Educational efforts in the implementation of rural family planning programs in East Pakistan

The pilot family planning studies reported in this paper were conducted in a rural area adjacent to the city of Dacca in East Pakistan. It reports the preliminary findings of action-research in the implementation of educational efforts to reach rural villagers of a developing country.Preliminary analyses of the records identify two significant educational problems: (1) most of the villagers (85-90 percent of the couples) who initially accepted contraceptives do not truly adopt and become continuing users and (2) the continuing users (10-15 percent of the initial users) are generally characterized by large families. (Later data show an even lower percentage of continuing users.)The field activities in the development of various educational approaches to family planning are described. Three separate geographic areas (from 15,000 to 20,000 population) were each approached in a different way, varying in the number and educational qualifications of the workers and in the degree of involvement of village leadership. Preliminary analyses of field records indicate that these variations of approach apparently have little effect on the percentage of the population willing to accept contraceptive supplies.It is the opinion of the writers that more intensive educational efforts are necessary at the village level to develop social support for continuing use of contraception and to gain adoption of contraception by younger married couples primarily for spacing of births.The impact of introduction of the IUCD in populations where condoms and foam tablets have been available for one to two years has also been reported. Preliminary findings indicate that the IUCD encourages adoption by previous non-users and may increase the over-all percentage of contraceptive users.     

Infant and child mortality in India: trends in inequalities across economic groups

This paper examines the trends in economic inequalities with respect to infant and child mortality in India using three rounds of the Indian National Family Health Survey conducted in 1992–1993, 1998–1999, and 2005–2006. The paper uses concentration index, and pooled discrete-time survival regression model to examine the aforementioned trends and regional patterns. The findings suggest a decreasing trend in economic inequality in infant mortality but an upward trend in economic inequality in child mortality in India. Economic inequalities in infant mortality have narrowed in the southern region, whereas they have widened in the western region and risen in the northern region. However, mixed trends in concentration indices were found in the different regions of India in the case of child mortality.     

CharacteriStics and utilization of midwives in a selected rural area of East Pakistan

The purpose of this study was to obtain information about the utilization of midwives (dais) by village women and to learn more about the characteristics and practices of those dais. Two interview schedules were prepared. The first was used to interview 632 village women to determine who performed or assisted with their last two deliveries. The second was used to obtain information from 21 dais.The results of the first phase may be summarized as follows: (a) 38 per cent of the women were delivered by relatives; (b) 33 per cent of the women delivered their own children; (c) 14 per cent were delivered by neighbors; (d) 6 per cent were delivered by dais; (e) 2 percent were delivered in hospitals; and (f) the remaining 7 per cent were accounted for by several minor categories.The results of the interviews with dais are summarized as follows: (a) they are mainly widows and older women; (b) they have no formal training; (c) they work for friends, neighbors, and relatives and receive a sari as compensation; (d) they cannot handle complicated deliveries; (e) they deliver 3-4 children a year; (f) their sterilizing procedures depend upon soap, water, and folk beliefs; (g) most think midwifery is a worthwhile service; (h) about one-half have a general understanding of the reproduction process; (i) most do not know how to prevent conception; and (j) about half think that it is a good idea to participate actively in a family planning program.     

Infant mortality in the Marshall Islands

Levy and Booth present previously unpublished infant mortality rates for the Marshall Islands. They use an indirect method to estimate infant mortality from the 1973 and 1980 censuses, then apply indirect and direct methods of estimation to data from the Marshall Islands Women's Health Survey of 1985. Comparing the results with estimates of infant mortality obtained from vital registration data enables them to estimate the extent of underregistration of infant deaths. The authors conclude that 1973 census appears to be the most valid information source. Direct estimates from the Women's Health Survey data suggest that infant mortality has increased since 1970-1974, whereas the indirect estimates indicate a decreasing trend in infant mortality rates, converging with the direct estimates in more recent years. In view of increased efforts to improve maternal and child health in the mid-1970s, the decreasing trend is plausible. It is impossible to estimate accurately infant mortality in the Marshall Islands during 1980-1984 from the available data. Estimates based on registration data for 1975-1979 are at least 40% too low. The authors speculate that the estimate of 33 deaths per 1000 live births obtained from registration data for 1984 is 40-50% too low. In round figures, a value of 60 deaths per 1000 may be taken as the final estimate for 1980-1984.     

Infant mortality and birth intervals

Summary In the course of a demographic inquiry which also offered medical advice to the respondent women, information was obtained on the reproductive life and child mortality of women in three regions of Upper Volta. Foetal mortality rates are inversely correlated with fertility rates, whereas the opposite holds true of the mortality of children aged up to four years. An explanation of this phenomenon is attempted, showing how large variations in mortality rates continue to exist in developing countries. The second section of the paper deals with spontaneous abortions which happen much more frequently than is believed in Black Africa and with the effect of pathological sterility on birth intervals. Account is taken of the taboo on sexual relations after children have been born, a taboo which continues to be kept in the region studied and which as an important effect on inter-birth intervals.     

Child mortality in rural India

This paper focuses on infant and child mortality in rural areas of India. We construct a flexible duration model, which allows for frailty at multiple levels and interactions between the child’s age and individual, socioeconomic, and environmental characteristics. The model is estimated using the Indian National Family and Health Survey 1998/1999. The estimation results show that socioeconomic and environmental characteristics have significantly different impacts on mortality rates at different ages. These are particularly important immediately after birth. The parameter estimates indicate that child mortality can be reduced substantially, particularly by improving the education of women, providing safe water, and reducing indoor air pollution caused by dirty cooking fuels. Finally, we still found substantial differences in mortality rates between states, which are associated with differences in schooling expenditures, female immunization, and poverty rates.     

Infant mortality decline in Chile: A replication

This replication of a previous analysis of the effect of sociological variables on infant mortality rates in Chile refines the earlier work by using the more numerous communes for comparisons, by presenting the basic data in the form of a path analysis, and by expanding the theory to include “health practices,” customs, such as avoiding teenage pregnancies, that are community-backed and maintained. This type of practice is then integrated into the “institutionalized problem-solving capacity” framework that guides the analysis. Urabnization and voting, the two indicators of institutionalized problem-solving capacity, predict reduced infant morality, as before. Teen pregnancies is a positive predictor, as expected, but the number of children already born does not predict. These results are net of two indicators of health technology-whether or not a physician was in attendance, and the number of clinics. Mother's education also predicted low infant morality, and the theory is applied to this well-known predictor to interpret its effect. In addition, the anomalous role of mother's education in the dominant biomedical explanation is highlighted.     

Use of the intra-uterine contraceptive device in rural West Pakistan

This paper presents selected aspects of experience with the intra-uterine contraceptive device (IUD) in rural West Pakistan. There were 1,162 IUD cases analyzed with respect to retention or non-retention. Retention rates were estimated, using life table methods, to be between 55 and 75 percent at one year; the smaller figure was obtained when theIUD was considered to be in situ only until the last examination, when it was observed to be in place. The latter or larger figure was obtained when the IUD was considered to be in situ unless known to be out.The extent of follow-up greatly affects estimates of the length of time the IUD remains in situ. Retention also varies with the type of I UD employed; exclusive use of Loop 3, which has the best retention record of those used,may be expected to yield higher retention rates by as much as 5 to 10 percent for one year. A number of other factors were examined that might explain non-retention. The objective variables that were examined in this experience, such as age, previous contraception, and husband's illiteracy, were on the whole rather poor predictors of IUD retention. Expulsion and other medical complications appear to account for most discontinuance of use of the IUD.     

Regional trends in fertility and mortality in Brazil

Abstract Questions asked in the 1970 Brazilian census allow the application of fertility and childhood mortality techniques developed by W. Brass. Using some propositions based on fertility estimates from the 1970 census data it was possible to extend the analysis to the 1940, 1950 and 1960 censuses. Estimates are also provided for ten Brazilian regions, for 1940, 1950 and 1970. These estimates show a slight decrease in the fertility level for the country as a whole, but two different trends at regional levels. Between 1940-50 and 1960-70 the poorer regions experienced constant or increasing fertility levels while developed regions experienced declining ones, with only one exception. The mortality estimates indicate a consistent decline in the mortality level of all regions, but also a divergent trend between poor and developed regions, in life expectancies at birth. This work is a summarized version of Chapters II, III and IV of my Ph.D. thesis written under the supervision of Professor D. V. Glass and Mr J. Hobcraft at the University of London. I am most grateful to my supervisors as well as to Professor W. Brass for valuable comments on several aspects of the thesis. While carrying out this study, the author was supported by grants from the Federal University of Minas Gerais, Brazil, and the Ford Foundation.     

The Effect of birth spacing on childhood mortality in Pakistan

Summary In this study retrospective data from the 1975 Pakistan Fertility Survey are used to examine the effects of birth spacing on infant and child mortality. The length of the preceding interval between live births emerges as a major determinant of mortality. The effect persists for rural and urban families, for children of uneducated and educated mothers, for both boys and girls, and for large and small families. The possibility that this relationship is the spurious consequence of data defects or of a common cause, such as early weaning, is examined but rejected. Once the length of the preceding interval is controlled, the average spacing of earlier births is found to be unrelated to survivorship. However, the length of the succeeding interval is significantly related to survivorship during the second year of life.     

A century of international mortality trends: I

An attempt is made to summarize the chief generalizations that can be drawn from available evidence on world mortality developments during the last hundred years. Past and prospective trends are compared for three broad groups of populations or approximately those in the West, Eastern and Southern Europe, and Latin America, Africa, and Asia. Two major points of emphasis are that the usual methods of comparing regional changes can usefully be supplemented by other approaches, and that the mortality history of Western nations may prove a highly unsatisfactory guide to future trends elsewhere. The study is based on a nearly complete compilation of the national life tables on record.     

Estimating infant mortality trends from child survivorship data

Summary Brass's procedure for estimating mortality from census or survey data on numbers of children born to women by age group and numbers of children surviving is generalized to allow the estimation of mortality trends. The new procedure is applied to data for Costa Rica and peninsular Malaysia. The resulting infant mortality rate estimates are compared with rates calculated from vital registration figures. The comparisons suggest, surprisingly, that the estimates derived from statistics for women aged 30-50 are not noticeably inferior to those derived from those for women aged 20-30. This suggests that the common practice of disregarding statistics for women aged over 30 or 35 years may be a mistake. Figures are presented which suggest that estimates based on women aged less than 20 are likely to be very seriously biased because of differential infant mortality by age of mother at birth.     

Long-range trends in adult mortality: Models and projection methods

In the study reported here, I had two objectives: (1) to test a new version of the logistic model for the pattern of change over time in age-specific adult mortality rates and (2) to develop a new method for projecting future trends in adult mortality. A test of the goodness of fit of the logistic model for the force of mortality indicated that its slope parameter is nearly constant over time. This finding suggests a variant of the model that is called the shifting logistic model. A new projection method, based on the shifting mortality model, is proposed and compared with the widely used Lee-Carter procedure.     

The influence of cohort effects on mortality trends in India

The inferences drawn from this study are as follows: The stagnation/ increase in mortality rates of adult ages in the recent years in India as well as for the major states may be attributed to food shortages and price hikes experienced in the country during 1960–74. In other words, all those who were adults during 1980s had experienced the crisis of hunger due to nonavailability of food as well as entitlement failure during their childhood. These persons would have had higher risk of dying in their life time and that may be one of the main reasons for the stagnation or increase in adult mortality in India and in most of the states. The findings of the study suggest that, the economic crisis experienced in India during the late eighties, may decrease the survival chances of those born during this period in their future life time. However, successful containment of increase in food prices during the period of crisis would be helpful in protecting the entitlement of vulnerable groups. The policy implication of the study is that it is essential to control the prices of food during the time of food shortages and or economic crisis and even in the period when food is available, measures should be undertaken to evolve efficient distribution system ensuring the supply of food to those vulnerable groups, who were unlucky to be born or were in infancy during the period of economic crisis. Thus, essentially this is a study in interaction of economic factors and demographic trends in an economy where large segments of the population are periodically subject to heightened food insecurities, compression of real wages and entitlement failures.     

Infant mortality in London, 1538-1850: a methodological study

A review of evidence on infant mortality derived from the London bills of mortality and parish registers indicates that there were major registration problems throughout the whole of the parish register period. One way of addressing these problems is to carry out reconstitution studies of individual London parishes, but there are a number of problems with reconstitution methodology, including the traffic in corpses between parishes both inside and outside of London and the negligence of clergymen in registering both baptisms and burials. In this paper the triangulation of sources has been employed to measure the adequacy of burial registration, including the comparison of data from bills of mortality, parish registers and probate returns, as well as the use of the same-name technique. This research indicates that between 20 and 40 per cent of burials went unregistered in London during the parish register period.     

Fertility trends in rural Hebei Province,People's Republic of China

Background: The People's Republic of China (PRC) has conducted several different population policies since its establishment. Although fertility has declined dramatically in the past three decades, the degree to which this was the result of the different population policies is still under debate. Purpose: We attempt to evaluate the effect of the different formal population policies conducted in the PRC by looking at the fertility behavior of rural women. Unlike urban women, rural women experienced less social control (in the absence of a work unit) and received fewer benefits from adhering to the one-child policy. Data: The data analyzed were collected from a stratified sample of households from 288 villages in 9 counties of Hebei Province, PRC, between 1996 and 1999. The number of children ever born was reported by 4,168 ever-married women aged 25 and over who had had at least one birth. Findings: Our analysis indicates that the formal population policies of the PRC had little effect on the number of children ever born to rural women in Hebei. These retrospective data, by cohort, indicate consistently declining fertility since the revolution (1949). Limited child bearing was associated with age and the level of education. Controlling for the effect of age and education, women born after 1960, at whom the one-child policy was directed, actually had more children than older women. Conclusions: The Chinese fertility decline, at least as reflected in the experience of rural women in Hebei Province, derived mainly from secular changes in women's access to education and other social resources rather than from the direct effects of population policies.