A New Look at the Asian Fertility Transition

The significance of the Asian fertility transition can hardly be overestimated. The relatively sanguine view of population growth expressed at the 1994 International Conference for Population and Development (ICPD) in Cairo was possible only because of the demographic events in Asia over the last 30 years. In 1965 Asian women were still bearing about six children. Even at current rates, today’s young women will give birth to half as many. This measure, namely the average number of live births over a reproductive lifetime, is called the total fertility rate. It has to be above 2— considerably above if mortality is still high—to achieve long-term population replacement. By 1995 East Asia, taken as a whole, exhibited a total fertility rate of 1.9. Elsewhere, Singapore was below long-term replacement, Thailand had just achieved it, and Sri Lanka was only a little above. The role of Asia in the global fertility transition is shown by estimates I made a few years ago for a World Bank Planning Meeting covering the first quarter of a century of the Asian transition [Caldwell (1993), p. 300]. Between 1965 and 1988 the world’s annual birth rate fell by 22 percent. In 1988 there would have been 40 million more births if there had been no decline from 1965 fertility levels. Of that total decline in the world’s births, almost 80 percent had been contributed by Asia, compared with only 10 percent by Latin America, nothing by Africa, and, unexpectedly, 10 percent by the high-income countries of the West. Indeed, 60 percent of the decline was produced by two countries, China and India, even though they constitute only 38 percent of the world’s population. They accounted, between them, for over threequarters of Asia’s fall in births.

Reaching a stationary global population: what we have learnt, and what we must do

Not supplie

The impact of the African AIDS epidemic

Not supplie

Old and new factors in health transitions

The introductory section of the paper notes that the health transition literature suggests a greater range of cultural, social and behavioural influences on health, especially child survival, than has attracted the attention of most social science researchers. They concentrate disproportionately on the impact of parental education, especially maternal education, perhaps because these are measures that are easily quantified and readily available in census and surveys. The major part of the paper discusses the implications of the finding by Preston and Haines that there is little evidence that child survival in the United States a century ago was much affected by mother’s literacy, ethnicity or English-speaking ability. This review draws on that evidence to argue that Third World mortality has in contrast been reduced over recent decades by two imports: modern medical technology and the Western scientific attitude that induces a successful collaboration with the former. This attitude is largely a product of modern education and it is this symbiosis in reducing mortality between modern medical technology and the scientific outlook that explains why steep mortality declines in the contemporary Third World depend both upon providing an easily accessible modern health service (with a significant curative component) and the development of mass schooling (particularly for girls). It also explains the steep differentials in child survival by mother’s education

What have we learnt about the cultural, social and behavioural determinants of health? From Selected Readings to the first Health Transition Workshop

The article explores the issue of whether the holding of an international workshop in Canberra in 1989, and the preparation of papers for it, increased our knowledge of the cultural, social and behavioural determinants of health and whether the publication of the proceedings placed new knowledge in the public domain. The approach adopted is to compare those proceedings with a collection of selected readings on the subject made shortly before as part of the same program and also with certain other publications. The conclusions reached are that, in addition to having stimulated interest in the field, the workshop and its proceedings furthered knowledge in at least five important areas: (1) the existence of mortality-prone households; (2) the impact of differing cultural situations of women in terms of individualism on their children’s survival; (3) the mechanisms whereby maternal education is translated into child survival; (4) the impact of culture and ethnicity on mortality; and (5) indirect indices of the impact of care. The workshop failed to contribute to substantial advances (or draw attention to the lack of advance) in the following areas: (1) the measurement of Third World morbidity or health; (2) adult health transition; (3) the impact of radicalism or egalitarianism in communities other than Kerala and Sri Lanka on mortality; (4) the impact of lifestyle diseases on Third World mortality; (5) the identification of economically optimum mixes of social change and the provision of health services in reducing mortality and improving health; and (6) the employment of health transition knowledge in the reduction of mortality and the improvement of health

Intervention strategies suggested by the Nigerian segment of the SAREC program on sexual networking, STDs and AIDS

The primary purpose of this paper is to survey the behavioural findings of the Nigerian program and to draw conclusions about the most needed interventions, and those most likely to be successful, in combating sexually transmitted diseases and HIV/AIDS. The emphasis is on the reduction of transmission of these diseases, partly because the number of Nigerian AIDS cases is as yet much smaller than was feared when the research program began. The Nigerian program began in 1989. It has always had two components. The first is a field research program, largely but not entirely focused on Ondo State; it was originally based in the Faculty of Social Science, Ondo State University, Ado-Ekiti, and has since been transferred to the University's Centre for Population and Health Research. Parallel to this work, there had been developed a research program initiated by the West African Research Group on Sexual Networking (WARGSN). This Group has comprised 20 researchers based in 15 institutions, mostly in Nigeria and Ghana. Finally, the paper refers briefly to experience reported by the SAREC programs in Ghana and Uganda which have as yet no parallel in Nigeria, but which are important for a comprehensive examination of the situation

Men's sexual behaviour in urban and rural Southwest Nigeria: its cultural, social and attitudinal context

Not supplie

The cultural, social and attitudinal context of male sexual behaviour in urban south-west Nigeria

From 1989 onward a research program based at Ondo State University, Nigeria, investigated the social and behavioural context of the sexually transmitted disease and AIDS epidemics (Orubuloye et al. 1994). Between 1989 and 1993 the researchers reached the conclusion that premarital and extramarital sexual activities were on a sufficient scale in Ondo State to maintain an STD epidemic and possibly to maintain an AIDS epidemic. The reason for caution with regard to AIDS arose from an awareness of the current relatively low seroprevalence levels in Nigeria and the demonstration by the program that much of the premarital and extramarital sexual activity was not with prostitutes but diffused more widely. The researchers also concluded that the economic returns to young women from commercial sex were so substantial and the current and later social sanctions so weak that no government intervention was likely to reduce the inflow of recruits to the occupation sufficiently to stem the STD epidemic or reduce the risk of a major AIDS epidemic. Clearly something would be achieved by a program aimed at increasing the practice of safe sex, especially the use of condoms, by everyone participating in sexual networking, particularly prostitution. There was little evidence that specific planned intervention was already achieving much, although some evidence that government and media AIDS publicity was raising the level of condom use in prostitution. There also seemed to be a need for STD education and curative interventions on a much greater scale. Nevertheless, until the achievement of decisive biomedical breakthroughs to halt the AIDS epidemic, the research increasingly suggested that the best chance of halting the AIDS epidemic and mitigating the impact of STDs was a change in male sexual behaviour

A note on suspect practices during the AIDS epidemic: vaginal drying and scarification in southwest Nigeria

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

A screening, referral, and follow-up program for high blood pressure at Henry Ford Hospital: Part II. Results of referral and follow-up

This is the second of two articles on the Henry Ford Hospital screening, referral, and follow-up program for high blood pressure. The first reported on the screening results of the program, along with associated epidemiological findings. This article presents the results of referral and follow-up. During the period of March 27 through December 11, 1975, 808 people were screened; 196 (24%) were found to have uncontrolled high blood pressure and were referred to physicians for diagnosis and possible treatment for hypertension. The program is currently following up with these people and their physicians to insure successful referral and maintenance of treatment. This paper outlines the overall procedures used for screening, referral, and long-range follow-up. It also presents an evaluation of these procedures, along with outcome data after an average duration often months of follow-up. As of June, 1976, the success rates recorded by the program Include the following: (a) of all people referred for high blood pressure, 86% were successfully referred (had visited a physician for this condition); (b) of the group successfully referred, 90% had entered (or re-entered) treatment for hypertension; and (c) of those under treatment, 67% were showing successful treatment (blood pressure below 140/90) or progressing toward successful treatment (blood pressure below the screening levels of 160/96)