Contemporary Marriage in Cambodia.

Previous work has suggested that the drastic Khmer-Rouge-era changes to the family institution have not endured. Potentially more influential in the long term were the rapid socio-economic changes Cambodia underwent starting in the 1990s. We use four waves of the Cambodian Demographic and Health Surveys from 2000 to 2014 to document contemporary trends in marriage formation and dissolution. We find little change in the centrality of marriage, as both cohabitation and sex between unmarried partners remain quite rare. Marriage also continues to be nearly universal and early for women, but we find that the transition to self-arranged "love" marriages occurred earlier and faster than previously documented. A sign that parental endorsement may still matter though, marriage dissolution continues to be associated with spousal characteristics deemed undesirable by past generations. While higher among recent marriage cohorts, especially in the first year after marriage, levels of marriage dissolution remain comparatively low overall.

Interpreting changes in life expectancy during temporary mortality shocks.

BACKGROUND: Life expectancy is a pure measure of the mortality conditions faced by a population, unaffected by that population's age structure. The numerical value of life expectancy also has an intuitive interpretation, conditional on some assumptions, as the expected age at death of an average newborn. This intuitive interpretation gives life expectancy a broad appeal. Changes in life expectancy are also routinely used to assess mortality trends. Interpreting these changes is not straightforward as the assumptions underpinning the intuitive interpretation of life expectancy are no longer valid. This is particularly problematic during mortality 'shocks,' such as during wars or pandemics, when mortality changes may be sudden, temporary, and contrary to secular trends. OBJECTIVE: This study aims to provide an alternative perspective on what changes in life expectancy measure that remains applicable during mortality shocks. CONCLUSIONS: Returning to two different models that the period life table may represent, I show that a difference in life expectancy is typically interpreted from the synthetic cohort model as the difference in mean longevity between different birth cohorts. However, it can also be interpreted from the stationary population model as a measure of premature mortality in a death cohort. The latter, less common interpretation makes more sense for temporary declines in life expectancy induced by mortality shocks. The absolute change in life expectancy is then an age-standardized value of the average lifespan reduction for people dying during the mortality shock. CONTRIBUTION: To clarify what a decline in life expectancy measures during mortality shocks is important, especially as demographers often assess the mortality impact of those shocks using this metric, which gets widely reported beyond demographers' inner circle.

The boundaries of genocide: Quantifying the uncertainty of the death toll during the Pol Pot regime in Cambodia (1975-79).

The range of estimates of excess deaths under Pol Pot's rule of Cambodia (1975-79) is too wide to be useful: they range from under 1 to over 3 million, with the more plausible estimates still varying from 1 to 2 million. By stochastically reconstructing population dynamics in Cambodia from extant historical and demographic data, we produced interpretable distributions of the death toll and other demographic indicators. The resulting 95 per cent simulation interval (1.2-2.8 million excess deaths) demonstrates substantial uncertainty over the exact scale of mortality, yet it still excludes nearly half of the previous death-toll estimates. The 1.5-2.25 million interval contains 69 per cent of the simulations for the actual number of excess deaths, more than the wider (1-2 million) range of previous plausible estimates. The median value of 1.9 million excess deaths represents 21 per cent of the population at risk. Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2015.1045546.

The Covid-19 pandemic and the expansion of the mortality gap between the United States and its European peers.

The mortality gap between the United States and other high-income nations substantially expanded during the first two decades of the 21st century. International comparisons of Covid-19 mortality suggest this gap might have grown during the Covid-19 pandemic. Applying population-weighted average mortality rates of the five largest West European countries to the US population reveals that this mortality gap increased the number of US deaths by 34.8% in 2021, causing 892,491 "excess deaths" that year. Controlling for population size, the annual number of excess deaths has nearly doubled between 2019 and 2021 (+84.9%). Diverging trends in Covid-19 mortality contributed to this increase in excess deaths, especially towards the end of 2021 as US vaccination rates plateaued at lower levels than in European countries. In 2021, the number of excess deaths involving Covid-19 in the United States reached 223,266 deaths, representing 25.0% of all excess deaths that year. However, 45.5% of the population-standardized increase in excess deaths between 2019 and 2021 is due to other causes of deaths. While the contribution of Covid-19 to excess mortality might be transient, divergent trends in mortality from other causes persistently separates the United States from West European countries. Excess mortality is particularly high between ages 15 and 64. In 2021, nearly half of all US deaths in this age range are excess deaths (48.0%).

Physical intimate partner violence in India: how much does childhood socialisation matter?

While a large number of studies assumed gendered socialisation leads to partner abuse, little evidence exists for India. We bridge this crucial gap by exploring the pathways between childhood socialisation and intimate partner violence, using data 'Youth in India: Situation and Need Study (2006-2007)' for 5573 young married men (15-29 years). Nearly 17 per cent of men inflicted physical IPV in the past 12 months. Seventy-seven per cent recognized the experience of gender discrimination in their family and reported exposure to violence in two ways-one-third witnessed fathers abusing their mothers and 48 per cent were beaten by their parents. Adverse childhood experiences were associated with IPV perpetration. The structural equation model indicated significant pathways between IPV and childhood socialisation in the forms of experienced violence and gender discrimination. Findings underscore the importance of a violence-free, gender-neutral family environment for young generations and call for a comprehensive policy to ameliorate the impacts of IPV.

Global and National Declines in Life Expectancy: An End-of-2021 Assessment.

Timely, high-quality mortality data have allowed for assessments of the impact of the novel coronavirus disease 2019 (COVID-19) on life expectancies in upper-middle- and high-income countries. Extant data, though imperfect, suggest that the bulk of the pandemic-induced mortality might have occurred elsewhere. This article reports on changes in life expectancies around the world as far as they can be estimated from the evidence available at the end of 2021. The global life expectancy appears to have declined by 0.92 years between 2019 and 2020 and by another 0.72 years between 2020 and 2021, but the decline seems to have ended during the last quarter of 2021. Uncertainty about its exact size aside, this represents the first decline in global life expectancy since 1950, the first year for which a global estimate is available from the United Nations. Annual declines in life expectancy (from a 12-month period to the next) appear to have exceeded two years at some point before the end of 2021 in at least 50 countries. Since 1950, annual declines of that magnitude had only been observed on rare occasions, such as Cambodia in the 1970s, Rwanda in the 1990s, and possibly some sub-Saharan African nations at the peak of the acquired immunodeficiency syndrome (AIDS) pandemic.

Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa.

PURPOSE: There is concern that adolescents experience worse quality of health care than older women. We compare quality of reproductive health services (family planning and antenatal care) for adolescents (<20 years) versus adult women (≥25 years), in four sub-Saharan African countries. METHODS: In total, 2,342 family planning visits and 8,600 antenatal care visits were analyzed from Democratic Republic of the Congo, Malawi, Senegal, and Tanzania. Service Provision Assessment surveys include observation of care and client exit interviews. We compare visit content and care satisfaction for adolescents versus adult women aged ≥25. All models are multilevel, weighted to reflect survey design, and include client, provider, and facility covariates (pooled models also include survey fixed effects). RESULTS: Adolescents receive more overall family planning care activities compared to adult women (2.31 activities in adjusted generalized linear models, standard error [SE] 1.29, p < .1), and 3.76 more discussion activities (e.g., counseling) on average (SE 1.94, p < .1), but significantly fewer discussion activities during antenatal care (-3.10 activities, SE .97, p < .01). However, adolescents' satisfaction with both care types was not significantly different than adult women. These relationships largely persist in country-stratified models, using different model specifications, and when comparing adolescents to women aged ≥20. CONCLUSIONS: Adolescents' family planning visits are similar to, or even slightly more comprehensive than, adult women-but their antenatal visits include fewer recommended care components, with particular gaps for activities requiring provider-client dialog. This suggests opportunities for strengthening communication between providers and young women, and improving care across the reproductive health continuum.

The Mean Unfulfilled Lifespan (MUL): A new indicator of the impact of mortality shocks on the individual lifespan, with application to global 2020 quarterly mortality from COVID-19.

Declines in period life expectancy at birth (PLEB) provide intuitive indicators of the impact of a cause of death on the individual lifespan. Derived under the assumption that future mortality conditions will remain indefinitely those observed during a reference period, however, the intuitive interpretation of a PLEB becomes problematic when that period conditions reflect a temporary mortality "shock", resulting from a natural disaster or the diffusion of a new epidemic in the population for instance. Rather than to make assumptions about future mortality, I propose measuring the difference between a period average age at death and the average expected age at death of the same individuals (death cohort): the Mean Unfulfilled Lifespan (MUL). For fine-grained tracking of the mortality impact of an epidemic, I also provide an empirical shortcut to MUL estimation for small areas or short periods. For illustration, quarterly MUL values in 2020 are derived from estimates of COVID-19 deaths in 159 national populations and 122 sub-national populations in Italy, Mexico, Spain and the US. The highest quarterly values in national populations are obtained for Ecuador (5.12 years, second quarter) and Peru (4.56 years, third quarter) and, in sub-national populations, for New York (5.52 years), New Jersey (5.56 years, second quarter) and Baja California (5.19 years, fourth quarter). Using a seven-day rolling window, the empirical shortcut suggests the MUL peaked at 9.12 years in Madrid, 9.20 years in New York, and 9.15 years in Baja California, and in Guayas (Ecuador) it even reached 12.6 years for the entire month of April. Based on reported COVID-19 deaths that might substantially underestimate overall mortality change in affected populations, these results nonetheless illustrate how the MUL tracks the mortality impact of the pandemic, or any mortality shock, retaining the intuitive metric of differences in PLEB, without their problematic underlying assumptions.

The Mean Unfulfilled Lifespan (MUL): A new indicator of the impact of mortality shocks on the individual lifespan, with application to mortality reversals induced by COVID-19.

Declines in period life expectancy at birth (PLEB) provide seemingly intuitive indicators of the impact of a cause of death on the individual lifespan. Derived under the assumption that future mortality conditions will remain indefinitely those observed during a reference period, however, their intuitive interpretation becomes problematic when period conditions reflect a temporary mortality "shock", resulting from a natural disaster or the diffusion of a new epidemic in the population for instance. Rather than to make assumptions about future mortality, I propose measuring the difference between a period average age at death and the average expected age at death of the same individuals (death cohort): the Mean Unfulfilled Lifespan (MUL). For fine-grained tracking of the mortality impact of an epidemic, I also provide an empirical shortcut to MUL estimation for small areas or short periods. For illustration, quarterly MUL values in 2020 are derived from estimates of COVID-19 deaths that might substantially underestimate overall mortality change in affected populations. These results nonetheless illustrate how MUL tracks the mortality impact of the pandemic in several national and sub-national populations. Using a seven-day rolling window, the empirical shortcut suggests MUL peaked at 6.43 years in Lombardy, 8.91 years in New Jersey, and 6.24 years in Mexico City for instance. Sensitivity analyses are presented, but in the case of COVID-19, the main uncertainty remains the potential gap between reported COVID-19 deaths and actual increases in the number of deaths induced by the pandemic in some of the most affected countries. Using actual number of deaths rather than reported COVID-19 deaths may increase seven-day MUL from 6.24 to 8.96 years in Mexico City and from 2.67 to 5.49 years in Lima for instance. In Guayas (Ecuador), MUL is estimated to have reached 12.7 years for the entire month of April 2020.

Beyond Deaths per Capita: Comparative CoViD-19 Mortality Indicators.

OBJECTIVES: Following well-established practices in demography, this article discusses several measures based on the number of CoViD-19 deaths to facilitate comparisons over time and across populations. SETTINGS: National populations in 186 UN countries and territories and populations in first-level sub-national administrative entities in Brazil, China, Italy, Mexico, Peru, Spain, and the USA. PARTICIPANTS: None (death statistics only). PRIMARY AND SECONDARY OUTCOME MEASURES: An unstandardized occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardized rate that can be derived even when the breakdown of CoViD-19 deaths by age and sex required for direct standardization is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of CoViD-19 deaths. RESULTS: To date, the highest unstandardized rate has been in New York, at its peak exceeding the state 2017 Crude Death Rate. Populations compare differently after standardization: while parts of Italy, Spain and the USA have the highest unstandardized rates, parts of Mexico and Peru have the highest standardized rates. For several populations with the necessary data by age and sex for direct standardization, we show that direct and indirect standardization yield similar results. US life expectancy is estimated to have declined this year by more than a year (-1.26 years), far more than during the worst year of the HIV epidemic, or the worst three years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding two years, are estimated for Panama, Peru, and parts of Italy, Spain, the USA, and especially, Mexico. CONCLUSIONS: With lesser demand on data than direct standardization, indirect standardization is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.

Beyond deaths per capita: comparative COVID-19 mortality indicators.

OBJECTIVES: Following well-established practices in demography, this article discusses several measures based on the number of COVID-19 deaths to facilitate comparisons over time and across populations. SETTINGS: National populations in 186 United Nations countries and territories and populations in first-level subnational administrative entities in Brazil, China, Italy, Mexico, Peru, Spain and the USA. PARTICIPANTS: None (death statistics only). PRIMARY AND SECONDARY OUTCOME MEASURES: An unstandardised occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardised rate that can be derived even when the breakdown of COVID-19 deaths by age and sex required for direct standardisation is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of COVID-19 deaths. RESULTS: To date, the highest unstandardised rate has been in New York, at its peak exceeding the state 2017 crude death rate. Populations compare differently after standardisation: while parts of Italy, Spain and the USA have the highest unstandardised rates, parts of Mexico and Peru have the highest standardised rates. For several populations with the necessary data by age and sex for direct standardisation, we show that direct and indirect standardisation yield similar results. US life expectancy is estimated to have declined this year by more than a year (-1.26 years), far more than during the worst year of the HIV epidemic, or the worst 3 years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding 2 years, are estimated for Panama, Peru, and parts of Italy, Spain, the USA and especially, Mexico. CONCLUSIONS: With lesser demand on data than direct standardisation, indirect standardisation is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.

Covid-19 Will Reduce US Life Expectancy at Birth by More Than One Year in 2020.

On December 3rd, 2020, the cumulative number of U.S. Covid-19 deaths tallied by Johns Hopkins University (JHU) online dashboard reached 275,000, surpassing the number at which life table calculations show Covid-19 mortality will lower the U.S. life expectancy at birth (LEB) for 2020 by one full year. Such an impact on the U.S. LEB is unprecedented since the end of World War II. With additional deaths by the year end, the reduction in 2020 LEB induced by Covid-19 deaths will inexorably exceed one year. Factoring the expected continuation of secular gains against other causes of mortality, the U.S. LEB should still drop by more than a full year between 2019 and 2020. By comparison, the opioid-overdose crisis led to a decline in U.S. LEB averaging .1 year annually, from 78.9 years in 2014 to 78.6 years in 2017. At its peak, the HIV epidemic reduced the U.S. LEB by .3 year in a single year, from 75.8 years in 1992 to 75.5 years in 1993. As of now, the US LEB is expected to fall back to the level it first reached in 2010. In other words, the impact of Covid-19 on U.S. mortality can be expected to cancel a decade of gains against all other causes of mortality combined.

Household Structure and Child Education in Cambodia.

We analyze the effects of household structure on education in Cambodia. Consistent evidence documents that residence with both biological parents benefits children's education in Western countries. Elsewhere, the issue is gaining more attention with the growing number of "left-behind children" due to adult migration and, possibly, changes in family behavior, but the extant record is both thinner and more contrasted. Controlling for the presence of grandparents and some household characteristics, we find children residing with both biological parents are more likely to be enrolled in school, in the appropriate grade for their age, and literate than those living with only one parent. The effect sizes appear comparable to those in most Western countries, but the effects shrink or even disappear when grandparents are present. The results for children not residing with either parent are mixed, suggesting negative effects for some children might be blurred by positive selection for some others.

One-Parent Families in Contemporary Cambodia.

Non-marital births and divorce remain rare in Cambodia. Due to dramatic levels of adult mortality reached during the late 1970s, growing up with a single parent is not. Using nationally representative, cross-sectional data, we estimate that about 12% of children under age 18 co-reside with only one of their biological parents. Using longitudinal data representative of the Mekong River Valley, we find this proportion to be declining. Nearly half of these children live in nuclear families (single parent with or without a step-parent), even though they live in multigenerational families more frequently than children who live with both their parents, especially, when young and not living with their mother. Last, we consider differences in socioeconomic conditions and child educational outcomes by number of co-residing parents.

A crossover in Mexican and Mexican-American fertility rates: Evidence and explanations for an emerging paradox.

Against a backdrop of two new developments in the fertility behavior of the Mexican-Origin population in the U.S., the present discussion will update contemporary Mexican-Origin fertility patterns and address several theoretical weaknesses in the current approach to immigrant group fertility. Data come from six national surveys (three from Mexico and three from the U.S.) that cover a twenty-five year period (1975- 2000). The findings demonstrate dramatic decreases in the fertility rates in Mexico at the same time that continuous increases have been documented in the fertility rates of native-born Mexican-Americans in the U.S. at younger ages. These changes necessitate a reexamination of the idea that Mexican pronatalist values are responsible for the high fertility rates found within the Mexican-Origin population in the U.S. Instead, they point to the increasing relevance of framing the fertility behavior of the Mexican-Origin population within a racial stratification perspective that stresses the influence of U.S. social context on fertility behavior. As a step in this direction, the analysis examines fertility patterns within the Mexican-Origin population in the U.S., giving special attention to the role of nativity/generational status in contributing to within group differences.

Impact of the HIV epidemic on population and household structure: the dynamics and evidence to date.

BACKGROUND: HIV is contracted most frequently at birth and during early adulthood. The epidemic may thus impact the demographic structure and the household structure of affected populations. METHODS: This paper reviews earlier evidence of such an impact, uses demographic theory to anticipate its changes over time, and reviews the most recent evidence for indications of these changes. RESULTS: Modest increases in the male : female ratio are beginning to show within certain age groups only (approximately 15% among 25-34 year olds). Similarly sized increases in the proportion of 15-29 year olds relative to 30-54 year olds are observed in some age pyramids. These 'youth bulges' are expected to fade out, whereas an aging effect phases in with the fertility impact of the epidemic. In the longer run, the size of all age groups will be reduced, but relatively less so for middle-aged adults. Proportions of orphans and widows have increased in the most affected countries. Fewer remarriage probabilities for widows were observed. Resulting increases in the proportion of female-headed households should only be temporary, as female mortality is catching up with male mortality. The number of double orphans is beginning to increase, but overall, orphans continue to live predominantly with a family member, most often the grandparents if not with the surviving parent. CONCLUSION: To date, the epidemic's impact on the population and household structure has been limited by demographic (aging) and social (adaptive movements of kin across households) processes that contribute to diffuse the epidemic throughout the entire population and all households.

The uneven tides of the health transition.

As spectacular mortality reductions have occurred in all developing nations at all national income levels, the epidemiologic transition theory suggests that cause-of-mortality patterns should shift from communicable diseases especially prevalent among infants and children to problems resulting from non-communicable conditions at older ages. Global estimates confirm this expectation, and mortality from these latter conditions has become predominant worldwide, leading some observers to argue for a corresponding shift in the public health agenda. In this paper, we nuance this finding by studying the important poverty-gradient concealed in the global estimates. Our results demonstrate the remaining cause-of-death disparities between the world's poorest and richest populations. We find that the poorest population (1st quintile) experiences higher mortality than the richest population (5th quintile) in each of the three main groups of mortality causes but that the excess mortality of the poorest population is mostly due to the higher incidence of communicable diseases (77% of excess deaths). Overall, those diseases only account for 34.2% of deaths in the world but still dominate mortality causes among the poorest 20% of the world population (58.6% of all deaths). Moreover, these results appear robust to alternative estimates of the international distribution of the world's poorest people. While recognizing the emerging agenda of the non-communicable conditions, we thus underscore the "unfinished agenda" of communicable diseases in many countries. As populations affected by these diseases are predominantly among the poorer, equity considerations should caution against a premature shift away from these diseases.

Adolescent and young adult mortality by cause: age, gender, and country, 1955 to 1994.

PURPOSE: To compare mortality rates from motor vehicle accidents (MVA), homicide, and suicide across countries, age groups, and time. METHODS: The World Health Organization Mortality Database was used to construct age- and gender-specific rates in 26 countries for individuals aged 15 to 34 years during the period 1955 to 1994. The rates were adjusted for differences among countries in the age-and-gender distributions of their populations. Cause-specific rates were compared by country, 4-year age groups, 8-year time blocks, and male/female ratios. RESULTS: The proportion of deaths in 15-34-year-olds owing to MVA, homicide, and suicide increased from 26% to 43% over the 40-year study period. Mortality rates differ by country more than time block, peak at ages 15-29 years, and are higher in males than females. Compared to the United States, 24 countries had lower homicide rates and 23 had lower MVA-death rates. CONCLUSIONS: Despite declining rates of death from other causes, the rates of adolescent and young adult death from MVA, homicide, and suicide remain high in countries throughout the world. The proportion of deaths attributable to these causes increased steadily during the latter half of the 20th century. Fatal risk behaviors begin to increase during adolescence but do not peak until age 30 years, suggesting that the target population for prevention extends well beyond the teenage years.

An International Comparison of Adolescent and Young Adult Mortality.

This paper analyzes mortality rates for 3 of the main causes of deaths between the ages of 15 and 34 (motor vehicle injuries, homicide, and suicide) from 1950 to 1996, and across 26 countries. Average sex ratios and age patterns and the trends in age- and sex-standardized mortality rates are analyzed for each cause. Overall, youth violent mortality levels have been remarkably stable since the 1950s. As mortality due to other causes has receded, the contribution of these three causes has increased from 25 to 40 percent between the 1950s and the mid-1970s, and has remained above 40 percent since. Last, a principal component analysis is performed to summarize the variance in age-, sex-, and cause-specific rates over time and across countries. This summary representation of international differences displays regional clusters and emphasizes the "outlying" position of the United States among industrialized nations.