Culture influences demographic behavior: evidence from India

Delhi migrants from low socioeconomic classes were compared based on their home origins in north or south India. The two groups differed in cultural beliefs, attitudes, and practices, but they lived in the same resettlement colony and had the same physical access to services and opportunities. Retrospective data was collected from a sample of ever-married women and household heads. Longitudinal data was collected on households with at least two living children younger than 12 in visits once every two weeks over a six-month period. Information was obtained on children's eating patterns, activities, illnesses, and the treatment of their illnesses. Households from Tamil Nadu in the south were more modern, had greater female autonomy, and were open to new ideas. Uttar Pradesh women from the north were more traditional, secluded, and restricted in economic activities. The results showed lower fertility, higher levels of contraceptive use, and earlier ends to childbearing among Tamil Nadu women, who had had more exposure to ideas about smaller family size, healthful childrearing practices, and positive attitudes about contraceptive use. For every 100 Tamil Nadu children who died, 111 Uttar Pradesh children died. Health care practices differed between groups; the urban slum environment was conducive to the spread of gastrointestinal infections among Uttar Pradesh girls discouraged from using the public water taps and toilet facilities. Among the Tamil Nadu migrants, girls actually had lower childhood mortality rates than boys. 115 girls died for every 100 boys among the Uttar Pradesh. The reason may be due to the avoidance or delay of outside medical attention until too late. The conclusion was that the status of women, and their exposure to and interaction with the outside world and control over decision making at home, explained the differences between the two groups. Policy implications are to make programs culturally sensitive for example, providing at-home care for women traditionally sheltered from contact with strangers.     

我国已婚育龄人群避孕水平及避孕方法使用趋势

利用中国20世纪60年代到2004年的全国计划生育调查数据,深入分析我国已婚育龄人群避孕水平及避孕方法的使用趋势。结果表明,我国一直是全球总避孕水平最高的国家,避孕方法以长效措施为主。90年代后,主要避孕方法中宫内节育器现用率逐年上升,女性绝育逐年小幅下降,男性绝育逐年明显下降,避孕套现用率逐年递增,口服避孕药、外用避孕药和其他避孕方法呈逐年下降趋势;且避孕方法的选择存在省市、城乡差异。     

Contraceptive use in China

A national sampling survey carried out in China in 1988 showed that 90.71% of the population were using some form of contraception: male sterilization (10.99%); female sterilization (38.24%); and IUDs (41.48%). Compared with 1982, the figures gathered in 1988 showed an increase in male sterilization and female sterilization and a decrease in condoms, oral or injected contraceptives, IUDs and spermicides. A great difference was found between the contraceptive methods used by women in rural areas as compared to women in urban areas. In urban areas IUDs accounted for 58%, female sterilization for 15%, male sterilization for 1% and condoms for 13%. In the country, female sterilization accounted for 42%, IUDs for 39%, male sterilization 15%, condoms 1% and oral contraceptives for 4%. There was also a strong difference between women of certain ages; the use of IUDs was highest among women between the ages of 15-29 years, while female sterilization was more prevalent for women over the age of 30. There was also a considerable difference between the birth control taken by women with children and those without; the majority of women (31%) without children used condoms; the majority of children (78%) with 1 child used IUDs; the majority of women (65%) with 2 children were sterilized. The sample study shows that 91% of the women using contraception used long-acting contraception.     

Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India*

Using data from India, we estimate the relationship between household wealth and children's school enrollment. We proxy wealth by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights. In Indian data this index is robust to the assets included, and produces internally coherent results. State-level results correspond well to independent data on per capita output and poverty. To validate the method and to show that the asset index predicts enrollments as accurately as expenditures, or more so, we use data sets from Indonesia, Pakistan, and Nepal that contain information on both expenditures and assets. The results show large, variable wealth gaps in children's enrollment across Indian states. On average a "rich" child is 31 percentage points more likely to be enrolled than a "poor" child, but this gap varies from only 4.6 percentage points in Kerala to 38.2 in Uttar Pradesh and 42.6 in Bihar.     

Can NFP be taught in two short,easy lessons? Simplified NFP for isolated and/or busy couples

Researchers used life table rates from study and comparison groups from rural and urban areas of Cagayan de Oro City, the Philippines to test a simplified method of teaching natural family planning (NFP) defined by calendar, mucus, and cervix indicators. This method included a 6 page booklet, 2 30-minute training sessions, and a question and answer period. Fear of side effects from other contraceptive methods was the leading reason for using NFP (79.4% urban, 85.8% rural). Religious motivation and fear of side effects followed for urban couples, but the percentage was low (14.6%). In rural areas, religious motivation place 3rd (4.1%) preceded by other reasons (6.9%). User error resulted in low accidental pregnancy rates (.8%). Method failure was responsible for higher failure rates than user error, but they were still relatively low (3.4% total). In rural areas, the reason for failure was unclear in 2.6% of couples, but it was only .9% among urban couples. Rural couples who used NFP to space births (spacers) had 2 times the failure rate of those rural couples who used NFP to limit births (limiters) [69% vs. 31%]. Urban spacers had a higher failure rate than urban limiters, but the difference was smaller than it was for rural couples (54.8% vs. 45.2%). Lactation did not have a clear effect on failure rates. For example, in urban areas, partially lactating women had a lower failure rate than nonlactating women (41.9% vs. 58.1%), but in rural areas, lactation had the opposite effect (63.6% for lactating women and 36.4% for nonlactating women). Risk taking resulted in more 6 month pregnancy rates among urban couples than rural couples (12.3% vs. 8.2%). At the end of 6 months, 67.5% of all couples still used the new simplified NFP method (70.3% rural vs. 64.7% urban). Therefore the new simplified NFP method was an effective method for spacing or limiting births.     

Community-based contraceptive distribution: a Korean success story

The results of a community-based contraceptive distribution program using village women canvassers in Cheju Island province, Korea, are evaluated. This rural province had the highest fertility and lowest contraceptive use before the project began. After pre-testing in another area, township-level family planning field workers recruited 365 new female canvassers per 150 women at risk of pregnancy, compared to 10,000-25,000 per worker in the previous scheme. The canvassers were to contact every household, offering them pills or condoms, or vouchers for an IUD or sterilization from the clinic. The former target system, which in reality had limited the numbers of acceptors, was suspended, necessitating an increase in budget outlays for family planning in Cheju province. By 1985 the contraceptive prevalence had doubled, and fertility fell 40.1 and 32.4% in the 2 Cheju counties. Costs per couple-year for the Cheju program were lower than those in other areas. The results of this project suggested that increasing the number of community workers or canvassers in rural areas helps reduce barriers to the use of contraceptives.     

The role of contraceptive supply and demand in Mexican fertility decline: evidence from a microdemographic study

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.     

The Role of Contraceptive Supply and Demand in Mexican Fertility Decline: Evidence from a Microdemographic Study

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.     

Population statistics] as of January 1, 1998

In thousands, Thailand's total population as of January 1, 1998, was 60,763, of which 30,363 were male and 30,400 were female. 19,127 live in urban areas and 41,636 live in rural areas. 11,363 live in the northern region, 20,720 to the northeast, 8021 in the South, 13,550 centrally, and 7109 in the Bangkok metropolis. 16,375 were under age 15, 39,282 aged 15-59, and 5106 aged 60 and over. There were 15,728 women of reproductive ages 15-44. Crude birth and death rates per 1000 population were 17.3 and 6.5, respectively, with an overall natural growth rate of 1.1%. Infant mortality was 25.0/1000 live births. Male and female life expectancies at birth were 66.6 and 71.7 years, respectively. Further life expectancies at age 60 for males and females were 20.3 and 23.9 years, respectively. The rate of total fertility per woman was 1.98, with a contraceptive prevalence rate of 72.2%.     

Understanding U.S. fertility: findings from the National Survey of Family Growth,Cycle III

The 1st overview of findings from Cycle III of the National Survey of Family Growth, the latest of 7 such surveys of US fertility since 1955 and the 1st to cover all women of childbearing age in the conterminous US is presented. Interviews between August 1982 and February 1983 with 7969 women, representative of 54 million women aged 15-44, reveal that sterilization is now the leading contraceptive method in the US, used by 33% of all contraceptors in 1982 (22%, female sterilization; 11% male sterilization), followed by the pill (29%), condom (12%), diaphragm (8%), and IUD (7%). Linked to this is the continuing decline in unwanted births since the baby boom peak in 1957, which accounted for nearly 1/2 of the drop between 1973 and 1982 in ever-married women's children ever born, from 2.2 to 1.9/woman. However, births conceived sooner than planned increased slightly among younger married women, probably due to the large drop in pill use since 1973 and increased use of the less effective diaphragm and condom among couples still intending to have more children. Black women are now more likely than white women to use the most effective female methods: female sterilization, pill, and IUD. Only 45% of women aged 15-44 in 1982 had used a contraceptive method at 1st intercourse. 4 out of 5 women married for the 1st time between 1975 and 1982 had intercourse before marriage. However, premarital sexual activity may be leveling off among white teenagers after a steep rise since the early 1970s and declining moderately among black teenagers. 16% of 1st marriages among ever-married women aged 15-44 in 1982 had been dissoved within 5 years, mostly by divorce or separation. 59% of black women with children in 1982 had their 1st birth before marriage, compared to 11% of white mothers. The proportion of babies who were breastfed more than doubled between 1970-71 and 1980-81, from 24 to 53%.     

Population policy in India

The financial allocations made for the family planning program in India since the early 1950s suggest that a very high priority is attached to population control policy. At the current rate of exchange, the public sector investment will have been over 5.3 billion U.S. dollars by the end of the Seventh Five Year Plan, 1985–1990. It is claimed that over 85 million births have been averted over the last three decades. The number of couples currently protected by the various contraceptive methods, as of March, 1987, is estimated to be 55 million, or 41.4% of the 132.6 million eligible couples with wives 15–44 years-old.The long-term goal of the national population policy is to attain replacement level fertility (approximately 2.3 children) per couple by the turn of the century, implying a crude birth rate of 21 and a death rate of 9 per 1,000 persons. In view of very slow progress in the reduction of the crude birth rate, particularly in the Hindi-speaking populous states of Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, and Haryana, the target for the country as a whole is most likely to be reached by 2010–2015 A.D.The observed stalled decline in the crude birth rate between 1975 and 1984 at the national level is analyzed in terms of changing age-sex composition, marital status, set-back to the family planning efforts, and other factors.The long-term projections indicate a national population of 996 million by the year 2,000 A.D., and 1,336 million in the year 2030 A.D. Further, for the very long run, a stationary population of 1.7 billion is hypothesized for India in the middle of the 22nd century.The data analyzed in this paper was collected in 1986 at the Delhi School of Economics through the courtesy of the Shastri Indo-Canadian Institute, Calgary/New Delhi. Appreciation is expressed to both institutions and to Drs. P.P. Talwar, M.K. Premi, K.B. Pathak, and Dr. Ashish Bose. Please direct correspondence to Dr. Chaudhry, Department of Political and Economic Science, Royal Military College of Canada, Kingston, Ontario, Canada K7K 5L0.     

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.     

A survey of China's birth control among women of child-bearing age

To further implement China's family planning policy of "prevention first, birth control first," a study of the current family planning situation was conducted. A survey of the birth control methods employed by women of childbearing age and by men was based on a nationwide randomized sampling of 1/1000. In the different age groups, ranging from 15-49 years old, IUD users accounted for over 50%, tubal sterilization 25%, and vasectomy 10%. The main IUD users were women in the 20-24 age group. Tubal sterilization was more prevalent among the women in the 35-39 age group. The use of oral contraceptives (OCs) was more common among younger women but accounted for less than 10% of the total. The survey was based on the replies to questionnaires from 172,788 married women of childbearing age; 120,022 of them practiced contraceptive methods for a birth control rate of 69.46%. The breakdown was as follows: IUD, 34.84%; tubal sterilization, 17.63%; vasectomy, 6.94%; OCs, 5.86%; condom users, 1.39%; and other methods (including chemical suppositories, rhythm, or safe period method and withdrawal before ejaculation), 2.78%. There was a higher percentage of OC users in urban areas, and a marked preference for IUDs in the rural communities. The rural birth control rate was 68.58%; the urban rate was 74.17%. The use of the IUD has priority in all the areas; its percentage approaches the national average level. The use of vasectomy as a birth control method varies considerably according to area as does the use of OCs, condom, and tubal sterilization. Rural minority groups prefer the IUD and OCs; tubal sterilization, the condom, and vasectomy are preferred by the Han nationality. The birth control rate differed according to the different occoupation groups: 77.85%, workers; 76.01%, farmers; 85.15%, cadres; 59.52%, housewives; and 66.67%, others. The birth control rate was higher among those who received a college education than the illiterates, but statistics did not show a significant difference in the rate of those with a high school education and the illiterates. Mothers of 0-1 children generally preferred OCs; tubal sterilization was preferred by mothers with 2-3 children. The nonusers of contraception accounted for 30.54% among married women of childbearing age. A breakdown gives the following figures: menopause and infertility, 6.17%; divorced and widowed, 1.64%; planned parenthood, 10.51%; nonusers who should have practiced contraception, 12.22%. On a national level, the estimated number of nonusers of contraception among those who should be practicing contraception comes to about 20,000,000 women.     

Population statistics] as of July 1, 1996

In thousands, Thailand's total population as of July 1, 1996, was 59,781, of which 29,873 were male and 29,908 were female. 18,879 live in urban areas and 40,902 live in rural areas. 12,009 live in the northern region, 19,464 to the northeast, 7484 in the South, 12,969 centrally, and 7855 in the Bangkok metropolis. 17,217 were under age 15, 38,200 aged 15-59, and 4364 aged 60 and over. There were 15,421 women of reproductive ages 15-44. Crude birth and death rates per 1000 population were 15.6 and 5.0, respectively, with an overall natural growth rate of 1.1%. Infant mortality was 29.0 per 1000 live births. Male and female life expectancies at birth were 66.6 and 71.7 years, respectively. Further life expectancies at age 60 for males and females were 18.8 and 22.0 years, respectively. The rate of total fertility per woman was 1.95 with a contraceptive prevalence rate of 74.0% and an anticipated population of 70,835 in the year 2012.     

Population statistics] as of January 1, 1997

In thousands, Thailand's total population as of January 1, 1997, was 60,103, of which 30,034 were male and 30,069 were female. 18,981 live in urban areas and 41,122 live in rural areas. 12,074 live in the northern region, 19,568 to the northeast, 7524 in the South, 13,039 centrally, and 7898 in the Bangkok metropolis. 16,197 were under age 15, 38,856 aged 15-59, and 5050 aged 60 and over. There were 15,558 women of reproductive ages 15-44. Crude birth and death rates per 1000 population were 15.6 and 5.0, respectively, with an overall natural growth rate of 1.1%. Infant mortality was 25.0/1000 live births. Male and female life expectancies at birth were 66.6 and 71.7 years, respectively. Further life expectancies at age 60 for males and females were 18.8 and 22.0 years, respectively. The rate of total fertility per woman was 1.95, with a contraceptive prevalence rate of 75.2% and an anticipated population of 70,627 in the year 2012.     

Population statistics] as of July 1, 1995

In thousands, Thailand's total population as of July 1, 1995, was 59,450, of which 29,707 were male and 29,743 were female. 18,774 live in urban areas and 40,676 live in rural areas. 11,942 live in the northern region, 19,356 to the northeast, 7443 in the South, 12,897 centrally, and 7812 in the Bangkok metropolis. 17,122 were under age 15, 37,988 aged 15-59, and 4340 aged 60 and over. There were 15,347 women of reproductive ages 15-44. Crude birth and death rates per 1000 population were 17.6 and 5.2, respectively, with an overall natural growth rate of 1.2%. Infant mortality was 30.8 per 1000 live births. Male and female life expectancies at birth were 66.6 and 71.7 years, respectively. Further life expectancies at age 60 for males and females were 18.8 and 22.0 years, respectively. The rate of total fertility per woman was 1.95 with a contraceptive prevalence rate of 74.0% and an anticipated population of 71,860 in the year 2012.     

Population statistics] as of July 1, 1997

In thousands, Thailand's total population as of July 1, 1997, was 60,440, of which 30,202 were male and 30,238 were female. 19,087 live in urban areas and 41,353 live in rural areas. 12,141 live in the northern region, 19,678 to the northeast, 7566 in the South, 13,112 centrally, and 7943 in the Bangkok metropolis. 16,288 were under age 15, 39,073 aged 15-59, and 5079 aged 60 and over. There were 15,558 women of reproductive ages 15-44. Crude birth and death rates per 1000 population were 15.6 and 5.0, respectively, with an overall natural growth rate of 1.1%. Infant mortality was 25.0 per 1000 live births. Male and female life expectancies at birth were 66.6 and 71.7 years, respectively. Further life expectancies at age 60 for males and females were 18.8 and 22.0 years, respectively. The rate of total fertility per woman was 1.98 with a contraceptive prevalence rate of 72.2% and an anticipated population of 70,642 in the year 2012.     

Population statistics] as of January 1, 1995

In thousands, Thailand's total population as of January 1, 1995, was 58,995, of which 29,480 were male and 29,515 were female. 18,630 live in urban areas and 40,365 live in rural areas. 11,851 live in the northern region, 19,208 to the northeast, 7385 in the South, 12,798 centrally, and 7753 in the Bangkok metropolis. 16,990 were under age 15, 37,698 aged 15-59, and 4307 aged 60 and over. There were 15,230 women of reproductive ages 15-44. Crude birth and death rates per 1000 population were 17.4 and 6.1, respectively, with an overall natural growth rate of 1.1%. Infant mortality was 30.9 per 1000 live births. Male and female life expectancies at birth were 66.6 and 71.7 years, respectively. Further life expectancies at age 60 for males and females were 18.8 and 22.0 years, respectively. The rate of total fertility per woman was 1.95 with a contraceptive prevalence rate of 74.0% and an anticipated population of 70,995 in the year 2012.     

Do Health Insurance and Residence Pattern the Likelihood of Tubal Sterilization among American Women?

American women have increasingly opted for tubal sterilization or tubal ligation surgery in recent decades. While research has begun to examine the unequal access to health care in the United States, little research has considered how this may impact whether women opt for a tubal ligation surgery. We first profile women with and without tubal ligations using bivariate analysis of the most recent data available, a nationally representative sample of 7,643 women from the National Survey of Family Growth, Cycle 6 (NSFG, Public use data file, 2002). We then use logistic regression models to examine the relationship between having tubal ligation and two focal variables: (1) type of health insurance (Medicaid compared with private, government or military, and no health insurance), and (2) rural or urban place of residence. We find that women on Medicaid are nearly twice as likely to have had a tubal sterilization compared with women who have private health insurance coverage. Also, women on Medicaid are substantially more likely to have a tubal sterilization than women with government or military insurance and women with no health insurance (26% and 36%, respectively). Further, we find that women living in rural areas are nearly twice as likely to have a tubal sterilization, compared with women in urban or suburban areas, all else being equal.     

India's population in transition

This demographic profile of India addresses fertility, family planning, and economic issues. India is described as a country shifting from economic policies of self-reliance to active involvement in international trade. Wealth has increased, particularly at higher educational levels, yet 25% still live below the official poverty line and almost 66% of Indian women are illiterate. The government program in family planning, which was instituted during the early 1950s, did not change the rate of natural increase, which remained stable at 2.2% over the past 30 years. 1993 marked the first time the growth rate decline to under 2%. The growth rate in 1995 was 1.9%. The total population is expected double in 36 years. Only Nigeria, Pakistan, and Bangladesh had a higher growth rate and higher fertility in 1995. India is geographically diverse (with the northern Himalayan mountain zone, the central alluvial plains, the western desert region, and the southern peninsula with forest, mountains, and plains). There are regional differences in the fertility rates, which range from replacement level in Kerala and Goa to 5.5 children in Uttar Pradesh. Fertility is expected to decline throughout India due to the slower pace of childbearing among women over the age of 35 years, the increase in contraceptive use, and increases in marriage age. Increased educational levels in India and its state variations are related to lower fertility. Literacy campaigns are considered to be effective means of increasing the educational levels of women. Urbanization is not expected to markedly affect fertility levels. Urban population, which is concentrated in a few large cities, remains a small proportion of total population. Greater shifts are evident in the transition from agriculture to other wage labor. Fertility is expected to decline as women's share of labor force activity increases. The major determinant of fertility decline in India is use of family planning, which has improved in access and use during the 1980s. If India is to keep a stable population under 1.6 billion in the future, Indians may have to accept only one child per family.