A close look at the demography of Afghanistan

The first survey designed to allow estimates of the demographic characteristics of Afghanistan's sedentary population was conducted during the period 1972-1974. Our analysis of these data, based on recently developed techniques for handling imcomplete or inaccurate data, suggests that this population lives under conditions that are extreme when judged by modern standards. Marriage is early, especially for females, and universal. Marital fertility conforms to a pattern of natural fertility and total fertility is high. The birth rate is among the highest in the world today, and the expectation of life at birth is among the very lowest. Mortality is lower in urban areas than in rural areas, whereas total fertility is approximately the same in both. Our estimates of fertility and mortality imply stable populations which match closely the observed age distributions for both the rural and urban areas.     

Diversity and change in Cambodian households, 1998–2006

Extant ethnographic studies suggest that the nuclear family has been the predominant living arrangement in Cambodia, and the country’s rapid socioeconomic transformation since the early 1990s may have accentuated that dominance. To examine these claims, we analyse here household structure in Cambodia between 1998 and 2006, based on data from the 1998 Census, two nationally-representative surveys (2000 and 2005), and a continuing demographic surveillance system (from 2000 on). Our analysis confirms the large prevalence of nuclear families, but not an unequivocal trend toward their increasing prevalence. First, nuclear families are less prevalent in urban than in rural areas, and nationwide, they appear to have receded slightly between 2000 and 2005. We find that increases in the prevalence of extended households correspond to periods of faster economic growth, and interpret these contrasted trends as signs of tensions during this transitional period in Cambodia. While the nuclear family may still be the cultural norm, a high degree of pragmatism is also evident in the acceptance of other living arrangements, albeit temporary, as required by economic opportunities and housing shortage in urban areas.     

Famine Mortality in Nineteenth-Century Japan: The Evidence from a Temple Death Register

Economic and demographic historians who have studied Japan's early modern period argue that preventive checks to fertility were the primary cause of Japan's stationary population in the eighteenth and early nineteenth centuries, and that the role of ‘positive’ checks was negligible. This paper presents evidence and a claim that mortality crises – famines in particular – also played an important role in checking population growth during this period. It analyses data from the death register of Ogen-ji, a Buddhist temple in the Hida region of central Japan. These data provide a remarkably detailed picture of the short-term demographic consequences of Japan's last great famine, the Tenpō famine of the 1830s. ‘Normal’ mortality patterns, by age and sex, are compared with patterns of mortality during the famine. Mortality of males rose considerably more than that of females, with the greatest rise occurring among young boys aged 5–14 and adult men aged 30–59. A surprising finding was that mortality at ages 0–4 rose relatively little, in part a consequence of a marked fall in the number of births during the famine. The Tenpō subsistence crisis was not the sole cause of population stagnation in the Ogen-ji population, but it was a prominent feature of the ‘high mortality regime’ that this population experienced during the eighteenth and nineteenth centuries.     

How bad will it be? Modelling the AIDS epidemic in Eastern Africa

The spread of HIV infection and the subsequent AIDS morbidity and mortality threatens to have a substantial impact on societies in subSaharan Africa. Infection levels are increasing rapidly in many regions, especially in urban areas. The consequences of high levels of infection are inescapable, although, due to the long incubation period, morbidity and mortality increases lag several years behind increases in infection levels. The impact of a serious AIDS epidemic will be felt by many sectors of the society. Mortality levels will substantially increase, especially among newborns and adults under age 50. This mortality will remove many productive members from the economy, while HIV-related illness will reduce the productivity of the infected population. Health care facilities will be severely strained to bear the increases in hospitalized populations. Those without access to the formal health care system will rely on family members for support and care.     

The socio-demographic legacy of the Khmer Rouge period in Cambodia

The study presented in this paper is an examination of the long-term impact of genocide during the period of the Khmer Rouge regime (1975-79) in Cambodia. The very high and selective mortality of the period had a major impact on the population structure of Cambodia. Fertility and marriage rates were both very low under the Khmer Rouge, but recovered immediately after the regime's collapse. Because of the shortage of eligible men, the age and education differences between partners tended to decline. The period also had a lasting impact on the educational attainment of the population. The school system collapsed during the period and therefore individuals -- especially men -- who were of school age at the time have a lower educational attainment than those from the preceding and subsequent birth cohorts.     

The changing contribution of smoking to educational inequality in female mortality

The negative association between education and mortality is well established in international research. The harmful effect of smoking on health is well known. However, the contribution of smoking to educational inequality in mortality varies across studies, and in some studies, the contribution is negligible. This paper demonstrates the use of an analytical approach to provide one explanation for this phenomenon. Analysing nationally representative survey data for two cohorts of Australian women born in 1920–1928 and 1945–1951 respectively, we found that in the 1994–2006 period, the less educated are subject to higher mortality by 38–50 %. In the total sample, the smoking contribution to excess mortality due to lower education is negligible. However, when the cohorts are analysed independently, the smoking contribution ranges from ?13 % among those born in 1920–1928 to +23 % among those born in 1945–1951. The smoking contribution is only seen in the cohort-specific analysis because smoking is more prevalent among tertiary degree holders in the earlier cohort but more prevalent among less educated women in the later cohort. The disaggregated analytical approach taken here deserves further attention in research on inequality.     

The role of public health improvements in health advances: The twentieth-century United States

Mortality rates in the United States fell more rapidly during the late nineteenth and early twentieth centuries than in any other period in American history. This decline coincided with an epidemiological transition and the disappearance of a mortality "penalty" associated with living in urban areas. There is little empirical evidence and much unresolved debate about what caused these improvements, however. In this article, we report the causal influence of clean water technologies--filtration and chlorination--on mortality in major cities during the early twentieth century. Plausibly exogenous variation in the timing and location of technology adoption was used to identify these effects, and the validity of this identifying assumption is examined in detail. We found that clean water was responsible for nearly half the total mortality reduction in major cities, three quarters of the infant mortality reduction, and nearly two thirds of the child mortality reduction. Rough calculations suggest that the social rate of return to these technologies was greater than 23 to 1, with a cost per person-year saved by clean water of about dollar 500 in 2003 dollars. Implications for developing countries are briefly considered.     

Do marriages forget their past? Marital stability in post-Khmer Rouge Cambodia

This paper assesses the impact of three main destabilizing factors on marital stability in Cambodia: the radical reformation of marriage under the Khmers Rouges (KR); the imbalanced gender ratio among marriageable adults resulting from gendered mortality during the KR regime; and, after decades of isolation from the West, a period of rapid social change. Although there is evidence of declining marital stability in the most recent period, marriages contracted under the KR appear as stable as adjacent marriage cohorts. Thesefindings suggest that the conditions under which spouses were initially paired matter less for marital stability than does their contemporaneous environment.     

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.     

Mortality and Metropolis: The Case of London 1675–1825

Recent work in population history emphasizes that demographic phenomena should be seen in a wider social and economic context. This perspective is, however, more easily achieved in the case of fertility than of mortality, which is widely treated as a variable ‘exogenous’ to economy and society. In the present paper it is argued that the inclusion of spatial structure and migration in accounts of historical demographic regimes can restore long-term variations in mortality to an ‘endogenous’ position. Within such a model a central role is played by large metropolitan populations, which act as endemic reservoirs of infection, with high but relatively stable levels of mortality. Data from the annual London Bills of Mortality allow empirical testing for the period 1675–1825, with results which generally conform to theoretical expectations, although a substantial reduction in mortality occurs during the latter part of the period.     

Socio-economic determinants of mortality in Latin America

The characteristics and sources of socioeconomic differentials of mortality in Latin America, in so far as they are currently known, are examined in an attempt to clarify the present situation and its perspectives. Mortality in a population is a function of the frequency of illness (incidence) and the probability of dying of the sick individual (lethality). Information on the socioeconomic differentials of mortality in Latin America is systematically reviewed with attention directed to the following: differentials among Latin American countries, regional differences within countries, urban-rural contrasts in mortality, mortality and income level and level of education, and mortality and ethnic groups. Latin America shows considerable heterogeneity with respect to the risk of dying, which varies from 202/1000 births in Bolivia to 38/1000 in Uruguay. It is estimated that more than 1/2 of the children born in Latin America are exposed to a mortality rate of over 120/1000. A study of the urban and rural populations of 12 Latin American countries revealed that the risk for rural populations exceeds that for urban populations by 30-60%. There is extensive evidence showing that mortality is higher in the working class and is associated with lower levels of education and income. Mortality was also higher in certain indigenous groups. Socioeconomic differentials of mortality are more marked in Latin America than in the developed nations. The mother's level of educational attainment is the variable most significantly associated with infant and child mortality. The prospect of reducing the current mortality levels is dependent primarily upon the implementation of policies aimed at a more egalitarian distribution of the benefits of socioeconomic development among the population.     

We must pay attention to the difference between the original intention and the current status of family planning]

Due to imperfections in the current family planning (FP) policy, and the differences un program implementation in urban and rural areas, the fertility of the urban population with higher IQ scores is under control but this is not the case for the rural population. Among rural couples, one child is rare and two or three are commonplace, while in cities over 70% of couples are having one child. In the metropolitan cities, this figure is about 90%. In the rural areas, provision of education is a serious problem because of insufficient resources, a lack of qualified teachers and inadequate facilities. At the present, at least 3 million school age children in rural areas can not go to primary school. Besides there is a big contrast in FP practice between Han nationality and minorities. Population growth is basically under control among the more advanced Han nationally but not among the less advances minority nationalities. This growth rate among the minority population was about 50.27/1000 in the past five years, which is alarming. Furthermore, the couples given opportunity to have a second child are often those whose first child had birth defects or is mentally retarded, whereas couples with a normal child can have only one child. This has become a vicious circle, since subsequent children are more likely to have the same birth defects. It was discovered from a 1983-85 survey that the prevalence of birth defects was 12.8/1000. The current situation is that the fertility of urban, educated, and healthy people is restricted while the less educated, those living in less developed areas, and those with health defects are having more children. The outcome of this situation is the decline of national population quality, which greatly deviates from the original intention of the FP.     

Maternal mortality in South Africa: an update from the 2007 Community Survey

The 2007 Community Survey conducted in South Africa included questions on maternal deaths in the previous 12 months (pregnancy-related deaths). The Maternal Mortality Ratio (MMR) was estimated at 702 per 100,000 live births, some 30% more than at the 2001 census. This high level occurred despite a low proportion of maternal deaths (4.3%) among deaths of women aged 15–49 years, which is even lower than the proportion of time spent in the maternal risk period (7.6%). The high level of MMR was due to the astonishingly high level of adult mortality, which increased by 46% since 2001. The main reasons for these excessive levels were HIV/AIDS and external causes of death (accidents and violence). Differentials in MMR were very marked, and similar to those found in 2001 with respect to urban residence, race, province, education, income, and wealth. Provincial levels of MMR correlated primarily with HIV/AIDS prevalence. Maternal mortality defined as ‘pregnancy-related death’ appears no longer as a proper indicator of ‘safe motherhood’ in this situation.     

Mortality and fertility in Arctic Communities Greenland - A case study

Summary The purpose of this paper is to estimate the present level of mortality and fertility as well as its history amongst the indigenous population of Greenland during the period 1834-1953 on the basis of a series of censuses taken during that time. Mortality and fertility parameters have been estimated by techniques particularly suited for the analysis of incomplete demographic data - e.g. stable population analysis. During the period studied Greenland was a Danish colony. It did not become constitutionally part of Denmark until 1953. The paper shows that even though the importance of Danish - and other European - influence should not be underestimated, the socio-economic structure of Greenland was relatively stable until 1953. The results show an extremely high mortality and a correspondingly high fertility. There is also evidence that mortality fluctuated considerably during the period. This might also be true of fertility, but it is impossible to establish this by means of the techniques used. These results are supported by an analysis of registrations of births and deaths for part of the period. The paper concludes with an evaluation of the validity of the techniques of estimation, having regard to the nature of the Greenland censuses. It is pointed out that the empirical material from which model stable populations must have been constructed varies somewhat from that applicable to an Arctic population.     

Barriers to contraceptive use among Pakistani couples

Despite the existence of a family planning program in Pakistan since 1965 and widespread knowledge among Pakistanis about contraception, there is a high level of unmet need for family planning. One recent survey found that while 53% of married women express the desire to avoid pregnancy, less than 20% use contraception. A recent Population Council study conducted in urban and rural areas of Punjab province investigated personal beliefs, family circumstances, social norms, and gender relations among 1310 married women and 554 of their husbands. The unmet need for contraception was highest among women over age 30 years, those with more living children, less educated women, and women living in rural areas. The study found that while most Pakistanis approve of family planning, obstacles to contraceptive use exist in most marriages. 97% of respondents who wanted another child wished for a boy. That preference for sons influences contraceptive use behavior. The fear of social disapproval of contraceptive use, perceived opposition from in-laws and husbands, and fear of health side effects and divine punishment were major reasons identified against contraceptive use. Female contraceptive users were more autonomous and likely to make domestic decisions without consulting their husbands, while husbands defer to social and cultural norms.     

Relationship of infant mortality and community development

A researcher applied indirect estimation techniques to data from 352 rural villages from the 1978 Republic of the Philippines Fertility Survey to determine if community factors affect mortality of children 5 years old. Children with the highest mortality risks included those of the poor and least educated parents. For example, infant and child mortality stood at 203 among mothers with no education compared to 42 among those with at least a college education. In addition, infant and child mortality among husbands who were farmers was 111 whereas it was 28 among husbands who worked in professional and clerical jobs. Low cost health services and midwives were the health factors that had the greatest effect ion the probability of survival for children 5 years old, especially among the poor and least educated. For example, the probability of dying fell from 123-80 among the poor and 152-79 among the least educated if a dispensary was accessible and from 131-88 among the poor and 154-96 among the least educated if a midwife was accessible. Furthermore, adequate nutrition, better housing conditions, safe water, and sanitation also played a key role in reducing the probability of death. In terms of community development, only accessibility to a newspaper outlet the families were. On the other hand, the presence of electricity was significant only when education of the mother, occupation of the father, and region of residence were used as control variables. Thus the government should expand health care services to the rural population. Further, it should integrate health components in social and economic development programs     

Trends and Socioeconomic Gradients in Adult Mortality around the Developing World

We combine data from 84 Demographic and Health Surveys from 46 countries to analyze trends and socioeconomic differences in adult mortality, calculating mortality based on the sibling mortality reports collected from female respondents aged 15–49. The analysis yields four main findings. First, adult mortality is different from child mortality: while under‐5 mortality shows a definite improving trend over time, adult mortality does not, especially in sub‐Saharan Africa. The second main finding is the increase in adult mortality in sub‐Saharan African countries. The increase is dramatic among those most affected by the HIV/AIDS pandemic. Mortality rates in the highest HIV‐prevalence countries of southern Africa exceed those in countries that experienced episodes of armed conflict. Third, even in sub‐Saharan countries where HIV prevalence is not as high, mortality rates appear to be at best stagnating, and even increasing in several cases. Finally, the main dimension along which mortality appears to differ in the aggregate is by sex. Adult mortality rates in sub‐Saharan Africa have risen substantially higher for men than for women—especially so in the high HIV‐prevalence countries. On the whole, the data do not show large gaps by urban/rural residence or by school attainment.     

Christian–Muslim differences in child survival in Egypt

Ethnic and religious inequalities in child survival have been documented in many countries. In Egypt, during the 1980s and 1990s, Christians had higher childhood mortality than Muslims despite their higher socio-economic status (SES) and concentration in urban areas. This paper explores reasons for this Christian–Muslim mortality gap. Data for this study are drawn from Egypt’s 1988, 1992, 1995, 2005 and 2008 Demographic and Health Surveys, which recorded the respondents’ religious affiliation. The main analysis compares children of Christian and Muslim mothers in survival to age five using proportional hazards Cox regression models. Results indicate that differences in the regional distributions of Christians and Muslims positively contributed to the mortality gap during the 1980s–1990s. The majority of Christians resided in Upper Egypt where childhood mortality rates were considerably higher than in other regions. However, only part of higher Christian mortality can be explained by their regional concentration. In Upper Egypt, despite their higher SES, as well as greater urban residence, Christians had higher mortality than Muslims. These findings are at odds with research demonstrating the significance of SES and urban concentration in explaining ethnic–religious mortality gaps.     

Why do the children of the poor die in Dhaka,Bangladesh?

Mortality data from much of the developing world show that the health advantage of urban over rural areas is being eroded. The single most important factor is the very high mortality of the slum populations, mostly rural-urban migrants in the large cities. This has been shown to be true of Dhaka, Bangladesh, where much of the mortality differential between the poor and other residents can be explained by higher mortality in the slums among young children, especially infants. This paper reports on a collaborative project, Access to Health and Reproductive Health Services in the Dhaka Slums, which confirmed this situation in a 1999 survey and employed an in-depth approach in 2000 to investigate the circumstances of child deaths. It is shown that these deaths mostly occur among illiterate rural-urban migrants who have brought pre-Islamic folk beliefs about illness and its treatment with them. This and cost in most cases preclude modern medical treatment. These disadvantages are reinforced by treatment decisions being made in a purdah society almost entirely by women, especially old women, with husbands and other male relatives often being beyond contact. Suggestions are advanced for improving the situation.