The new international population movement: a framework for a constructive critique.

PIP: With the support of the international women's movement, the ideology and methods of traditional population policy were effectively attacked at the 1994 International Conference on Population and Development (ICPD). The author discusses some of the complaints about population policy and family planning programs, then considers the substantive, ethical, and feasibility issues of population and reproductive health policy. The majority of the international population movement's (IPM) new agenda is motivated by goals which tend to be more sensitive to individual needs and human rights than earlier, more impersonal versions of population policy in the developing world. Critical academic examination of the old IPM forced the discussion of the meaning of population policy and population research as they relate to the new reproductive health approach. However, the new population policy approach is now itself ready to be examined internally with regard to its practical recommendations and its assessment of the population problem. An internal critique developed by the movement but drawing upon the experience of mainstream population research and policy will strengthen the movement and hone its ability to match methods to goals. Internal dissent within the movement needs to be aired.^ieng

A gender more vulnerable.

PIP: The greater risks of death faced by females in India are discussed in terms of the differences between the norther and southern regions of India, culture compounding inequality, and intervention strategies. When the assumption of a sex ratio of equality of 950/1000 is make, every region in the north is below (ranging from 874-913), and every region in the south above (ranging from 960-1040). The same north/south division remains for the male probability of dying by age 5 as a proportion of female probability (rural) in 1981. 2 explanations are given for female's greater survival changes in the south. 1) Marriage and kinship systems are different. Girls in the north typically marry earlier; many times marriage is to a stranger in a distant area so that family contact is reduced. The consequence is a reduction in female autonomy and status in both her father's and her husband's home. 2) Economic roles are different. Research has revealed that male/female survival equality occurs in states with high female labor force participation rates. At the micro level, working women's children tend to have more equal death rates. Physical devaluation is not only evidenced in death and survival, but also in the disparity in schooling. The states with the greatest gender differentials in mortality also have the greatest differences in literacy. This has been interpreted as household resources are disproportionately invested in males. Cultural inhibitions about the physical freedoms of girls also are involuntary reasons for the sex differential. The example is given of the apprehension generated for a male doctor's examination of a girl, a coeducational school environment, or a school located a distance from the home. There is the tradition of female seclusion and inhibition. In combination with the dependence on sons to limit the choices open to women, and to limit the growth and development, the product is inequality. Amniocentesis has lead to the increase in numbers of sex determination and abortion clinics. There is evidence that aborted fetuses are primarily female. Without change in these practices, there will not be a reversal in the sex ratio. Interventions suggested include increasing the number of facilities for the equal development of girls and women. There must be increases in female medical staff, more girl's schools in villages, and more nutrition programs for girls, Women's economic independence must be enhanced.^ieng

Women's economic roles and child survival: the case of India.

This article provides evidence that women's employment, in spite of its other benefits, probably has one crucial adverse consequence: a higher level of child mortality than is found among women who do not work. We examine various intermediate mechanisms for this relationship and conclude that a shortage of time is one of the major reasons for this negative relation between maternal employment and child survival. However, even in the area of child survival, there is one aspect which is positively affected by female employment: the disadvantage to girls in survival which is characteristic of South Asia seems to be smaller among working mothers. This is in contrast to the effect of maternal education which may often have no clear relation to the sex ratio of childhood mortality even though absolute levels of child mortality are lower for educated mothers.

Cultural influences on health care use: two regional groups in India.

While health care services are increasingly being seen as a major proximate determinant of decreased mortality in a population, it also seems to be the case that the mere provision of services does not lead to their better utilization. However, in general, it is difficult to explore differences in utilization because the availability of services itself varies so greatly. This report presents the results of a study in India of two distinct regional groups of similar socioeconomic status, residing in the same locality and, therefore, theoretically exposed to the same health services. Both groups share a strong faith in modern medicine (especially if it is obtained from a private practitioner) for the treatment of most common illnesses. However, important cultural differentials exist in the medical services sought for childbirth and in the treatment of morbidity in children of different ages and sexes. These cultural commonalities and differentials are described, their possible causes--primary among these being the status of women--explored, and some policy recommendations made.

PIP: While health care services are increasingly being seen as a major proximate determinant of decreased mortality in a population, it also seems to be the case that the mere provision of services does not lead to their better utilization. However, in general, it is difficult to explore differences in utilization because the availability of services itself varies so greatly. This report presents the results of a study in India of 2 distinct regional groups of similar socioeconomic status, residing in the same locality and, therefore, theoretically exposed to the same health services. Both groups share a strong faith in modern medicine (especially if it is obtained from a private practitioner) for the treatment of most common illnesses. The treatment of illness episodes according to ethnic origin, type of illness, and age in Uttar Pradesh and Tamil Nadu, 1985-86 are shown in tabular form; as is the distribution of living children according to immunization status in the same 2 places for the same years. However, important cultural differentials exist in the medical services sought for childbirth and in the treatment of morbidity in children of different ages and sexes, based primary on the status of women. Sample households believed in antibiotics, particularly injectables. Preventive vaccinations are mistrusted and feared. The figures for the acceptance of at least 1 dose of triple antigen are low. The numbers of children who receive the full recommended 3-dose course has fallen sharply. According to the 1979 Survey of Infant and Child Mortality, 94% or rural Uttar Pradesh births were delivered by untrained personnel, in rural Tamil Nadu, 50% of births were delivered by untrained personnel. The women will accept only a trained doctor for delivery, or an untrained neighbor or helper. The usual sex differential in child and infant mortality, with boys having an advantage, exists in much of South Asia. There is a sex differential in health care. In Matlab, Bangladesh, when free treatment of diarrhea was offered, in spite of the fact that incidence levels of diarrhea were nearly equal, male children were more likely than females to be brought for treatment.

The domestic servant as family planning innovator: an Indian case study.

This paper reports on the relatively low fertility of female domestic servants in India. domestic servant have fewer numbers of ever-born and living children than women working in other occupations and women who are unemployed. This low fertility, which appears to be volitional, may have its roots in the incompatibility between the servant's reproductive and the productive roles, as well as in the changing values generated by continued exposure to a wealthier lifestyle. It is suggested that family planning messages aimed at and elicited by more "elite" classes may have a greater impact on fertility behavior than message from prompters with a socioeconomic background similar to the clients', which tend to concentrate on the harsher day-to-day realities of poverty.

PIP: The National Council of Applied Economic Research in Delhi, India surveyed 578 ever-married 15-49 year-old women who had migrated to Delhi from the southern Indian state of Tamil Nadu. Researchers learned that domestic servants had fewer numbers of ever-born and living children (2.33 and 1.85 respectively) than women working in other occupations (3.12 and 2.47) and women who are unemployed (2.40 and 2.06). The researchers suggested that this low fertility, which they believe to be volitional, may have been due to the incompatibility between the servant's reproductive and productive roles and the changing values caused by continued exposure to a wealthy lifestyle. They recommended that, at least in urban settings as described in this report, middle-to-upper class housewives employed on a part-time basis should promote family planning to the poor. The researchers further suggested that these well-off women may have a greater impact on fertility behavior than family planning workers from a similar background. They admitted, however, that there may be problems as to the ethical value of this approach given that the poor and the wealthy are distinguished by much more than different fertility levels.

Ignorance of family planning methods in India: an important constraint on use.

Interviews wih women in six villages in India and with educated, working women selected to be trained as interviewers in five states, and evidence from formal studies are discussed to support the conclusions that (1) the low overall rates of contraceptive use in India are at least partly due to low levels of knowledge about different methods of birth control, especially of the modern reversible methods; and (2) the low use of all methods except sterilization is a good proxy for lack of knowledge about these methods. It is suggested that, both in the interests of achieving demographic targets and in the interests of the clientele of the family planning program, much greater emphasis must be placed on spreading practical information about reversible contraception. The information dissemination activities of the program so far have tended to concentrate on the why of family planning and neglect the how, except in promoting sterilization.

PIP: Interviews with women in 6 villages in India and with educated, working women selected to be trained as interviewers and evidence from formal studies are discussed. Poor knowledge of family planning favors high fertility in India. The awareness and ever use of different birth control methods among married women, aged 15-49, are given. There is much ignorance and misinformation as shown by data on awareness of contraceptives in 1970 awareness of family planning methods among general responders and local leaders is also poor. Why is knowledge so low? Some reasons are socioeconomic development factors. Women reporting knowledge of various methods of contraception, by urban-rural residence and for urban sample, education and type of housing is given, as is of respondents who had heard of various contraceptive methods in Uttar Pradesh and Narangwal. Sterilization is fairly well accepted, however more knowledge is needed on reversible methods. The program needs to increase its level of IEC activities, and change the content of these activities by shifting the emphasis from why birth control is essential (most couples are now aware of the officially propagated advantages of small families) to how a small family can be achieved by methods less drastic than an operation.