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Population Weights In The International Order, Geoffrey Mcnicoll

Poverty, Gender, and Youth

Population relativities play little part in the international system. A nation’s economic and military power is influenced by population size, but as one factor among many. Formal relations among states exclude population from consideration by the principle of sovereign equality. Three sources of possible change in this situation are explored, in which states would be “population-weighted” to a greater degree than before. Convergence of productivity levels around the world, expected by many, would bring the economic and population rankings of states more into line. Such convergence is occurring, but selectively and for the most part quite slowly. Anticipation of its …

Premarital Sex And School Dropout In Kenya: Can Schools Make A Difference?, Barbara Mensch, Wesley H. Clark, Cynthia B. Lloyd, Annabel Erulkar

Poverty, Gender, and Youth

Although an overall decline has occurred in adolescent fertility in Kenya, the proportion of births to teenagers that takes place prior to marriage is rising. At the same time that premarital sex and childbearing have increased, educational participation has expanded considerably, especially for girls. Using data from nearly 600 adolescents aged 12-19 in combination with data collected from 33 primary schools that the adolescents attended, this paper explores whether certain aspects of the school environment affect the likelihood of early and unprotected sex among adolescent girls and boys in three districts of Kenya. Because of the concern with “schoolgirl pregnancy” …

Mortality Decline And The Demographic Response: Toward A New Agenda, Mark R. Montgomery

Poverty, Gender, and Youth

A central proposition of demographic transition theory is that declines in infant and child mortality can encourage subsequent declines in fertility. Even the earliest formulations of the theory recognized that fertility decline would occur only with a lag, but neither theory nor empirical work has explored the length of such lags. This paper urges that individual perceptions and beliefs about mortality risks, conspicuously absent from the demographic research agenda, be studied directly. It proceeds to link mortality perceptions to health care decisionmaking and investments in children. The paper concludes by calling for a new agenda on mortality decline. This agenda …

The Decline Of Female Circumcision In Egypt: Evidence And Interpretation, Omaima El-Gibaly, Barbara L. Ibrahim, Barbara Mensch, Wesley H. Clark

Poverty, Gender, and Youth

Female circumcision is widespread in Egypt. Research suggests that the practice persists because of a belief that circumcision will moderate female sexuality, that it will assure a girl’s marriageability, and that it is sanctioned by Islam. Using data from a nationally representative survey of adolescents, this paper investigates the prevalence and social correlates of circumcision among girls aged 10-19, the circumstances surrounding the procedure, and the attitudes of adolescents towards it. While the vast majority of adolescents are circumcised, a life table analysis indicates that girls today are at least 10 percentage points less likely to undergo female circumcision than …

The Spread Of Primary Schooling In Sub-Saharan Africa: Implications For Fertility Change, Cynthia B. Lloyd, Carol E. Kaufman, Paul C. Hewett

Poverty, Gender, and Youth

Caldwell has hypothesized that the onset of the fertility transition would be linked with the achievement of “mass formal schooling.” In sub-Saharan Africa, a region where some countries have begun the fertility transition but many have not, the extent of progress toward mass schooling has not yet been assessed. This paper fills a gap in the literature using newly available Demographic and Health Survey data to assess schooling patterns and trends for 17 sub-Saharan African countries. As background to that assessment, the paper includes a literature review, an overview of the recent history of African education, and an evaluation of …

Fertility Preferences And Contraceptive Change In Developing Countries, Bamikale J. Feyisetan, John B. Casterline

Poverty, Gender, and Youth

Fertility has declined substantially in developing countries in the period since 1960, primarily as the result of increases in contraceptive prevalence. Little dispute is found on this point, but considerable debate has arisen about the causes of the increase in contraceptive prevalence. One unresolved issue is the causal contribution of changes in fertility desires. The sources of increase in contraceptive prevalence are analyzed in 22 countries in Latin America, Asia, and Africa in the period from the 1970s to the 1990s, using World Fertility Surveys and Demographic and Health Surveys data. Through regression decomposition, change in prevalence is attributed to …

Urban Growth In Developing Countries: A Review Of Projections And Predictions, Martin Brockerhoff

Poverty, Gender, and Youth

Comparison of the United Nations’ earliest and most recent projections to the year 2000 suggests that urban and city growth in developing regions has occurred much more slowly than was anticipated as recently as 1980. A modified “urban population explosion” in developing countries since the 1970s conforms to explanatory models of urban growth developed by economists around 1980. Trends in productivity and terms of trade, in particular, have been highly favorable to agriculture as compared to manufacturing, presumably slowing migration to urban centers. Increases in national population growth rates have produced less than commensurate in rates of city growth, further …

Measuring Living Standards With Proxy Variables, Mark R. Montgomery, Michele Gragnolati, Kathleen A. Burke, Edmundo Paredes

Poverty, Gender, and Youth

Very few demographic surveys in developing countries gather information on household income or consumption expenditure, despite the theoretical importance of these measures. Consequently, researchers have been forced to rely on ad hoc collections of proxy measures for living standards, and the properties of these proxies have not been systematically analyzed. In this research, we ask what hypotheses can be tested using proxy variables, and evaluate the performance of proxy measures in relation to consumption expenditures per adult, our preferred measure of living standards. We find that the proxy variables commonly employed in demographic research are very weak predictors of consumption …

Motherwork, Artwork: The Mother/Artist In Fiction By Parton, Phelps, Chopin, Woolf, Drabble, And Walker, Nancy Hoyt Lecourt

Doctoral Dissertations

This study asks the question, What happens to a practicing (fictional) mother who also tries to be a practicing artist? How do literary texts represent such people? How do they represent the relationship between material and artistic work? The primary works studied are Sarah Parton's Ruth Hall, (1855), Elizabeth Stuart Phelps' The Story of Avis (1877), Kate Chopin's The Awakening (1899), Virginia Woolf's To the Lighthouse (1927), and Margaret Drabble's The Millstone (1965). The conclusion focuses on Alice Walker's short story, "Everyday Use."

Mother-artists finds themselves on the "wrong" side of the nature/culture binary, where ideologies about "true womanhood" and …

Lessons From Community-Based Distribution Of Family Planning In Africa, James F. Phillips, Wendy L. Greene, Elizabeth F. Jackson

Poverty, Gender, and Youth

This paper reviews findings and experiences from efforts to implement community-based family planning services in sub-Saharan Africa. Although research suggests that community-based service delivery can contribute to contraceptive use, the magnitude of impact is often in doubt or is considerably less than was observed in similar projects in Asia in the 1970s and 1980s. Reasons for the constrained impact of community-based family planning in Africa are reviewed and assumptions about the efficacy and mechanism of community-based distribution (CBD) are discussed. Whereas several contrasting approaches to CBD have been tried, little is known about the relative merits of alternative CBD approaches.

The Quantity-Quality Transition In Asia, Mark R. Montgomery, Mary Arends-Kuenning, Cem Mete

Poverty, Gender, and Youth

Societies in which fertility is falling and human capital investment per child increasing are experiencing a “quantity-quality transition.” Such transitions imply, over the long term, both slower rates of labor force growth and higher levels of human capital per worker. They are fundamental to economic development. Yet, these transitions are neither automatic or self-propelling. Their momentum depends on competing forces acting at both the family and the macroeconomic levels; the balance can easily tip against further transition. Family decisions about schooling are largely motivated by its private economic returns. These returns are determined in labor markets, and here the logic …

Review Of The Policy Process In Bangladesh Following Icpd, Nancy J. Piet-Pelon, Ubaidur Rob, Syeda Nahid Mukith Chowdhury, Abul Barkat, Sushil Ranjan Howlader, Sharif M.I. Hossain, Ismat Bhuiya, Siraj-Us- Saleheen

Reproductive Health

The International Conference on Population and Development (ICPD) in Cairo in 1994 was the culmination of months of national and international discussions. The issues had been crafted into a Program of Action, which represented a potential shift in thinking. Delegates left the conference espousing a new paradigm and a broad definition of what people, especially women, should expect from their national health services. Governments were encouraged to recognize that the improved health status of women could only be achieved by a life-cycle approach and that health depended not only on good family planning information and services but on women’s empowerment …

The Cost Of Health Services At The Facilities Level Of The Nakuru Municipal Council, Nakuru, Kenya, Andrew Thompson, Barbara Janowitz, Julie Solo

Reproductive Health

The Nakuru Municipal Council (NMC), in Kenya, is concerned with the financial sustainability of its services and is considering increasing prices. The Council is currently charging for services but these fees are not based on the cost of providing services. Before changing its prices, the NMC wanted information on its costs because another strategy to improve financial sustainability is to decrease the costs of producing various services. Information on current costs of services can also help the NMC to determine ways to reduce these costs. The NMC, in collaboration with the Africa OR/TA II project and Family Health International, conducted …

Assessing The Potential Demand For And Effectiveness Of Integrating Sti/Hiv Management Services With Zimbabwe National Family Planning Council's Clinic-Based Family Planning Services, Baker Ndugga Maggwa, Ian Askew, Hazel M.B. Dube, Caroline S. Marangwanda, Sithokozille Simba, Ahmed Latif

Reproductive Health

HIV/AIDS is a threat to individual lives and the national economies of many sub-Saharan African countries, despite efforts to contain its spread. The region also suffers from high levels of other reproductive tract infections (RTIs), some of which increase the risk of sexual transmission of HIV. The control of RTIs is therefore seen not only as an important reproductive health care strategy, but as a key strategy in reducing the spread of HIV/AIDS. Most national health care programs in the region are actively seeking cost-effective ways of implementing an RTI management program that would reduce and prevent RTIs and HIV. …

The Costs Of Integrating Reproductive Health Services: An Example Using Syndromic Management Of Stis In Family Planning Clinics In Zimbabwe, Baker Ndugga Maggwa, Ian Askew, Caroline S. Marangwanda, Barbara Janowitz, Laura Johnson, Andrew Thompson, Caroline West

Reproductive Health

Estimates from the United Nations Population Fund indicate that the costs of family planning (FP) and other reproductive health (RH) services are increasing and that it will be difficult for donors and countries to meet these costs. Many institutions delivering RH services operate significantly below their physical capacity to see clients, and much of the equipment required for expanding RH services may already be available for use. The marginal costs of adding infrastructure could be low. Many institutions have staff that are not fully occupied, and thus the staff necessary to expand RH services may also be in place. In …

Expanding Men's Participation In Reproductive Health In Kenya, Bolaji M. Fapohunda, Naomi Rutenberg

Reproductive Health

To increase men’s participation in family planning (FP) and reproductive health (RH) both for their own well-being and as gatekeepers to women’s health, the African Population Policy Research Center and the Population Council’s OR/TA Project II launched a study designed to explore best practices for delivering services to men. The study examined men’s knowledge, perceptions, and concerns about RH issues, including FP, and the social context of their knowledge. In sub-Saharan Africa, FP and reproductive health-care research and interventions place a disproportionate emphasis on women and largely ignore the role of men. As a result, male participation in FP and …

Testing Strategies To Improve Access To Emergency Contraception Pills: Prescription Vs. Prophylactic Distribution, John P. Skibiak, Yusuf Ahmed, M. Ketata

Reproductive Health

This report is the second in a series of research summaries produced in connection with the operations research project “Enhancing Access to Family Planning Services through the Introduction of Emergency Contraception.” Launched in September 1997, the project explores the many issues surrounding the introduction and delivery of emergency contraception services in a developing country context. The study described in this report compares two different approaches to overcoming barriers that prevent women from accessing emergency contraception during the 72-hour period when the first dosage of emergency contraception pills (ECPs) must be taken. In one approach, new family planning (FP) acceptors were …

Integrating Sti And Mch/Fp Services, Population Council

Reproductive Health

The integration of STI and HIV/AIDS information and services into existing MCH/FP programs has been strongly supported in recent years, following recommendations from the 1994 Cairo ICPD. Moreover, it is now widely accepted that early detection and management of STIs can reduce the incidence of HIV infection. Thus, there are powerful incentives to increase efforts to broaden the capacity of MCH/FP programs to provide STI prevention and management information and services for their clients, both as a comprehensive reproductive health service and as a preventive measure for reducing the transmission of HIV. As described in this brief, the Africa OR/TA …

Estimating Costs Of Post-Abortion Services. General Hospital Aurelia Valdivieso, Oaxaca, Mexico, Population Council

Reproductive Health

Health care systems around the world are facing problems providing quality care with increasingly constrained resources. While modern practices and diagnostic tests have made pregnancy a much less risky event than in the past, not all pregnancies have a favorable outcome. Spontaneous abortion occurs in 15–45% of all known pregnancies, and studies show that 25% of all obstetric/gynecology hospital admissions are for incomplete abortion. Given the high level of resources devoted to treating this condition, it is imperative to develop cost-effective methodologies to provide quality care. Unsafe abortion performed by untrained and inexperienced providers is the fourth leading cause of …

Zimbabwe: Rti Screening Methods For Women Are Not Cost-Effective, Population Council

Reproductive Health

Reproductive tract infections (RTIs) are common in Zimbabwe. Many RTIs increase the risk of human immunodeficiency virus (HIV) infection. In 1998, the Zimbabwe National Family Planning Council (ZNFPC) conducted an operations research study to assess the feasibility of adding RTI diagnosis and treatment to its menu of services. The study population consisted of 1,634 clients at three ZNFPC clinics. Each client was asked about lower abdominal pain, vaginal discharge, and other RTI symptoms; examined for clinical signs of RTIs; and given laboratory tests to confirm the accuracy of diagnosis based upon symptoms and signs. Findings detailed in this brief were …

Reproductive Tract Infections: A Set Of Factsheets, Population Council

Reproductive Health

Reproductive tract infections (RTIs) are being increasingly recognized as a serious global health problem with impact on individual women and men, and their families and communities. RTIs can have severe consequences, including infertility, ectopic pregnancy, chronic pelvic pain, miscarriage, and increased risk of HIV transmission. For effective prevention and management of RTIs, accurate information is necessary and should be widely available. In addition to a brief introduction to RTIs, this document contains 13 factsheets addressing medical and social issues on a variety of topics related to RTIs. The document, produced by the Population Council with support from the Ford Foundation, …

Quality Of Care And Utilisation Of Mch And Fp Services At Kenyan Health Facilities, Lewis Ndhlovu

Reproductive Health

Quality of services is playing an increasingly important role in many family planning (FP) programs. In 1995, a national Situation Analysis Study of 254 health facilities was conducted in Kenya to assess the status and quality of FP services in the country. An in-depth survey of a subsample of 28 health facilities was conducted the following year. From these facilities, 1,834 women were interviewed about their experiences with services at facilities when they sought antenatal, child health, and FP services. The goal of the survey was to examine the links between quality of care in FP services and contraceptive behavior. …

Strengthening Reproductive Health Services In Africa Through Operations Research, Population Council

Reproductive Health

The health status of women, men, and children in sub-Saharan Africa remains the poorest in the world. Moreover, virtually every country in the region is suffering mediocre economic growth or economic decline, thereby reducing the ability of their health care systems to respond adequately, and increasing dependence on external donor assistance. In terms of reproductive health (RH), the region is faced with high levels of unwanted fertility; high levels of maternal, child, and infant morbidity and mortality; and an almost exponential growth in HIV prevalence. Access to and quality of RH services remains poor in most countries, thereby maintaining unmet …

Reproductive Decisionmaking In The Context Of Hiv/Aids In Ndola, Zambia, Naomi Rutenberg, Ann E. Biddlecom, Frederick A.D. Kaona

Reproductive Health

Family planning (FP) programs are increasingly being considered as a logical focal point for STD and HIV/AIDS prevention services because they serve large numbers of women at risk, address the sensitive issue of sexual behavior and fertility control, and the methods for preventing unwanted pregnancy and disease can be the same. FP programs, by providing contraceptive methods, are currently one of the few sources of assistance in the sub-Saharan African region for preventing perinatal transmission of HIV, while the promotion of barrier methods contributes to the prevention of heterosexual transmission. Given this potential, research is needed to understand how the …

Investing In Youth: Testing Community-Based Approaches For Improving Adolescent Sexual And Reproductive Health, Tamara Fetters, Fines Munkonze, Julie Solo

Reproductive Health

The world is now sustaining the largest number of youth in human history; today there are nearly 900 million 10–19-year-olds and their health and livelihood issues are becoming increasingly important to policymakers worldwide. In Zambia, as in many other countries, young people face severe problems, including limited access to jobs, secondary education, and health care. The social, economic, and peer pressures that youth face often lead to high levels of sexual activity, often with subsequent negative impacts on their sexual and reproductive health. In spite of the magnitude of the reproductive health problems facing youth, they still have limited access …

Strengthening The Evaluation And Research Unit Of The Zimbabwe Family Planning Council (1995–1998), Lewis Ndhlovu, Hazel M.B. Dube, Caroline S. Marangwanda

Reproductive Health

The Evaluation and Research Unit (ERU) plays a crucial role in supporting the research activities of the Zimbabwe National Family Planning Council (ZNFPC). Research activities are conducted in addition to analysis of service statistics and compilation of quarterly and annual reports. With a staff capacity of five and inadequate research skills existing in other units, the ERU finds it difficult to manage and monitor the diverse activities of the organization. To address these problems, a buy-in was signed between the Zimbabwe Government and USAID in May 1995. The objectives were to assist the ZNFPC in conducting operations research studies and …

Demand For And Cost-Effectiveness Of Integrating Rti/Hiv Services With Clinic-Based Family Planning Services In Zimbabwe, Baker Ndugga Maggwa, Ian Askew, Caroline S. Marangwanda, Sithokozille Simba, Hazel M.B. Dube, Rick Homan, Barbara Janowitz, Ahmed Latif, Peter R. Mason

Reproductive Health

The current spread of HIV/AIDS poses a major threat to individual lives and national economies in many sub-Saharan African countries. The region also has some of the highest levels of other reproductive tract infections (RTIs) in the world. Some of these RTIs increase the risk of sexual transmission of HIV infection. Thus, the control of RTIs is seen not only as an important reproductive health care strategy to alleviate symptoms of infection and long-term gynecological, obstetric, and neonatal complications, but also as a key strategy in reducing the spread of HIV/AIDS. As a result, all national health care programs in …

Improving Quality Of Care In India's Family Welfare Programme: The Challenge Ahead, Michael A. Koenig, M.E. Khan

Reproductive Health

This book on family planning in India includes detailed empirical data and analysis of the various dimensions of quality of care in different regions of the country. Focus areas include: women’s perceptions of the care they receive; observations of provider-client interactions; barriers to quality of service delivery; existing interregional variations; contraceptive choice and interpersonal relations; technical quality of care; and the effect of the target system on the work style of outreach staff. All elements of the quality-of-care framework elaborated by Judith Bruce are well documented and their relationships to broader program constraints are clearly identified. The overall impression one …

The Tostan Story: Breakthrough In Senegal Ending Female Genital Cutting, Population Council

Reproductive Health

In Senegal, elements of the Tostan education program were fundamental to the ending of the practice of female genital cutting (FGC) which has persisted for centuries, despite outside efforts to abolish such a dangerous and harmful operation. This paper is an attempt by those who lived through these events to share the experience with others. At a time when there has been little reduction in the numbers of women ending FGC in 28 African countries, when different programs and strategies have rarely succeeded in making an impact on the number of women still practicing FGC despite laws abolishing the tradition, …

Indonesia: Analysis Of Conflicting Crisis-Related Research Results, Michelle Gardner, Lila Amaliah

Reproductive Health

This report aims to explain the discrepancies in crisis-related research results in Indonesia, and to recommend methodologies to enhance future crisis-related monitoring and surveillance. The discussion aims to identify where the discrepancies are in the readily available data, and how these discrepancies can be explained. The report does not attempt to clarify the impact that the economic crisis is having on the health status of women and children in Indonesia. Recommendations are made to deal with the following findings: Aggregation of data may hide important crisis impacts; attribution of identified changes to the economic crisis may be misleading; differences in …