Family Planning and Women’s and Children’s Health: Long-Term Consequences of an Outreach Program in Matlab, Bangladesh

We analyze the impact of an experimental maternal and child health and family planning program that was established in Matlab, Bangladesh, in 1977. Village data from 1974, 1982, and 1996 suggest that program villages experienced a decline in fertility of about 17 %. Household data from 1996 confirm that this decline in “surviving fertility” persisted for nearly two decades. Women in program villages also experienced other benefits: increased birth spacing, lower child mortality, improved health status, and greater use of preventive health inputs. Some benefits also diffused beyond the boundaries of the program villages into neighboring comparison villages. These effects are robust to the inclusion of individual, household, and community characteristics. We conclude that the benefits of this reproductive and child health program in rural Bangladesh have many dimensions extending well beyond fertility reduction, which do not appear to dissipate rapidly after two decades.     

Bangladesh

In Bangladesh the Population Control and Family Planning Division of the Ministry of Health and Population Control has decided to delegate increased financial and administrative powers to the officers of the family planning program at the district level and below. Currently, about 20,000 family planning workers and officials are at work in rural areas. The government believes that the success of the entire family planning program depends on the performance of workers in rural areas, because that is where about 90% of the population lives. Awareness of the need to improve statistical data in Bangladesh has been increasing, particularly in regard to the development of rural areas. An accurate statistical profile of rural Bangladesh is crucial to the formation, implementation and evaluation of rural development programs. A Seminar on Statistics for Rural Development will be held from June 18-20, 1980. The primary objectives of the Seminar are to make an exhaustive analysis of the current availability of statistics required for rural development programs and to consider methodological and operational improvements toward building up an adequate data base.     

Thinking about several problems of the research of our family planning strategy]

On the basis of 1982 census data, it is estimated that from 1987-1997 13 million women will enter the age of marriage and child-bearing each year. The tasks of keeping the population size around 1.2 billion by the year 2000 is arduous. Great efforts have to be made to continue encouraging one child/couple, and to pursue the current plans and policies and maintain strict control over fertility. Keeping population growth in pace with economic growth, environment, ecological balance, availability of per capita resources, education programs, employment capability, health services, maternal and child care, social welfare and social security should be a component of the long term development strategy of the country. Family planning is a comprehensive program which involves long cycles and complicated factors, viewpoints of expediency in guiding policy and program formulation for short term benefits are inappropriate. The emphasis of family planning program strategy should be placed on the rural areas where the majority of population reside. Specifically, the major aspects of strategic thrusts should be the linkage between policy implementation and reception, between family planning publicity and changes of ideation on fertility; the integrated urban and rural program management relating to migration and differentiation of policy towards minority population and areas in different economic development stages. In order to achieve the above strategies, several measures are proposed. (1) strengthening family planning program and organization structure; (2) providing information on population and contraception; (3) establishing family planning program network for infiltration effects; (4) using government financing, taxation, loan, social welfare and penalty to regulate fertility motivations; (5) improving the system of target allocation and data reporting to facilitate program implementation; (6) strengthening population projection and policy research; (7) and strengthening training of family planning personnel to improve program efficiency.     

Bangladesh: programs geared to meet population goals; communication as a major factor in UNFPA funded projects

The population policy of Bangladesh is aiming for a zero population growth rate at a suitable level of equilibrium. It is hoped that a net reproductive rate of 1.0 will be achieved by 1990, and that by 1985 fertility will be reduced to replacement level. Various measures to attain these goals have been suggested and they include such ones as the integration of family planning programs with other development efforts through a multisectoral approach and the introduction of incentives and disincentives for acceptance of the idea of the small family. Communications by radio and television play a critical role in the program to reduce fertility. UNFPA-funded projects emphasize education, motivation, and communication with the hope of creating a favorable attitude towards family planning and the concept of the small family. Numerous projects in progress are mentioned with regard to their current status. These projects include: rural development cooperatives and population education; pilot projects for family planning motivation and services in industry and on plantations; population education in agricultural extension; strengthening (IEM) information, education, and motivation and training; population awareness for out-of-school youth; a population education program for the Ministry of Education; and a national population information service.     

Incentives help delay marriage among Bangladeshi girls

In Bangladesh, especially in the rural areas, education has been affordable only for the wealthy. In view of such a situation, the Bangladesh government instituted two incentive programs. One scheme provides wheat to parents of poor primary school boys and girls, and the other offers scholarship money to female secondary school students. Both programs eliminate school fees and provide free books. Aside from the above, a nongovernmental organization, Bangladesh Rural Advancement Committee, administered another program for primary-school students that also provides books and stationery, as well as eliminates fees. This paper assessed the effects of these programs on various aspects of the boys? and girls? lives. Overall, findings showed that the three programs created significant influence on increasing the number of children who were attending a grade appropriate for their age, although impacts on the number of hours spent in school activities are different. With shorter hours spent in school, depending on grade, children still had the time to make significant contributions to the family economy. Finally, the research shows that the secondary school scholarships had an immediate effect in delaying marriage. If sustained, these delays can have considerable long-term implications for women's status, as early marriages have long been strongly associated with gender inequality.     

Adolescent fertility programs: responding to the needs of today's youth

The 1983 conference on Adolescent Fertility Management in Asia and the Pacific provided a forum for sharing information and experiences. The project was designed to stimulate interest in and strengthen existing programs on adolescent fertility in participating countries, i.e., Bangladesh, Fiji, India, Indonesia, Nepal, Philippines, Sri lanka, and Thailand. Specifically, the conference sought to identify adolescent fertility problems and share experiences in managing adolescent fertility programs, identify gaps in the development and implementation of adolescent fertility programs and projects, and formulate plans to meet the adolescent fertility needs of the participating countries. Capsule presentations of the experiences of the participating countries are presented. Focus is on the projects they have undertaken and proposed activities. In Bangladesh Jatio Tarum Sangha, the national youth organization, seeks to get youth involved in family planning activities through information/education/motivation programs and community development projects. Fiji proposes to establish a youth center to be operated by the Ministry of Health to reduce the incidence of unplanned pregnancy and sexually transmitted diseases in adolescents and to make them more aware of sex-related health problems and the importance of responsible sex. India's Family Planning Association has initiated population education programs for youth. Several projects have been launched in Jakarta to cope with adolescent fertility problems including the adolescent health project, the Consultation Center for Adolescents, and the university-based family health project. The Family Planning Association of Nepal has completed some major programs under its youth project. The Philippines' proposed youth centers are planned to respond to the fertility related needs and problems of Filipino adolescents. Innovations of the center are: the operation of several youth-serving government and private agencies under 1 roof, and encouragement of youth participation in designing and running the center. Sri Lanka does not have much of an adolescent fertility problem. Virtually all fertility is said to occur within marriage. A study on adolescent fertility is planned. Thailand has launched several government and nongovernment programs to reach adolescents both in and out of school. Government programs include counseling services and the National Family Planning Communication for Premarriage adolescents. Key issues are identified and recommendations are made.     

Policies for fertility reduction: focus on Asia

Fertility can be affected by many factors. Over the long run, socioeconomic development has a decisive effect on reducing fertility. But in the short run, its effects are mixed. Providing greater educational opportunities, particularly for women, typically leads to lower fertility. Urban fertility tends to be much lower than rural fertility since urban residents have better access to information and health care. To the degree that governments are able to extend the reach of the modern sector to rural areas, they may be able to reduce fertility without encouraging urban growth. The effects of income on fertility are mixed: given sufficient time, higher incomes lead to lower fertility; but rising incomes in developing countries can, in the short run, increase fertility. Socioeconomic development factors, however, have less effect on fertility than do fertility dynamics at the individual level. Age at marriage, duration of breastfeeding, and use of contraceptives have important implications for fertility reduction policies. The contribution of of these factors to fertility control have been analyzed for a number of Asian and Pacific countries. Breastfeeding plays a key role in controlling fertility in Pakistan, Nepal, Bangladesh, and Indonesia. Later marriages compensate for lower breastfeeding levels in controlling fertility in other Asian and Pacific countries. The contribution of contraception to fertility control varies from 2% in Nepal to as much as 28% in Thailand. A low total fertility rate is almost always the result of relatively widespread use of contraceptives. Fertility rate reduction in India, Thailand, Indonesia, and Korea in he 1970s can largely be explained by increases in contraceptive usage.     

The Bangladesh fertility decline: an interpretation

The claim has been made, notably in a 1994 World Bank report, that the Bangladesh fertility decline shows that efficient national family planning programs can achieve major fertility declines even in countries that are very poor, and even if females have a low status and significant socioeconomic change has not occurred. This article challenges this claim on the grounds that Bangladesh did experience major social and economic change, real and perceived, over the last two decades. This proposition is supported by official data and by findings of the authors' 1997 field study in rural southeast Bangladesh. That study demonstrates that most Bangladeshis believe that conditions are very different from the situation a generation ago and that on balance there has been improvement. Most also believe that more decisions must now be made by individuals, and these include decisions to have fewer children. In helping to achieve these new fertility aims, however, the services provided by the family planning program constituted an important input.     

Women's lives and rapid fertility decline: Some lessons from Bangladesh and Egypt

The recent experiences of Bangladesh and Egypt show thatfertility can sustain impressive declines even when women's lives remain severely constrained.Since the late 1970s, rural and urban areas in both countries have experienced steadydeclines in fertility, with recent declines in rural Bangladesh similar to those in ruralEgypt, despite lower levels of development and higher rates of poverty. This paperprovides an in-depth exploration of the demographic transition in these two societies andaddresses three basic questions: (1) have measurable improvements in economic opportunities forwomen been a factor in the fertility decline?; (2) can preexisting differences in gender systemsexplain the more rapid fertility decline in Bangladesh, despite the more modest economicachievements?; (3) can the development strategies adopted by the governments ofBangladesh and Egypt, be seen as additional factors in explaining the similar rural fertilitydeclines despite dissimilar economic circumstances? The paper concludes that neither gender systemsnor changes in women's opportunities appear to have contributed to declining fertility.Indeed, low levels of women's autonomy have posed no barrier to fertility decline in eithercountry. However, there is a case to be made that Bangladesh's distinct approach to development,with considerable emphasis on reaching the rural poor and women and a strong reliance onnongovernmental institutions, may have played a part in accelerating the transition in thatenvironment and in helping women to become more immediate beneficiaries of that process.

     

Rural electrification and fertility change

This article addresses the possible linkage between the spread of electrification in rural areas and subsequent declines in human fertility. Evidence from nine studies in six countries is reviewed and compared. The conclusion from this review is that there is, in fact, some link and that the higher the level of rural electrification the higher is contraceptive prevalence and the lower is the level of fertility. This link appears puzzling at first glance, but the article proposes a conceptual and theoretical framework for interpreting these results and fitting them into accepted theories of fertility. Finally, some important policy implications are discussed and future directions for research indicated.This paper was prepared for a workshop on The Relationship between Rural Electrification and Fertility Decline sponsored by the National Rural Electrical Cooperatives Association and the Population Issues Research Center of Pennsylvania State University. The workshop was held in Washington, D.C. on November 15, 1984. (Copies of a summary of the proceedings of the workshop can be obtained from Mr. Philip P. Costas, International Programs Division, National Rural Electrical Cooperatives Association, 1800 Massachusetts Avenue N.W., Washington, D.C. 20036, U.S.A.) The authors received helpful comments on the paper from Richard Bilsborrow, Gretchen Cornwell, Gordon DeJong, Ronald Freedman, and Ozzie Simmons as well as many other participants in the workshop.     

Sub-Saharan Africa: population pressures on development

The population of sub-Saharan Africa, estimated at 434 million in 1984, is expected to reach 1.4 billion by 2025. The birth rate, currently 48/1000 population, continues to increase, and the death rate, 17/1000, is declining. Rapid population growth has curtailed government efforts to provide adequate nutrition, preserve the land base essential for future development, meet the demand for jobs, education, and health services, and address overcrowding in urban areas. Low education, rural residence, and low incomes are key contributors to the area's high fertility. Other factors include women's restricted roles, early age at marriage, a need for children as a source of security and support in old age, and limited knowledge of and access to modern methods of contraception. Average desired family size, which is higher than actual family size in most countries, is 6-9 children. Although government leaders have expressed ambivalence toward development of population policies and family planning programs as a result of the identification of such programs with Western aid donors, the policy climat is gradually changing. By mid-1984, at least 13 of the 42 countries in the region had indicated that they consider current fertility rates too high and support government and/or private family planning programs to reduce fertility. In addition, 26 countries in the region provide some government family planning services, usually integrated with maternal and child health programs. However, 10 countries in the region do not support family planning services for any reason. Unfortunately, sub-Saharan Africa has not yet produced a family planning program with a measurable effect on fertility that could serve as a model for other countries in the region. Social and economic change is central to any hope of fertility reduction in sub-Saharan Africa. Lower infant and child mortality rates, rising incomes, higher education, greater economic and social opportunities for women, and increased security would provide a climate more conducive to fertility decline. Given the limited demand, great sensitivity must be shown in implementing family planning programs.     

Fertility of U.S. farm women during the electrification era, 1930–1950

The research reported here examines the fertility of U.S. farm women during the period in which rural America became electrified. It suggests that electrification was relatedly indirectly to fertility through the impact it had on farm and home production modes, and also through its facilitation of more general socioeconomic change. The model is tested using Census and Agricultural Census data for 473 rural farm counties at three points in time — 1930, 1940, and 1950. Overall, the results of multivariate analyses generally support the conceptual model. The effects of farm production/technology factors, electrification, and sociodemographic characteristics are evaluated using OLS. The effects of electrification net of the other variables are significant when subsamples of Southern and non-Southern counties are examined separately, with electrification related to lower fertility in Southern counties and higher fertility in non-Southern counties. The findings emphasize the importance of considering potential demographic impacts when introducting rural development projects in developing countries.     

农村留守女性人力资源开发问题及其对策研究—以昆明市郊区为例

农村留守女性是改革开放以来在我国农村出现的一个独特的女性群体。本文根据昆明市郊区农村留守女性抽样调查所得的数据，分析了她们在教育、就业、身心健康、社会地位、娱乐休闲等方面存在的问题、特征及其原因，并从人力资源开发的角度提出相应的对策与建议。     

Sex preference and fertility: what is the link?

It is argued that investment in programs for changing attitudes toward sex preference may not have the greatest impact on reducing fertility or increasing fertility control. Arnold's new method of analysis of determining sex preference was applied to data from a 1977 Egyptian survey of 36,000 rural households in Menoufia Governorate. Findings indicated that couples increased their use of modern contraceptives in direct proportion to an increase in the number of sons. Arnold determined that a large majority of all couples would have at least one boy early in their childbearing years. Thus sex preference would not have a large effect on fertility. Arnold's analysis among 27 countries found that without any sex preference, contraceptive usage would increase by an average of less than 3.7 percentage points. Arnold found that sex preference was strongest in Asia, particularly in South Korea and Taiwan that already have reduced fertility levels. In Africa, where fertility is high, the total elimination of sex preference would have only a 2.9 percentage point difference in contraceptive use. Sex preference had small effects on the percent of women who practice contraception, the percent who desire no more children, and the average number of additional children wanted. For example, in Bangladesh having no sex preference would show a percentage difference of 1.6 percentage points for contraceptive use, 4.7 percentage points difference for women desiring no more children, and -0.1 percentage point difference for the average number of additional children wanted. The effect of having no sex preference was strongest in India compared with Bangladesh, Indonesia, Nepal, the Philippines, Thailand, Ghana, Kenya, Costa Rica, Haiti, Paraguay, and Peru. The effect of no sex preference in India would have the respective percentage point effect of 3.7, 8.9, and -0.2. Public policy should be directed to information, education, and communication with other social goals.     

Economic development and fertility decline: lessons from Asia's newly industrialized countries

The general thesis that economic development and fertility decline are interrelated is substantiated in literature that discusses the successes of the newly industrialized countries of Hong Kong, Korea, Singapore, and Taiwan. When countries are developing rapidly, family planning accelerates the rate of fertility change, particularly among the poor uneducated rural population. Relying on economic and social development is not enough. National policy in Hong Kong, Singapore, Korea, and Taiwan recognized that population growth drains resources and the family planning programs operating since the 1960s contributed to a drop from 5 children/woman to 2 by 1988, and 70% of married couples used contraception. Coupled with this, age at marriage rose, contraception became more available, and educational and employment opportunities increased. Economically, the growth rate in the 1980's was 6-10% annually, with growth in the manufacturing and service sectors and export trade. Close economic ties evolved between governments and private sectors. Social development programs had been fully funded and gains evident in education, living standards, health care and nutrition, and life expectancy. The success of family planning is attributed to encouraging contraceptive awareness and use. Fertility reduction may occur with social and economic development, but no developing countries have reduced fertility without family planning. The relative importance of family planning may change over time, and reducing the cost through government sponsored family planning programs and encouraging the acceptability of contraceptive usage.     

Socioeconomic determinants of China's urban fertility

This paper examines socioeconomic forces other than population policies and family planning programs that have affected the fertility transition in urban China. The authors argue that before and since the intensification of population planning activities, the government influenced fertility directly and indirectly through socialization of the economy, the transformation of the Chinese family, and the provision of education, employment, health, medical, welfare, cultural, and related services in urban areas. The various social institutions and subsystems of society have greatly weakened the motivation for large families. The byproducts of the slow urbanization process in urban China including housing shortages, unemployment, rising living standards, changes in the cost of raising a child, and urban-rural downward mobility have affected the social and economic costs of childbearing, which in turn have affected the postponement of childbearing. Thus, our considerations of urban China's fertility transition must be broadened to include the issues of social development strategy in Chinese urban experience.     

城市化的城乡差别效应和城乡协调发展

城市化作为人口和地域的乡 -城转化过程 ,必然会对城市和乡村两个方面产生各种差别效应。深入研究这种差别效应 ,对统筹城乡发展 ,具有重要意义。本文主要利用 2 0 0 0年人口普查省内迁移有关数据 ,分析乡 -城迁移体现于收入水平、年龄结构、生育水平、受教育程度、劳动就业、人口分布等特征的城乡差别效应。认为全面建设小康社会 ,必须充分注意城市化的差别效应对城乡协调发展的影响 ,实施城乡协调型的城市化战略 ,走城市化推动型的城乡协调发展道路。     

Women in development: the road toward liberation

Although women in the Philippines traditionally enjoyed considerable independence and equality, 3 centuries of Spanish colonialism greatly effaced their rights. The importance of the role women can play in development was highlighted at a recent consultation-workshop jointly sponsored by the FAO and the Population Center Foundation. Although 82% of Philippine women are literate, female education is accorded much less importance than that of males, and girls are often forced to discontinue their schooling early to help in housework. Rural Filipino women marry younger than their urban counterparts, and their fertility is correspondingly higher. Only 13% of rural women practice birth control. Participation of Filipino women in community affairs is mostly in social activities, although a few privileged women have gained elective office. The legal status of Filipino women is inferior to that of men in the areas of mixed marriage, choice of residence, parental authority, property rights, right to work, court suits, legal separation, and widow's rights. Labor force participation among women is only 1/2 that of men. As of 1975 only 0.6% of women workers occupied administrative or managerial positions. The National Commission of the Role of Filipino Women was created in 1975 as a coordinating body to promote the advancement of women in all levels of society to enable them to contribute more effectively to the development process. Specific programs carried out by government and private sector groups include extension education for women, basic skills training for income generating projects, community development, and population and family planning projects.     

民族地区农村公共产品供给与农村劳动力转移研究——以新疆为例

农村公共产品供给是影响农村劳动力就业、收入与转移的重要原因。新疆农村劳动力结构中少数民族居多且聚居。主要从事第一产业，剩余劳动力规模巨大。新疆农村劳动力收入水平普遍偏低，仅能维持基本生存，基本无法保障其发展权实现。新疆城乡居民收入差距不断扩大，2007年基尼系数则达到0．4604，突破了公认的警戒线。由于少数民族农村劳动力的素质低。其转移仍较为困难。本文从农村基础设施建设不足、教育投入不足等角度分析了农村公共产品供给不足对农村劳动力就业、收入与转移的制约。并提出了改善上述状况的若干思考。     

A review of the studies on fertility transition in China]

This article is a summary of papers and analysis in recent years on fertility transition and the association between fertility decline and socioeconomic development in China. These papers discuss the causes of fertility decline and the role of family planning programs in demographic transition. The major points are: 1. The demographic transition in China has the same characteristics as in the countries that have completed the transition. The transition had already started in the more developed areas or completed in a few large cities before family planning programs were implemented. 2. The role of family planning programs is to lead and to accelerate the demographic transition, which is the key idea of the "induced fertility transition". 3. The socioeconomic development and family planning programs worked together to affect the fertility decline, however socioeconomic development is the fundamental factor. Without the existence of the socioeconomic development, which included the changes in the function of family, traditional ideas on fertility, increased level of education, the status of women and social security system; the family planning program is not likely to make an impact.