Amy O. Tsui

Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions

Sexually transmitted diseases, unintended pregnancies, infertility, and other reproductive problems are a growing concern around the world, especially in developing countries. Reproductive Health in Developing Countries describes the magnitude of these problems and what is known about the effectiveness of interventions in the following areas: * Infection-free sex. Immediate priorities for combating sexually transmitted and reproductive tract diseases are identified. * Intended pregnancies and births. The panel reports on the state of family planning and ways to provide services. * Healthy pregnancy and delivery. The book explores the myths and substantive socio-economic problems that underlie maternal deaths. * Healthy sexuality. Such issues as sexual violence and the practice of female genital mutilation are discussed in terms of the cultural contexts in which they occur. Addressing the design and delivery of reproductive health services, this volume presents lessons learned from past programs and offers principles for deciding how to spend limited available funds. Reproductive Health in Developing Countries will be of special interest to policymakers, health care professionals, and researchers working on reproductive issues in the developing world.

Factors associated with HIV/AIDS knowledge and risk perception in rural Malawi.

Measures of HIV/AIDS knowledge and risk perception are important because they are often linked to behavioral change both in theory and in practice. This study examines knowledge and risk perception by assessing their relationship with demographic characteristics, first source of HIV/AIDS information, and behavioral and cognitive risk exposures among men and women in a rural district of Malawi. The data come from a panel study of 940 women aged 15–34 years and 661 men aged 20–44 years. Descriptive statistics and multivariate regression models are used for the analysis. The results indicate that knowledge of HIV/AIDS does not necessarily translate into perceived risk. In addition, there appears to be a gender difference in the influence of cognitive and behavioral factors on perceived risk.

Husbands reproductive health knowledge attitudes and behavior in Uttar Pradesh India.

To enhance the reproductive health status of couples in developing countries, the knowledge, attitudes, and behavior of both women and men must be investigated, especially where women depend on men for the decision to seek care. This study analyzes data from a survey of 6,727 husbands from five districts in the northern state of Uttar Pradesh, India. Data are presented on mens knowledge of womens health and on their own sexual behavior outside the context of marriage, on their perceptions of sexual morbidity and their attempts at treatment for specific conditions, and on their opinions concerning the social role of wives. Findings indicate that men know little about maternal morbidity or sexual morbidity conditions. Few husbands reported that they had had sexual experience outside of marriage and the majority of these few said they had had such a relationship with more than one partner. Of men who said they had had reproductive morbidity symptoms, many said they had not sought treatment. Mens views concerning the role of wives indicate a low level of womens autonomy in this region of India. Results indicate a pressing need for reproductive health education that targets both women and men in Uttar Pradesh.

Changing living arrangements: a hazard model of transitions among household types.

This paper analyzes movements among household types. Persons in one household may join another type. Correspondingly, a household’s structure may change when someone joins it. Data are from the Panel Survey of Income Dynamics, spanning 1968–1980. The individuals followed in the survey generated spells analyzed with a multivariate competing risk hazard model. We develop a map of the flow among household types and of the economic and demographic profiles of individuals making the transitions. We find wide variability in the stability of household types and marked racial differences in the relative stability and pattern of destination choices.

Marriage timing in Sri Lanka : The role of modern norms and ideas

Modernization theory argues that a shift occurs from family to individual orientation which leads to later marriages. This study argues that in Sri Lanka modern and traditional value orientation are intertwined and that social change is not a linear process of shifts from one set of traditional norms to another modern set of norms. Findings from event history analysis reveal that family organization interests and culture remain central to the issue of marriage timing among Sri Lankan women. Sri Lanka is different from other Asian countries in that cultural norms prescribe later marriages due to poor economic and political conditions. Women have enjoyed a favorable position in terms of kinship support and educational access. Sri Lanka did not experience the economic boom of countries such as Taiwan or Korea. Modern norms and ideas are measured by variables such as preferences for nuclear households economic independence of women (interest in jobs for income or for accumulating a dowry) and marriages of choice. Other ideational measures are urbanization media exposure and school attendance. Modernization is also reflected in womens occupational experience years of education and vocational training or volunteer work. Cultural factors include ethnicity religion and sibling status. Data were obtained from surveys among 1089 women aged 18-33 years in 1989 and 1992-93 life histories and focus groups from the Kalutara district. Discrete-time hazard models are used to examine the probability of entering marriage in 6-month intervals during 1989 and 1992-93. Findings show that only 42% of women were married by 1992-93. 40% of women aged 25-29 years were unmarried. About 57% were married in 1989 and 43% married during the study period. In multivariate models only the expected arrangement of marriage and school attendance consistently predicted the timing of marriage. Women with Moor backgrounds married later and were more likely to live in urban areas and have arranged marriages. Years of schooling or work experience did not have a significant effect on marriage timing after ethnic background was accounted for.

What husbands in northern india know about reproductive health: Correlates of knowledge about pregnancy and maternal and sexual health

Women in India suffer from a high incidence of reproductive disease, disability and death. Very little work has been done on men, but a much higher incidence of sexual experience outside marriage and sexually transmitted diseases (STDs) among males than previously expected for this population is now being documented. In north India, women are dependent on their husbands and other family members for health-related decisions. Therefore, the behaviour, knowledge and attitudes of men are integral to the reproductive health status of couples there. This study explores knowledge about three distinct areas of reproductive health among 6549 married men in five districts of the northern state of Uttar Pradesh, India. Factors contributing to mens knowledge in the areas of fertility, maternal health and STDs were investigated. Results showed that very few men had basic knowledge in any of these areas. The likelihood of reporting knowledge was associated with a set of determinants that differed in their magnitude and effect across the areas of reproductive health explored. In particular, mens belief about the ability of an individual to prevent pregnancy demonstrated an independent association with mens knowledge. After controlling for factors such as age, parity and educational and economic status, men who believed it not possible to prevent a pregnancy were less likely to know when during the menstrual cycle women would become pregnant and certain facts about STDs, but they were more likely to be able to name two or more symptoms of serious maternal health conditions. Possible explanations for this trend are discussed.

Curbing Population Growth: An Insider's Perspective on the Population Movement.

Introduction: What Is in This Book. Beginnings of the Modern Population Movement. The Population Movement Flourishes: The Sixties and Seventies. Studying the Causes and Effects of Population Change. The Search for Better Contraception. India Faces Its Population Problems. Population Issues in the United States. New Directions for the Population Movement? Commentaries: The Present Status of the World Population, Demography, and Population Policy A.J. Coale. Expanding Contraceptive Choices for Men and Women S.J. Segal. Reforming Population Paradigms for Science and Action A.O. Tsui. Index.

The Relationship between Prenatal Care and Subsequent Modern Contraceptive use in Bolivia, Egypt and Thailand

Determinants of modern contraceptive use are usually examined in isolation of the effect of exposure to other aspects of health care systems. Maternal interaction with organised health service provision during post-conception and postpartum stages of reproduction can provide an opportunity to transfer contraceptive service information and counselling. We found that living in a community in which women have widespread health service contact is related to both prenatal care use and subsequent modern contraceptive use. After controlling for effects of living in high health service contact areas and various demographic and background factors, our results suggest that prior use of prenatal care has a strong influence on subsequent use of modern contraception in Bolivia, Egypt and Thailand.

Ethnic differentials in child-spacing ideals and practices in Ghana.

Postpartum sexual abstinence may be a major determinant of fertility and of maternal and child health in sub-Saharan Africa. This study examines the relationship between ethnicity and abstinence using data from the 1988 Ghana Demographic and Health Survey. There is considerable diversity in the length of abstinence although only for one ethnic group, the Mole-Dagbani and other Ghanaians, is abstinence, both actual and ideal, very long. Respondents in most ethnic groups believe their abstinence to be adequate. A key motivation for abstinence is the unwillingness to have sexual intercourse with nursing mothers. Education, urbanisation, changes in marriage patterns and religious traditions are major factors shaping the ethnic differentials in abstinence. In comparison to breast-feeding, abstinence appears to have relatively little impact on the length of the birth interval and for Ghana, has relatively few implications for fertility and child health.

A study of infant mortality and causes of death in a rural north-east Brazilian community

In 1984 a prospective study of 1645 women and 1677 births in a rural community in north-eastern Brazil showed the infant mortality rate to be 65 per 1000 live births. Neonatal, post-neonatal and infant mortality are analysed to determine the most important risk factors for each period. Post-neonatal survival depends largely on factors relating to child care, while neonatal deaths are more likely to be associated with biological factors. The principal cause of death, diarrhoeal disease, was responsible for a third of the deaths.