Adolescent fertility programs: taking the first few steps

Adolescent fertility programs in Asia and the Pacific have a long way to go to check the problems associated with adolescent fertility, but a start has been made. Delegates from 8 countries met in 1982 to share their problems and experiences in their own countries. The conference participants drew up plans to deal with a high rate of adolescent fertility, sexually active adolescents, out-of-wedlock births, unwanted pregnancies, sexually transmitted diseases, prostitution, rape, abortion, and drug addiction. The delegates felt that for adolescent fertility programs to be effective the program workers must first be equipped with the needed skills through proper training. Inadequate knowledge of the subject matter, inability to communicate with adolescents, personal bias, and lack of counseling skills were among the worker-related problems that conference participants identified. A few months after the conference, participant countries conducted a training program on the effective delivery of adolescent fertility-related information and counseling services. The training program, held in Manila from January 23 to February 2, 1984, was conducted by the Population Center Foundation and sponsored by the Family Planning International Assistance. Training program objectives included: in crease the participants' knowledge of sexuality-related matters; help them to communicate better with adolescents on matters related to sexuality and fertility; make them aware of other ways of responding to fertility-related information needs of adolescents; and improve their skills in counseling adolescents. Lectures, structured learning activities, discussions, role playing, and other methods were used to maximize learning. The training program was divided into 6 modules: group dynamics; human sexuality; information dissemination; counseling techniques; management; and action planning. The plans of Fiji, India, Indonesia, Nepal, Sri Lanka, Thailand, and the Philippines are reviewed. Organizers of the training program are confident that the action plans of the individual countries will take shape soon and clear the path toward more effective adolescent fertility programs.     

Asian-Pacific round of WFS activities

The primary aim of the World Fertility Survey (WFS) program is to assist countries to acquire the scientific information that will permit them to describe and interpret the fertility of their populations. A 2nd purpose is to increase national capacities for fertility and other demographic survey research, particularly in developing countries; while a 3rd objective is to collect and analyze data on fertility which are internationally standardized and therefore permit comparisons between 1 country and another. The WFS studies are generally single-round surveys of households selected to provide a national probability sample, with information collected from eligible women with the help of a carefully designed individual questionnaire. The recommended WFS questionnaire consists of 7 sections: 1) respondent's background; 2) maternity history; 3) contraceptive knowledge and use; 4) marriage history; 5) fertility regulation; 6) work history; and 7) current husband's background. For countries wishing to investigate certain topics in greater depth, various modules have been developed by WFS which can be incorporated into the questionnaire. So far, 35 developing countries and 17 developed countries have been participating in the WFS program, including 14 ESCAP countries. 11 of these countries (Bangladesh, Fiji, Hong Kong, Indonesia, Japan, Malaysia, Nepal, Pakistan, Republic of Korea, Sri Lanka, and Thailand) have already completed their 1st report and many have begun activities with regard to the 2nd-stage analysis of the WFS data. 3 of these, Nepal; Sri Lanka; and Indonesia; have also held seminars to discuss the survey findings and further analyze the WFS data.     

Coping with adolescent fertility

In the Philippines, despite the conservative values of the population, factors brought about by increasing modernization encurage the youth to practice sex, although actual sexual behavior lags behinds attitudes. This is particlarly the case in Metropolitan Manila, the country's most urbanized region. In 1982, 4 of 10 live births were to women aged 15-24. There also are reports that births out of wedlock have increased in the past few years, with the biggest number of such births registered by women in the younger age groups. The magnitude of the problem causes concern among the policymakers, throughout the world, the Philippines included. The government and the private sector in the philippines have started to recognize the need to protect adolescents, particularly girls, from unplanned parenthood. Adolescent fertility programs in the Philippines and neighboring countries are relatively new and policymakers are working to strengthen them. Recently, the Commission on population (Popcom) organized the Youth and Premarriage Task Forces to address the specific needs and concerns of the youth. In line with this objective, private and government agencies have developed programs and projects for specific youth sectors which influence or may be influenced by adolescent secxuality norms. There are projects designed to suit the specific needs of in school youth, out of school youth, working youth, pregnnant unmarried women, and adolescent counselors. Some of these programs and projects are described. Similar to other projects, the adolescent fertility projects in the Philippines experience their share of problems and constrants, including shortage of trainers, lack of reliable data, inadequate supply of resource materials, and the need to strengthen government policy. In view of all this, a need exists to attract more people to train service providers who will attend to adolescents' information needs, ranging from common concerns like dating to more serious concerns like pregnancy. In a recent survey many service providers indicated that the were wary of providing contraceptive information and services to adolescents for 2 reasons: they believe these might promote sexual promiscuity among the married; and the fear they might be sued by irate parents. Coupled with the problem of lack of reliable data is the fact that few materials on sexually related materials have been developed in the philippines. Such local materials are needed for the benefit of both the youth and the service providers and counselors.     

Integrating family planning with nutrition and parasite control

At the Inter-Governmental Coordinating Committee Workshop on an Integrated Approach towards Family Planning and Health Programs held at Kuala Lumpur from March 23 to 25, 1977, the feasibility of integrating family planning with nutrition and parasite control through the proper planning of motivational considerations, resource allocation and coordination was studied in detail. Discussion focused on the experience of participating countries in generating community participation in total health programs. Malaysia reported that in the expansion of the national program into the rural areas functional integration has been the approach. In Indonesia nutrition has been an important objective of maternal and child health services. A total integrated development approach has been the objective in the Philippines where family planning information-education-communication has been integrated with nutrition programs and a pilot project on integration of family planning and parasite control has been conducted. Thailand reported on the introduction of an integrated family planning and parasite control program, while Sri Lanka reported on an integrated approach that included family planning with maternity and child health services. A recommendation of the meeting was that experimental pilot projects be established which include nutrition and parasite control elements within the framework of family planning services.     

Increasing contraceptive use in Bangladesh: The role of demand and supply factors

This article analyzes the determinants of contraceptive use in Bangladesh, focusing on the roles of demand for additional children and of family planning service supply. Data from the Matlab Family Planning Health Services Project are used to examine the contributions of these factors to the difference in prevalence of modern contraceptive use between the project area and a control area served by the government family planning and health programs. Results of multivariate analysis deriving from the Easterlin synthesis framework show the importance of family planning supply factors in reducing psychic and resource costs of fertility regulation and in activating latent demand for contraception. Demand for birth limiting and for birth spacing emerge as important explanatory factors; demand for birth spacing is greater in the project area, and both demand measures exert a stronger effect on contraceptive behavior in that area.     

Pakistan: FPAP projects reflect integrated approach

The Family Planning Association of Pakistan has conducted a number of projects reflecting the government's integrated approach to family planning. The youth project aims at alerting young people to the need for family planning. A full-scale feasibility scan was conducted prior to implementation of the project to determine the best way to reach people. Volunteers were recruited among college students. The project's strategy for 1979 included organization of a youth leadership national workshop and oratorical contest on the topic, "Whatever your cause, it is a lost cause without population planning." Other FPAP projects include a group of "better living projects" which aim to educate young mothers in child care and family nutrition. Projects in the organized sector include a program at the Pakistan Mint, where a motivation center and clinic are set up. Training projects concentrate on fieldworkers and traditional birth attendants (dais). A 3-day course for dais includes reorientation on septic deliveries, child care, maternity care, and record keeping. In the cities, FPAP has a network of multipurpose centers in slum areas, where adult education and income generating activities are integrated with family planning.     

Integrating parasite control and family planning

A pilot project started recently in 4 locations by the Family Planning Organization of the Philippines in cooperation with the Japanese Organization for International Cooperation in Family Planning and the Asian Parasite Control Organization uses de-worming as an entry point to establish credibility for family planning workers among the target population. The ultimate goal of the project is to encourage community participation to such an extent that family planning and related efforts are sustained by the community itself and the field worker is no longer needed. Integrated parasite control/family planning projects have already gone through the 4 principal developmental stages of strategic planning, project design and development, implementation and assessment, and program maintenance in some areas since their beginnings in 1976. Support for such programs has been obtained from 3 international bodies working in family planning, and 2 others have recently indicated interest. Activities to develop criteria for project expansion are now underway. The 4 projects in the Philippines, located in Binakayan, Cavite; San Pedro, Laguna; Caramoan, Camarines Sur; and Davao City, are each staffed by a project manager, doctors, nurses, and medical technologists. The projects, especially the Caramoan project, have been quite successful, and efforts are being made to include nutrition in the integrated program.     

A look at Asia's changing youth population

This report summarizes findings from a recent East-West Center study on demographic and social changes among young people aged 15-24 years in 17 countries in East, Southeast, and South Asia. Nearly every country in Asia has experienced fertility decline. Decline began in Japan and Singapore during the 1950s, followed by declines in Hong Kong, South Korea, Sri Lanka, the Philippines, Brunei, Taiwan, Malaysia, Thailand, and China during the 1960s. Declines occurred during the 1970s in Indonesia, India, and Myanmar. A "youth bulge" occurred about 20 years later due to declines in infant and child mortality. This bulge varies by country with the timing and magnitude of population growth and subsequent fertility decline. The proportion of youth population rises from 16% to 18% about 20 years after the beginning of fertility decline and declines to a much lower stable level after several decades. The bulge is large in countries with rapid fertility decline, such as China. Governments can minimize the effects of bulge on population growth by raising the legal age at marriage, lengthening the interval between first marriage and first birth, and increasing birth intervals. School enrollments among adolescents are rising. In South Korea, the population aged 15-24 years increased from 3.8 to 8.8 million during 1950-90, a rise of 132% compared to a rise of 653% among school enrollments. It is expected that the number of out-of-school youths will decline from 5.1 to 3.6 million during 1990-2025. Youth employment varies by gender. Policies/programs in family planning and reproductive health will need to address the changing needs of youth population.     

Fertility and Financial Development in South Asia

The paper empirically examines old-age security hypothesis to explain fertility rates in South Asia. Panel data is used for the period 1972–2013 for seven South Asian countries which include Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. The estimated results reveal that in South Asia fertility rate decreases with the increase in financial development. Thus, the findings support old-age security hypothesis that parents use children as financial instruments to secure their old age. This paper validates the theory that the availability of alternative financial tools reduces the incentives of households to have large offspring. Infant mortality is also shown an important factor for high fertility rate in South Asia. This implies that households cover their risk from losing children by producing more children. The results also reveal that fertility rate decreases with the increase in per capita income, which implies that households treat children as inferior good in this region. In other words, households prefer quality of children over quantity of children when their income level increases. The results have also shown that fertility decreases with the increase in education, urbanization, agriculture productivity and industrialization. The study has some important policy implications.     

Below-replacement fertility: Determinants and prospects in South Asia

Although 10 countries and two of China’s special administrative areas, totalling 1,528 million people or 44 per cent of Asia’s total population, are now characterized by fertility rates below long-term replacement levels, no such countries are yet found in South Asia. This paper first examines the characteristics of 12 Asian administrations with very low fertility at various stages of their fertility declines and then compares the findings with the present situation in three South Asian countries, Sri Lanka, India and Bangladesh. This allows a prediction of when the South Asian countries will reach replacement fertility in accord with the trends in two key criteria, the percentage of girls in secondary school and the infant mortality rate. These conclusions are then buttressed for each country by the findings of anthropological demographic research programs in which the authors were involved. The predictions are that all three countries will attain a total fertility rate of 2.1 within the next 30 years and that the UN2000 Revision of the medium population projection is plausible in that regard. However, the authors part company with the UN projection in their assessment that the nature of these societies means that they will all subsequently fall to still lower fertility levels.     

Sri Lanka: sterilization bonus announced in Sri Lanka; new CBD experiments in Sri Lanka; orchids and family planning

The government of Sri Lanka will give a minimum bonus of SRs 100 ($US6.00) to anyone voluntarily being sterilized. Women will be given 7 days leave and men 3. Many public and private corporations pay sterilization bonuses; the new bonus was set to compete with generous maternity benefits. The average daily wage is about SRs 120. Currently the demand for sterilization is greater than the health services' ability to meet it. Depo-provera is becoming increasingly popular in Sri Lanka, especially among the Muslim communities. The Family Planning Association of Sri Lanka is to test new forms of social marketing of contraceptives to provide wider coverage through community-based distribution. One system will use the route of a commercial firm, Reckitt and Coleman Ltd., and another system will use a network of provincial organizers, commission agents, and local retailers. To create an awareness in young people of their responsibility toward society the Family Planning Association organized an orchid cultivation and family planning propaganda project. 40 young boys are being taught orchid culture and the benefits of family planning. Orchids can be grown in the back yard without any capital investment. There is a steady market for the orchids, and the training program lasts 6 months for each cohort of boys.     

Nepal: NFP/MCH Project's prime target

Sterilization as a means of permanent family planning will be the prime target of the Nepal Family Planning and Maternity and Child Health Project in the current fiscal year. Under the permanent sterilization scheme, the project plans to open 18 laparoscopic camps in addition to 34 vasectomy camps in different parts of the country. The 146 mobile teams of the project sent to different parts of the country performed vasectomies on over 9000 males in the previous fiscal year. According to project statistics, more than 38,000 males have undergone vasectomy so far in Nepal. The rate of population growth is estimated to continue to increase by 3% in the next 5 years. This estimate is much higher than the original estimate made during the formation of the current 5-year plan.     

Integrated family planning/parasite control project: a different approach to community health problems

An obstacle to the acceptance of family planning is the fact that its advantages are not immediately apparent or tangible. A way to get around this obstacle is through the use of "entry points"--projects which yield tangible results in a relatively short time. Through these entry points, the fieldworker builds credibility and wins the confidence of the people in the community he or she is serving. Thus, when the time comes, the people will be receptive to the family planning message. This strategy of the use of entry points is common to integrated projects with a community development program becoming a sort of entry point for family planning fieldworkers. 1 such project, begun quite recently by the Family Planning Organization of the Philippines (FPOP) in 4 pilot sites, uses deworming as an entry point. It is officially known as the Integrated Family Planning/Parasite Control/Nutrition Project. It is 1 of several projects cosponsored and financed by the Japanese Organization for International Cooperation in Family Planning (JOICFP) and the Asian Parasite Control Organization (APCO) in almost a dozen other Asian and Latin American countries. The immediate objective of the project is to establish or increase the credibility of family planning fieldworkers among the people in a target area. Fieldwork connected with family planning is conducted alongside a related community health effort that can produce immediate and visible results. The ultimate goal is to encourage community participation to such an extent that there will no longer be a need for the fieldworker. Strategic planning involves thinking up the "backbone" and molding the "skeleton" of the project, i.e., its concept and basic policies. As the project goes into the design and development stage, additional people are drawn into it. Project experience in Thailand underscores the need to consult with local leaders. The earliest projects were initiated in 1976, but some are already showing successful results. The overall Philippine experience provided support to JOICFP Director Kunii's reiteration of his belief in the effectivity of parasite control as an entry point for population planners. Integration of the nutrition element in the project is regarded as essential.     

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.     

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.     

Emerging population issues among adolescents and youth

The authors "examine the emerging population issues of adolescents and youth [in Sri Lanka]. The demographic pressures have resulted in the expansion of the numbers in this age category which in turn has caused problems of employment creation. The educational expansion has brought about changes in the age at marriage and life styles, which in turn has created the need for greater attention on reproductive health issues among adolescents and youth."     

吉林省“计划生育服务车”基层服务研究

吉林省榆树市自2003年开展"计划生育服务车"基层服务以来,市计生局发挥服务车机动、便捷的特点,采取"直接进屯,服务到人,逐村推进,一年一回"的服务方式,有效地提高了避孕节育措施的落实率,稳定了农村育龄人群的生殖健康水平。在各方面综合因素作用下,服务车的发展运行健康、有序、规范,拓宽了人口计划生育事业的发展空间,提升了新时期人口计划生育工作的水平和品质,提高了农村计划生育人群和家庭的生育、生活和生命质量。表现了人口计生部门转变工作思路、改进工作方法,推进基层基础工作,乃至推进计划生育的整体工作力度。     

The effect of female education on fertility: A simple explanation

This paper investigates the structure of the relationship between female education and fertility. It is based on data published in First Country Reports of the World Fertility Surveys for eleven countries—Costa Rica, Colombia, Dominican Republic, Panama, Fiji, Korea, Malaysia, Pakistan, Sri Lanka, Thailand, and Indonesia. The cumulative marital fertility of educated women is shown to be similar in different settings. A lack of uniformity in the education and fertility relationship including the curvilinear nature of this relationship observed across countries is shown to be attributable to marked differences between countries in the average fertility of women with no education rather than to the presumed differences in the average fertility of the educated women. The structure of the relationship is shown to be similar across several developing countries. This analysis suggests that advancement in female education can be expected to influence fertility behavior even without simultaneous changes in other factors such as increasing opportunity for participation in the paid labor force in the modem sector.     

Meeting health and family planning needs in Latin America and the Caribbean

The operations research and technical assistance (OR/TA) project in The Population Council has concentrated on fertility and infant mortality issues in Latin American and the Caribbean for more than a decade through INOPAL. INOPAL is an acronym for Investigacion Operacional en Planificacion Familiar y Atencion Materno-Infantil para America Latina y el Caribe (Operations Research in Family Planning and Maternal-Child Health in Latin America and the Caribbean). In March 1995, the project entered its third phase, INOPAL III, with the renewal of its contract from the United States Agency for International Development (USAID). To facilitate communication between INOPAL, collaborating agencies, and USAID, INOPAL Director James Foreit moved from Peru to a Council office in Washington, D.C. INOPAL has six objectives: 1) to test the integration of family planning and reproductive health services; 2) to increase access to family planning; 3) to develop strategies to reach special populations; 4) to improve the sustainability of family planning programs; 5) to improve service quality; and 6) to institutionalize operations research capability in the region. INOPAL II conducted 61 subprojects in 12 countries in collaboration with 24 USAID cooperating agencies and other international organizations. The project established new services for postpartum women, adolescents, and rural women; improved program quality and financial sustainability; increased vasectomy promotion and the range of available contraceptives; and developed new modes of service delivery. A key finding of INOPAL II operations research was the importance of increasing cost-effectiveness to ensure program sustainability. INOPAL III will work toward all six objectives, with an emphasis on integrating reproductive health and family planning services. Operations research and technical assistance (OR/TA) subprojects will focus on the prevention and treatment of sexually transmitted diseases, perinatal and postpartum care, and postabortion care.     

A demographic perspective on the Muslim world

A demographic perspective is relevant to understanding the position of Muslims in today’s world. This paper examines the size and growth of Muslim populations, and whether most Muslims live in overwhelmingly Muslim countries. It also examines indices of poverty and human development for Muslimmajority countries, and the growth of the youth population; finally, it examines the key components of population growth: mortality and fertility. Mortality has declined sharply over the past 15 years in many Muslim countries, though not in all, and Muslim countries are no longer prominent among the ‘outliers’ with higher mortality than expected on the basis of their income levels. Fertility rates are also declining sharply in a number of major Muslim-majority countries, raising interesting issues about attitudes of different schools of Islamic jurisprudence, village-level religious leaders and ordinary Muslims towards contraception and abortion, as well as the role of socio-economic development and family planning programs in fertility declines. Despite these declines, past high fertility in many Muslim-majority countries leaves as a legacy a rapidly growing adolescent population and a burgeoning, inadequately educated labour force.