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HEALTH TRANSITION REVIEW
1995 - VOLUME 5, SUPPLEMENT
The Third World AIDS Epidemic
Edited by I. O. Orubuloye, John C. Caldwell, Pat Caldwell, Shail Jain
97.57.1 - English - Lawrence A. ADEOKUN, Institute of Statistics and Applied Economics, Makerere University, Kampala (Uganda), Jeremiah TWA-TWA, AIDS Control Programme, Ministry of Health, Entebbe (Uganda), Agnes SSEKIBOOBO and Rose NALWADDA, Institute of Statistics and Applied Economics, Makerere University, Kampala (Uganda)
Social context of HIV infection in Uganda (p. 1-26)
Some of the important policy and research implications of accumulating HIV/AIDS data are being ignored because of the attraction of social science research focused on the 'multiple sexual mechanism' of infection and transmission. Attention is drawn to the other policy and research issues relating to information on the timing of infection through a reanalysis of existing data on cumulative AIDS cases. The most urgent need is to supplement the mainstream research on risk groups with studies of the timing and circumstances of entry into sexual activity in the pre-teen years. (UGANDA, AIDS, EPIDEMICS, RESEARCH)
97.57.2 - English - Joseph K. KONDE-LULE, Institute of Public Health, Makerere University, Kampala (Uganda)
The declining HIV seroprevalence in Uganda: What evidence? (p. 27-33)
Papers presented at the ninth International Conference on AIDS and STDs in Africa, held at Kampala in December 1995, show that HIV prevalence has apparently been on a downward trend in several sectors of the population of Uganda over the past few years. This article reviews the relevant presentations. (UGANDA, AIDS, EPIDEMICS)
97.57.3 - English - Christine OPPONG, Development Policies Branch, Department of Development and Technical Cooperation, International Labour Office, Geneva (Switzerland)
A high price to pay: For education, subsistence or a place in the job market (p. 35-56)
97.57.4 - English - Donatus O. OWUAMANAM, Faculty of Education, Ondo State University (Nigeria)
Sexual networking among youth in southwestern Nigeria (p. 57-66)
Young people in Southwestern Nigeria are engaged in risky sexual behaviour patterns. Unfortunately they are not quick at taking actions that would prevent or reduce the risk of STD and AIDS/HIV transmission. In these days of the AIDS epidemic, sexual networking should be associated with condom use, and immediate report of infection to medical personnel and to one's partner so that he or she can seek medication. There is also need to worry about a proportion of the population that is still ignorant of AIDS, is indifferent about AIDS or feels that AIDS has not spread. To some extent however, sexual behaviour among the youth has been modified since there is awareness of AIDS. Sex education with emphasis on appropriate attitudes to AIDS/HIV should be included in the secondary school curriculum to increase young people's understanding of AIDS. (NIGERIA, AIDS, YOUNG POPULATION, SEXUAL BEHAVIOUR, SEXUAL EDUCATION)
97.57.5 - English - O. B. BOROFFICE, Department of Physical and Health Education, Lagos State University, Ojo-Lagos (Nigeria)
Women's attitudes to men's sexual behaviour (p. 67-79)
97.57.6 - English - O. ADEGBOLA, O. BABATOLA, Department of Geography and Planning, University of Lagos (Nigeria), and J. ONI, National Centre for Development Studies, Australian National University (Australia)
Sexual networking in Freetown against the background of the AIDS epidemic (p. 81-112)
97.57.7 - English - Ebenezer OLUTOPE AKINNAWO, Department of Psychology, Ondo State University, Ado-Ekiti (Nigeria)
Sexual networking, STDs, and HIV/AIDS transmission among Nigerian police officers (p. 113-121)
This study examines the sexual behaviour of Nigerian police officers, the number of their sexual partners, relation with commercial sex workers, prevalence of STDs and the use of condoms among them. Three hundred and fifty-eight police officers, randomly sampled from Ondo State Police Command, Akure, responded to an interview guide. Results show that Nigerian police officers belong to the high-risk group and run the risk of being infected by HIV/AIDS. Whilst premarital and extramarital sexual relations were very common among the officers, they also maintained a high level of multiple sexual partners. Most of the police officers' extramarital sexual partners were single girls, mainly students. A number of the police officers also engaged in sexual relations with commercial sex workers in hotels and brothels, particularly when on transfer to new stations. The prevalence of STDs was 23.8 per cent and gonorrhoea was the most reported type of STD. Most of the officers contracted STDs from their woman friends and commercial sex workers. They sought and received treatment from modern doctors. A large proportion of the infected police officers informed their partners, while few of the married ones told their wives. The officers were knowledgeable about the use of condoms and had used condoms in sexual relations. (NIGERIA, AIDS, EPIDEMICS, POLICE)
97.57.8 - English - I. O. ORUBULOYE, O. P. OMONIYI, Ondo State University, Ado-Ekiti (Nigeria), and W. A. SHOKUNBI, University College Hospital, Ibadan (Nigeria)
Sexual networking, STDs and HIV/AIDS in four urban gaols in Nigeria (p. 123-129)
97.57.9 - English - John K. ANARFI, Institute of Statistical, Social and Economic Research, University of Ghana, Legon (Ghana), and Phyllis ANTWI, AIDS Control programme, Ministry of Health, Accra (Ghana)
Street youth in Accra-city: Sexual networking in a high-risk environment and its implications for the spread of HIV/AIDS (p. 131-151)
97.57.10 - English - Paul KISHINDO, University of Malawi, Chancelor College, Zomba (Malawi)
Sexual behaviour in the face of risk: The case of bar girls in Malawi's major cities (p. 153-160)
The first case of AIDS in Malawi was diagnosed in 1985. The close association of AIDS with sexual promiscuity led the Ministry of Health to mount a campaign to create awareness of the dangers of promiscuous sex. Surveys so far carried out indicate that about 80 per cent of bar girls carried the HIV virus. This study sought to investigate why young women became bar girls, how much they knew about AIDS, and why they persisted in what is regarded as a high-risk occupation. The study revealed that economic necessity was a major consideration in engaging and persisting in commercial sex. Poverty then may be a major factor in the rapid spread of AIDS in Malawi. (MALAWI, AIDS, EPIDEMICS, PROSTITUTION)
97.57.11 - English - I. O. ORUBULOYE, Centre for Population and Health Research, Ondo State University, Ado-Ekiti (Nigeria), Pat CALDWELL and John C. CALDWELL, Health Transition Centre, National Centre for Epidemiology and Population Health, Australian National University, Canberra (Australia)
A note on suspect practices during the AIDS epidemic: Vaginal drying and scarification in southwest Nigeria (p. 161-165)
Vaginal drying and scarification have been reported as possible risk factors. Published research on the former has been confined to East and Middle Africa. This paper reports on research in West Africa employing a survey of 1,976 females in southwest Nigeria, where they reported on their own vaginal drying, the scarification of their sons, and their participation in blood oaths. It was concluded that vaginal drying is not a risk-factor for AIDS in southwest Nigeria, and probably more broadly in West Africa, that scarification may be in the few cases when group scarification is practised, and that the practice of blood oaths probably puts those involved in danger. (NIGERIA, AIDS, EPIDEMICS, BLOOD, TRADITION)
97.57.12 - English - Pat CALDWELL, Health Transition Centre, The Australian National University, Canberra (Australia)
Prostitution and the risk of STDs and AIDS in Nigeria and Thailand (p. 167-172)
97.57.13 - English - Ebenezer OLUTOPE AKINNAWO, Department of Psychology, Ondo State University, Ado-Ekiti (Nigeria)
Mental health implications of the commercial sex industry in Nigeria (p. 173-177)
97.57.14 - English - Philip SETEL, National Centre for Epidemiology and Population Health, The Australian National University, Canberra (Australia)
The effects of HIV and AIDS on fertility in East and Central Africa (p. 179-189)
Concern has been expressed about the fertility of people infected with HIV: the worry has been that on learning of their condition, HIV-affected individuals may attempt to accomplish unmet reproductive goals knowing that they will not live a normal life span. This article addresses the potential effects of AIDS on fertility and reproductive decisions in East and Central Africa. The problem is seen in terms of a tightly knit continuum of biological epidemiologic and cultural contexts, and the prevailing conditions of response to the epidemic. AIDS can influence fertility among individuals and groups regardless of any awareness of serostatus by increasing death rates among reproductive populations, and damaging the physical capacities of infected men and women to reproduce. In much of the region, high prevalence of STDs may simultaneously impair the fertility of men and women and increase their risk of contracting HIV. These biological conditions are compounded among those for whom fertility is a highly valued marker of adult status, where the social and economic marginality of young women contributes to reliance on commercialized sex, where the mobility of young men leads to instability in sexual partnerships and frequent partner change, or where women lack the ability to negotiate their fertility with spouses. It appears that even focused programs of testing and counselling with HIV-positive women in Europe and in Africa have not motivated a significant change in reproductive action. Were there a demonstrable effect of counselling on the fertility choices of infected persons, there are numerous practical limitations on the role that interventions can play in affecting the fertility of HIV-positive people. (EASTERN AFRICA, CENTRAL AFRICA, AIDS, FERTILITY, FERTILITY DETERMINANTS)
97.57.15 - English - Jackson MUKIZA-GAPERE and James P. M. NTOZI, Department of Population Studies, Institute of Statistics and Applied Economics, Makerere University (Uganda)
Impact of AIDS on the family and mortality in Uganda (p. 191-200)
Although the method of study of questioning 143 opinion leaders who were not completely randomly selected is less than statistical, it is reassuring that the findings of the study are remarkably close to the results of other studies on the subject in Uganda. The effect on the household composition and structure is dramatic. Infant, childhood, adolescent and adult mortality rates have increased substantially. The study is revealing a major change of customs in order to cope with the epidemic. This may result in a future Ugandan society with new values, customs and practices. (UGANDA, AIDS, EPIDEMICS, FAMILY, MORTALITY, CULTURAL CHANGE)
97.57.16 - English - Jackson MUKIZA-GAPERE and James P. M. NTOZI, Department of Population Studies, Institute of Statistics and Applied Economics, Makerere University (Uganda)
Impact of AIDS on marriage patterns, customs and practices in Uganda (p. 201-208)
97.57.17 - English - E. M. PRESTON-WHYTE, University of Natal (South Africa)
"Bring us the female condom": HIV intervention, gender and political empowerment in two South African communities (p. 209-222)
97.57.18 - English - Eka ESU-WILLIAMS, AIDSCAP Field Office, Calabar (Nigeria)
Sexually transmitted diseases and condom interventions among prostitutes and their clients in Cross River State (p. 223-228)
97.57.19 - English - Kofi AWUSABO-ASARE, Department of Geography, University of Cape Coast (Ghana)
HIV/AIDS education and counselling: Experiences from Ghana (p. 229-236)
97.57.20 - English - John C. CALDWELL, Pat CALDWELL, Health Transition Centre, National Centre for Epidemiology and Population Health, Australian National University, Canberra (Australia), and I. O. ORUBULOYE, Centre for Population and Health Research, Ondo State University, Ado-Ekiti (Nigeria)
Intervention strategies suggested by the Nigerian segment of the SAREC program on sexual networking, STDs and AIDS (p. 237-244)
97.57.21 - English - James P. M. NTOZI and Jackson MUKIZA-GAPERE, Department of Population Studies, Institute of Statistics and Applied Economics, Makerere University (Uganda)
Care for AIDS orphans in Uganda: Findings from focus group discussions (p. 245-252)
97.57.22 - English - John KWASI-ANARFI, Institute of Statistical, Social and Economic Research, University of Ghana, Legon (Ghana)
The conditions and care of AIDS victims in Ghana: AIDS sufferers and their relations (p. 253-263)
97.57.23 - English - Kofi AWUSABO-ASARE, Department of Geography, University of Cape Coast (Ghana)
Living with AIDS: Perceptions, attitudes and post-diagnosis behaviour of HIV/AIDS patients in Ghana (p. 265-278)
AIDS infection has created a fear of stigma tization, isolation and panic among infected persons. There are, however, few studies that explore the perceptions and attitudes of HIV/AIDS patients in sub-Saharan Africa, partly because of the isolation and withdrawal of patients. Using data from a study on the social dimensions of AIDS infection in Ghana, this paper explores the attitudes and behaviour of patients and their perception of the attitudes of their relations and neighbours towards them. The traditional forms of support for sick persons in Ghana are under strain either due to or independent of HIV infection. In spite of changes, infected persons perceive their female relatives to be more sympathetic than their male relatives. Some patients continue to deny to themselves their HIV status. These findings have implications for programming as the disease enters its second decade. (GHANA, AIDS, EPIDEMICS, ATTITUDE, FAMILY ENVIRONMENT)
97.57.24 - English - H. J. A. N. MENSA-BONSU, Faculty of Law, University of Ghana, Legon (Ghana)
AIDS and the Ghana legal system: Absolute ignorance or denial syndrome? (p. 279-291)
97.57.25 - English - Moni NAG, Population Council, New York (U.S.A.)
Sexual behaviour in India with risk of HIV/AIDS transmission (p. 293-305)
APRIL 1996 - VOLUME 6, NUMBER 1
The Cultural, Social and Behavioural Determinants of Health
97.57.26 - English - C. M. LANGFORD, Department of Social Policy and Administration, London School of Economics, Londres (U.K.)
Reasons for the decline in mortality in Sri Lanka immediately after the Second World War: A re-examination of the evidence (p. 3-23)
Newman estimated that 42 per cent of the decline in mortality in Sri Lanka between 1930-1945 and 1946-1960 was attributable to DDT-spraying; Molineaux estimated 27 per cent; Gray judged that 23 per cent of the decline between 1936-1945 and 1946-1960 was due to DDT. Here the Newman-Cray-Molineaux approach is criticized, the main point being that they ignored a significant improvement in mortality in the early 1940s, before DDT spraying. Bearing this, and certain other complexities of the situation, in mind, an attempt is made to assess the impact of DDT on mortality. (SRI LANKA, MORTALITY DECLINE, MORTALITY DECLINE, SANITATION, EVALUATION)
97.57.27 - English - Jacob BAMIDELE ONI, Graduate Studies in Demography, National Centre for Development Studies, Australian National University, Canberra (Australia)
Qualitative exploration of intra-household variations in treatment of child illness in polygynous Yoruba families: The use of local expressions (p. 57-69)
Before the introduction of the 'user pays' principle to health care, treatment in many government hospitals was free. Intra-household variations in response to treatment of child illness, especially in polygynous Yoruba households in Nigeria, occurred for a number of other reasons. Probably because the mother and her children usually form a social unit within a polygynous union, meeting the cost of treatment and some other minor daily needs of the child has always been the responsibility of the mother, although the economic independence of most senior wives seems to have waned as a result of current economic difficulties. In the past, a woman's ability to meet the cost of treatment of her children was partly explained by her separate income from that of her husband, but with the persistent rise in cost of treatment, many mothers now have to look to their husbands or other sources for assistance in paying for treatment of their children.
This paper examines treatment behaviour under the present circumstances and explores how common expressions of the Yoruba can be used to explain differences in a polygynous husband's responses to the treatment of illness of his wives' children. Such treatment poses a great risk of child morbidity and mortality now that the role of the father has become important in meeting the current high cost of treatment in many Yoruba families. (NIGERIA, POLYGAMY, MATERNAL AND CHILD HEALTH, EXPENDITURES, MEDICAL CARE, FATHER)
1996 - VOLUME 6, SUPPLEMENT
The Shaping of Fertility and Mortality Declines: The Contemporary Demographic Transition
97.57.28 - English - Dov FRIEDLANDER and Barbara S. OKUN, Hebrew University of Jerusalem (Israel)
Fertility transition in England and Wales: Continuity and change (p. 1-18)
The focus of this paper is whether the transition from high to low fertility reveals continuity or discontinuity with the past. Our analyses of districts of England and Wales over time reveal an overall picture of continuity. Specifically, we show that (1) a substantial proportion of districts experienced pretransition variations in marital fertility that were so large that they are suggestive of deliberate fertility control; (2) the changes over time in the distributions of marital fertility levels and the relative importance of marital fertility levels to the determination of overall fertility levels were gradual and smooth; (3) the proportion of districts dominated by marital fertility variation, as opposed to nuptiality variation, increased gradually over time, and both marital fertility and nuptiality variations were present in all periods considered; and (4) there are important relationships between changes over time in marital fertility and socioeconomic variables in periods both before and after the transition. The last conclusion is based on our estimated equations from the pooled cross-sectional, time-series data. Moreover, these estimated equations reveal relationships between changes in specific explanatory variables and changes in marital fertility that are very similar both before and after the onset of the transition. (ENGLAND, WALES, DEMOGRAPHIC TRANSITION, FERTILITY DECLINE, FERTILITY DETERMINANTS)
97.57.29 - English - James C. RILEY and George ALTER, Department of History, Indiana University (U.S.A.)
The sick and the well: Adult health in Britain during the health transition (p. 19-44)
Using adult life-long histories of health experience among a group of men and women born in Britain between 1725 and 1874, this paper examines individual health during the mortality decline. The risk of initiating a new sickness declined sharply between the cohorts born in the eighteenth century and those born during 1825-74, but the average duration of each episode increased. As successive cohorts added to their life expectancy, survival time rose more sharply than did well time.
Continuity rather than change is apparent in another aspect of their health experience, the capacity of prior health to predict future sickness and wellness. Among the men and the women and in the eighteenth-century cohorts as well as the cohorts of 1825-74, the degree of wellness or sickness evident early in adult life strongly predicted future sick time for 15 to 20 years, and strongly predicted future sickness events for a longer period still. Moreover, women surpassed men in their propensity to hold on to the health status exhibited in early adulthood. (UNITED KINGDOM, HISTORY, HEALTH, EVENT HISTORY ANALYSIS)
97.57.30 - English - Bruce CALDWELL, International Centre for Diarrhoeal Disease Research, Dhaka (Bangladesh)
The family and demographic change in Sri Lanka (p. 45-60)
Sri Lanka has almost completed the demographic transition with low mortality rates and fertility rates approaching replacement levels. Sri Lanka shares these characteristics with the South Indian states of Kerala and Tamil Nadu in contrast to elsewhere in South Asia where mortality and especially fertility rates remain much higher. A key part of the explanation for these differences lies in the nature of the family.
The Sri Lankan family is essentially the conjugal unit of husband, wife and dependent children whereas in northern South Asia agnatic relations between son and parents are central to family structure. Related to this family system the position of women in Sri Lankan society was relatively high in South Asian terms. Consequently women had a strong say in health and fertility behaviour. When required, for example, mothers take the initiative in seeking health care for themselves and their children. Importantly family structure has facilitated female education which is associated with both mortality and fertility decline. There are few concerns that the values imparted by secular education are contrary to the values of the family or to women's roles within it. The egalitarian family structure has also contributed to fertility decline by raising the costs of children and reducing the long-run benefits to be gained from them.
Sri Lanka is particularly distinctive in the contribution of changes in female age at marriage to its fertility decline, marriage age having risen six years this century. This change has been accompanied in recent times by a shift from family-arranged to selfselected (love) marriage. The explanation lies in changes in the socioeconomic system which have reduced the centrality of the family in wider social and economic relations, and placed a greater premium on an individual's own abilities and attributes. (SRI LANKA, DEMOGRAPHIC TRANSITION, FAMILY COMPOSITION, WOMEN'S STATUS)
97.57.31 - English - Etienne VAN DE WALLE and Nadra FRANKLIN, University of Pennsylvania, Philadelphia (U.S.A.)
Sexual initiation and the transmission of reproductive knowledge (p. 61-68)
Initiation rituals are still widely practised among the Kaguru of Morogoro district in Tanzania. Young women are introduced to the digubi dance at the time of puberty, and a version of the dance is performed at the time of marriage. This form of traditional theatre serves a function of education and socialization, and the question is raised of how much of reproductive behaviour is transmitted in this medium. Our informants suggest that notions of female dependence and standard of behaviour are conveyed in the process, but that information on child rearing and postpartum abstinence are transmitted by personal contact with older women at the time of the first birth. (TANZANIA, WOMEN'S STATUS, PUBERTY RITES, VALUE SYSTEMS, EDUCATION OF WOMEN)
97.57.32 - English - Jorge BALÁN, CEDES, Buenos Aires (Argentina)
Stealing a bride: Marriage customs, gender roles, and fertility transition in two peasant communities in Bolivia (p. 69-87)
This paper deals with changing marriage customs in a pre-transitional setting where nuclear households and relatively high female status have been dominant values. Two Bolivian communities are compared. In one of them, the persistence of early marriages is associated with a specialized agricultural economy where women play roles as wives and mothers as well as partners in agricultural production but are not engaged in autonomous income earning activities. Women maintain a relatively subordinate, even if highly valued, position within the family. Marriage customs are simple, with little parental opposition to early marriage. In the other, economic diversification and tertiarization of the economy, as well as the emergence of a youth culture, are producing a revolution in marriage patterns. Increase in female age at marriage is associated with an extension of spinsterhood, growing acceptance of courtship, and a decline in parental influence over the selection of marriage partners. These are processes promoting both nuclearization and an increase in the bargaining power of women within the nuclear family, conditions for the emergence of favourable attitudes towards birth control. Marriages are taking place later as a consequence of the increasing individualized capacity of females as income earners. Young men achieve independence much later today than in the past, and have to show individual resourcefulness in order to find a wife. Stealing a bride, a ritualized version of elopement, is a key aspect of marriage customs through which men show the ability to constitute a new household. (BOLIVIA, TRANSITIONAL SOCIETY, NUPTIALITY, MARRIAGE CUSTOMS, WOMEN'S STATUS)
97.57.33 - English - Ashish BOSE, I-1777 C.R. Park, New Delhi (India)
Demographic transition and demographic imbalance in India (p. 89-99)
In the coming decades, there will be growing demographic disparity in India and, like economic disparity, this should be a matter of serious concern for our planners and policy-makers. This demographic disparity leading to demographic imbalance may cause considerable social turbulence and may even pose a threat to political stability. Demographers must look far beyond demographic statistics and anticipate the consequences of demographic imbalance between different regions and states in India as well as between different religious communities, castes and tribes. Relevant data based on 1991 Census and National Family Health Survey (1992-93) are presented to highlight the 'North-South Demographic Divide'. (INDIA, DEMOGRAPHIC TRANSITION, REGIONAL DEMOGRAPHY, POPULATION PROJECTIONS)
97.57.34 - English - Penny KANE, University of Melbourne (Australia), and Lado RUZICKA, Major's Creek, NSW (Australia)
Women's education and the demographic transition in Africa (p. 101-113)
97.57.35 - English - P. N. SUSHAMA, Office of Population Health and Nutrition, New Delhi (India)
Transition from high to replacement-level fertility in a Kerala village (p. 115-136)
This paper uses a micro-approach to examine the motivation and processes of rapid fertility decline in a Kerala village. Fertility declined in the village substantially during the 1970s and continued to decline to reach replacement level at the time of study. The proximate determinants are postponement of marriage and extensive use of contraceptives. However, the changes in these factors were the result of changing socioeconomic conditions. At the time of study the singulate age at marriage was 29 years for males and 23 years for females, higher than elsewhere in India. Delayed age at marriage was a combined effect of favourable attitudes to education and economic changes. Smaller families became advantageous because of decreasing agricultural opportunities, expanded education and mortality decline. Contraceptives were available with the implementation of the family planning program. Higher use of contraceptives can be attributed to favourable conditions resulting from socioeconomic changes. (INDIA, REGIONS, DEMOGRAPHIC TRANSITION, FERTILITY DECLINE, FERTILITY DETERMINANTS)
97.57.36 - English - Lakshman DISSANAYAKE, Department of Geography, University of Adelaide (Australia)
The first generation with mass schooling and the fertility transition: The case of Sri Lanka (p. 137-154)
This study attempts to explain the Sri Lankan fertility transition in terms of the pretransition fertility regime and conditions leading to its destabilization. This study therefore deviates from previous studies of fertility in Sri Lanka which have largely focused upon the post-transitional fertility differentials. From the first formulation of demographic transition theory, education has been used as a significant factor relating to the fertility transition, but Caldwell's 'mass education-fertility transition' thesis can be regarded as the major attempt to explain the relationship between education and the onset of the fertility transition, with education a central explanatory factor in fertility transition theory. My analysis uses existing fertility theory to explain the education-fertility transition relationship, systematically tests that theory and suggests some modification to the theory on the basis of the Sri Lankan experience. The availability of relevant information in Sri Lanka has provided the opportunity to analyse the generations which contributed to the onset of the fertility transition and the continuance of that transition. (SRI LANKA, DEMOGRAPHIC TRANSITION, FERTILITY DECLINE, LEVELS OF EDUCATION, THEORY)
97.57.37 - English - BARKAT-E-KHUDA, The Population Council, New York (U.S.A.), and Mian Bazle HOSSAIN, International Centre for Diarrhoeal Disease Research, Dhaka (Bangladesh)
Fertility decline in Bangladesh: Toward an understanding of major causes (p. 155-167)
Bangladesh has undergone a considerable decline in fertility, despite the absence of conditions believed to be necessary for such reproductive changes. Indeed, Bangladesh is the only one among the world's twenty poorest countries where such a change has occurred. The paper examines the nature of fertility transition in Bangladesh, looks at the trends in contraceptive use and fertility, and identifies the major factors accounting for the fertility decline, despite poor socioeconomic conditions. Two types of factors in the decline are: (a) positive factors which encourage eligible couples to contracept, and (b) negative factors which compel women to contracept, for spacing or limiting births. The effects of positive and negative factors on contraceptive use and fertility are analysed with data from a rural sample of 4,194 women from the 1993-94 Bangladesh Demographic and Health Survey (BDHS), 2,597 women from the MCH-FP Extension Project area, and 8,110 women from the Matlab MCH-FP Project area. Logistic regression is used in the analysis. Strong and highly significant effects of female education, female employment and access to media on contraceptive use and fertility have been found. (BANGLADESH, FERTILITY DECLINE, FERTILITY DETERMINANTS, CONTRACEPTIVE USAGE)
97.57.38 - English - Elisha P. RENNE, Department of Sociology, Ahmadu Bello University, Zaria (Nigeria)
Shifting boundaries of fertility change in Southwestern Nigeria (p. 169-190)
Anthropologists and demographers rely on distinctive methodologies and forms of evidence even while they share a common interest in explaining fertility change. This paper proposes a cultural anthropological approach that focuses on the process whereby meanings associated with practices and things are reinterpreted over time. Using the image of shifting boundaries of kinship relations, it examines changing interpretations of three fundamental aspects of social life -- family land, marriage, and foster parenthood -- in the Ekiti area of Southwestern Nigeria which suggest an attenuation of the mutual obligations of extended kin. While these reinterpretations have moral associations that legitimate practices supporting fertility decline, political and economic uncertainty may counter this process. (NIGERIA, FERTILITY TRENDS, FERTILITY DETERMINANTS, ANTHROPOLOGY, FAMILY RELATIONSHIPS)
97.57.39 - English - Alan MARTINA, Department of Economic History, Australian National University, Canberra 0200 (Australia)
The quantity/quality of children hypothesis in developing countries: Testing by considering some demographic experiences in China, India and Africa (p. 191-212)
Initially a general regression equation is estimated, making use of cross-country data, relating the level of the total fertility rate to a range of variables, including the level of per capita real income. There is a statistically significant negative relationship between the level of the total fertility rate and real income per capita. Once the theory of the quantity-cum-quality of children hypothesis is set out formally, and in a flexible form, it is clear that this statistical relationship is not inconsistent with this theory. However, this relationship is not a strong or convincing, test of this hypothesis. To provide more satisfactory tests of this hypothesis, additional relevant information from various developing countries is used. Information on recent demographic changes in China provides a comparatively powerful, direct test of the theory. More indirect tests of the theory are provided by drawing on data for India in the 1960s, and for sub-Saharan African countries in the 1980s and early 1990s. These various tests suggest that the quantity-cum-quality hypothesis, in its flexible form, appears to explain some of the changes in fertility rates observed in various developing countries in recent decades. (CHINA, INDIA, SUB-SAHARAN AFRICA, TOTAL FERTILITY RATE, PER CAPITA INCOME, THEORY)
97.57.40 - English - Monica DAS GUPTA, Center for Population and Development Studies, Cambridge, MA (U.S.A.)
Life course perspectives on women's autonomy and health outcomes (p. 213-231)
This paper examines how different patterns of kinship and inheritance affect intergenerational relationships and the ramifications of gender inequality. Peasant societies of pre-industrial Northern Europe are contrasted with those of contemporary South Asia to illuminate some of these relationships. While Northern European kinship and inheritance systems made for high status in youth and a loss of power and status as people aged, South Asian systems make for lower power and status in youth and a rise as people age.
From this follow more conflict-ridden relationships between the generations and a stronger conjugal bond in Northern Europe, while in South Asia intergenerational ties are strong and the conjugal bond is weak. This in turn leads to a greater potential for marginalizing women in South Asia, although gender inequality exists in both settings. The convergence of low autonomy due to youth as well as sex amongst young married women in South Asia means that women are at the lowest point in their life cycle in terms of autonomy during their peak childbearing years. As shown in this paper, this has considerable implications for demographic and health outcomes: in terms of poorer child survival, slower fertility decline, and poorer reproductive health. (NORTHERN EUROPE, SOUTHERN ASIA, WOMEN'S STATUS, KINSHIP, HERITAGE, MATERNAL AND CHILD HEALTH)
97.57.41 - English - P. H. REDDY, Population Centre, Malleswaram, Bangalore (India)
The health of the aged in India (p. 233-244)
Because of declining fertility, the proportion of the aged in the Indian population has risen. Although the rise has been modest, as shown by an increase in the population over 60 years of age from 5.5 to 7.0 per cent between 1951 and 1995, by the latter date, India's experience with 65 million people of this age is unusual. The paper employs data on persons 65+ years of age drawn from the 42nd Round of the National Sample Survey, and for the analysis subdivides them into three age groups, 60-64, 65-69 and 70+. It is shown that, among population over 60 years of age, 10 per cent suffer from impaired physical mobility and 10 per cent are hospitalized at any given time, both proportions rising with increasing age. Of the population over 70 years of age, more than 50 per cent suffer from one or more chronic conditions. The very limited support provided to the old by goverment is brought out by the fact that even in Karnataka, one of the states with the most generous provision, only 15 per cent of persons over 65 years of age receive any type of pension. (INDIA, AGED, DEMOGRAPHIC AGEING, PUBLIC HEALTH, RETIREMENT PENSIONS)
97.57.42 - English - Robert M. DOUGLAS and Rennie M. D'SOUZA, National Centre for Epidemiology and Population Health, ANU (Australia)
Health transition research in the control of morbidity and mortality from Acute Respiratory Infection (p. 245-252)
The essence of health transition research is its multidisciplinary character and openness to broad theory. Theories of health transition provide the context in which classic epidemiological studies can, most effectively, contribute to population health improvement. Acute respiratory infections are a leading cause of morbidity in all countries, and a major cause of premature death in countries where mortality is high. The international ARI control program in childhood sponsored by the World Health Organization is built on conventional biomedical foundations.
Health systems in Australia and Pakistan continue to be driven by this conventional model which has contributed to changes in mortality but probably not exclusively. A health transition approach forces us to step back, and place the gains of the biomedical model in a social and historical perspective. Using that perspective to move public health policy forward in the modern nation state requires adventurous lateral thinking. We review here the problem of acute respiratory infections in Australian and Pakistani children. In Australia, we focus on the large differences in respiratory infection severity and outcomes between Aboriginal children and Caucasians. We also draw attention to our current ignorance on what differentiates children who are prone to respiratory infections from those who are not. In Pakistan, we highlight the problem of refocusing a health care system that is already seriously underfunded for the biomedical task. A major challenge for social scientists is to become involved more directly in the medical care system and devise health care interventions that can address social inequities, and can provide a better integration between social and biomedical views of the world. (AUSTRALIA, PAKISTAN, INTERDISCIPLINARY RESEARCH, HEALTH POLICY, RESPIRATORY DISEASES)
97.57.43 - English - Stephen J. KUNITZ, Department of Community and Preventive Medicine, University of Rochester, NY (U.S.A.)
What Yugoslavia means: Progress, nationalism, and health (p. 253-272)
Theories of modernization have assumed that the creation of nation-states involved the breakdown of parochial ethnic boundaries and increasing secularism, all of which resulted in a demographic transition from high to low fertility and mortality. Recent experiences suggests, however, that in some circumstances nation-states may be highly unstable as ethnic minorities assert their rights to self-determination. Under such conditions, converging patterns of mortality may begin to diverge as growing inequalities appear between newly independent region of once unified states. The recent history of Yugoslavia is described to provide an example of how this process might occur and what the results might be. (YUGOSLAVIA, STATE, ETHNIC MINORITIES, DIFFERENTIAL MORTALITY, POLITICAL SYSTEMS)
97.57.44 - English - K. Ruben GABRIEL, Department of Statistics, University of Rochester, NY (U.S.A.)
Appendices aux calculs de mortalité de Kunitz (Appendices to Kunitz on mortality calculations) (p. 273-282)
97.57.45 - English - J. H. POLLARD, Nanyang Technological University (Singapore)
On the changing shape of the Australian mortality curve (p. 283-300)
Over the course of the twentieth century, mortality rates in Australia have shown substantial improvements at all ages. The improvements which have taken place at different ages, however, have not occurred at a uniform pace, and as a result, the shapes of the national mortality curves have varied over time. The most noticeable change for males has been the development of an 'accident hump' in the late teens and early twenties mid-century, the growth of this 'hump' in the 1960s and 1970s, and its sudden disappearance, or transformation into a 'bulge', in the late 1980s. This paper examines the reasons for the disappearance of the male 'accident hump' and the changes in mortality by cause which have occurred over the decade to 1992 and influenced the level and shape of the whole mortality curve both for males and for females. Extrapolating the trends observed for the various cause-specific mortality rates obtains projected life tables for Australian males and females in the year 2002. (AUSTRALIA, MORTALITY TRENDS, CAUSES OF DEATH, LIFE TABLES, PROJECTIONS)
97.57.46 - English - I. O. ORUBULOYE, Ondo State University, Ado-Ekiti (Nigeria), and J. B. ONI, Australian National University (Australia)
Health transition research in Nigeria in the era of the Structural Adjustment Programme (p. 301-324)
97.57.47 - English - Patrick O. OHADIKE, UNDP, Lagos (Nigeria)
The African population growth and development conundrum (p. 325-344)
97.57.48 - English - S. Kwesi GAISIE, Department of Demography, University of Botswana, Gaborone (Botswana)
Demographic transition: The predicament of sub-Saharan Africa (p. 345-369)
97.57.49 - English - S. Ryan JOHANSSON, Cambridge Group for the History of Population and Social Structure, Cambridge (U.K.)
Doing "health" research in an unhealthy research environment (p. 371-384)
97.57.50 - English - Peter McDONALD, Demography Program, Australian National University, Canberra (Australia)
Demographic life transitions: An alternative theoretical paradigm (p. 385-392)
Event history analyses, while useful, have limited explanatory power in relation to demographic life transitions. This is because demographic behaviour has a future orientation. People marry, cohabit, have children, divorce or migrate primarily because they have expectations or hopes about how these transitions will affect their lives. Individuals weigh up alternatives about their future within their personal and cultural context. The paper proposes and develops a holistic approach to the investigation of demographic life transitions which revolves around three dimensions: the self, the intimate and the social. Event histories were spawned by the life history approach. The paper argues that we need to get back to examining the histories of lives, that is, how events fit into lives, rather than abstracting events from lives. (METHODOLOGY, EVENT HISTORY ANALYSIS, VITAL EVENTS)
97.57.51 - English - Kenneth S. WARREN, The Picower Institute for Medical Research, 300 Community Dr., Manhattan, New York 11030 (U.S.A.)
Rationalizing health care in a changing world: The need to know (p. 393-403)
The World Development Report 1993 announced that global life expectancy was then 65. Experience in the developed world suggests that the World Health Organization's dictum, 'health is a state of complete physical, mental and social well-being', is simply not attainable for the foreseeable future. As physical health has improved, mental problems have become more prominent and a sense of well-being has declined. Furthermore, as the population ages and medical technology improves, the cost of health care grows almost exponentially. Since the population of the developed world is continuing to age and aging is spreading rapidly throughout the developing world, knowledge is the principal way of dealing with this seemingly intractable problem: we must know, quantitatively, the age-specific causes of ill health, and we must know which means of prevention and treatment are effective. Finally, we must apply that knowledge rationally. (RESEARCH, PUBLIC HEALTH, DEMOGRAPHIC AGEING, MORBIDITY)
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