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HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE. 1986 Sep; 487:201-12.US attitudes toward both legal and illegal immigration tended to be highly restrictionist during the 1st half of the 20th century. Both legislative and executive-branch policy supported this restrictionist outlook up until the 1940s, when a gradual liberalization of immigration policy toward refugees began to occur because of foreign policy requirements and the onset of the cold war. Although only a very small percentage of Americans have advocated increasing the number of immigrants, the percentage who feel that the numbers should be decreased began to decline during the 1950s and 1960s. Liberalization of public opinion and governmental policy occurred. During the past 15 years, however, public opinion and government policy began to diverge. Because of economic and other problems, Americans became more restrictionist toward immigrants, at least when surveyed by public opinion polls. But the government has difficulty implementing a more restrictionist policy for a variety of reasons, among them the strong lobbying efforts of pro-alien activist groups combined with American ambivalence toward the plight of immigrants as individuals. (author's)
YEARBOOK OF POPULATION RESEARCH IN FINLAND. 1986; 24:29-42.The goal in this paper is to present and discuss results from several Dutch research projects dealing with the acceptance and demographic effects of new policy measures aimed at increasing fertility. The discussion covers the history of Dutch population policy since 1945, research on the acceptance of future pronatalist policy measures, a preliminary test of Mancur Olson's collective action theory applied to the relationship between population concern and acceptance of population policy, and evidence from social demographic research on the demographic impact of 1 particular type of pronatalist policy. The population has increased by over 10 million people over the last 100 years with some 45% of the increase taking place after 1945. The years immediately following the war were characterized by high birthrates. Natural population growth, mainly in the early 1950s, was attenuated by the number of persons leaving the country. This lasted until about 1960. Since then there has been an immigration surplus, yet in the 1970s the annual population growth was smaller than in the early years. A marked decrease in fertility was responsible for this. The fertility decrease is caused mostly by the fact that the number of high parity births has decreased. Since 1970, the number of 1st births also has decreased. The 1st stage in Dutch population policy covers the period 1945 to the late 1960s. In the first 15 years after World War II, the annual marked increase in population numbers worried the government and several segments of the general population, but an explicit interest on the part of the government in steering (natural) population growth did not exist. The 2nd stage of population policy covers the period from 1970 to the early 1980s. A Royal Commission on Population was established in 1972, and the essential message of their 1974 report was the termination of natural growth as soon as possible. 2 years after the publication of the Commission's final report the government stated their position, that is, for the Netherlands to reach a stationary population. During the 1970s, the total fertility rate declined from 2.6 (1970) to 1.6 (1980). It was this decline, combined with the aging of the population, that led the Interdepartmental Commission on Population Policy (ICB) in 1982 to become alert to the forecast that a stationary population of 12-14 million might not be reached in the near future. In early 1983 the government formulated a new position. The government now considers as imperative a change in the fertility trend over the next several years. If this change fails to occur, they maintain that it may be necessary to implement pronatalist policy measures. A public opinion survey conducted in early 1983 showed that 22% of the respondents responded affirmatively to the question about whether or not they would like to have more children when a pronatalist policy is introduced, yet only 12% indicated a willingness to reconsider their fertility intention upon implementation of this type of policy (N=250). Only 1/3 indicated a willingness to change their fertility intention in a pronatalist way. A government that uses data obtained from public opinion surveys instead of information stemming from demographic policy research may be deceived in the long run. More attention needs to be paid to demographic policy research.
Attitudes towards demographic trends and population policy: a comparative multi-variate analysis of survey results from Italy and the Netherlands.
[Unpublished] 1987. Presented at the European Population Conference, 1987, Jyvaskyla, Finland, June 11-16, 1987. 18 p.The results of surveys of the attitudes toward current demographic trends and population policies conducted in Italy and Netherlands were compared. The Dutch and Italian surveys were comparable because their aims and parts of the questionnaire were similar, making it possible to analyze the common aspects. The Italian data were taken from a recent survey of the National Institute of Population Research. The survey population included all those of reproductive and marriageable age. 1503 interviews were conducted. The survey was initiated in November 1983 and terminated in February 1984. 952 people were interviewed in the Dutch survey, initiated in 1983. It comprised a representative 2-stage stratified random sample of the Dutch population aged 20-64 years. Both the Dutch and the Italians knew that the birthrate had been declining: 93% of the Italians and 63% of the Dutch. This trend was rated positively by 52% of the Italians and 46% of the Dutch. 52% of the Italian respondents and 58% of the Dutch wanted the population to remain stationary in the future. The 1st important difference was that in Italy the number of respondents who evaluated the birth decline negatively was about 2.5 times as high as in the Netherlands where there was a very high percentage of people who were indifferent to the problem--40% in the Netherlands, 10% in Italy. In Italy, 15% favored an increase in population size in contrast to 8% in the Netherlands. The respondents in both countries had clear ideas on the causes of the fertility decline, but the Italians generally had less set ideas than the Dutch. The economic crisis and the lack of confidence in the future were identified as the most important causes; in the Netherlands, women's work outside the home was considered to be more important than in Italy. In both countries, state intervention concerning fertility was rejected in the majority of cases--67% of the Italians and 81% of the Dutch. A 2-step elaboration was carried out for the identification of typologies of respondents. The Multiple Correspondence Analysis was carried out on 2 subjects: Knowledge and evaluation of current demographic trends; and the acceptance of population policies concerning fertility in relation to their perception of the falling birthrate. The analysis identified typologies of respondents with different levels of information and opinion towards population trends, and 4 clusters for Italy and 4 for the Netherlands were comparable. both the "pronatalist" and the antinatalist" respondents in both countries were, in general, well informed, and in both countries the "interventionists" were, in general, people with a low level of education.
Lancet. 1987 Aug 15; 2(8555):394.I have questioned 1000 people in 4 sample populations in China about their attitude to and knowledge of health information on smoking and about smoking habits. I then interviewed 50 people from this sample in greater detail. I also studied past smoking control efforts in China. Greater attention must be given to health education in schools and to young people. Smoking is common among schoolchildren and, and at least in Guangzhou, Canton, health education about smoking appeared limited. Of 250 schoolchildren only 40% reported exposure to health education. Smoking is banned in schools and the attitude seemed to be that there was therefore no need for education about the dangers. On the other hand, 70-80% of the whole sample seemed aware that smoking is harmful to health. Thus there is a need to increase not only the level of health education but also its sophistication, so that the gap between health knowledge and behavior can be closed. Attention must be given to women's attitudes to smoking. Generally I found a small proportion of female smokers (a study in Tianjin excepted), and the impression at interview is that smoking among women is considered impolite or "not done." Add this to the fact that women were more aware of the dangers of smoking (77% of 286 females vs 63% of 701 males, with 62% of women saying smoking was "very" harmful compared with 37% of men) and the potential for using women as health educators becomes apparent. The increasing understanding of passive smoking and the fact that women are usually the casualties might also be useful ammunition in this context. However, there may be competition for the attention of women--'Slim Kings' aimed specifically at the female market, have already been introduced into Hong Kong. 1 of the most important elements in any approach to smoking control must be an attempt to influence public policy. The history of government China is 1 of sporadic initiatives originally formulated by a joint committee involving several departments (public health, finance, agriculture, and light industry), but more recently only involving the Department of Public Health. Some action has been taken but a question mark remains over the strength of political will. Many factors operate against a reduction in cigarette production, which earned the state $6 million in 1984. Remarks by a representative of the State Tobacco Company suggest enthusiasm for increased production and more joint ventures with the multinational tobacco companies. Both British American Tobacco and Reynolds are now working in China, and the Canton Biannual Trade Fair and Grand Prix Tennis Tournament were sponsored by tobacco companies. I recently revisited China after 2 years and was struck by the volume and increasing sophistication of advertising and by the continuing cheapness of cigarettes which are now sold by increasing numbers of private entrepreneurs. Deregulation of the market and farmland may encourage increased tobacco production. These are all worrying developments for the "antismokers", who will need all the determination Sir John Crofton talks of to help them push forward a multipronged attack on the smoking pandemic and the vested interests that support it. (full text)
JOURNAL OF APPLIED SOCIAL PSYCHOLOGY. 1986; 16(2):95-106.Government policy toward provision of sex education and contraception for adolescents is influenced by public opinion. This is reflected in the fact that recent program formulation appears to follow the conventional wisdom of a general conservative shift among the American public; i.e., recent policy toward adolescent pregnancy is conservative in the sense of being reactive rather than preventive. The validity of this conventional wisdom was checked by examining available data on public opinion toward sex education and birth control services for teenagers. However, these data reveal an upward, not a downward, trend in public approval of such services for adolescents, which runs counter to the conventional wisdom. The available data on American opinions and values demonstrate that the overall movement in attitudes decisively contradicts the idea of a simple conservative swing. Provision of more and better contraceptive services and sex education to teenagers is an important policy goal that would lower the incidence of adolescent pregnancy and would be supported by the American people. (author's modified.)
Italians' attitudes towards the births decline and the acceptance of a population policy concerning fertility
In: Contribution of Italian scholars to the IUSSP XX General Conference/Contribution des Italiens au XX Congres General de l'UIESP, Firenze, 5-12 giugno 1985. Rome, Italy, Consiglio Nazionale delle Ricerche, Istituto di Ricerche sulla Popolazione, 1985. 125-42.This paper reports the results of a survey carried out in Italy in 1983-84 of attitudes and opinions concerning current demographic trends and population policy. The 1503 respondents answered questions on topics such as nuptiality, the image of marriage, life style changes, population structure, the causes and effects of the recent fertility decline, ideal and actual family size, birth spacing, and state intervention in population issues. 93% of respondents were aware that births have declined in the past 10 years, and most attributed this to economic factors. 52% of respondents indicated the fertility decline is a positive trend in light of socioeconomic factors such as unemployment and the housing crisis. In addition, 56% expressed the opinion that ideal family size in Italy (2.2 children) is congruent with actual family size. 67% of respondents indicated that the State should not interfere in any way in the reproductive behavior of Italian citizens. 26% favored intervention, either to increase (12%), maintain (8%), or decrease (6%) present fertility levels. In general, respondents equated state intervention in fertility with repression and violation of personal freedom akin to that which occurred under the fascist regime. The minority of respondents who were in favor of state intervention, either to increase or decrease fertility, expressed a preference for noncoercive measures such as public information campaigns and removal of economic barriers to parenthood. These results suggest that Italy's family policy should be based on democratic consensus and guarantee reproductive choice to couples without outside interference or reference to questions of national welfare.
[Attitudes toward population policy in the Netherlands: results of a survey] Einstellungen zur Bevolkerungspolitik in den Niederlanden: Ergebnisse einer Untersuchung
Zeitschrift fur Bevolkerungswissenschaft. 1985; 11(1):45-56.This article reports on some of the results of a  sample survey among 952 inhabitants of the Netherlands, aged 20-64 years. Attitudes and evaluations on aspects of current family policy as well as on hypothetical regulations for the benefit of people with children are presented. A new pronatalistic policy was welcomed most by respondents below age 35 who did not yet have children. General support was primarily given to arrangements for leave or for adjustment of working hours. A model is also presented for measuring the possible direct effect of new family policy regulations on reproductive intentions. The results suggest that the direct effect is limited. (summary in ENG, FRE) (EXCERPT)
Journal of Social History. 1985 Spring; 18(3):399-411.The transition from resistance to acceptance of birth control in the US can be characterized as a 3 stage process, with each period facing its own issues and choices. The 1st stage -- the fight over birth control in the early 20th century -- has been documented by historians like James Reed, Linda Gordon, and David Kennedy. A 2nd stage, approximately the years from 1936-60, has not been fully explored although the period was crucial in shaping the current system of contraceptive health care. This discussion focuses on this transitional period, particularly its 1st decade, 1936-47. Physicians' attitudes, as revealed through American Medical Association (AMA) policy and a national survey conducted in 1947, are considered in relation to reported data on clinic and private practice. This evidence reveals that despite the liberalization of laws and public opinion in the mid-1930s, contraception did not become widely available until after 1960 -- the beginning of the 3rd stage in the history of American contraception -- and that the restriction of birth control information during the period was traceble in large part to the medical profession. Analysis of the 1936-47 decade, particularly with regard to the concerns of doctors, provides a framework for understanding the forces that affected contraceptive health care in the mid 20th century and suggests conditions that continue to shape the politics of birth control. In 1936, when the AMA's committee on contraception submitted its 1st report, it was clear that legal and public opinion had moved decisively toward more liberal attitudes concerning birth control. In 1937 the AMA passed a qualified endorsement of birth control, indicating that the organized medical profession as represented by the AMA held views on birth control at the beginning of the 2nd stage that were more conservative than those of most middle-class Americans. Its conservatism was challenged by lay groups who threatened to circumvent standard office practice if physicians failed to modify their views. Public opinion and behavior thus had a demonstrable effect on medical attitudes. 10 years after the AMA resolution a suvey found that more than 2/3 of physicians approved of contraception for any married women who requested it. The 1937-47 period witnessed 2 important changes in medical attitudes toward contraception: the profession's public, though cautious, endorsement of birth control; and the apparent adoption of liberalized standards for the prescription of contraceptive materials. The period also was a time of tremendous growth for the new birth control clinics that offered services to women who could not afford private care. Available evidence suggests that physicians' attitudes toward contraception, and particularly toward birth control clinics, were more important than either laws or public opinion in limiting the availability of those contraceptives considered most efficient (and most compatible with sexual pleasure) between 1936-60.
Genus. 1984 Jan-Jun; 40(1-2):155-71.State intervention in population and family planning has been gradually increasing on the assumption that unregulated population growth poses serious national problems requiring public action. Among 152 developing nations in areas surveyed with respect to population and family planning policies in 1980, 52 supported family planning primarily from a demographic rationale and 65 from a health or human rights rationale, while only 35 provide no support. There appear to be 4 major underlying sociophilosophical perspectives on the role of the state in population planning: 1) the deontic/utilitarian whose prime concern is with the rights and obligations of present generations to future generations; this view provides a very vague basis for a general policy of population planning, 2) the environmentalist, which with varying degrees of pessimism in different formulations argue the need to limit population and economic growth because of the limited nature of the world's resources; this view ignores a considerable body of evidence that more than just overpopulation is involved in environmental problems, 3) the family planning perspective, advocated and supported by various international organizations and conferences, holds that decisions about birth control should be made by prospective parents. The assumption is that making birth control methods and education readily accessible to everyone will eventually result in birth rates which are desirable for the society as a whole. In practice, it is difficult to establish whether such voluntaristic measures are enough to control population, 4) the developmental distributionist position sees low birth rates as resulting from modernization, including such factors as more equitable distribution of income and increased educational and social services. Pakistan's family planning program has undergone 3 major bureaucratic reorganizations and shifts in strategy consequent on changes in national leadership since services were 1st offered in 1965. Singapore's leadership has supported family planning actively and consistently since 1966, and the country's socioeconomic development has contributed to its remarkable fertility decline. A 1975 survey of 864 persons in Singapore and a 1981 survey of 584 persons in Pakistan included questions on opinions of the appropriate role of the state in population planning. In Singapore and Pakistan respectively, 31 and 17% felt that the government should have a strict role in controlling family size, 32 and 10% felt that the government should primarily provide advice and pass laws, 18 and 18% felt the government should provide advice only, 17 and 37% felt it should be left to the married couple, and 2 and 18% didn't know. The empirical evidence suggests that the political legitimacy of the state and public policies to promote distributive justice, are both more developed in Singapore than Pakistan, have significant influence on the degree of public acceptance of state intervention in family planning.
American Journal of Obstetrics and Gynecology. April 15, 1971; 109(8):1118-1127.The 1970 Nelson Committee hearings were held to determine whether Pill users were properly told about the side effects and suspected complications. The author charges the Committee hearings of sensationalizing adverse results of the Pill, causing 18% of all U.S. users to stop this treatment and another 23% to seriously consider quitting. A survey following the Nelson hearings showed 97% of the 13,000 U.S. obstetricians and gynecologists questioned believed oral contraceptives to be medically acceptable. The Scowen report of England (1970) said the Pill is the best contraceptive available, and the low-estrogen pill (50 mcg) is the safest. Because of the relationship of the pill to thromboembolism brought out by Nelson hearings oral contraceptives now must carry a health warning, and the result of the Scowen Committee will most likely encourage doctors to prescribe low dosage estrogen pills.