Fertility decline in Bangladesh: an emerging family planning success story

Bangladesh has a population of 115 million people, and the economic growth rate of 3.7% during the 1980s was undermined by rapid population growth. The annual population growth rate was 3% in the 1960s and early 1970s, 2.5% between 1981-91 decreasing to 2.3% in 1991. The average of number of children is 4.6/woman compared with 7 in the 1960s. Infant mortality dropped from 150/1000 births in 1976 to 118/1000 in 1991. Life expectancy rose from 47 to 54 years. The 1991 Contraceptive Prevalence Survey showed that 39.9% of married women under 50 use contraceptives in 1991 vs. 18.6% in 1981. The use of modern methods increased from 10.9% in 1981 to 31.2% in 1991, while traditional methods rose from 7.7% to 8.7%. Sterilization was most prevalent in 1981. 29,000 female family planning (FP) workers were aggressively engaged in dispensing FP services in 1990. The Social Marketing Company sells pills, condoms, and oral rehydration salts through 130,000 retail outlets. The 1989 Contraceptive Prevalence Survey showed that 40% of pill and condom users obtained them from this network, and 95.4% of women knew about 4 methods of contraception. In 1990 there were 120 private organizations providing contraceptive services. Some of the components of the government FP program include field worker distribution door-to-door of injectable contraceptives (50% injectable usage rate in the Matlab project); recordkeeping activities; a satellite clinic network with access to contraceptive services; and decentralization through the Upazila (subdistrict) approach. The logistics system of FP has improved the warehousing, transportation, and management information system. Foreign aid (mainly USAID) financing of contraceptives helped avert 14.4 million births between 1974-90. The increase of contraceptive prevalence to 50% by 1997 would avert another 21.9 million births during 1991-96 (replacement fertility requires 70% prevalence.     

Determinants of fertility and the unmet need for family planning in Indonesia

Indonesia's fertility has declined to an average of slightly more than 3 children/woman. The islands of Java and Bali have the lowest birth rates. Indonesia's family planning program has been a model of innovation, flexibility, and community involvement, and has been effective in reducing fertility, changing family preferences, and increasing contraceptive use. Fertility decline is also determined by factors other than contraceptive use, as provinces in Jakarta and East Java has low fertility and low contraceptive use. Recent research by Suyono and Palmore found that among cohorts of women in Jakarta lowest fertility rates were explained by greater nonexposure to pregnancy in an unmarried state or by a divorced or widowed status, and by infecundity. In East Java, fertility determinants were the same with the possible addition of lower coital frequency. The study estimated nonexposure due to marriage, infecundity, and contraceptive use. Policy considerations, however, are concerned with the exposed state of the percentage of time women are currently married, fecund, not using contraceptive, and sexually active. Suyono and Palmore also calculated the percentage of time spent in the exposed state by province. The estimates ranged from 12% in Yogyakarta to 25% in West Java and the Outer Islands. Exposed was further divided into groups with a manifest, latent, and no current need. Women with a manifest need for family planning are those who are aware of their contraceptive needs to stop or postpone childbearing and not using. Manifest need was highest in high fertility areas: 12% in Central Java, 13% in West Java, and 12% in the Outer Islands. Programs targeting these women should focus on wider availability of information and services. Women with latent needs are unaware of their need for family planning and are not using contraception. These women were also concentrated in high fertility areas. The percentage of years spent in the latent unmet need state was estimated at 23-24% in West Java and the Outer Islands. Program emphasis should be on education and motivation to show how family size can be controlled. Women with current need can be educated toward future acceptance.     

Shifts in household demographics herald economic changes for Thailand

In Thailand, dramatic changes in households and the health status of the population have led to important implications for the economic sector. These changes affect health, education, housing, employment and transportation. A new book on the economic impact of demographic change by Andrew Mason and Burnham O. Campbell is referred to as a full discussion of the issues. National planning and projections must include household characteristics as well as numerical projections. The analysis of Mason and Campbell is summarized in this article. Important changes are occurring in the size, rate of growth, and age structure of Thailand's population. Life expectancy has risen to 63 years for men and 68 years for women. Fertility has fallen to 2 children/woman. Population growth was 1.9% in 1990. In 1990, there were only 1 in 3 under the age of 15, and these numbers are expected to shrink to 1 in 4 by the year 2000. 60% of the population is of working age; this is expected to increase to 65% by the year 2000. The 60 years old population is expected to be 7.5% of the total in the year 2000. The average household has 1.6 children. 96% of households live with a relative. The expectation is that household size will continue to decrease and the number of households will continue to grow. The number of elderly heads of households is expected to rise to 11% by 2010. Households will become "adultified." The policy implications for education are that the school age population will gradually decreases but the number enrolled will increase. Primary school enrollment will stabilize and then decline after 1995. Secondary school enrollment will increase and level off in 2005. Total enrollment will increase from 10.5 million in 1990 to 11.4 million in 2000 and decline to 10.7 in 2015. These changes will allow for improvements in the quality of education and expand educational attainment. In health care, the demand for maternal and child health services will decline; changes will occur in the kinds of medical care needed.     

Social Return on Investment Analysis

This article uses a social return on investment (SROI) methodology to analyze the social impact of a social enterprise offering a job and skills training program to an unemployed, largely female population. The social enterprise is based in Toronto (Canada) and run by a nonprofit agency dedicated to the advancement and empowerment of women, primarily immigrants, through access to employment. We focus our analysis on a job and skills training program that provides clients with the skills and tools that they need to successfully seek employment in their efforts to (re‐)enter the Canadian labor market. Our goal is to determine the tangible and intangible program outcomes by applying and testing the SROI methodology.     

Projection and Misperception in Couples Treatment

Projective identification is discussed as an interpersonal mechanism involved in distortions of perceptions and communications. Several case illustrations are presented to show how this mechanism manifests itself in relatively healthy, though neurotic, couples. A treatment approach based on correction of the perceptual distortions is suggested as a model for short-term counseling with such couples.     

Developing a variables repetitive group sampling plan based on process capability index C pk with unknown mean and variance

In this paper, variables repetitive group sampling plans are developed based on the process capability index C _pk when the quality characteristic follows a normal distribution with unknown mean and variance. The sampling plan parameters such as the sample size and the acceptance constant are determined to minimize the average sample number. Symmetric and asymmetric cases, in percent defectives due to two specification limits, are dealt with for specified combinations of acceptable quality level and limiting quality level. Tables are provided and examples are given to use proposed plans in practice.     

Family planning's benefits include improved child health and nutrition: new data from Bangladesh

2 recent studies from the Matlab in Bangladesh confirm that family planning promotes child survival. The 1st study is a longitudinal analysis of 3370 births in 1985 to women living in 70 villages who were served by the International Centre for Diarrhoeal Disease Research, Bangladesh's Matlab Family Planning and Health Services Project. The 2nd is a study of 12-26 month old children and 24-36 month old children, all of whom were born in the same 70 villages between July 1985 and June 1986. The 1st study demonstrates that family planning improves child survival by lengthening the birth interval. In fact, if women delay a subsequent birth by about 2 years, child survival improves at all ages up to 5 years. Longer birth intervals result in a reduction of very high order births. The same study also reveals that family planning improves child survival indirectly by granting mothers access to integrated maternal and child health services. The 2nd study indicates that a child is 3 times more likely to suffer malnutrition, even at age 3, than a child whose mother gives birth again at an interval greater than 24 months. Specifically, the mother removes the index child from the breast prematurely, thereby adversely affecting the index child's nutrition. The birth interval prior to the index child does not adversely affect the index child's nutritional status, however. The 2nd study's result suggest that birth spacing, as promoted by family planning programs, improves child health and nutrition. The findings from these studies show the importance of continued investments in family planning programs in developing countries.     

Apocalypse when? Population growth and food supply in South Asia

Food demands for staple grains are expected to almost double over the next 25 years in South Asia, due to population growth and increased standards of living. Trends in the mid-1990s suggest that neither pessimism nor optimism prevails in the region. There is wide diversity among and within countries. Trends suggest that population densities are already the highest in the world, and the amount of arable land is declining. Urban growth has moved onto farm land and farmers have been pushed onto more marginal lands or have become landless. Land intensification has produced mixed results. Cereal production per capita has increased since the 1950s in India, with about 75% of the region's population, but Pakistan's increases were not sustained into the 1980s. Average daily caloric intake per person in the region of 2214 is below the level in Sub-Saharan Africa. In Bangladesh, levels are particularly worrisome at 2037. The environmental impact has not been easily quantified, but experts have suggested that pressure on farm land has contributed to loss of soil fertility and water resource loss. Further intensification of farming is feasible, but difficult and more expensive than in the past. Regardless of production problems and solutions, there is also the very real problem of poor food distribution and lack of purchasing power. Farm management skills must be utilized, if environmental degradation is to be avoided. There is the added unknown of what climate changes will occur and how agricultural production will be affected. The policy implications are that increased food production must be made a political priority. Policies must support agricultural research into improved technologies and support distribution of technological advances to a wider number of farmers. Rural infrastructures such as roads, market outlets, and credit agencies must be established. Policies must be removed that disadvantage farmers, such as inappropriate subsidies for irrigation water, inadequate tenure agreements, and price setting. Slowing population growth provides time to adjust to expanding production and saving the environment.     

Conceptions of Progress: How is Progress Perceived? Mainstream Versus Alternative Conceptions of Progress

Progress is a powerful political concept, encompassing different and sometimes contradictory conceptions. This paper examines the results of a survey on progress conducted at the OECD World Forum entitled “Measuring and Fostering the Progress of Societies” held in Istanbul in June 2007. First, a distinction is drawn between the two approaches to progress (skeptical and optimistic) and four theories of progress (Liberal, Social Liberal, Green, and Conservative). Second, the survey results are examined in order to find the prevailing conception among the participants. Findings show that while the literature regards the Liberal, economically based theory of progress as sitting at the heart of the mainstream conception of progress, it is notable that, in fact, there emerged among the participants a different mainstream conception of progress: one that is optimistic in approach, yet both Social Liberal and Green in its theory.