Gay youth and AIDS

Gay male teenagers face considerable adversity during their "coming out" process due to the AIDS epidemic. They must decide whether to be tested for HIV-1 infection, whether to postpone sexual activity, how to select a partner, and which kinds of sexual practices to engage in. Gay youth often make such decisions based upon misinformation and faulty premises. This paper reviews what is known about gay youth and AIDS, and assesses their possible risk for HIV-1 infection. It is recommended that school and community-based health education programs be developed to teach gay and bisexual youth about safe sex. Moreover, research is needed into sociocultural variations among gay youth in order to develop appropriate and effective intervention strategies for AIDS risk reduction in this diverse population.     

Adolescent fertility programs: responding to the needs of today's youth

The 1983 conference on Adolescent Fertility Management in Asia and the Pacific provided a forum for sharing information and experiences. The project was designed to stimulate interest in and strengthen existing programs on adolescent fertility in participating countries, i.e., Bangladesh, Fiji, India, Indonesia, Nepal, Philippines, Sri lanka, and Thailand. Specifically, the conference sought to identify adolescent fertility problems and share experiences in managing adolescent fertility programs, identify gaps in the development and implementation of adolescent fertility programs and projects, and formulate plans to meet the adolescent fertility needs of the participating countries. Capsule presentations of the experiences of the participating countries are presented. Focus is on the projects they have undertaken and proposed activities. In Bangladesh Jatio Tarum Sangha, the national youth organization, seeks to get youth involved in family planning activities through information/education/motivation programs and community development projects. Fiji proposes to establish a youth center to be operated by the Ministry of Health to reduce the incidence of unplanned pregnancy and sexually transmitted diseases in adolescents and to make them more aware of sex-related health problems and the importance of responsible sex. India's Family Planning Association has initiated population education programs for youth. Several projects have been launched in Jakarta to cope with adolescent fertility problems including the adolescent health project, the Consultation Center for Adolescents, and the university-based family health project. The Family Planning Association of Nepal has completed some major programs under its youth project. The Philippines' proposed youth centers are planned to respond to the fertility related needs and problems of Filipino adolescents. Innovations of the center are: the operation of several youth-serving government and private agencies under 1 roof, and encouragement of youth participation in designing and running the center. Sri Lanka does not have much of an adolescent fertility problem. Virtually all fertility is said to occur within marriage. A study on adolescent fertility is planned. Thailand has launched several government and nongovernment programs to reach adolescents both in and out of school. Government programs include counseling services and the National Family Planning Communication for Premarriage adolescents. Key issues are identified and recommendations are made.     

On the Varying Meaning of “Open and Affirming”

Some religious denominations offer programs where member congregations can signal their acceptance of all gender identities and sexual orientations. The United Church of Christ (UCC) created one of the earliest of such programs in the mid-1980s by which congregations can adopt an “Open and Affirming” identity. However, there has been little research examining this program and how it has evolved over time. Research suggests that organizational innovations like the Open and Affirming program often become institutionalized over time, leading to changes in how the program is expressed or conducted. We examine Open and Affirming (ONA) congregations in the UCC to see if the manner in which they express their ONA identity depends on when they adopted the identity. We find that early adopters of such programs are more likely than later adopters to focus on sexual orientation. While this could be seen as a troubling pattern, we argue that it could represent greater awareness of the Open and Affirming program's meaning, which has allowed for greater flexibility in its expression.     

On the varying meaning of "open and affirming"

Some religious denominations offer programs where member congregations can signal their acceptance of all gender identities and sexual orientations. The United Church of Christ (UCC) created one of the earliest of such programs in the mid-1980s by which congregations can adopt an "Open and Affirming" identity. However, there has been little research examining this program and how it has evolved over time. Research suggests that organizational innovations like the Open and Affirming program often become institutionalized over time, leading to changes in how the program is expressed or conducted. We examine Open and Affirming (ONA) congregations in the UCC to see if the manner in which they express their ONA identity depends on when they adopted the identity. We find that early adopters of such programs are more likely than later adopters to focus on sexual orientation. While this could be seen as a troubling pattern, we argue that it could represent greater awareness of the Open and Affirming program's meaning, which has allowed for greater flexibility in its expression.     

Well-being and Mobility: A Theoretical Framework and Literature Review Focusing on Older People

There is an increasing attention for how mobility is associated with well-being amongst people in general and older adults in particular. Comparisons across research projects and articles are, however, hampered by the different understandings and conceptualisations of well-being that are employed. We, firstly, develop a heuristic framework for understanding the concept of well-being, and secondly, use this to explore possible linkages between well-being and mobility and to critically examine the various conceptualisations of well-being in research on mobility in later life. It is argued that future work on well-being and mobility should consider both the objective and the subjective and the hedonic and eudaimonic dimensions of well-being, and should pay detailed attention to the multiple ways in which well-being and its linkages to mobility are context-dependent and shaped by the particularities of time and place.     

The child survival hypothesis

Summary Because of current interest in the child survival hypothesis, we have reviewed available evidence bearing upon the relationships of infant and child mortality to fertility and contraceptive behaviour. The evidence is drawn from time series data for local and national vital events, from special in-depth studies of the infant mortality-fertility relationships in family formation, and from service statistics from health and family planning programmes. As a result of this review, we suggest five clarifications which should be made in redefining the child survival hypothesis and assessing its potential programme implications. The child survival hypothesis states that improved child survival will contribute to increased family planning motivation and consequent fertility decline. The evidence presented here suggests that the effect is not automatic and probably not a necessary pre-condition for fertility decline. There is certainly not a reflexive one-to-one replacement, but a partial effect may still be important. In the clearly demonstrated reduction in inter-pregnancy intervals after a child death, the major component is undoubtedly the removal of the biological protection of lactational amenorrhoea. A separate but somewhat smaller effect has been demonstrated in situations where lactation did not seem to have been the explanation. It is expected that increased child survival will contribute to fertility decline mainly in countries experiencing rapid mortality decline and population growth. The replacement of children who die is probably not so much 'volitional' as a result of alterations in sub-conscious expectations. It is apparent that in traditional agrarian populations, few direct and manipulable means of influencing motivation for fertility limitation are available, and, therefore, it must be stressed that integrated health and family planning programmes do provide opportunities for immediate programme development. By making parents aware of improved changes of survival through health services in which they develop confidence, the spontaneous linkages between mortality and fertility can presumably be reinforced. Family planning services must be provided as an essential initial step in programme development, but they can be made more effective, as well as politically more acceptable if appropriately integrated with maternal and child health and nutrition services.     

Infectious diseases -- new and ancient threats to world health

Infectious and parasitic diseases remain a leading cause of death and disability in developing countries and are re-emerging as a serious health problem in developed countries. Outbreaks of Ebola, dengue hemorrhagic fever, cholera, and bubonic plague have occurred in low-income countries and multidrug-resistant organisms have surfaced throughout the world. Since 1973, over 28 new disease-causing microbes have been identified. This issue of "Population Bulletin" analyzes the impact of factors such as population growth, urbanization, migration, poverty, travel, agricultural practices, climate changes, natural disasters, and medical technology on the resurgence of infectious and parasitic diseases as well as the influence of diseases such as AIDS on population dynamics and socioeconomic development. Most of these diseases could be prevented, cured, or eradicated with known public health measures. National governments can help reduce poverty, step up immunization programs, and lessen the chances of introducing new diseases. Nongovernmental organizations can disseminate preventive knowledge and monitor disease outbreaks. The medical profession can strengthen infection control precautions and institute surveillance of the use of antibiotics and other antimicrobial agents. Since the geographic isolation that used to contain disease outbreaks has been replaced by permeable international borders, the campaign against infectious and parasitic diseases must be global.     

人力资本投资：应对“三农”问题的战略选择——关于实施农村人力资源开发工程的思考

转型时期我国农村人口和劳动力对有限农业资源的巨大压力所导致的农村劳动力不充分就业乃是当前“三农”问题本质所在。对农村人口“开流断源”即“转移农民 ,减少农民 ,农民变市民”是应对“三农”问题的根本选择。建议立即启动普及基础教育为主体的“农村人力资源开发工程” :( 1 )由中央财政直接承担农村九年制义务教育 ;( 2 )重建农村合作医疗网点 ;( 3)继续强化农村计划生育 ,切断人口过量增长的“源头” ;( 4 )政府通过法律、法规和政策方面的制度创新保障人力资本投资的公平性。     

NFP promotion in the Philippines: all program components covered

At least 50 of the 105 agencies in the Philippines listed in the "Directory of Agencies with Population Activities" are actively participating in the promotion of natural family planning (NFP). Of these, 40 offer instruction on its use, 22 provide training to clinic personnel or field workers, 19 conduct information/education/communication (IEC) activities, and 6 undertake research. The Population Center Foundation's (PCF's) Information Support to Population Projects (ISP) has prepared a preliminary inventory of programs and projects on NFP, covering some of those that were done in recent years, are being implemented, or have been proposed. Some projects described in the inventory are reviewed. Recent research or research proposals are showhow related, all leading to how the method can be effectively promoted and how couples can be taught its proper use. Instruction on NFP appears in all training activities of Popcom's regional offices, particularly in their refresher courses. Program managers are being trained in managing and monitoring activities to promote the method. In 1980 outreach workers, doctors, nurses, and midwives were trained by Popcom to motivate couples to practice the method and to teach them how to use it correctly. That same year, Popcom's office in the Ilocos region introduced the rhythm dial calendar, a simplified version of the rhythm slide rule. The Ministry of Health National Family Planning Office incorporates natural family planning instruction in its training seminars for the Ministry's health personnel in the regions. As in training, all regional offices of Popcom promote NFP along with other methods that they make available to prospective acceptors. This is in keeping with the program's "cafeteria approach" to family planning. In 1982 Popcom began intensifying the provision of services in NFP, allocating around 4 million pesos to preparations for its effective promotion. In support of service delivery efforts are IEC activities such as the development, production, and distribution of brochures and other reading material on NFP, schoolroom instruction, and lectures. The intensification of IEC efforts in the private sector to promote the modern and scientific techniques of NFP is most clearly evident in a fairly recent seminar sponsored by the Communication Foundation for Asia. Program agencies with activities in natural family planning are listed.     

Research capacity building in midwifery: Case study of an Australian Graduate Midwifery Research Intern Programme

BackgroundHaving the research capacity to identify problems, create new knowledge and most importantly translate this knowledge into practice is essential within health care. Midwifery, as well as other health professions in Australia, is challenged in building its research capacity to contribute evidence to inform clinical practice.AimThe aim of this project was to evaluate an innovative Graduate Midwifery Research Intern Programme offered at a tertiary obstetric hospital in Western Australia, to determine what was working well and how the programme could be improved.MethodA case study approach was used to gain feedback from graduate midwives within a Graduate Research Intern (GRI) Programme. In addition outcomes were compiled of all projects the GRI midwives contributed to. Six GRI midwives participated in a survey comprising of four open ended questions to provide feedback about the programme.ResultsFindings confirm that the GRI programme increased the graduates understanding of how research works, its capacity to define a problem, generate new knowledge and inform clinical practice. The GRI midwives’ feedback suggested the programme opened their thinking to future study and gave them enhanced insight into women's experiences around childbirth.ConclusionTo grow our knowledge as a professional group, midwives must develop and promote programmes to build our pool of research capable midwives. By sharing our programme evaluation we hope to entice other clinical settings to consider the value in replicating such a programme within their context.     

Assessment of ASEAN population programme

The objectives of the 5th meeting of the ASEAN Heads of Population Program, held at Chiang Mai during November 1981, were the following: to discuss and consider the midterm reviews of some of the Phase 1 projects; to discuss and consider the ASEAN population experts' views on the progress made in the rest of the phase 1 projects; to discuss and consider the progress made in the implementation of the phase 2 projects; to discuss and consider the ASEAN population experts' recommendations on the ASEAN population program in the 1980s based on the report of the programming exercise submitted by the consultant in the expert group meeting; and to discuss administrative and other problems faced by the program implementors in the operationalization of the ongoing ASEAN population projects and provide appropriate directions to solve such problems. As a result of the programming exercise, the meeting established the directions for the future ASEAN population program and strongly recommended the continuation, intensification, and expansion of the ASEAN population program. A total of 12 projects comprise the ASEAN population program: 5 projects under phase 1 and 7 under phase 2. Under phase 1, 1 project has been completed, and the 1st parts of 2 other projects are in the process of implementation. Phase 2 projects, which started in September/October 1980, are all in the process of implementation. The following phase 1 projects are summarized: integration of population and rural development policies and programs; modular training for trainers of population and development agencies in ASEAN countries; multi-media support for population programs in the context of rural development in ASEAN countries; and migration in relation to rural development. The following phase 2 projects are also summarized: institutional development and exchange of personnel; women in development in ASEAN countries; and migration in relation to rural development. The following phase 2 projects are also summarized: institutional development and exchange of personnel; women in development; developing and strengthening national population information systems and networks in ASEAN countries; population and development dynamics and the human resource balance; studies on health and family planning in ASEAN countries; development of ASEAN social indicators; and population migratory movement and development.     

The Sustainability of Population Health

The study of population health encompasses analysis of the fundamental influences on human health, the consequences of such influences for societies and individuals, and the ways in which people and institutions respond to these consequences. A theme lacking from the present discourse is that of the sustainability of population health. To be sustainable, societies must respect the boundaries of natural systems and scorn disparities in standards of living. Preliminary analysis of data from 152 countries reveals an inverse relation between measures of population health and sustainability, although there are examples of societies where this inverse relation does not hold. Future research in population health should begin to question the sustainability of improving the health of some populations at the expense of others, and investigate how some societies appear to be able to achieve population health without compromising the health of the biosphere.     

Gender inequalities and demographic behavior

A summary was provided of the central findings about gender inequalities in Egypt, India, Ghana, and Kenya published by the Population Council in 1994. These countries exhibited gender inequalities in different ways: the legal, economic, and educational systems; family planning and reproductive health services; and the health care system. All countries had in common a high incidence of widowhood. Widowhood was linked with high levels of insecurity, which were linked with high fertility. Children thus became insurance in old age. In Ghana, women's insecurity was threatened through high levels of marital instability and polygyny. In Egypt, insecurity was translated into economic vulnerability because of legal discrimination against women when family systems were disrupted. In India and all four countries, insecurity was reflective of limited access to education, an impediment to economic autonomy. In all four countries, women's status was inferior due to limited control over reproductive decision making about childbearing limits and contraception. In India, the cultural devaluation of girls contributed to higher fertility to satisfy the desire for sons. In India and Egypt, family planning programs were dominated by male-run organizations that were more concerned about demographic objectives than reproductive health. The universal inequality was the burden women carry for contraception. Family planning programs have ignored the local realities of reproductive behavior, family structures, and gender relations. The assumption that husbands and wives have similar fertility goals or that fathers fully share the costs of children is mistaken in countries such as Ghana. Consequently, fertility has declined less than 13% in Ghana, but fertility has declined by over 30% in Kenya. Family planning programs must be aware of gender issues.     

ASEAN projects reviewed

The ASEAN Population Expert Group met in Manila and was followed by a meeting of the ASEAN heads of population programs, during the period November 5-10, 1979. Heads of population programs from Indonesia, Malaysia, Singapore, Thailand, and the Philippines attended. The meetings were held to review progress-to-date on phase 1 projects and to consider the development of an expanded population program. 5 projects funded by UNFPA are reviewed in tabular form with the project, the sponsoring country, date of implementation, data analysis, and date of completion. Suggestions were made for improving and extending these projects and it was also suggested that all projects being developed and proposed should include a section on use of research. 7 new projects were proposed as phase 2 projects. The 1st, sponsored by Malaysia, deals with women in development; project 2, lead by Thailand, will investigate population movement and its effect on development; project 3, led by the Philippines, will develop and strengthen national population information systems and networks in ASEAN countries; project 4, led by Indonesia, is directed towards institutional development and exchanges of personnel; project 5, led by the Philippines, will examine population and development dynamics and the man/resources balance; project 6, led by Thailand, will develop ASEAN social indicators; and project 7, led by Indonesia and Malaysia, will make a comprehensive analysis of existing medical/health care and family planning systems. It was recommended that an executive director of the proposed ASEAN population coordination unit should be appointed to expedite the recommendations of the meeting related to preparation and submission of phase 2 project proposals.     

Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.     

Measuring the value of statistical life: estimating compensating wage differentials among workers in India

Policy makers confronted with the need to introduce health and safety regulations often wonder how to value the benefits of these regulations. One way that a monetary value could be placed on reductions in health risks, including risk of death, is through understanding how people are compensated for the different risks they take. While there is an extensive literature on VSL and compensating wage differentials for the developed countries, few such studies exist when it comes to developing countries. Our study is an attempt at obtaining estimates of VSL that reflects Indian risk preferences. Based on a survey of 550 workers in Chennai and 535 workers in Mumbai, we find the value of a statistical life in India to be approximately Rs. 15 million. The value of statistical injury ranges from Rs. 6,000 to Rs. 9,000. Policy makers interested in programs to decrease environmental and health risks could use these numbers as one bench-mark against which costs can be assessed.

Community: Toward an integration of research,theory, evaluation,and public policy considerations

This article presents a paradigm for the analysis of communities and investments designed to improve them. Its fundamental objective is to provide the researcher, the theoretician, the evaluator, and the public policymaker with a common analytic framework. Direct and indirect effects of investment programs (e.g., in education, economic development, and health) can be documented longitudinally, and the community analyzed as an independent, dependent or mediating variable. The roots of this approach in social science and policy theory are explored. Five concepts (Status, Change, Interaction, Duality of Interaction and Change, and Viability) are incorporated. Community is operationally defined to include fifteen sectors whose interactions and changes can be studied systematically over time. This approach can help to clarify how a community, its people, culture, and institutions, and the outside world both influence and are influenced by investment programs.     

Older women and the health care system: a time for change

In spite of women's active involvement in a woman's health care movement, the mainline health care system continues to hold tight to its androcentric focus. If women are to be subjected to a health care system that employs sexist and ageist practices, the quality of life in their later years will continue to be jeopardized. The purpose of this paper is to first, recognize the existing health care practices which limit the health care opportunities and choices of older women; and secondly, to discuss how such basic feminist principles as education, egalitarianism, empowerment, and inclusion can be used to improve an older woman's experience.     

Future population growth: researchers in three countries quantify causes and propose policies

This article discusses Population Council analyses conducted by social scientists from India, Kenya, and the Philippines. These scientists agreed that population momentum would continue to increase population size, and that governments must strengthen and create a range of economic, health, and social programs and policies to slow population growth. Multiple approaches will be needed. John Bongaarts is credited with being the first to identify the key role of population momentum and to decompose growth into unwanted fertility, high desired fertility, and population momentum. Unwanted fertility is responsible for about 19% of projected population growth in India, 26% in Kenya, and 16% in the Philippines. High wanted fertility accounts for 20% of future growth in India, 6% in Kenya, and 19% in the Philippines. Population momentum can account for under 50% or over 90% of growth. Unwanted fertility can be addressed by fulfilling unmet need and increasing knowledge of methods, reducing the fear of side effects and disapproval, and eliminating poor service. Family planning programs need to be strengthened and integrated with maternal and child health services. Preferred and actual family sizes can be reduced by lowering infant mortality by means of increasing infant and child health services and girls' educational attainment. Population momentum can be addressed by delaying age at marriage and childbearing through improving social conditions. Investments in human development through education, training, and income generation can create the conditions for slowing population growth. Countries should decompose population growth into its components of unwanted and high wanted fertility and population momentum as a means of distributing resources most effectively.