Older Women's Health and Its Impact on Wealth

As many elderly women tend to outlive their spouses, there is a growing population of unmarried elderly women. Unmarried women are worse off than married women both financially and physically. A question that has not been answered is whether and how the relationship between health and wealth differs across elderly women's marital status. Do the negative impacts of health problems cause more serious financial consequences for unmarried elderly women than married women? Using the five waves of data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) from 1993 to 2002, this question is empirically investigated. Results indicate that severe chronic conditions result in 4 to 10% greater wealth depletion for unmarried women than married women. This finding calls for heightened awareness of the negative financial consequences of health problems and also calls for increased lifetime earning potential, reconsideration of women's retirement benefits, and greater attention to preventive care.     

对我国育龄妇女生育健康状况的分析——个体指标的应用实例

本文利用 1997年全国人口与生殖健康调查数据 ,应用作者提出的育龄妇女生育健康个体指标 ,从人口、社会、经济几个方面对我国育龄妇女生育健康状况的部分影响因素进行了定量分析。分析结果显示 ,我国育龄妇女的生育健康状况及存在主要问题与妇女年龄、文化程度、居住地及社区环境密切相关。文章最后根据分析结果 ,对改善我国育龄妇女生育健康状况提出了几点建议     

Sex and sexual orientation: the effect of group membership on individuals' judgments about self and others' HIV risk

No previous study has directly compared homosexual and heterosexual men and women's perceptions of HIV risk. In fact, empirical research focusing on homosexual women's perception of HIV risk is scarce. This paper, therefore, examines whether homosexual and heterosexual women and men (N = 60) make varied self and other (peer and non-peer) HIV risk judgments. The paper also examines the roles of motivational (health anxiety) and cognitive (HIV knowledge) factors in relation to HIV risk judgments. The results show that each group held different perceptions of risk for various "other" groups. Only homosexual men showed evidence for an optimistic bias, whereas homosexual women showed evidence of realistic perceptions. Both cognitive and motivational factors were shown to be associated with risk judgments for homosexual women and heterosexual men. Methodologically the use of Multidimensional scaling as an analytic strategy is recommended.     

育龄妇女生殖健康状况及其影响因素分析

0 77%的妇检者查出患有疾病 ,患病率在地区、城乡、年龄和受教育程度间呈极大差异 :居民 >村民 ,中部 >西部 >东部 ,少数民族 >汉族。影响妇女生殖健康的因素包括个人行为和社会环境因素 ,涉及个人特征、婚育状况、避孕状态、保健意识、宣传教育等。结果提示 :1 增强自我保健意识 ,提高自我保健能力是有效的预防手段。 2 .生殖保健工作重点在农村和中西部。 3 实现生殖健康目标需要重视教育尤其是对女性的教育     

Adding choice to the contraceptive mix: lessons from Indonesia

Researchers asked 1945 women of reproductive age living in East Java, Indonesia what contraceptive method they preferred during the women's 1st visit to a government family planning clinic. Soon after field workers introduced them to a method, the researchers asked the women what method the field workers suggested and what method the women planned to use. They again spoke to them 1 year later to determine contraception continuation. The field workers granted 86.3% of the women their method choice. Only 9% of these women had stopped using their chosen method while 72% of the women who were not allowed to use their chosen method stopped using the method assigned to them. Thus choice was a key factor in sustained use of contraceptives. Further if family planning workers stick to a mutual participation of both themselves and their clients, they respect clients' method choices and, by informing clients about the chosen method, they strengthen clients' decision making. In the early 1990s, another researcher had developed a system to determine contraceptive needs at various stages of the reproductive period (before 1st marriage, after 1st marriage but prior to 1st birth, after 1st birth but prior to last birth, and after last birth). She applied observed contraceptive preferences for women using contraception within each life cycle stage to the age specific contraception need, derived from data from the 1987 Contraceptive Prevalence Survey for Indonesia, to determine the ideal contraceptive mix. Her calculations demonstrated that oral contraceptive use was high, IUD use was low, particularly among older women, and too few sterilizations had occurred, particularly among older women. Thus Indonesia needed to broaden the contraceptive mix to encourage methods that better meet women's reproductive life cycle needs.     

Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.     

HIV testing,perceptions of AIDS risk,and condom use motivation among US women

As STD infections including HIV increase in the United States, it has become increasingly important to policy makers to ascertain the extent to which knowledge and perceptions of AIDS risk affect an individual's probability of altering their sexual or contraceptive behavior to avoid infection. This paper examines the extent to which women's perceptions of their own and their partners' risk of HIV infection affects the probability of using a condom for protection against sexually transmitted diseases. This paper also examines the extent to which HIV testing may affect motivation for condom use. Crosstabulations reveal that prophylactic condom use is more prevalent among women who have been tested for HIV and increase as perceptions of their chance (and their partner's chance) of being positive increases. The multivariate results from this study indicate that having an HIV test significantly predicts the likelihood of using a condom for STD prevention for US women. Furthermore, women who perceive themselves to be at least somewhat likely to be HIV positive have a higher probability of using a condom to prevent sexually transmitted disease, and women who perceive their partners to be HIV positive are twice as likely as other women to use a condom for STD prevention. However, women who consider themselves likely to be HIV positive are no more likely to use a condom than those who consider themselves not at risk.     

A chronology of the study of older women's health: data, discoveries, and future directions

Women have been traditionally ignored in health and medical research. Some reasons for this mentality include a fear of harming a woman's reproductive ability, fear that variations in the menstrual cycle could confound results, fear that a woman's body could not withstand the rigors of clinical research, and an assumption that male and female body chemistry is similar. Thankfully, these fears and assumptions are being challenged and several major data-bases, designed specifically to study women's health, have emerged. The purpose of this paper is to: (1) characterize the major longitudinal studies on women's health, (2) summarize the major discoveries from these studies that are relevant to older women, and (3) pose several future directions for research throughout the paper.     

Gender inequalities and demographic behavior

A summary was provided of the central findings about gender inequalities in Egypt, India, Ghana, and Kenya published by the Population Council in 1994. These countries exhibited gender inequalities in different ways: the legal, economic, and educational systems; family planning and reproductive health services; and the health care system. All countries had in common a high incidence of widowhood. Widowhood was linked with high levels of insecurity, which were linked with high fertility. Children thus became insurance in old age. In Ghana, women's insecurity was threatened through high levels of marital instability and polygyny. In Egypt, insecurity was translated into economic vulnerability because of legal discrimination against women when family systems were disrupted. In India and all four countries, insecurity was reflective of limited access to education, an impediment to economic autonomy. In all four countries, women's status was inferior due to limited control over reproductive decision making about childbearing limits and contraception. In India, the cultural devaluation of girls contributed to higher fertility to satisfy the desire for sons. In India and Egypt, family planning programs were dominated by male-run organizations that were more concerned about demographic objectives than reproductive health. The universal inequality was the burden women carry for contraception. Family planning programs have ignored the local realities of reproductive behavior, family structures, and gender relations. The assumption that husbands and wives have similar fertility goals or that fathers fully share the costs of children is mistaken in countries such as Ghana. Consequently, fertility has declined less than 13% in Ghana, but fertility has declined by over 30% in Kenya. Family planning programs must be aware of gender issues.     

Taiwan＇s Economy Adversely impacted by Dichotomous Migration Pattern

A survey of 2,002 unmarried women under 24 years of age who requested abortions in four Chinese cities indicates that reproductive tract infection (RTI) has become a major factor affecting the reproductive health of unmarried women having abortions.     

典型贫困地区农村妇女生育观念和健康状况调查与分析

对典型贫困地区农村妇女的调查发现：典型贫困地区农村妇女生育意愿有了较大的进步,但男孩偏好的传统观念仍然根深蒂固;潜在的人口逆向淘汰现象需要引起注意;妇女的身体素质、健康水平和人口质量处于较低水平,将会产生代际间的继承性,影响新农村的可持续发展能力。     

Situation analysis: assessing family planning and reproductive health services. Quality of care

This issue of Population Briefs contains articles on researches conducted by the Population Council concerning the delivery of quality of care, contraceptive development, safe abortion, family planning, demography, and medical anthropology. The cover story focuses on a systematic data collection tool called Situation Analysis that helps managers in program evaluation. This tool has a handbook entitled "The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services" that contains all the information needed to conduct a Situation Analysis study. The second article reports about a new contraceptive method, the two-rod levonorgestrel, which was developed at the Population Council and was recently approved by the US Food and Drug Administration. The third article reports on a medical abortion procedure that was proven to be safe, effective, and acceptable to women in developing countries. Moreover, the fourth article presents initial findings of the Community Health and Family Planning Project conducted in Northern Ghana. The fifth article discusses the paper written by the Population Council demographer, Mark Montgomery entitled "Learning and lags in mortality perceptions". Finally, the sixth article deals with another paper that reports on women's health perceptions and reproductive health in the Middle East.     

Female genital mutilation: common,controversial, and bad for women's health

Female genital mutilation has grave consequences for women's sexuality, health, and fertility. Studies conducted since 1990 have found that 97% of women in Egypt, 94% in Mali, 72% in Northern Ghana, 43% in the Ivory Coast, and 20% in Senegal have undergone female genital mutilation. The Population Council seeks to discourage the continued practice of this procedure in Africa while at the same time respecting cultural norms regarding women's sexuality. Change will require political support, culturally sensitive education, and community development. Current Population Council research projects in North and West Africa are expanding understanding of the cultural, attitudinal, and behavioral factors that influence decisions about female genital mutilation, while Demographic and Health Surveys will provide baseline data on the current prevalence of this practice. An emphasis on the reproductive health implications of female genital mutilation, backed by the support of the medical profession, may prove to be the most effective strategy. Of the 8% of women in the 1995 Egyptian Demographic and Health Survey who indicated they would not have their daughters' genitalia excised, more than 40% cited medical complications as the reason.     

Women’s land ownership and participation in decision-making about reproductive health in Malawi

Given the centrality of land to rural livelihoods and the high rates of fertility in Africa, there is a need for more research that explores the intersection between gendered patterns of land ownership and reproductive health outcomes. Drawing on a household bargaining framework, I hypothesize that women’s land ownership should be associated with increases in women’s decision-making in multiple domains in the household including financial decision-making (the focus of bargaining literature), but also decision-making about reproductive health. Using the 2010 Malawi Demographic Health Survey (DHS), I find women’s ownership of land (sole or joint) is associated with increases in women’s participation in financial decision-making in the household and women’s sole ownership of land is associated with increases in women’s participation in reproductive health decision-making. However, women’s joint ownership of land with spouses is negatively associated with participation in reproductive health decision-making, perhaps because of backlash or intra-household conflict.     

Measurement of Women's Reproductive Health and Reproductive Rights: An Analysis of Developing Countries

This study attempts to develop measurement scales for women'sreproductive health and reproductive rights by using data from125 developing countries. Data were obtained from varioussources, such as the United Nations and the World Bank. Existing studies on women's reproductive rights suggest atwo-factor model. Women's reproductive health is viewed as beingunidimensional. These proposed attributes are evaluated usingconfirmatory factor analysis. Results indicate the presence oftwo sub-dimensions related to women's reproductive rights. Aone-dimension model of women's reproductive health is empiricallysupported. Validity and reliability of the scales are assessed.Limitations of the measurement scales are discussed.     

Child mortality in India: the community-level effect of education

When assessing the health benefits of increased education in less developed countries, many researchers have been concerned about the omission of important determinants of an individual's education from the models. The study presented here shows that one should also be concerned about the limitations of the individual-level perspective. According to a multilevel discrete-time hazard model estimated with data from the National Family Health Survey II, the average education of women in a census enumeration area has a strong impact on child mortality, in addition to the effect of the mother's own education. The lower child mortality associated with women's autonomy is taken into account in this estimation. Results from similar models for various health and health-care variables suggest that the effect of community education, like that of individual education, operates through the use of maternity services and other preventive health services, the child's nutrition, and the mother's care for a sick child.     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

贫困地区的妇女赋权和生育控制

妇女赋权是生殖健康的核心内容之一,它通过赋予妇女权力和机会,转变那些客观上存在性别歧视和社会不平等的一些结构和制度,增强妇女在社会、政治、经济上的权力,实现性别的平等与发展,改善妇女地位,使妇女生育率客观上得到控制。本文从妇女赋权的角度出发,通过妇女赋权对生育水平影响的路径分析来探讨从根本上解决贫困地区控制人口的可能途径：通过实现妇女赋权,增强妇女的自主性、独立性,促使妇女地位的提高,从而使妇女的状况得以改变,降低生育率。     

Older women's body image and embodied experience: an exploration

This paper presents and analyzes findings from unstructured interviews with women aged 61 to 92 regarding their perceptions and feelings about their aging bodies. The data are discussed in light of the existing literature on women's body image which has largely ignored the experiences of women in later life and which has tended to focus on adolescent and middle-aged women. Given the fact that beauty is equated with youthfulness and thinness in our society, older women face unique challenges as they strive to construct and maintain positive evaluations of self. The women in the study exhibit the internalization of ageist beauty norms even as they assert that health is more important to them than physical attractiveness and comment on the 'naturalness' of the aging process.     

Sweden faces zero population growth

In this discussion of Sweden as it approaches zero population growth, focus is on the following: population growth in perspective, fertility trends (childbearing concentrated and cohort versus period fertility), marital status (non-marital cohabitation, out-of-wedlock births, and divorce), women's changing status (increasing education and increasing employment), constraints and supports for women's dual role (family allowances and housing), birth control (contraceptive methods and practice and abortion), mortality trends, changing age structure and the elderly (average population age and proportion of elderly and cost of elderly support), international migration (from emigration to immigration and demographic impact of immigration), immigration policy, recent population debate (immigration issues and facing zero population growth). Since 1900 the primary features of Sweden's demographic history are a continuing decline in the birth rate to very low levels -- relieved by some upward movement in the 1940s and 1960s -- and a marked shift in the migration balance from emigration to immigration. It is almost entirely because of immigration that Sweden's population growth rate has not yet turned negative. If Swedish women were to continue to bear children at the rate that all women in the reproductive ages actually did in 1978, each women would end up with an average well below the level necessary to exactly replace each adult in the population leaving migration out, an annual total fertility rate of 2.1 children per woman would have to be sustained for births and deaths to be in balance under the low mortality conditions prevaling in Sweden.