The need for another revolution after the reproductive revolution in Thailand.

PIP: This article reviews the progress made in lowering fertility in Thailand, and discusses strategies and needs for social development. During 1970-90, Thailand had a very successful family planning (FP) program and achieved a "reproductive revolution" (RR). Fertility declined to 1.95 children/woman. Contraceptive prevalence rose from 15-75% during 1970-95. The success of national FP is based on more methods, outlets, and practitioners. Thailand's socioeconomic context and social changes increased acceptance and readiness for FP. The culture is loosely structured and flexible; Buddhism values respect for women. Socioeconomic changes accelerated the pace of household acceptance of modern values, consumption patterns, and contraception. The opportunity cost of children increased. The RR contributed to considerable savings in public services and within families. Family wealth, women's economic activities, and children's educational attainment improved. The age structure of population resulted in a low dependency burden. The government now aims to improve quality of life. Threats to achieving higher quality of life include the increasing illegal immigration from Myanmar, the concentration of workers in the low productivity agricultural sector, and deficits in skilled workers. A human resources revolution is needed and will require training the largest population group of workers in their 30s and 40s and increasing levels of education past primary school. The human resource revolution requires applying the lessons learned from the RR and greater engagement of the private sector.^ieng

Community and contraceptive choice in rural Thailand: a case study of Nang Rong.

This paper blends quantitative with qualitative data in an investigation of community and contraceptive choice in Nang Rong, Thailand. Specifically, it develops an explanation of 1) method dominance within villages, coupled with 2) marked differences between villages in the popularity of particular methods. The quantitative analysis demonstrates the importance of village location and placement of family planning services for patterns of contraceptive choice. The qualitative data provide a complementary perspective, emphasizing the importance of social as well as physical space and giving particular attention to the structure of conversational networks.

The impact of child care on fertility in urban Thailand.

Women's labor force participation in Thailand, particularly in the modern sector, recently has increased in conjunction with rapid declines in fertility. This paper examines whether a relationship exists between child care considerations and fertility decision making among Bangkok women. Although the two-child family has become the norm in recent years, and although most respondents said that ideally they would like to have two children, a high proportion of women surveyed said they planned to only have one child. Women's work status and type of employment is found to strongly affect the likelihood of having a second birth: those who work at jobs that not only are low-paying but are located in a formal setting are least likely to have a second child. The type of child care for the first child also has an impact: those whose first child is in a less preferred situation are less likely to have a second. Variables measuring the need for and type of child care are found to have greater consequences for fertility than do usual measures of socioeconomic status.

Internal migration in Thailand.

"Internal migration of the population of Thailand involves a number of distinct forms of movement. Three forms are identified in this research: single-move, seasonal and repeat. The first can be treated as long-term migration while the latter two are more temporary. All forms are characterized by different geographical flows and different selectivity patterns. Long-term migration is highly selective of young adults, females and the more highly educated. It is most likely to occur between urban areas or from rural to urban areas. Temporary migration mainly involves movement back and forth between urban and rural places and is most likely to be engaged in by those with a medium level of education."

Rural Thai social setting and family planning activity: effects on female sterilization.

PIP: The authors explore how social setting and family planning program activity affect the acceptance of female sterilization among a sample of Thai women. Family planning activity and social setting variables are measured at the community level while sterilization is measured at the individual level. Individual-level data are drawn from a national sample of 7085 ever-married women aged 15-49 years interviewed across 27 provinces in the Contraceptive Use Pattern Survey during the period April-June 1987. The survey collected data on socioeconomic characteristics, patterns of contraceptive use, and fertility. The analysis illustrates the difficulties of establishing a link between family planning program activities and contraceptive use in a context where contraceptive use exceeds 70% and the family planning program has been in existence for a number of years. One can assume motivation for using contraception to be high in such a context and it is unlikely that variations in program activities will have significant effects upon patterns of use. Female sterilization may be the contraceptive method which requires the highest level of motivation and both social setting variables and individual characteristics contribute to explaining variations in levels of recent female sterilization. The demand for sterilization can be expected to grow as areas become more integrated economically, geographically, and socially into the development process. Increases in local family planning personnel and greater efforts aimed at increasing the demand for family planning will, however, probably have little or no effect upon levels of sterilization at moderate to high levels of contraceptive use. Improvements in medical facilities may have a positive effect in areas where the demand for sterilization has not been met.^ieng

A multi-level analysis of the determinants of fertility in the four regions of Thailand.

PIP: A multilevel model of macro and micro variables is used to examine the fertility determinants in the 4 regions of Thailand. The level and pace of fertility decline has varied across regions. Fertility behavior is considered at parity 0, at parities 1-3, and among women with 4 children. Contextual level variables are the status of women, the value of children, infant mortality in 1970, and population pressure. Micro data were obtained from 1970 and 1980 census files for women 15-49 years matched with own children data (aged 1-4 years and born between 1975-79). In general, contextual variables were more important determinants at parity 1-3 and had no effect at parity 0, and individual differences were more important at parity 0. The findings in the regression analyses show consistent results with prior research: older ages effecting a decrease on fertility, migrants having fewer children, higher female education and higher occupational status of husbands lower fertility. When marriage status is controlled at parity 0 the relationship between individual variables and marriage shows sign changes and reduced effects. The effects of individual variables are strongest at parity 4 and over, but affect all parities. Variations between regions on individual variables are small. Contextual variables show less consistency in results. Status of women results show significant negative effects at parity 4 for the central and northern regions. At parity 1-3 the status of women with contextual variables shows status as an important determinant of fertility. Provinces with higher levels of education had lower fertility. The value of children is negatively associated with fertility. The effect is greatest for parity 1-3 women. The north shows significant relationships, while the other regions are inconsistent; the implications are discussed. Infant mortality is not related to fertility except at 0 parity in the north (positive relationship). Population pressure is related to lower fertility in the northeast and south; in the north the results are significant but the sign changes. Only with parity 4 in the south were family planning programs related to lower fertility (negative association); the results are positive in the north and northeast. The policy implications are that increasing the opportunities for women will have an impact on fertility, and fertility would be indirectly affected through improvements in women's status. Decentralization of policy making on fertility is needed along with awareness of the cultural and social environment.^ieng

Knowledge and perceptions about AIDS among married women in Bangkok.

People's knowledge and perceptions about AIDS are critical in efforts to combat the further spread of this disease. Using data from a study on "Determinants and Consequences of Contraceptive Use Patterns in Thailand", this paper investigates the knowledge and perceptions about AIDS among ever-married women in Bangkok Metropolis. Differentials in knowledge and perceptions are investigated by socio-economic subgroups. The results indicate the need to inform and educate people about AIDS, especially those in low-income groups or with lower levels of education.

Family planning program effort and the initiation of contraceptive use: a multi-level analysis.

PIP: The family planning (FP) and population programs of Thailand have been effective in increasing contraceptive use and causing declining fertility in a timely manner. Evaluation of these programs could be useful in applying successful elements here in other programs. To do this evaluation statistical analysis was used to determined which elements and in which settings are related with program success. Both qualitative and quantitative methods are used to measure program effectiveness at the district and subdistrict level. Questionnaires were used from district, health officers, hospital directors, and subdistrict health workers. There were inputs from outside agencies, private family planning associations, and other organizations whose goals include increasing contraceptive use. Questionnaires were then used in 8 districts, the variables obtained from these focused on 4 categories: demand creation, service availability, management and outside support indicators. Correlation analysis was used to evaluate the relation of individual and composite efforts and program effectiveness from service statistics. Then questionnaires were given nationally in a sample of 145 districts using the same methods as in the smaller sample. This data, with individual and village data from another survey, "The Determinants and Consequences of Contractive use Patterns in Thailand", were used to determine which efforts at the district or subdistrict level are associated with contraceptive usage at the individual level. Multiple regression analysis and analysis of variance are used in this determination. The results confirmed that the individual demand is the most valuable factor. The differences in setting and program efforts are small in relation to contribution. Socioeconomic factors should be taken into consideration when programming resources for national program evaluation. The largest impacts on Thailand's program, were inputs that improved access to service and demand creation and management also contributed significantly. Evaluation should be done when the programs are new and growing, and results here show that both demand and supply sides are almost equally significant.^ieng

Determinants of contraceptive use dynamics: research needs on decision and choice.

Because of the importance of contraceptive behaviour in most societies today a better understanding is needed of the social and behavioural factors affecting contraceptive decisions and choices of individuals and couples. This paper examines the need for longitudinal, theoretically-based studies of contraceptive use dynamics, including the timing, duration and interaction of reproductive events which may be more important than contraceptive technology in the social, cultural and economic context of fertility control. New research methods and appropriate analysis of data are relevant. Consideration of the social context is essential for the formulation and implementation of effective policies relating to the provision of contraceptive services.

Variations in marriage patterns in central Thailand.

Data from a survey of marriage patterns in central Thailand illustrate the complexity of change in marriage patterns in a developing society--the diversity of traditional patterns, the different directions of change, and the variations in current patterns. The data were collected in 1978 and 1979 from ever-married women aged 15-44 in three settings:a central plains village, established areas in Bangkok, and a Bangkok squatter settlement. Three forms of entry into marriage were identified:ceremonial marriage with parental involvement in the choice of spouse, ceremonial marriage with self-choice of spouse, and nonceremonial marriage (elopement and living together). All three forms of marriage existed in each setting, and the dominant form differed in each. In general, a family background of higher socioeconomic status led to a greater likelihood of a marriage ceremony and greater parental involvement in spouse choice. Women with more education were also more likely to marry with ceremony, but higher education for daughters was associated with less parental involvement in spouse choice. These findings suggest that marriage patterns may remain diverse in Thailand, even as further development occurs.

The impact and efficiency of the family planning programme in Thailand.

PIP: Recent research was done to review the impact and efficiency of the family planning (FP) program in Thailand. The objectives of this work were to develop measures of program efficiency that would be useful in making administrative decisions in relation to program strategy, choice of methods, deployment of personnel and to sort out the relative contribution of program effects on acceptance and fertility, taking the socio-economic conditions into account. Thailand was one of the 1st countries to investigate alternatives to using doctors to deliver FP services. The positive response to this policy led to the concept of community based distribution of the pill. Also a study was initiated to assess the use of midwives and nurses to insert IUD's and to give injections. Models for the impact and efficiency model hypothesizes that the program inputs will have a greatest effect on FP acceptance than the environmental improvement. The results indicate overall contraceptive prevalence through the national FP program is the major source of influencing fertility reduction. The FP service infrastructure development and expansion has a direct impact on use. Also hospital based clinical contraception should be emphasized and health centers should be enabled to function like small hospitals in FP service delivery.^ieng

Contraceptive practice and fertility in Thailand: results of the Third Contraceptive Prevalence Survey.

The Third Contraceptive Prevalence Survey in Thailand was conducted in 1984. Results indicate a continuation of the rapid rise in contraceptive use among married couples that has been taking place over the past 15 years. Prevalence levels are approaching those common in economically advanced countries. Sterilization is now the most common method, although a fairly broad range of other methods is also widely used. Only modest levels of unmet need for contraception for either limiting family size or spacing children now exist. Fertility rates have fallen since the previous survey, done three years earlier, but to a lesser extent than would be expected from the increased use of contraceptives. Family size preferences are concentrated at small family sizes. A comparison between the Buddhist majority and Moslem minority, made possible through a special sample design, reveals substantial differences between the two groups. Contraceptive use is lower and fertility levels and preferences are higher among Moslems than among Buddhists.

PIP: The 3rd Contraceptive Prevalence Survey (CPS-3) in Thailand was conducted in 1984, sampling 7,576 ever-married women aged 15-49. It was based on a weighted sample scheme, interviewing approximately equal numbers in each of the 4 major regions and in Bangkok, including the same 24 provinces as in the previous CPS-2, and a supplementary population of southern Moslems. Results indicate a continuation of the rapid rise in contraceptive use among married couples that has been taking place over the past 15 years. Prevalence among currently married women has continued to increase from 53% in 1978 to 65% in 1984; approaching rates common in developed countries. Female sterilization is the most common method (23.5% of all married women) although a range of other methods is also seen (pill, 19.8%, injectables, 7.6%; IUD, 4.9%, male steralization, 4.4%; condom, 1.8%; and other, 2.6%). Low levels of unmet need for contraception for either limiting family size or spacing children now exist. National total fertility rates had fallen since the previous survey (from 3.68 in 1981 to 3.36 in 1984), but to a lesser extent than would be expected from the increased contraceptive use. Family size preferences are concentrated in small family sizes, slightly higher for rural women and women with 4 years' education, but with group averages ranging from 2.3 (urban women currently married 5 years with 4 years' education) to 3.4 (all currently married rural women educated 4 years). A comparison between the Buddhist majority and Moslem minority reveals that contraceptive use is lower and fertility levels and preferences higher among Moslems than among Buddhists. Contraception practice by region, racial/language group, work status; % having undesired pregnancies by rural and urban residency; source of supply (government or private); and method are also examined.

Infant feeding practices, postpartum amenorrhea, and contraceptive use in Thailand.

The findings from Thailand's 1984 Contraceptive Prevalence Survey suggest that an earlier trend toward reduced breastfeeding may have halted, with the initiation of breastfeeding virtually universal in rural areas and very common in urban areas. Breastfeeding duration, although quite prolonged on average, shows substantial rural-urban, regional, and educational differences. The introduction of supplemental food including infant formula and, to a much lesser extent, condensed milk, is very common and occurs when the infant is very young. Thus duration of breastfeeding in the absence of any supplemental food is very short, with a median duration of only one month. A sizeable minority of women start practicing contraception during postpartum amenorrhea. As amenorrhea is of only moderate duration, however, the extent of overlap in protection against pregnancy is very modest. Furthermore, the resumption of menses is clearly associated with a substantial increase in contraceptive practice.

A multilevel model of family planning availability and contraceptive use in rural Thailand.

This paper assesses the ways in which the availability of family planning program outlets influences the likelihood of contraceptive use in rural Thailand. It focuses on a village-level measure of actual availability of sources rather than respondent perceptions of availability. Individual-level and village-level data collected as part of the second Thailand Contraceptive Prevalence Survey are used to test three hypotheses about the effects of actual availability: that (a) availability of family planning outlets increases the likelihood of contraceptive use; (b) it enhances the effect of a desire for no more children on the likelihood of use; and (c) it weakens the positive relationship between education and the likelihood of use.

Breastfeeding in Thailand: data from the 1981 Contraceptive Prevalence Survey.

PIP: Studies in the decade from 1969 to 1979 have indicated a moderate and relatively steady decline in the duration of breastfeeding among both rural and urban women of all classes in Thailand. Nonetheless breastfeeding is almost universal among rural women and practiced by most urban women. Important additional information on Thai breastfeeding practices became available from the 2nd round of the Contraceptive Prevalence Survey (CPS2) conducted on a national sample of 7038 ever-married women throughout Thailand in 1981. Data from the CPS2 does not show conclusively whether there has been a decline in breastfeeding since 1979, although some of the evidence points to a decline among urban women. What emerges is support for the data of the preceding decade, with additional confirmation of substantial rural urban, educational, and regional differences in overall breastfeeding patterns. New information is gained on the behavior of Thai mothers with respect to full breastfeeding, supplemental feeding and postpartum amenorrhea. Full breastfeeding is discontinued fairly early, within the 1st few months after birth. No sharp differentials in this practice are obvious among the population of women. Because of the early switch to mixed feeding, the period of postpartum amenorrhea is not long. The baby's diet is supplemented mainly with rice mixed with fruit and eggs, or some other ingredient. It is not known if milk products are introduced into the diet, or to what extent supplemental foods constitute the diet of the infant.^ieng

The impact of alternative mortality assumptions on own-children estimates of fertility for Thailand.

PIP: Own-children fertility estimates are somewhat in error when the life tables used in generating them assume constant mortality, as when reliable life tables are available for only a single date in the recent past. When they are specified by geographic subdivision and socioeconomic characteristics, they are somewhat in error when the life tables used in generating them lack geographic and socioeconomic detail. This paper attempts to assess the general magnitude of these errors, by generating and comparing several sets of own-children fertility estimates from the 1970 Census of Thailand, based on 3 alternative mortality assumptions: 1) That mortality was constant during the 15 years previous to the 1970 Census at specified levels. 2) & 3) That mortality conforms to a set of changing life tables, the estimates in these cases deriving from different calculations. To illustrate the impact of the alternative mortality assumptions, own-children fertility estimates are examined by region, rural-urban residence, and education. The authors conclude that the error in own-children fertility estimates caused by using constant mortality is small (less than 2% for Thailand). The error in regional fertility estimates is also 2% or less, and the errors in residence-specific and education-specific fertility estimates are also small (less than 5 and 8%). Unfortunately, the assumption of similar mortality across geographic subdivisions and socioeconomic characteristics results in errors of own-children fertility estimates for these factors that are not unidirectional. Given the positive association between mortality and fertility levels, the result is that fertility levels are usually underestimated. Although absolute errors in estimated fertility differentials are usually small, relative errors are frequently large.^ieng