Anthony Pramualratana

Fertility Transition in Thailand: A Qualitative Analysis

This paper analyzes qualitative information gathered through focus group sessions with men and women who built their families before the Thai fertility decline and with a younger generation whose members are limiting family size to 2 or 3 children. The ultimate aim of the study is to generate qualitative data (perceptions opinions and attitudes) that will complement the quantitative documentation of the ongoing fertility transition in Thailand including its timing and pace. 4 major components are identified all of which interacted to result in an abrupt and rapid shift in reproductive patterns. 1) Fundamental social and economic changes under way in Thailand for some time are responsible in part for the latent demand for fertility control among the older generation and far more so for the current desire for smaller families among the younger. Participants viewed larger numbers of children as a burden with which they are either unable or unwilling to cope. The analysis points to a perceived increase of monetary costs of raising children and a decrease in some benefits. However some participants felt that more was to be gained from rearing few better educated children than from having many less educated ones. 2 The cultural setting is relatively conducive to the acceptance of deliberately regulated fertility and limitation of family size as adaptations to changing circumstances. There exists a prevailing expectation that each conjegal unit will be largely responsible for the support of their ownn children. In addition Thai women enjoy a considerable degree of autonomy and influence over birth control and family size enabling them to effectively take into account their own stake as the bearers and rearers of children. Finally Budddhism as practiced in Thailand also appears to pose no barriers to fertility control. 3) Organized efforts to provide contraception throughout the country met with immediate success largely because of the existence of a receptivity of latent demand for effective and acceptable birth control prior to the widespread availability of contraceptives. 4 The national family planning programs efforts to promote and provide effective modern contraception have facilitated the widespread use of birth control. The analysis shows that the 2 most dynamic components explaining Thailands fertility transition are the set of fundamental social changes that have been taking place and the effect of the family planning program. It is the interaction between these 2 forces both operating within a cultural setting conducive to reporoductive change that has resulted in the rapid and extensive decline of fertility. (summaries in ENG FRE SPA)

Origins and working conditions of female sex workers in urban Thailand: Consequences of social context for HIV transmission

This paper examines the social origins and working conditions of selected female commercial sex workers in Thailand. Quantitative data gathered from 678 commercial sex workers (CSWs) in low-price brothels, tea houses and other work sites in three urban centers were supplemented by focus group discussions and in-depth interviews. The commercial sex establishments were selected from lists provided by local health officials. Social factors associated with entry into commercial sex work and condom use for sexual intercourse were investigated as they operate on contextual, intermediate and proximate levels. Women from the North region of Thailand predominated (68%) and they tended to be younger than the 27% from the Northeast. The majority of all women maintained financial ties to the home by sending income to parents, siblings and other relatives but this pattern is stronger among Northern women. Qualitative data suggest that women were systematically recruited into prostitution from villages in the North and their work enabled them to comply with traditional family support roles. Women from the Northeast revealed a more complex pattern of entry with intrafamily strife, divorce, efforts to find other employment, and entry into sex work at a later age than the women from the North. Northeastern women were more than twice as likely as Northern women to have had a husband as their first sex partner (55% vs 22%). The lives of CSWs were found to be tightly controlled by brothel owners and managers, although 8% were living with a husband or partner, and non-commercial sexual relationships in the month prior to interview were reported by up to 23%. Data indicate need for even more intensive education on HIV transmission, especially with respect to risk of transmission in the absence of AIDS symptoms. Appearance and a trusting relationship were the common reasons given for not using condoms. With the most recent client, 92% reported use if the client was not known and 70% reported use if the client had visited the same CSW three or more times. Education on HIV must take these attitudes and motivations into account as well as sanctions for brothel owners who do not enforce condom use. The proportion of Thai men who visit brothels in addition to other sexual partners, high rates of HIV among CSWs, and inconsistent use of condoms create a complex web that accelerates the spread of the HIV epidemic in Thailand.

The relational determinants of condom use with commercial sex partners in Thailand

Objective: To analyze the extent and determinants of condom use with commercial sex partners among lower socioeconomic status groups in the Thai population. Design: Respondents were sampled in Udon Thani, Saraburi and Bangkok in 1992. Completed sample size was 678 women in brothels, 330 male truck drivers and 1075 men aged 17‐45 years. Behavioral data and local sexual network information were collected using structured questionnaires (face‐to‐face interviews), focus groups and in‐depth unstructured interviews. Methods: Data were analyzed using univariate and multivariate logistic regression. Results: Condom use with commercial partners remains inconsistent. Consistent use was reported by 61% of women in brothels, 25% of truck drivers, and 29% of men in the low‐income population. The single strongest predictor of consistent condom use for all groups is type of partnership. Consistent use drops significantly with regular (multivisit) commercial sex partners compared with casual (single visit) commercial partners; adjusted odds of consistent use are 0.22 for women and 0.25 for men. Brothel women report that one in five of their commercial partners is a ‘regular’, and 20% of the young men who report a commercial partner report a ‘regular’. Discussion: The strongest determinant of consistent condom use is the nature of the relational bond between the partners, rather than their individual characteristics, knowledge or attitudes. To raise condom use further, programs will have to move beyond the standard knowledge‐attitudes‐practices paradigm focus on individual attributes to address the contextual determinants of behavior. AIDS 1995, 9:507‐515

In the company of friends: Peer influence on Thai male extramarital sex

We explore some of the key social dynamics underlying patterns of male extramarital heterosexual behavior in Thailand. We analyze transcripts of focus group discussions and focused individual interviews conducted during 1993 and 1994 with married men and women living in both urban and rural areas of central Thailand. We discern several pathways of peer influence on extramarital commercial sex patronage that are common across our sites and interpret these peer effects in light of contemporary theories of social influence and sexual behavior.

Prospects for increased condom use within marriage in Thailand.

In Thailand where commercial sex patronage is widespread among married men the transmission of human immunodeficiency virus (HIV) from infected husbands to their wives has become a significant component of the acquired immunodeficiency syndrome (AIDS) epidemic. Although 70% of Thai couples of reproductive age are current users of a contraceptive method condoms are selected by fewer than 2%. Qualitative data from 14 focus groups (involving 59 men and 55 women) and 47 in-depth interviews identified numerous obstacles to condom use within marriage. Condoms are perceived as a means of preventing venereal diseases not pregnancy. As a result of effective government AIDS prevention campaigns condoms are now used in the majority of sexual encounters with prostitutes and have become associated with extramarital sex. Thus requests for condom use within marriage are viewed as insulting to the partner and arouse suspicions of marital infidelity. When either partner suspects infection with a sexually transmitted disease short-term abstinence until treatment can be obtained is more likely than condom use. A further barrier to condom use within marriage is mens strong dislike of the associated reduction of sexual pleasure. Of concern was the failure of any respondent to mention condom use as a precaution against premaritally acquired HIV infection; none had been tested for HIV. Recommended to increase the perception of personal risk is voluntary HIV testing and counseling among men with a history of risky behavior and possibly optional premarital testing. Continuation of government promotion of condom use in commercial sex encounters remains essential given the formidable obstacles to condom use within marriage.

Exploring the normative basis for age at marriage in Thailand: an example from focus group research.

The normative basis of marriage timing in Thailand was explored using focus group sessions as a way of obtaining qualitative information about attitudes and beliefs concerning the appropriate age at 1st marriage for men and women. A focus group session consists of a group discussion in which a small number of participants (usually 6-9) under the guidance of a moderator talk about topics of importance to the particular research study. The informal group situation is intended to encourage participants to elaborate on behavior and opinions to a greater extent than might be forthcoming from more formalized individual interview situations. Given the main objective of exploring the recent transformation of reproductive behavior in Thailand the project was designed to facilitate a comparison between the pre and post fertility decline generations. The pretransition generation was defined as married persons who had experienced most or all of their childbearing prior to the rapid changes in reproductive behavior that took place over the last decade and who had at least 5 living children. The post transition generation was defined as young married persons in their 20s for women and in their 20s or early 30s for men who wanted to have 2 or 3 children. Separate sessions were held for older men older women younger men and younger women. Complete sets of 4 sessions were held in 1 village each in the Central North and Northeastern Regions and in both a Buddhist and a Moslem village in the South. All but an older generation mens session have been held among construction workers in Bangkok all of whom migrated from rural areas. The findings draw on material from all 23 sessions. The discussions indicated that there was a reasonably clear consensus that a woman should marry in his mid 20s with 25 being most commonly mentioned. in general the recommended ages at marriage resemble the distribution of acutal ages at which men and women marry in Thailand and the mean of the recommended ages is fairly close to the actual average age at 1st marriage. During all the focus group sessions only once was the issue of brideprice payments raised and there seemed to be no acknowledged relationship between brideprice payments and appropriate age at marriage for men or women. There also was no link made between the onset of menarche and age at marriage for women and no concern expressed about a delay of marriage increasing the danger of a woman having her virginity compromised. There likewise was no advocacy that a woman should marry early in order to maximize her reproductive potential. The findings suggest that the link between age at marriage and family size is largely unintentional and that decisions as to when to marry are not viewed as a way to deliberately control family size.