Health concerns among India's elderly.

This article critically examines the health situation among elderly from two sets of independent sources. National Sample Survey in its 42 Round (July 1986-June 1987) canvassed a nationwide survey covering 50,000 households in 8312 villages and 4546 urban blocks in India to understand the socio-economic profile of aged persons. Secondly, an aging survey (1993) was conducted in Tamil Nadu, Kerala, Gujarat, and Karnataka states in India by the authors to study the elderly life in terms of general feeling, living arrangements, living support, social security, health, nutrition, their involvement in social and religious matters, views of old age homes and particularly life preparatory measures. The survey is based on interviews with about 2,253 persons aged 60 years and above, of whom 1325 are males and 928 are females. In fact, this survey is a part of a larger study conducted for the Social Development Section, Economic and Social Commission for the Asia and Pacific (ESCAP), United Nations, Bangkok, along with four other South East Asian countries-China, Korea, Singapore, and Thailand. From the survey conducted by us, we report only the health aspects of the elderly in this paper. The last section examines the major cause of death among elderly as reported from the Model Registration System of the Registrar General of India and concludes with feasible policy prescriptions.

Induced abortion potential among Indian women.

Information on abortion is limited and inaccurate, especially in the developing world, which has led to speculation on the prevalence of abortion in these regions. A rise in prevalence of abortion is mostly counted in terms of increase in the prevalence of induced abortions which reflects on the reproductive health of women. With the growing concern for the reproductive health of women, the study of abortion has drawn the attention of researchers world-wide. This paper is an attempt to assess the induced abortion potential among Indian women by utilizing information on proportion of unwanted and ill-timed pregnancies obtained through National Family Health Survey, India. This exercise may facilitate a better understanding of the exact prevalence of induced abortion, which necessarily should be less than the estimated potential depending on the levels of unwanted and ill-timed fertility.

PIP: An increase in the prevalence of abortion is mainly counted in terms of an increase in the prevalence of induced abortions which, in turn, reflects the status of women's reproductive health. The growing concern for women's reproductive health has fueled the study of abortion among researchers worldwide. The authors assess the induced abortion potential among women in India by using information on the proportion of unwanted and ill-timed pregnancies obtained through the National Family Health Survey, India. The number of births reported as ill-timed and unwanted was used to calculate potential abortion rates by age for the 15 major states in India. The distribution of ill-timed and unwanted births indicates that unwanted births occur mainly among women over age 30 years, while ill-timed births are concentrated more among younger women. The total potential for abortion is highest in Uttar Pradesh and lowest in Gujarat. The peak ages for abortion potential is 20-24 years in 10 of the 14 major states, while that peak is at ages 25-29 years in Assam, Bihar, Madhya Pradesh, Orissa, and Uttar Pradesh. The potential for induced abortion is expected to decline with improved access to limiting services and overall improvement in the quality of family planning services for birth spacing.

Long-term implications of low fertility in Kerala, India.

PIP: This study reviewed patterns of low fertility in Kerala state, India, and the implications for employment, the elderly, the marriage squeeze, and education. The total fertility rate (TFR) in Kerala declined from 5.6 to 1.7 children/woman during 1951-93. In 1993, infant mortality was 13/1000 live births. The demographic transition was enhanced by high population density and state policies and programs. Economic conditions are poor. Unemployment in 1997-98 was 10% of total Indian unemployment, despite Kerala's having only 3.4% of total population. Unemployment is high among the educated and those aged 15-29 years. Kerala has a high level of migrant population. Health conditions are good in Kerala. Mortality is low; life expectancy at birth is high, especially among females. The TFR varied from 1.6 in Emakulam to 3.4 in Malappuram districts during 1984-90. Only 5 districts in 1990 had above-replacement fertility. Continued patterns of fertility decline suggest that zero population growth may occur in 25-30 years. The implications of the age distribution are that the school-age population will decline, as will the need for youth products and services. The demographic pressure on unemployment will not decline until after 2021. The proportion in the labor force will begin to decline after 2000. The proportion aged 50-64 years out of total population will increase to 35.5% by 2021. By 2001, the number of females aged 20-24 years will almost equal the number of males aged 25-29 years. In 2021, if old-age benefits are extended to all elderly, the cost will rise to Rs. 138 million. Elderly voters will be 1 in 5 in 2021.^ieng

Women and work in Kerala: a comparison of the 1981 and 1991 censuses.

PIP: This study examines census data on women's work status during 1981 and 1991 in Kerala state in India. During 1981 and 1991, Kerala had a stable female work participation rate (FWPR), which placed Kerala 19th out of 30 states and Union territories. However, Kerala's FWPR declined in size and in the ratio to the male work participation rate during 1951-81. The work participation rate in Kerala was 15.85 for women and 47.58 for men in 1991 and 16.61 for women and 44.89 for men in 1981, which was under the national average. Fertility declined from 3.7 during 1970-75 to 1.7 in 1992. Life expectancy at birth was 74.7 years for women and 68.8 years for men, which is higher than the national average. The proportion of persons aged 15-59 years increased. Several explanations are offered to explain the low FWPR. Women increased in the number of enrollments in higher education. The increase for women was 50% compared to only 24% for men. The number of unemployed women aged 15-34 years rose during 1961-81. A 1987-88 unemployment survey revealed that over 10% of the unemployed in India lived in Kerala state, which had only 3.4% of total Indian population. A 1987 migration survey indicated that 300,929 workers from Kerala migrated to the Middle East, of which 92.5% were men. 31.43% of Kerala's population in 1991 were workers. The increase in the proportion of workers during 1981-91 was due primarily to the increase in male workers. The number of main workers increased over the decade for men and women, although only marginally for women. Marginal workers declined for both genders. Work participation rates of main and marginal workers increased for men and declined for women. Urban employment for women increased. Two districts had very low FWPRs. 48.78% of the female work force worked as cultivators and agricultural laborers. Growth occurred in urban and tertiary activities.^ieng

Maternal mortality in India: estimates from a regression model.

This report outlines a new technique for the estimation of maternal mortality by relating the sex differentials in mortality for people of reproductive age to the age schedule of fertility. The application of this method to the data from the Sample Registration System for 1982-86 indicates a level of maternal mortality of 580 deaths per 100,000 live births for India as a whole, 638 deaths in rural areas, and 389 deaths in urban areas. Estimates derived for the major states suggest relatively high maternal mortality in the eastern and northern parts of the country. They also indicate a substantial decline in maternal mortality since the 1960s. The decline in the birth rate is estimated to have accounted for nearly one-fourth of the decrease in the maternal death rate and 5 percent of the fall in the maternal mortality ratio in the 10-year period between 1972-76 and 1982-86. The method of estimation described here is well-suited to the data circumstances in India.

PIP: This report uses a new method for estimation of the level of maternal mortality using the relationship between sex differences in mortality among reproductive age groups and age-specific fertility. This parametric method assumes a standard age pattern of maternal mortality among women 15-49 years old. Data requirements are identified as age-specific death rates from all causes by sex, age-specific fertility rates, the ratio of maternal mortality at different ages to ages 20-24 years (country specific or a similar country's data), and the age pattern of sex ratios of death rates excluding maternal mortality. This new method is applied to data obtained from the Sample Registration System and the National Sample Surveys of India. Data obtained from Matlab, Bangladesh, are used to express the ratio of the age pattern of maternal mortality to women 20-24 years old. Age-specific fertility and mortality rates are averaged during 1982-86 for 15 major states, excluding Kerala, Punjab, Orissa, and Rajasthan states. Regressions are constructed for estimating the level of rural maternal mortality for women 20-24 years old. When the model uses the dependent variable, the sex ratio of mortality, maternal mortality at age 20-24 years is estimated at 465 deaths per 100,000 live births. When the model is fitted to female death rates, maternal mortality at age 20-24 years is 480 deaths per 100,000 live births. Further adjustments are made to conform to state patterns. Final estimation of maternal mortality under two specifications reveals a maternal mortality ratio of 568 or 591 deaths per 100,000 live births during 1982-86. An average maternal mortality ratio of 580 for India is given as the equivalent of a maternal mortality rate of 82 per 100,000 women 15-49 years old, or 21% of deaths of females 15-49 years old. State variations range widely from 20 deaths per 100,000 women in Kerala to 160 in Uttar Pradesh. This estimation is comparable to adjustment of Survey of Cause of Death estimation, suggesting the reliability of this method.

Aging in Kerala: one more population problem?

PIP: In India, in 1981, the number of persons over age 60 was 42.5 million; this number is expected to increase to 75.9 million in 2001. The average proportion of elderly (over age 60) in India as a whole was 6.3% in 1981; for Kerala, the percentage was 7.6%. Kerala's growth rate was always faster than India's as a whole, until 1971 when the annual growth rate declined. Population projections predict that the elderly population in Kerala will increase from 2.2 million in 1986 to 4.6 million in 2011 to 8.3 million in 2026. Factors which contribute to population aging include 1) decreases in fertility and mortality; 2) decline in the infant mortality rates, from 242/1000 live births (1911-1920) to 30/1000 live births in 1985; 3) from 1971-1981, a substantial improvement in the mortality rates for ages 0-14, but only a marginal change among youth and a moderate decline in the middle ages and among the elderly; 4) except for ages 35-39, male mortality rates higher for men than for women; 5) the highest life expectancy in India, which is also increasing; and 6) a projected total fertility rate of 2.3 for 19861990. Changes in age composition include 1) the percentage of those aged 0-14 years declined 42.6% in 1961 to 35% in 1981, and the percentage of elderly increased from 5.8% in 1961 to 7.5% in 1981; 2) in all 3 census periods, 1961, 1971, and 1981, the percentage of females aged 0-14 was smaller than males, but larger in all other age groups; 3) over 80% of Kerala's elderly population reside in rural areas; 4) projections of population by broad age group between 1986 and 2026 show a continuous decline in the age group 0-14 and an increase among the elderly; 5) in 2026, more women will be in older age groups than men; 6) in 2026, the number of men and women in the working age population will substantially increase; 7) in 2026, there will be a marked decline in the proportion of children; 8) the youth dependency ratios are expected to decrease from 52.9 in 1986 to 37.3 in 2026, while the elderly dependency ratios are expected to increase from 13 in 1986 to 30.9 in 2026. By 2026, Kerala will have 6.3 million people aged 60-74 and 2 million people aged 75 and older.^ieng

Curbing child marriages.

PIP: Demographers are interested in marriage age because women who marry early are exposed to conceptions through the most fecund years of their lives. Women who marry young are exposed comparatively to a longer duration and tend to shorten the intergenerational years, consequently influencing the fertility to be higher. In India, despite the law, child marriages occur in many states, more prevalent among the backward conservative communities. According to India's Child Marriage Restraint Act, a woman must be 18 to marry (a man 21), but in fact in 1981 the marriage age of females was 15. This young marriage age is substantiated by available survey and report data. For example, in a mass marriage solemnized at Wardha village in Vidisha district in 1981, there was not 1 of the 110 couples of the prescribed marriage age. 55 of the brides were below age 10 and 48 were between 10-12 years. Only 8 brides were older than 14 years. A survey conducted by the Population Research Center, Lucknow University, revealed that more than half of the females surveyed were married before age 15. The census data for 1981 provide the following information: 1.19 million or 2.63% of the total 45.18 million boys aged 10-14 years and 2.67 million or 6.59% of the total 40.49 million girls were married. Christians had the highest mean age at marriage followed by Sikhs and Jains, but all religious groups had shown an improvement in their age at marriage. Several factors are responsible for child marriage. Consequently, a multidimensional approach to dealing with the problem is needed. The way to bring about this change is through creating more job and educational opportunities for women.^ieng

Family planning programme in India: an economic evaluation.

PIP: The author evaluates the cost-effectiveness of India's national family planning program.^ieng