A lesson learned from community-based integrated long-term care in Thailand

Abstract

Thailand is the second most rapidly ageing of the Association of Southeast Asian Nations (ASEAN) countries. With this rapid pace of population ageing, the demand for long-term care has increased. Due to lower fertility and migration of adult children, the availability of children as a main source of long-term care has been reduced. In order to retain the traditional lifestyle of ageing-in-place, community-based integrated long-term care has been implemented as an alternative approach in Thailand. The development of such community-based care and its challenges can be used as a lesson for other ASEAN countries in confronting ageing societies.     

Desired family size in Thailand: Are the responses meaningful?

Data for both rural and urban women in Thailand indicate that the large majority of respondents are able to provide numerical responses to questions on desired family size. Although there is evidence that some women tend to rationalize the number of children they have when stating the number they would want if they were recently married, the vast majority of respondents prefer a number which is different from the number of living children they had at the time of the interview. Women who had already reached or exceeded their desired number were almost universal in stating they wanted no additional children, whereas only a minority of women who had yet to reach their desired family size said they wanted no more children. Finally, the proportion of women who practiced family planning is substantially greater among women who had already achieved or exceeded their desired family size than among women who had fewer than their desired number. The results thus suggest that, in Thailand at least, responses to family size preferences need to be interpreted with caution but nevertheless can be of use to the population analyst.     

Family growth and family planning: Responses to a family-planning action program in a rural district of Thailand

A resurvey of a rural district in Thailand, of about 70,000 population, was conducted after a family-planning program had been in operation for eight months in order to ascertain indications of effectiveness of the program. Both the "before" and "after" surveys employed a 25 percent simple random, though non-overlapping, sample of married women 20-44 years of age whose husbands were living. The only difference in design and execution was the inclusion in the resurvey of questions about the action program. Barring one or two exceptions, the characteristics of the two population samples were so similar that differences in knowledge, attitudes, and practices could be regarded as effects of the program.The action program not only made itself widely known in the district, it also evoked a highly favorable appraisal, to such an extent that nine of every ten women thought the program should be extended over the entire kingdom. Motivation to engage in family planning increased perceptibly. A substantial proportion (23 percent) of the women who formerly disapproved of the practice changed their attitudes to approval, mainly because they had become convinced of the harmlessness and the utility of fertility control. Less than 3 percent of the former approvers had become negative.The proportion of women who claimed some kind of knowledge about contraceptive methods more than doubled during the eight months of the program's operation. More impressive, however, was the change in actual use of methods, which rose from 1 to 21 percent of the eligible women (women who were not pregnant, subfecund, or sterilized). Another 16 percent, in the resurvey, planned to begin use of contraceptives in the near future, in most instances after a current pregnancy. The frequency of acceptance of family planning practice exceeded the expected frequency among women who were approaching or had attained the "ideal" number of children (4.0 children). High-parity women 40 or more years of age seldom accepted clinical assistance.     

Demographic aspects of fertility in Thailand

Abstract Data from a national rural and urban sample survey are analysed in order to examine various demographic aspects of fertility in Thailand. Marital fertility rates found for Thailand are among the highest in Asia. Particularly noteworthy is the persistence of high fertility at older ages of childbearing for rural women. Cumulative fertility shows a pronounced relationship with age at marriage and current marital status. Women who marry at an older age or who experience disruption of their marriages are clearly more likely to have fewer children ever born. Differences in both current and cumulative fertility are strongly associated with residence. Rural women who constitute the vast majority of Thai women, experience the highest fertility, Bangkok-Thonburi women experience the lowest fertility and provincial urban women are characterized by an intermediate fertility level which is closer, however, to the experience of their counterparts in the capital than in the countryside. Rural-urban fertility differences are mitigated but by no means eliminated by differences in infant mortality. In both rural and urban areas a positive association between cumulative fertility and infant morality is evident. Breast-feeding, commonly practised for extended periods-among both rural and urban Thai women, undoubtedly serves to some extent as an intervening variable in this relationship. A comparison of current fertility with cumulative fertility strongly suggests that a decline in marital fertility has been under way recently among urban women, especially those residing in the capital, but not at all among rural women. Although it seems safe to assume that the urban fertility decline results in large part from an increasing use of contraception among urban women, those still in the reproductive ages who were using or had previously used birth control were characterized by higher cumulative fertility than women who had never practised contraception. Evidently couples resort to family planning only late in the family building process after they have already achieved or exceeded the number of children they wish to have.