Marital therapy with couples whose lack of self-sustaining function threatens the marriage

In the hierarchy of internal structures that contribute to a complete, mature sense of self, certain psychic functions are essential. In particular, adults who can maintain a sense of intactness of the self can, by-in-large, provide the following five psychic functions for themselves: self-security, self-realness, self-esteem, self-love and identity. Dr. Dan Buie (1989) has described the lack of these five self-sustaining psychic functions in certain clients and the consequences for the therapist/patient relationship. This paper will summarize Buie's contribution to understanding clients who lack the ability to provide these self-sustaining functions, then apply this conceptual framework to the understanding of certain marital conflicts, discussing aspects of the therapeutic process and the therapist's role with respect to these marital conflicts.     

Changes in fertility patterns can improve child survival in Southeast Asia

This analysis of 1988 Philippine Demographic Survey data provides information on the direct and indirect effects of several major determinants of childhood mortality in the Philippines. Data are compared to rates in Indonesia and Thailand. The odds of infant mortality in the Philippines are reduced by 39% by spacing children more than two years apart. This finding is significant because infant mortality rates have not declined over the past 20 years. Child survival is related to the number of children in the family, the spacing of the children, the mother's age and education, and the risks of malnutrition and infection. Directs effects on child survival are related to infant survival status of the preceding child and the length of the preceding birth interval, while key indirect or background variables are maternal age and education, birth order, and place of residence. The two-stage causation model is tested with data on 13,716 ever married women aged 15-49 years and 20,015 index children born between January 1977 and February 1987. Results in the Philippine confirm that maternal age, birth order, mortality of the previous child, and maternal education are directly related to birth interval, while mortality of the previous child, birth order, and maternal educational status are directly related to infant mortality. Thailand, Indonesia, and the Philippines all show similar explanatory factors that directly influence infant mortality. The survival status of the preceding child is the most important predictor in all three countries and is particularly strong in Thailand. This factor acts through the limited time interval for rejuvenation of mother's body, nutritional deficiencies, and transmission of infectious disease among siblings. The conclusion is that poor environmental conditions increase vulnerability to illness and death. There are 133% greater odds of having a short birth interval among young urban women than among older rural women. There is a 29% increase in odds for second parity births compared to third or higher order parities. Maternal education is a strong predictor of infant survival only in the Philippines and Indonesia. Adolescent pregnancy is a risk only in Indonesia. Socioeconomic factors are not as important as birth interval, birth order, and maternal education in determining survival status.     

Does low fertility call for new policies in some Asian countries?

Over the past 2 decades, Japan, China, Singapore, Hong Kong, and South Korea have completed a demographic transition from high birth and death rates and runaway population growth to reduced fertility and mortality and population growth approaching replacement levels. Among the outcomes of fertility decline, 3 have particularly far reaching effects: 1) Changes in family types and structures. Marriage and family formation are postponed, childbearing is compressed into a narrow reproductive span that begins later and ends earlier, and higher-order births become rare. Large families are replaced by small ones, and joint and extended families tend to be replaced by nuclear families. 2) Shifts in the proportions of young and old. Declining fertility means that the population as a whole becomes older. Decreases in the proportion of children provides an opportunity to increase the coverage of education. Increases in the proportion of the elderly means higher medical costs and social and economic problems about care of the aged. 3) Changes in the work force. There is concern that low fertility and shortages of workers will cause investment labor-intensive industries to shift to countries with labor surpluses. Another outcome may be an increase in female participation in the work force. The potential consequences of rapid fertility decline have sparked debate among population experts and policy makers throughout Asia. Current family planning programs will emphasize: 1) offering a choice of methods to fit individual preferences; 2) strengthening programs for sexually active unmarried people; 3) encouraging child spacing and reproductive choice rather than simply limiting the number of births; 4) making information available on the side effects of various family planning methods; 5) providing special information and services to introduce new methods; and 6) promoting the maternal and child health benefits of breast feeding and birth spacing.     

Age at marriage is rising for Asian women and men,according to new data

The social transformations in Asia are described: delayed age at marriage and the proportions marrying. Policy implications are ascertained. The norm for female age at marriage has risen from 15 years to 17-18 years in south Asia, and from 18 years to 24 years and older in east Asia. Men's marriage age has also risen but not as much. Concurrent changes have occurred with fertility declines and small family sizes and lower population growth, with changing roles for women, and with emergent youth subcultures and increased prevalence of premarital sexual behavior. The number of singles is rising and expected to continue to rise. Examples are given of marriage age changes for Nepal and Bangladesh, Sri Lanka, Malaysia, South Korea, and regional totals. Southeast Asian countries experienced less dramatic changes, and changes primarily in the 20-24 year old group (from 30% to 74% of single women). Change for men has been less regular and with less magnitude. In Southeast Asia, the rise in marriage age for men has risen only 1-2 years compared with women. East Asia patterns vary by country, i.e., South Korean increases of 6 years, Taiwanese increases of 4 years, and 2 years in Japan. Single males have been common in South and Southeast Asia, while in East Asia married male teens 25 years are rare. Marriage timing for men is not as closely associated as for women with social and cultural change. Downturns for men follow momentous, temporary disruptions such as happen during wars and periods of migration, while women's patterns are more reflective of structural change. The trend for never marrying is on the increase, particularly for men in Japan (1.1% in the 1920s to 18% in the early 1980s for men 50 years). Women not ever marrying are increasing in Thailand, Bangladesh, and Hong Kong. Never marrying is common in urban or educated populations, i.e., Singapore, Thailand, and Philippines. The implications are a longer gap between successive generations and a shorter period of exposure to risk of conception. Research findings have shown that a 1 year delay in age at 1st marriage reduces fertility by 20% of a child. Schooling delays marriage age as well as marriage laws, but structural and economic changes may be more important than policy changes. Policies affect the status of women and opportunities.     

Relational Interactions Between Immigrant and Native-Born Volunteers: Trust-Building and Integration or Suspicion and Conflict?

VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations - We investigate the bridging interactions between migrant-background and native-born volunteers. Bridging interactions are...     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

After the demographic transition: policy responses to low fertility in four Asian countries

In the low fertility countries of South Korea, Taiwan, Singapore, and Thailand, policy-makers are concerned about the consequences of low growth. In South Korea, a family planning (FP) program was instituted in the early 1960s, and fertility declined to 1.6 by 1987. Rural fertility is still higher at 1.96, and abortion rates are high. 32.2% of fertility reduction is accomplished through abortion. South Korean population will not stabilize until 2021, at 50.6 million people. The elderly are expected to increase and strain housing, energy, and land resources. Government support for FP is being reduced, while private sector services are being enhanced. Government sterilization programs have been reduced significantly, and revisions in the Medical Insurance Law will cover part of contraceptive cost. Integrated services are being established. Many argue for an emphasis on birth spacing, child and family development, sex education, and care of the elderly. In Taiwan, replacement level fertility was reached in 1983. Policy in 1992 recommended increasing fertility from 1.6 to 2.1. The aim was to stabilize population without pronatalist interventions. Regardless of policy decisions, population growth will continue over the next 40 years, and the extent of aging will increase. In Singapore since the 1960s, the national government focused on encouraging small families through fertility incentives, mass media campaigns, and easy access to FP services. Fertility declined to 1.4 in 1988. Since 1983, government has established a variety of pronatalist incentives. In 1989, fertility increased to 1.8. The pronatalist shift is viewed as not likely to succeed in dealing with the concern for an adequate work force to support the elderly and economic development. In Thailand, fertility declined the fastest to 2.4 in 1993. The key factors were rapid economic and social development, a supportive cultural setting, strong demand for fertility control, and a successful FP program. The goal is to reduce fertility to 1.2 by 1996. Replacement level may be reached in 2000 or 2005. Future trends are not clear.