Socio-economic Development, Population Policies, and Fertility Decline in Muslim Countries

Islam is one of the world’s major monotheistic religions. Its followers, spread all over the world and numbering about 1.5 billion people, constitute about one-fourth of the world’s population. The Economist (2003). Muslims are mainly concentrated in about 50 countries, most of which have had slow pace of fertility transition, mainly due to low level of socio-economic development, on the one hand, and lack of effective population policy, on the other. With the help of macro level data available on Muslimmajority countries, this paper examines fertility decline in these countries, their socio-economic indicators, and support for family planning. Examples from two neighbouring countries—Pakistan and Iran—are also given.Population Policy, Fertility

Changing Demographic, Social, and Economic Conditions in Karachi City, 1959–94: A Preliminary Analysis

Kingsley Davis (1961) had argued that the reason that the ancient cities failed to survive was that they were too deadly. He suggested that “three of their (cities) main traits....the crowding of many people in little space, their dependence on widespread contacts (due to in-migration), and their wealth...laid them open to contagious diseases, environmental contamination, occasional starvation and warfare”. Even in the medieval age, some European cities provide examples of such problems; but especially so following the Industrial Revolution. Do the events of the 1980s and the 1990s in Karachi suggest that the city may be heading in the same direction. Recently, The Times London in a lead article in November 1994, labelled Karachi as a “City of Riches and Shattered Dreams”. It further said that Karachi had grown into a megalopolis where life moved fast and street violence had become a norm. Indeed, more than 65 percent of Pakistan’s industries and 80 percent of its finance, banking, and business are concentrated in the city and people come to it from all over the country to find jobs and fulfil their dreams [Husain (1994)]. During the past decade, street violence in the form of ethnic clashes has become a sort of regular event in Karachi. At times, these clashes have been more frequent and even bloodier than the ones before. According to the local newspaper accounts, between 1985 and 1988 (in four years), about 400 people died in Karachi due to violence, which has increased substantially over time. Thus, while the number of violent deaths remained between 350–500 during 1991–93, in 1994 alone the number exceeded 1,100, and during the first three months of 1995, over 300 persons have died due to violence.

Poor Performance of Health and Population Welfare Programmes in Sindh: Case Studies in Governance Failure

Over the past few years, the issue of what is meant by “good governance” has generated increasing attention and debate both at the national and international level [Streeten (1997)]. The role of state and how that role is to be exercised is appearing high on the agenda of politicians, policy-makers and academicians in the developing world. Governance has been defined by the World Bank as “the manner in which power is exercised in the management of the country’s economic and social resources” [World Bank (1994)]. The somewhat narrow scope of this definition has been broadened in recent years to “the sum of the many ways individuals and institutions, public and private, manage their common affairs” [Commission on Global Governance (995)] The Human Development Report [UNDP (1999)] goes beyond these definitions and gives a much more radical notion of good governance, underpinning the importance of peoples’ participation in shaping their own governance and development. This type of governance has been labeled as “humane governance”. A review of existing literature thus shows that governance has been interpreted to have different elements such as management of economic and social resources for development, formulation and implementation of policies, discharging of functions, accommodation of diverse interests towards cooperative action and above all, accountability to people and ownership by the people of the governance process. In view of the above, one may ask what constitutes good governance for the health sector? Management of resources pertains to the concept of efficiency, a term appearing with increasing frequency in global literature on health care reforms; policy formulation and discharging of functions allude to the objective of effectiveness which itself has a wide scope encompassing relevance, quality and availability of health care; while “humane governance” brings in the notion of community participation and accountability with regards to decision-making and delivery of health care.

Socio-economic Development, Population Policies, and Fertility Decline in Muslim Countries

As societies transform from a predominantly traditional to a predominantly modern system, they tend to experience considerable demographic changes. Coale (1984) notes that this “transformation is the substitution of slow growth achieved with low fertility and mortality for slow growth maintained with relatively high fertility and mortality rates”. Demographic transition in Muslim countries is a fairly late phenomenon as discussed in the next section. Most of these countries have followed a similar trend as by many other developing countries. According to the most recent estimate provided by The Economist [September (2003)], the number of Muslims was 1.5 billion in 2003, of which about 97 percent were living in Asian and African countries. About one fourth were concentrated in South Asia and another one-fifth in the Middle-East and North Africa (Arab countries). Figure 1 provides the breakdown of Muslim population living in different regions of the World. Percentage of population in major Muslim countries and their estimated number at the beginning of the 21st Century are given in Table 1. Of 47 Muslim-majority countries, where more than 50 percent of the total population is reported to be followers of Islam,1 36 have populations that are more than 85 percent Muslims, while only seven of them contain less than 70 percent Muslims. However, the six largest Muslim-majority countries (in order, Indonesia, Pakistan, Bangladesh, Iran, Turkey and Egypt) contain about two-thirds of th

Changing Demographic, Social, and Economic Conditions in Karachi City, 1959–94: A Preliminary Analysis

Kingsley Davis (1961) had argued that the reason that the ancient cities failed to survive was that they were too deadly. He suggested that “three of their (cities) main traits....the crowding of many people in little space, their dependence on widespread contacts (due to in-migration), and their wealth...laid them open to contagious diseases, environmental contamination, occasional starvation and warfare”. Even in the medieval age, some European cities provide examples of such problems; but especially so following the Industrial Revolution. Do the events of the 1980s and the 1990s in Karachi suggest that the city may be heading in the same direction. Recently, The Times London in a lead article in November 1994, labelled Karachi as a “City of Riches and Shattered Dreams”. It further said that Karachi had grown into a megalopolis where life moved fast and street violence had become a norm. Indeed, more than 65 percent of Pakistan’s industries and 80 percent of its finance, banking, and business are concentrated in the city and people come to it from all over the country to find jobs and fulfil their dreams [Husain (1994)]. During the past decade, street violence in the form of ethnic clashes has become a sort of regular event in Karachi. At times, these clashes have been more frequent and even bloodier than the ones before. According to the local newspaper accounts, between 1985 and 1988 (in four years), about 400 people died in Karachi due to violence, which has increased substantially over time. Thus, while the number of violent deaths remained between 350–500 during 1991–93, in 1994 alone the number exceeded 1,100, and during the first three months of 1995, over 300 persons have died due to violence. According to the Karachi Police sources, most of the victims of violent deaths in Karachi during 1994 were men in the age group 13–50

Poor performance of health and population welfare programmes in Sindh: case studies in governance failure

Over the past few years, the issue of what is meant by “good governance” has generated increasing attention and debate both at the national and international level [Streeten (1997)]. The role of state and how that role is to be exercised is appearing high on the agenda of politicians, policy-makers and academicians in the developing world. Governance has been defined by the World Bank as “the manner in which power is exercised in the management of the country’s economic and social resources” [World Bank (1994)]. The somewhat narrow scope of this definition has been broadened in recent years to “the sum of the many ways individuals and institutions, public and private, manage their common affairs” [Commission on Global Governance (995)] The Human Development Report [UNDP (1999)] goes beyond these definitions and gives a much more radical notion of good governance, underpinning the importance of peoples’ participation in shaping their own governance and development. This type of governance has been labeled as “humane governance”. A review of existing literature thus shows that governance has been interpreted to have different elements such as management of economic and social resources for development, formulation and implementation of policies, discharging of functions, accommodation of diverse interests towards cooperative action and above all, accountability to people and ownership by the people of the governance process. In view of the above, one may ask what constitutes good governance for the health sector? Management of resources pertains to the concept of efficiency, a term appearing with increasing frequency in global literature on health care reforms; policy formulation and discharging of functions allude to the objective of effectiveness which itself has a wide scope encompassing relevance, quality and availability of health care; while “humane governance” brings in the notion of community participation and accountability with regards to decision-making and delivery of health care

The hidden figure: sexual intimate partner violence among Pakistani women

Background: The objectives of the present study were to determine the magnitude and factors associated with sexual intimate partner violence (SIPV) in women presenting to tertiary-care hospitals of Karachi, Pakistan. Methods: Five hundred women who presented to four tertiary-care hospitals to deliver were interviewed from September to December 2005. SIPV was assessed by using questions on sexual abuse in WHO Domestic Violence Module designed to determine intimate partner violence. Multiple logistic regression analysis was applied to determine factors associated with SIPV. Results: Twenty-one percent of women reported experiencing sexual violence in their married life. Gravida with five or more pregnancies [adjusted odds ratio (AOR) = 2.78, 95% confidence interval (CI) 1.12-6.96], index pregnancy as unwanted (AOR = 2.64, CI 1.16-6.02) and conflict with in-laws (AOR 1.9 CI 1.14-3.16) were independently associated with sexual abuse. Women who had social support were less likely to be abused by their intimate partners (AOR 0.76, CI 0.58-0.98). Conclusion: One in five women reported spousal sexual abuse in their married life. Women having more than five children, unwanted pregnancies or reporting differences with in-laws are more likely to be subjected to such abuse. Social support protects women from sexual abuse by intimate partner

Knowledge, attitudes and practices (KAP) regarding sexuality, sexual behaviors and contraceptives among college/university students in Karachi, Pakistan

OBJECTIVE: To assess the knowledge, attitudes and practices regarding sexuality, high risk sexual behaviors and methods of contraception, among college/university students of Karachi, Pakistan. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Higher Education Commission-recognized government and private colleges/universities in Karachi from 2005-2006. METHODOLOGY: Two colleges/universities were randomly selected from each category i.e. government medical, government non-medical and private medical and non-medical colleges/universities. Three stage cluster sampling was employed to draw a representative sample of students. A self administered questionnaire was used to elicit information on knowledge, attitudes and practices regarding high risk sexual behaviors, methods of contraception and sources to obtain information about sexual issues. RESULTS: A total of 957 students were interviewed. They comprised 542 (56.6%) males and 415 (43.4%) females with mean age of 21 1.8 years. Bivariate analysis showed that students enrolled in medical colleges/universities were less likely to watch adult films (O.R. 0.7, CI; 0.5-0.9) to acquire sex related knowledge and go out on dates (O.R. 0.6, CI; 0.4- 0.8). Similarly, medical students were less likely to consider contraception as being against Islamic teachings (O.R. 0.7, CI; 0.5-0.9). CONCLUSION: The curricula of non-medical studies at undergraduate level should include education regarding sexual health and contraception

Case-control study of suicide in Karachi, Pakistan

Background: In recent years suicide has become a major public health problem in Pakistan. Aims: To identify major risk factors associated with suicides in Karachi, Pakistan. Method: A matched case-control psychological autopsy study. interviews were conducted for 100 consecutive suicides, which were matched for age, gender and area of residence with 100 living controls. Results: Both univariate analysis and conditional logistic regression model results indicate that predictors of suicides in Pakistan are psychiatric disorders (especially depression), marital status (being married), unemployment, and negative and stressful life events. only a few individuals were receiving treatment at the time of suicide. None of the victims had been in contact with a health professional in the month before suicide. Conclusions: Suicide in Pakistan is strongly associated with depression, which is under-recognised and under-treated, The absence of an effective primary healthcare system in which mental health could be integrated poses unique challenges for suicide prevention in Pakistan

11. Son Preference in Pakistan: Its Effects on Sex Ratio, Preferential Treatment of Boys and Sex Differentials in Infant Mortality

In Pakistan as well as in many other countries in Asia, there is a strong son preference. Using data from the 1998 population census and sample surveys conducted during the past decade, this paper examines: evidence of sex preference in Pakistan; sex ratios at birth; sex ratios among children under five; sex differentials in mortality in infancy and early childhood; and, whether preferential treatment is given to male (over female) children.Since Pakistan has not reached yet a stage of low fertility, sex-selective abortion to the purpose of having a son is rarely practised. Instead, couples who desire to have male children do so by having successive female children until they achieve their goal. Consequently, the sex ratio at birth in Pakistan is currently consistent with the accepted biological norm. Thus, it appears that although there is a strong desire for sons, daughters are not unwanted or grossly neglected after birth. However, a more rapid decline in infant mortality is observed among males than among females.Au Pakistan comme dans de nombreux autres pays en Asie, il existe traditionnellement une forte préférence pour les fils. En utilisant les données du recensement de 1998 et d’enquêtes conduites au cours des dix dernières années, l’auteur étudie les tendances récentes du rapport de masculinité à la naissance et chez les enfants de moins de cinq ans, de même que les différentiels de mortalité infantile et juvénile selon le sexe. Il examine également la possibilité de traitements préférentiels selon le sexe, pouvant favoriser les garçons.Etant donné que la fécondité est encore élevée au Pakistan, les avortements sélectifs selon le sexe sont encore très peu pratiqués. Les couples ne renoncent pas pour autant à un fils, mais acceptent de faire plusieurs tentatives, c’est à dire d’avoir plusieurs filles, avant d’y parvenir. Par conséquent, le rapport de masculinité à la naissance au Pakistan est conforme à la norme biologique. L’auteur démontre également que, en dépit d’une forte préférence pour les fils, les naissances de filles ne sont pas malvenues, et que les filles ne sont pas particulièrement discriminées après leur naissance. Il constate cependant que, ces dernières années, la mortalité infantile des garçons a diminué plus vite que celle des filles