Health conditions in rural and urban areas of developing countries

The poor quality and meagre supply of data prohibit conclusions as to the relationship of health status to rural-urban residence in underdeveloped countries. Demographic indicators of health, specifically infant mortality and average life expectancy, do not seem to vary systematically according to rural-urban residence in the less developed countries ofAsia, Africa and Latin America. Further differences between rural and urban areas in availability of health services and facilities do not always conform with apparent differences between the areas in health status. However, nutritional standards, housing conditions, and sanitation, water supply and other pertinent environmental circumstances account to some extent for differences observed in health status between rural and urban inhabitants of these countries.     

An analysis of the fertility transition in developing countries]

Most developing countries are in the demographic stage of early mortality, high birth rates and high rates of natural population increase. A characteristic of developing countries is that after World War ii, particularly since the 1960s fertility rates are on the decline, even though they still remain high. The fertility rate of developed countries fell from a 1950 rate of 22.9/1000 to 15/1000 in 1982, a decrease of 34.5%, whereas the fertility rate of developing countries hovered around 43/1000 between 1930-1950, 40.6/1000 during the 1960s and 33/1000 in 1982. Between 1950 and 1982 there was a decrease of 24.8%. But the main reason for this decrease is the decline in the last 20 years of the fertility rates of China and India, whose rates fell 34.9% from 1960-1980. Changes in fertility rates are influenced by the age structure of a country, as seen in the changing age structure of developing countries from 1960-80. For example, an increase in fertility rates was 1 consequence of an increase in the number of fertile women aged 15-45 from 42.6% in 1960 to 44.4% in 1980. Nevertheless, there exists some sort of birth control, whether conscious or subconscious, because the number of births per fertile woman is 3-4 fewer than the 14-15 children a woman can theoretically bear. The reason for changes in fertility rates in developing countries can be traced to marriage and family customs, and even more important, to social and economic factors. For example, Asian, African and Latin American cultures tend to support early marriages. When the fertility rates of developed and developing countries are looked at for a comparable period, then the rate of decrease for developing countries is slower than developed countries. But, if the comparison is made for a transitional period (i.e., industrialization), then the rate of decrease for developing countries is faster than for developed countries. Currently there are 25 developing countries that have attained a fertility rate of 25/1000 or lower, and 52 developing countries with a rate of 35/1000.     

Comparing relative effects of education and economic resources on infant mortality in developing countries

Research on the social determinants of health has often considered education and economic resources as separate indicators of socioeconomic status. From a policy perspective, however, it is important to understand the relative strength of the effect of these social factors on health outcomes, particularly in developing countries. It is also important to examine not only the impact of education and economic resources of individuals, but also whether community and country levels of these factors affect health outcomes. This analysis uses multilevel regression models to assess the relative effects of education and economic resources on infant mortality at the family, community, and country level using data from demographic and Health Surveys in 43 low-and lower-middle-income countries. We find strong effects for both per capita gross national income and completed secondary education at the country level, but a greater impact of education within families and communities.     

Using survey data to assess neonatal tetanus mortality levels and trends in developing countries

Demographic and health surveys are a useful source of information on the levels and trends of neonatal mortality in developing countries. Such surveys provide data on mortality occurring at 4–14 days of life, which is a sensitive indicator of neonatal tetanus mortality. We analyze birth history data from 37 national surveys in developing countries to assess the quality of neonatal mortality data and to estimate levels and trends in mortality occurring at 4–14 days. It is shown that mortality at 4-14 days has declined considerably during the last decade in most developing countries, concomitant with development and expansion of programs to reduce neonatal tetanus. These declines show that reductions in neonatal tetanus mortality probably have been an important contributor to the decline of neonatal and infant mortality during the 1980s.     

An international labour migration to developing countries in Asia: a case study of Korea

This study is based on a random sample of 431 temporary migrant workers from developing countries in Korea. Interviews were conducted from mid-October 1995 to mid-March 1996 with 105 Pakistanis, 77 Filipinos, 71 Sri Lankans, 67 Bangladeshi, 40 Indonesians, 26 individuals from Myanmar, 22 Chinese, 16 Nepalese, 2 Iranians, 2 Kazakstanians, 1 Malaysian, 1 Vietnamese, and 1 Ghanaian. Migration follows legal and illegal patterns. Legal trainee migrants leave before their contract time due to low pay, inadequate living conditions, forced overtime work, and lack of freedom. Trainees tend to be ethnic Koreans born in China and Chinese nationals. The number of illegal migrants is increasing. Foreign workers gain entry illegally through smuggling networks and legally through industrial work or tourist visas. Sample data reveal that the average age ranged from 26 to 32 years. Almost 70% were unmarried, and most were males. Filipinos tended to be older and show gender and marital balance. Age, marital status, religion, and education varied widely by ethnic group. Indonesians and Sri Lankans had lower household income than Pakistanis and Filipinos. Pakistanis tended to come from larger families. Total travel costs ranged from $3000 to $5000. Korea is one of four rapidly developing countries that shifted from being a major exporter of labor to a major importer of workers. Shortages of workers accompanied the shift. This case study illustrates that the traditional structural paradigm does not explain some unique features of international labor migration (ILM) in Asia, including the encouragement of illegal migration. The clandestine networks are different from those in developed countries. State policies mediate the flow of ILM.     

Determinants of mortality transition in developing countries before and after the Second World War: Some evidence from Cuba

Few studies provide an insight into what factors contributed to declines in the mortality rates of developing countries before the Second World War. In this paper, statistics on causes of death from Cuba, particularly Havana, are used to investigate what may have been some of the principal determinants of mortality decline in the developing world before the arrival of modern drugs and insecticides. Trends in cause-specific mortality are examined in the light of Cuba's social, economic, medical and public health history. The Cuban experience strongly suggests that in this country public health and sanitary reforms and nutritional improvements were largely responsible for initial declines in mortality throughout the first half of the twentieth century. One important finding is that the impact of these reforms and improved nutrition was greatly influenced by prevailing economic conditions. Periods of economic prosperity facilitated declines in mortality; but in times of adversity, the reverse occurred. It appears that during prosperous periods the maintenance and expansion of public health and sanitary facilities were made possible by increased public and private revenues, and that individuals had access to a more abundant diet. The severe economic crisis of the Great Depression had the opposite effect. With the appearance of sulphonamides in the late 1930s, antibiotics, and residual insecticides and other specific measures at the end of the Second World War, the relevance of economic conditions as a determinant of mortality decline diminished. Although this analysis points to the aforementioned trends, the Cuban experience also suggests that other factors enter into the process of declining mortality and that this phenomenon can only be explained as the result of the complex interplay of many forces.     

On allocating resources for fertility reduction in developing countries

Summary Substantial resources are currently being devoted in attempts to reduce fertility in developing countries. Can their allocation be made more efficient, i.e. more effective per unit of investment? This is an exploratory attempt to apply benefit-cost analysis to various realistic interventions, as judged by knowledgeable experts in the absence of sound empirical information on such impacts. (Such judgements appear to represent essentially the same sort of judgements as are made by policy-makers in the field). The paper concentrates on the methods by which several such analyses are made and illustrates the difficulties and problems encountered, but it also presents certain findings and conclusions of substance that show what results can be derived.     

Population settlement alternatives in developing countries

Until recently it was almost an article of faith that urbanization and capital intensive technology are the keys to development. However, many critics now maintain that the Western-inspired urban-industrial model may not be applicable to developing nations. The first part of this paper critically examines the role of large cities in developing countries. Although primate cities and economic dualism are associated with serious inter-class and inter-regional inequity problems, the principal alternative development strategies-promotion of medium-size growth centers and emphasis on rural development-also are beset by conceptual and practical difficulties. If no single development trategy appears to have universal validity, suggestions nevertheless are made for improving social welfare through a better organization of human settlement systems.     

Children's living arrangements in developing countries

This paper documents the wide variation in living arrangements experienced by children in developing regions using data from 19 Demographic and Health Surveys. Traditionally, researchers and policymakers concerned with child welfare have assumed that, apart from exceptional cases, children live with their mothers, experience childhood together with their siblings, and have access to resources from both biological parents. Data presented in this paper contradict this assumption. The data demonstrate that, in many countries of sub-Saharan Africa and Latin America as opposed to parts of Asia and North Africa, children spend substantial proportions of their childhood years apart from one or both parents and, by extension, apart from at least some of their siblings. The mothers of many of these children do not live with a partner or are in marital circumstances that may attenuate the link between the child and the father. In countries where child fostering is practiced, the likelihood that children will live apart from their mothers is negatively related to their mother's access to the resources of their fathers and other relatives and positively related to the number of younger siblings. The focus of the paper is on four essential elements of children's living arrangements that influence their access to resources: (1) mother-child co-residence, (2) father-child coresidence, (3) household structure and (4) the number, presence and spacing of siblings. The research suggests that significant proportions of young children, particularly in sub-Saharan Africa, benefit from the support provided by family members other than their parents. This support, which involves the coresidence of family members beyond the nuclear unit, can take many forms: the co-residence of three generations within the same household, the inclusion of a single mother and her children as a sub-family within a more complex household, or the exchange of children between kin. Surprisingly, despite enormous variations between countries in current fertility rates (ranging from roughly 2 to 7 births per woman), children in countries as diverse as Thailand and Mali spend their childhood with no more than 2 to 3 children on average sharing the same household. Thus, childhood as it is experienced in many parts of the developing world has much that is common despite apparent differences and much else that is different despite apparent similarities.This is a substantially revised version of a paper presented at the Demographic and Health Surveys World Conference in Washington, DC, 5–7 August 1991.     

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.     

Social factors of migration from rural to urban areas with special reference to developing countries: The case of Korea

The current state of Korean internal migration in 1961–75 is examined from three perspectives: (1) where migrants go; (2) who moves; and (3) why they move. It is followed by a closer examination of the experiences that in-migrants to Seoul, the capital city of Korea, undergo in regard to (1) decision-making of migration; (2) job mobility; (3) settlement patterns; and (4) living conditions of squatters. Evaluation of the migration policies named in the Seoul population dispersal and relocation plans leads to a conclusion that they have little concern with the welfare of the urban poor and in-migrants to Seoul.     

Family planning and population control in developing countries

This essay aims at a critical analysis of the major assumptions of the family planning movement and their implications for population and development policy in the less developed countries. A neo-Malthusian perspective, in which a reduction of the current high rates of population growth is considered to be a necessary condition for economic development in the less developed countries, is dominant among professionals in family planning. Population control has come to be regarded as a kind of“leading sector” in the development process. The position taken in this paper is that the contention that fertility reduction is crucial to short term economic development is not substantiated empirically and represents a distorted view of the economic development process. Nor is there good evidence that demographic modernization can move far ahead of other aspects of modernization. Skepticism about the success of family planning tends to lead to advocacy of alternative methods of population control which are generally beyond the economic, administrative, and political capacities of the less developed countries and are sometimes repressive in tone. The family planning movement, in overstressing the independent contributions of fertility reduction programs, has tended to underplay conditions such as improved health, lowered mortality, and altered opportunity structure which make these contributions possible at all.     

Population growth overshooting and trade in developing countries

This paper examines a developing economy using a family-optimization model in which the number of children is a normal good. Trade liberalization generates two effects: the income effect that increases population growth and the gender wage effect that, in the short run, increases, but, in the long run, decreases population growth. With higher income, families invest more in capital if the status of the capital is significant. Because female labor is complementary to capital, higher investment increases the relative wages of women and attracts them from child rearing into production. Ultimately, the population growth falls below the original level.      

Perspectives on family and fertility in developing countries

Abstract Two aspects of the family in relation to fertility in developing countries are discussed: set stratification within the family and extended family networks. As both these are central to J. C. Caldwell's theory of fertility transition, the paper is structured as a critique of his position. Drawing on examples and data from Asia, it is argued that the causal significance of sex stratification for fertility lies in the economic risks it imposes on women, deriving from their dependence on men, rather than, as Caldwell suggests, in the disproportionate gain that men derive from their dominant position within families. While Caldwell and others associate strong extended family networks of mutual obligation and support with persistent high fertility, it is argued here that such systems should, instead, facilitate fertility decline. Close-knit and strong kin networks can be viewed as alternatives to children as sources of insurance, and may facilitate fertility decline by preventing children from becoming the focal point of parental concerns for security.     

Routes to low mortality in poor countries revisited

In June 1986, Population and Development Review published a highly influential article by John Caldwell entitled “Routes to Low Mortality in Poor Countries.” Amid growing anxiety over decelerating world mortality decline, Caldwell explored social and political pathways to mortality success on the basis of two lists of superior mortality achievers and exceptionally poor mortality achievers, countries whose mortality rankings drastically differed from their income rankings. To mark the quarter-century since Caldwell's study and chart new pathways, this article looks at the subsequent performance of Caldwell's original exceptional achievers and develops an updated list of achievers. Analysis highlights the presence of many more poor achievers today; the rising importance of adult mortality as a marker of exceptional achievement; the increasing success of countries in Latin America and the Muslim world; the continued success of China, Vietnam, Cuba, and Costa Rica. dramatic improvements in schooling outcomes, particularly for women, have reduced the importance of education as a determinant of superior achievement. Reinforcing Caldwell's original assertions, the synthesis highlights how interactions between social consensus, health care systems, and human capital dependence offer a pathway to superior achievement. These forces may be especially powerful at moments of national crisis.     

Altitude, fertility and mortality in Andean countries

Abstract Using the census data for Peru, Bolivia and Ecuador, previous writers have investigated some possible determinants of inter-regional differences in fertility; language spoken, female participation rates, and altitude. This paper points out the many sources of inaccuracy in the census data used. It argues that the indicators of unusually low fertility in the highland, predominantly Indianspeaking areas fail to control effectively for the very high levels of infant mortality in these regions. Fragmentary survey results give some indication of the scale of infant mortality, and appear to refute the idea that fertility is exceptionally low in areas of high altitude. In an attempt to explain why such high mortality rates persist in the Andean region the main health problems of Bolivia are examined. It seems that the causes are economic and social, rather than physiological. Unfortunately a change of policy which reduced death rates would produce grave new social problems.     

Infant mortality trends in rural East Pakistan

Infant mortality trends in a rural area of East Pakistan are analyzed utilizing the Bogue pregnancy history technique. The findings indicate that infant mortality has declined slightly over 20 percent between 1958 and 1967. The existence of development programs in women’s education and family planning since 1961 are proposed as possible reasons for this finding. A convergence in infant mortality rates to mothers in the age range 15–39 years was found in the final year under analysis, while the standard U shaped pattern of infant mortality with age structure was exhibited in the previous years. One possible explanation for the convergence is that the development programs are reaching women within this age range more equally than in the past. An alternative explanation relating to the problems of recall of mortality events was discussed.     

Household dynamics and fuelwood consumption in developing countries: a cross-national analysis

Previous research has suggested a link between household dynamics (i.e., average household size and number of households) and environmental impacts at the national level. Building on this work, we empirically test the relationship between household dynamics and fuelwood consumption, which has been implicated in anthropogenic threats to biodiversity. We focus our analysis on developing countries (where fuelwood is an important energy source). Our results show that nations with smaller average households consume more fuelwood per capita. This finding indicates that the household economies of scale are, indeed, associated with the consumption of fuelwood. In addition, we found that number of households is a better predictor of total fuelwood consumption than average household size suggesting a greater relative contribution to consumption levels. Thus, insofar as declining average household sizes result in increased number of households and higher per capita consumption, this trend may be a signal of serious threats to biodiversity and resource conservation. We also found further support for the ??energy ladder?? hypothesis that economic development reduces demand for traditional fuels.     

Urban poverty and health in developing countries: Household and neighborhood Effects

In the United States and other high-income countries, there is intense scholarly and programmatic interest in the effects of household and neighborhood living standards on health. Yet few studies of developing-country cities have explored these issues. We investigated whether the health of urban women and children in poor countries is influenced by both household and neighborhood standards of living. Using data from the urban samples of 85 Demographic and Health Surveys and modeling living standards using factor-analytic MIMIC methods, we found that the neighborhoods of relatively poor households are more heterogeneous than is often asserted. Our results indicated that poor urban households do not tend to live in uniformly poor neighborhoods: about 1 in 10 of a poor household’s neighbors is relatively affluent, belonging to the upper quartile of the urban distribution of living standards. Do household and neighborhood living standards influence health? Using multivariate models, we found that household living standards are closely associated with three health measures: unmet need for modern contraception, attendance of a trained health care provider at childbirth, and young children’s height for age. Neighborhood living standards exert a significant additional influence in many of the surveys we examined, especially for birth attendance.