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Demography India. 1984 Jan-Dec; 13(1-2):153-67.The threshold hypothesis shares with transition theory the basic assumption that a decline in fertility is interrelated with a decline in mortality and change in the social, economic, and cultural conditions of the population. However, threshold theory fails to formulate a causal chain between fertility and the other variables and its application at the aggregate country level is limited by intracountry heterogeneity in cultural and social variables. Problematic is the fixing of the timing for a country of a decline in fertility to be inferred from the fact that some indicators of development have reached the threshold zone while others have not. This paper attempts to develope a combined index for socioeconomic development on the basis of data from 12 countries of the ESCAP region of South East Asia. Variables included were life expectancy at birth, infant mortality rate, adult female literacy, percentages of females economically active, GNP per capita, and percentage urban population. In 1970, 3 of the countries analyzed had a crude birth rate below 25, 6 countries had a rate between 25-40, and 3 had a rate above 40. The lowest value of the index recorded for countries of low fertility (crude birth rate below 25) and the highest value recorded for countries of high fertility (above 40) are taken as the threshold zones for the overall index. The number of countries in the threshold range increased from 5 in 1970 to 8 in 1975. With the increase in the index value, a reduction in the fertility level was noted. In contrast, where socioeconomic development was slow, fertility showed little change. Policy makers could use this system to assess which indicator could be pushed through to raise the overall index of development so as to effect a decline in fertility.
Comparative study of social and biological effects on perinatal mortality. Etude comparative des effets des facteurs sociaux et biologiques sur la mortalite perinatle.
World Health Statistics Report. Rapport de Statistiques Sanitaires Mondiales. 1976; 29(4):228-34.The World Health Organization's (WHO) comparative study, in 8 countries (Austria, Cuba, Hungary, Japan, New Zealand, Sweden, UK, and the US), of social and biological effects on perinatal mortality is discussed, including the background and the objectives of the study, reportingon the progress achieved thus far, and some of the results likely to emerge. Perinatal mortality, as currently defined, comprises late fetal deaths (stillbirths) and early neonatal deaths, i.e., it includes deaths between the 28th week of pregnancy and the end of the 1st week after birth. In developed countries between 1.6-4% of all pregnancies result in perinatal death. Although many less developed countries give priority to the reduction of postneonatal and early childhoo mortality, with increasing success in their efforts, the hard core of perinatal mortality will gain in importance. Perinatal mortality may be considered as reflecting standards of obstetric and pediatric care as well as the effectiveness of social measures in general and of public health actions in particular. In a 1968 joint UN/WHO Meeting on Programs of Analysis of Mortality Trends and Levels reference was made to the serious gaps in knowledge of the magnitude and determinants of perinatal mortality. In a 1971 follow-up, WHO Consultation on Fetal, infant, and Childhood Mortality, it was recommended that WHO initiate and coordinate studies of the biological, socioeconomic, and cultural factors associated with perinatal mortality and that detailed guidelines for the collection, classification, and tabulation of these biological, socioeconomic, and cultural factors for both national and international purposes be worked out. The proposed study would have the following general objectives: it would serve as a stimulus to countries to make better use of the information to be derived from vital statistics and would encourage detailed studies of the determinants of perinatal mortality and their interrelationships as a basis for the planning of public health programs designed to reduced perinatal mortality; it would enable WHO to obtain precise and detailed information on the significance and the international comparability of perinatal mortality rates and would provide a basis for WHO to develop guidelines concerning the collection, processing, and presentation of national perinatal mortality data as an important part of a national health information system. To achieve the general objectives a draft study protocol was developed. The specific aims established for the study are outlined. More attention will be directed to the problem of perinatal mortality and how it might be reduced.