 amendment to the republic's constitution guarantees the fetus the same right to life s the mother and bans the provision of information on abortion. Although a recent well publicized case of a pregnant, suicidal 14-year-old who travelled to England for an abortion resulted in an Irish Supreme Court ruling that abortion was acceptable in cases of "real and substantial risk" to a woman's life, uncertainty still surrounds the right to travel to England for the procedure. In Northern Ireland, the 1967 Abortion Act does not apply and abortions are denied even in cases of rape and incest. A total of 1766 women from Northern Ireland and 4158 from the republic travelled to England for abortions in 1991. Public opinion seems to have shifted toward support for less restrictive abortion laws, however. Whereas 80% of those surveyed in a 1980 Irish poll supported to ban on abortion in all cases, this statistic had dropped to 30% by 1990. Similarly, a 1991 poll taken in Northern Ireland found 80% of respondents to be a favor of abortion in cases where the procedure is necessary to maintain a woman's physical or mental health.
Irish student leaders gagged over abortion.
The Irish High Court, upholding an order sought by the Society for the Protection of the Unborn Child, has banned 14 Dublin students from providing information on abortion. Attorneys for the student leaders argued that the ban contradicts a recent European Community declaration supporting the right of Irish women to receive such information and travel abroad for abortions. It was also argued that the ban denies women the right to bodily integrity, protected under the Irish Constitution. Concern was expressed that this ruling will force foreign physicians who perform abortions on Irish women to administer the procedure without access to essential medical information such as drug reactions and allergies to anesthesia. The High Court judge countered that the information ban was not a breach of the European Community law and instructed the public prosecutions director to consider filing contempt charges against the 14 students. Despite this action, the Union of Students in Ireland has announced its intention to continue to provide abortion information and the Irish Family Planning Association has decided to include abortion counseling in its newly established pregnancy advisory service.
Radio wave.
In developing countries with high rates of poverty and illiteracy, radio is emerging as an excellent medium for delivering information on health issues, family planning, nutrition, and agricultural development. Since radio does not require wired electricity, it can reach remote rural populations. Surveys have found that between 50-75% of poor rural households in developing countries own radios, and the majority listen to educational radio at least once a week. A program that reaches the urban poor outside of Lima, Peru, has been instrumental in controlling the spread of cholera. A Bolivian station broadcasts 8 hours of literacy, health, agricultural, and cultural programming a day to an audience of more than 2 million Aymara Indians. Small village radio stations with a broadcast range of 15 miles can be established for under US$400 and can generally achieve sustainability through local fundraising events such as raffles. In many cases, listeners have become broadcasters at their local radio stations.
Condom use among male injecting-drug users -- New York City, 1987-1990.
As part of the Centers for Disease Control's AIDS Community Demonstration Projects, a study on the condom use of male intravenous drug users was conducted in New York City's Lower East Side in 1987-90. The overall aim of the study was identification of ways of reducing the heterosexual transmission of HIV. In 1991, 22% of women in the US with AIDS reported sexual intercourse with male intravenous drug users as their major risk factor. The 450 study subjects were recruited by former addictions outreach workers and were offered monetary compensation as well as a variety of medical and social services. 37% were white, 32% were black, and the remaining 31% were Hispanic. 53% were 30-39 years of age and 74% had not completed high school. Of the 165 participants who consented to HIV testing, 85 (52%) were HIV seropositive. 1913 respondents (43%) reported never use of condoms, 139 (31%) claimed to always use condoms, and 118 (26%) used condoms some of the time. Men with steady and casual sex partners were more likely to report occasional condom use than those with only steady or only casual sex partners. Consistent condom use was more common (72%) among men with casual partners than those with steady partners (30%). The factors most strongly associated with steady condom use were having peers who engaged in safe sex practices and the adoption of regimens aimed at reducing the risk of injection-related HIV transmission, e.g. cleaning needles with bleach or use of only new needles. These findings suggest that need for 3 strategies: 1) greater emphasis on condom use promotion among men who are in primary relationships; 2) use of peer outreach and group methods to maximize the positive impact of social influence on condom acceptance, and 3) messages that link both drug injected-related and sexual modes of HIV prevention.
Behind Bush's mixed abortion signals.
Republican Party unit is being threatened by internal ambiguity on the abortion rights issue. Presidential advisors have urged George Bush to take a strong anti-abortion stance to mollify the conservative wing of the Party, yet several Party influentials, including Barbara Bush, have categorized abortion as a personal decision. The 1992 Republican Party platform declares that the fetus has a fundamental right to life and calls for a constitutional ban on all abortions. On the other hand, a poll of the 2210 delegates to the 1992 Party convention revealed that 55% opposed such a constitutional amendment. National polls of Republican voters have found that fewer than 20% favor banning abortion. The National Republican Coalition for Choice has announced its intent toraise the abortion issue on the floor of the upcoming convention.
Government should support family planning.
Any steps on the part of the US Government to restrict abortion rights should be accompanied by measures to make birth control less expensive and more accessible. Similarly, an essential part of strengthening family values is ensuring that children are healthy and wanted. Despite the centrality of contraception to the welfare of women and families, federal funding for reproductive health clinics in the US has remained constant at $150 million for the past decade in the face of soaring health costs. Moreover, every dollar spent on family planning has been shown to save $4 in federal programs for children born into poverty. A similar disregard for cost-effectiveness is reflected in the National Institute of Health's allotment of $1 billion on AIDS research compared to $10 million on contraceptive research, when the latter is essential to preventing the spread of sexually transmitted diseases such as AIDS.
[PRITECH mission in Guinea: the marketing aspect]
The PRITECH mission in Guinea had the objectives of assessing the local production feasibility or oral rehydration salt (ORS) by encouraging local manufacturers and appraising the market of local ORS. 2 companies were evaluated: Songuipharm and Sogip. Discussions were held with international organizations, Ministry of Health and Population officials, managers of these firms and importers and distributors of drugs, and pharmacists. The incidence of diarrhea was 6-8 episodes/child under 5 years of age. The medium-term market potential was 2.8 million sachets of ORS with the current market being 650,000 sachets. Diarrhea treatment consisted of antidiarrheals, antibiotics, vitamins, and ORS. In hospitals iv therapy was used. The private distribution system importing drugs from European firms but willing to buy from local producers consisted of 6 wholesalers, 128 pharmacies, and 29 selling outlets in rural areas. Pharmaguinee was a public sector distributor supplying hospitals and government entities under reorganization to dispense affordable medicines from the Essential Drugs list to primary health centers including 400 ORS sachets for 5000 people every 6 months. ORS is extremely expensive on the illegal drug market that normally sells stoles or illicit drugs at a discount. The projected prices of ORS produced by the above 2 companies would exceed the current prices: US$.22 and US$.31, respectively. Promotion contingent on permission by a regulatory commission would entail information, education, and communication and social marketing to create public awareness. However, the operation of the Education Pour la Sante would require equipment and foreign assistance to start. The production of branded ORS along with generic ORS, a social medicines regulation for curtailing the profits of wholesalers and pharmacists, and the competition of firms for assuring low prices are recommended.
[Nutritional practices and diarrheal diseases in children under five in Mali]
The study was justified under the National Program of Combatting Diarrheal Diseases to examine the interaction between nutrition and diarrhea especially in children under 5 years of age in Mali. The Bambara ethnic group was chosen. Bankoni, a suburban district northeast of Bamako with 47,891 inhabitants was studied in 1987. Villages around the district of Fana with 56,189 people were also included in the analysis. In the urban sample 15 mothers were interviewed: 10 with a diarrheic child under 3 years of age. In addition 8 old people and traditional healers were also interviewed. In the rural segment, 25 others were interviewed: 20 had a child under 3 years of age with diarrhea. 12 traditional healers (age range 47-103 years) were also queried. Definition of diarrhea included watery stool, short stomach, and broken stomach. Diarrhea was classified as simple diarrhea, diarrhea of diseases, diarrhea of teething, diarrhea of weaning, diarrhea pertaining to a new pregnancy of the mother, and diarrhea because of the incompatibility between breast feeding and sexuality. The gravity of diarrhea was recognized according to the color, liquidity, frequency, duration of stools, and lack of response to treatment. 65% in urban and 85% in rural areas favored traditional treatment (a cord against evil, medicinal plants), while 20% in urban (1 in 3 cities oral rehydration salt--ORS) and 12% in rural areas (no ORS use) utilized modern medicine. 3% in rural and 15% of mothers with diarrheic children in urban zones visited health centers mostly after the failure of traditional treatment. The behavior of mothers concerning weaning, meals, feeding practices and appetite stimulation, feeding in the etiology of diarrhea, traditional classification of foods, feeding restrictions and diarrhea, foods for the improvement of diarrhea (fish, soup, cereal, biscuits, rice, meat soup, powdered baobab), and utilization of results were also addressed.
[Technical visit to Guinea concerning the establishment of an oral rehydration salts (ORS) production unit within two local pharmaceutical companies]
The objectives of the technical visit were to evaluate the oral rehydration salt (ORS) production capacity of the companies Soguipharm (9 employees) and Sogip (with 8 employees) located outside of Conakry, Guinea including the level of training and experience of staff, the conditions and adaptation of existing facilities, and their manufacturing and quality control systems. The Ministry of Public Health and Population of Guinea initiated the local production of ORS under the Combatting Communicable Childhood Diseases (CCCD) program envisioning the installation of good manufacturing practices. Although the personnel proved to be qualified and experienced, on-site technical assistance of about 3 months' duration would be needed to transfer the technology to meet product standards specified by WHO, UNICEF, and USAID. A certain amount of renovations and a system of manufacturing and quality control of ORS would also be needed at these companies in order to attain the estimated annual production capacity for 500,000 sachets. Sogip had 2 rooms for storing palettized raw materials, however, the dosing system has to be replaced by a more accurate machine. The option of installing an automatic or semiautomatic production line was advanced depending on the prices of the respective machines and final production unit costs. The investment costs for Soguipharm would be US$126,750 and those for Sogip only US$54,249, while the cost of raw materials and packaging would cost an estimated, US$26,010 for each. It is recommended that the market size and investment outlays should be considered in the event the decision concerning local production of ORS is made. The Republic of GUinea would have to contact these companies about renovations, UNICEF about raw materials and packaging material for 1 year of production, and USAID about technical assistance.
The relationship between attitude, assertiveness and condom use.
The Australian study investigated condom-specific assertiveness and condom use as a means of prevention infection from sexually transmitted diseases. 211 men participated including 83 homosexual men (aged 19-62 years) and 128 heterosexual men (aged 17-49) who completed a questionnaire that comprised demographic details such as age, monogamy, and sexual activity as well as attitudinal and assertiveness measures. General assertiveness was measured by the Rathus Assertiveness Schedule (RAS) which had been widely used across a wide range of social situations. Assertiveness relating specifically to situations involving condoms was measured by the Condom Assertiveness Scale (CAS). Intention to use condoms was positively related to favorable attitudes, which were related to condom-specific assertiveness for both groups. For the heterosexual men only, general social assertiveness was negatively related to attitudes toward condoms. For both groups, the condom-specific measure of assertiveness was positively correlated with attitudes toward condoms. Condom-specific assertiveness was positively related to general social assertiveness as measured by the Rathus Assertiveness Schedule for the homosexual, but not for the heterosexual men. The negative relationship between general assertiveness and attitude to condoms among the heterosexual men implies that the risk reducing behavior of condom use did not seem to accord with the perceptions of masculinity and social assertiveness among heterosexual men. Thus, female partners of such heterosexual men exhibiting negative attitudes toward condom use combined with assertiveness would have to overcome resistance to insist on the use of condoms. Recently some advertising campaigns have been directed at women. The promotion of condom use among heterosexual men has to deal with the perceptions of condom use as unmasculine behavior.
[Promotion of breast feeding in Spain. What to do?]
In Spain, the decision of the mother to breast feed her child is influenced by health professionals and the direct promotion of formula feeding by the dietary industry although this effect accounts for only 3.3%. In the 1970s, research was concentrated on studying formula milk rather than human milk resulting in a change in the attitude of young professionals not to insist on breast feeding. Among professionals under 30 those with negative opinions about breast feeding made up 30.2%, citing insufficient milk, 9.5%; inadequate milk, 6.5%; breast disease, 5.8%l and nuisance, 8.4%. The average number of visits per pediatrician in Spain is 20.1 +or- 12.6 (20.7 +or- 11.3 in rural areas) leaving little time for discussing breast feeding; 80/9% admit that the information transmitted to mothers is not always sufficient owing to the lack of information and health education in 87.1% of cases. A survey among single women showed that only 56.4% had formed an opinion on breast feeding of their future child. 68.6% thought that it was old-fashioned, 50% considered its inconvenience the most negative aspect, and 11.5% of those who responded deemed 30 days the maximum duration. As high as 44% (or only 29.6% according to pediatricians) of grandmothers influence the decision, and 17% of them have negative opinions about breast feeding. 74.2% of mothers quit breast feeding because of hypogalactia, misconstruing the crying of the child after feeding ceases, and weight gain. The authentic causes of hypogalactia-agalactia need to be explained to mothers to prevent premature weaning. 40.3% of higher class women quit lactation because of inconvenience and 23.8% of middle-class mothers because of work. During a child's first 3-6 months only 53.9% of women go regularly to pediatricians. It is necessary to direct promotional efforts not only at mothers and the public but also at health professionals in order to increase breast-feeding practices.
[Cholesterol and phospholipids in human seminal plasma before and after vasectomy]
38 men who had undergone vasectomy for fertility regulation had 3 semen samples taken before and 2 and 6 months after the operation in order to determine the concentration of cholesterol and phospholipids in the seminal plasma for the evaluation of any possible changes in the physiology of genital glands. Prior to vasectomy there were 130 +or- 50 million of spermatozoa/ml of ejaculate with a 75% +or- 11% motility in a sample of 35 men. There was no statistically significant change in cholesterol content before and 2 and 6 months after vasectomy, nor was there a significant difference between free cholesterol and esterified cholesterol. This indicated good correspondence in the content of glandular secretions of the male genital tract, mainly the prostate and the seminal vesicles. On the other hand, the concentration of phospholipids diminished 2 and 6 months after vasectomy from 230 +or- 90 mcg moles/in 21 patients to 100 +or- and 100 +or- 20 mcg moles/1 in 15 patients, respectively. There was no significant difference in the average volume of seminal plasma 2 and 6 months after vasectomy. The decrease of the phospholipid content could be attributed to the inhibition of the biosynthesis of phospholipids owing to the hypertrophy of the epididymis or the absence of phospholipid secretion originating from the testicular fluid. Not all alterations in genital glands are apparent immediately, therefore time is an important parameter in the evaluation of the response of the organism to vasectomy.
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