Do family planning programs enhance children's health?

The findings of the 1993 National Demographic Survey (NDS) in the Philippines provide implications for child health of family size and whether a child was wanted at the time of conception. About 15% of the more than 8000 births considered in the NDS were classified as unwanted. In 1995, the East-West Center's Program on Population has helped research centers in the Philippines to conduct an extended analysis of NDS results. Children under age 5 who had been unwanted at the time of conception (unwanted children) were almost 25% and 15% more likely to have had diarrhea or respiratory infections, respectively, in the last two weeks than those who were wanted at the time of conception (wanted children). Unwantedness had little effect on the likelihood of treatment once the child was ill, however. When the researchers controlled all other variables, including unwantedness, family size did not have a direct influence on the likelihood that a child would become ill, but it did have a significant influence on whether or not an ill child would receive treatment. Each additional sibling reduced the likelihood that an ill child would receive treatment by about 5% for diarrhea and by about 4% for respiratory infection. Another factor that influenced disease incidence was age (at 18 months, most likely to be ill with respiratory infection or diarrhea). Older children were more likely to receive treatment than younger children. Other factors influencing treatment and disease incidence were socioeconomic status and maternal educational status. These findings further justify family planning programs based on child health. They demonstrate that children suffer when they are born into a household where they are not wanted. Since about 33% of all child deaths are caused by diarrhea or respiratory infections in the Philippines, unwantedness affects the incidence of these infections, and family size has a direct effect on the likelihood an ill child will receive treatment. A policy intervention that would greatly reduce child mortality would be extremely beneficial.     

Indonesian survey looks at adolescent reproductive health

The Baseline Survey of Young Adult Reproductive Welfare in Indonesia, conducted from September to December 1998, provides information about young Indonesians on topics concerning work, education, marriage, family life, sexuality, fertility, and HIV/AIDS and other sexually transmitted diseases. The survey interviewed 4106 men and 3978 women aged 15-24 years in three provinces of Java. Survey findings showed that 42% of the women and 8% of the men are currently or have been married. There was a strong inverse relationship between marriage and schooling, which suggests that greater educational attainment and a higher average age at marriage are likely to go together. Although most young couples prefer to delay and space births, only half of currently married young women are using any type of contraception. These results indicate that there is a need for better reproductive health care as well as improved reproductive health education. Moreover, the current economic crisis has lead to a decline in the use of the private sector for health care. Instead, young people are using the less-expensive government services, and young women are turning to pharmacies and midwives rather than to private doctors to obtain contraceptives. These findings have several policy implications including the need for reproductive health programs that provide services needed by young people.     

Nepal survey shows that "family planning saves lives"

This article presents the results of the Nepal Family Health Survey (NFHS) conducted from January through June 1996. Data on fertility, family planning, and maternal and child health were collected from 8429 ever-married women aged 15-49 years. These women provided information on 29,156 children. Using the method of regression analysis, findings reveal those factors, such as young mothers, large families, and short birth intervals, substantially increase under-five mortality risks. However, socioeconomic factors have only a limited effect on under-five mortality. Statistics have suggested that much of the urban/rural differences in mortality have been due to factors closely related to residence, mother's level of education and economic status. In addition, although positive effects of interventions (antenatal and postpartum checkups, tetanus immunization and assistance at delivery by a traditional birth attendant) have been documented, statistical results show that few children in Nepal are receiving the benefits of maternal health care. In conclusion, results of the 1996 NFHS show that delaying, spacing, and limiting births can substantially reduce infant and child mortality.     

A look at Asia's changing youth population

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

A Note on CBD: It's All in a Name

I recently saw an article with the following title: “Medical cannabis relieves symptoms in children with autism.” On reading it, I realized that the Drug Target Review was talking about cannabidiol, otherwise known as CBD, not THC (tetrahydrocannabinol, the psychoactive ingredient in cannabis). I also realized the words cannabis and marijuana are no longer useful in talking about marijuana now that CBD has been moved to Schedule V of the Controlled Substances Act when manufactured by GW Pharmaceuticals. Still, it is common to see CBD lumped with the hundreds of other cannabinoids, especially if not produced by a Food and Drug Administration (FDA)–approved pharmaceutical company where it is still classified as Schedule I by the Drug Enforcement Administration (DEA). I think this has implications for popular understanding and clinical utility.     

India's National Family Health Survey provides new information on maternal and child health and AIDS awareness

Teams surveyed a sample of 88,562 households, drawn from 99% of the population of India in 24 states plus the National Capital Territory of Delhi, between April 1992 and September 1993 to collect a basic set of information on all 500,492 household members, with more details on the 89,777 women in the households who had ever been married and were aged 13-49 years. This National Family Health Survey (NFHS) collected information from the women on a range of health topics including child immunization, women's knowledge of AIDS, services and facilities use during pregnancy and childbirth, infant feeding and treatment for diarrhea, and infant, child, and maternal mortality. Levels of infant and child mortality declined in India, but 8% of all children still die before their first birthday and 11% die before reaching age 5. As for maternal mortality, there are an estimated 420 maternal deaths per 100,000 live births annually. That rate implies that at least 100,000 Indian women die each year due to causes related to pregnancy and childbirth. Survey results indicate the need to strengthen vaccination programs and teach women about proper infant feeding practices. They also highlight the need to increase antenatal care and other medical services. In all of these areas, the NFHS results indicate wide variation among India's regions and states. Furthermore, a general lack of AIDS awareness suggests that the government's AIDS awareness campaign, relying primarily upon electronic media, has not yet reached the majority of India's population.     

Women are key players in the economies of East and Southeast Asia

In 1996, the East-West Center's Program on Population investigated the links between population change and economic growth in Japan, South Korea, Taiwan, Singapore, Thailand, and Indonesia. This document discusses the findings pertaining to women's changing marriage and childbearing patterns, education attainment, and labor force participation as well as changes in family life. In eastern and southeastern Asia, women are delaying marriage and having fewer children as a result of their overwhelming acceptance of modern contraception. Concurrently, women's secondary school enrollment has increased dramatically since 1960, and women have accounted for steadily increasing proportions of total labor force growth. Economic development has led to fewer women employed in agriculture and more in clerical positions. Women continue to be marginalized in low-paying manufacturing jobs and to lose these jobs more frequently than do men. Women's labor force participation continues to be dependent upon their child care responsibilities, but women are beginning to combine both activities with the help of live-in grandparents. Women have made an important contribution to economic growth in Asia. Policies should address job discrimination against married women, wage discrimination, the problems faced by young women who leave home for employment in the manufacturing and service sectors, and the lack of child care facilities.