Aphichat Chamratrithirong

Thailand's reproductive revolution : rapid fertility decline in a Third-World setting

The fertility decline in Thailand is the 3rd largest fertility decline behind only South Korea and China. Thailands total fertility rate of 6.4 during the 1st half of the 1960s was quite typical of large Third World countries; by the early 1980s total fertility in Thailand had fallen to 3.6. Thailand is an especially intriguing case because of the rapidity and pervasiveness that have characterized the fertility decline there and because reproductive change has occurred during a period when the country is still predominantly rural and agrarian. The significance of Thailand as a case study of reproductive change in the Third World is further enhanced by the fact that at an early stage of the fertility decline an official policy and program were instituted to encourage and facilitate the practice of contraception with the explicit goal of reducing the population growth rate through lowering fertility. Although Thailand is not among the least developed of the Third World countries neither does it rank particularly high with regard to many conventional indices of socioeconomic development. Chapter 2 discusses sources and methods and provides socioeconomic and related background information for Thailand. Chapters 3 and 4 review recent trends in fertility and family size preferences. The quantitative evidence concerning the proximate determinants of reproductive change is examined in chapter 5 which includes an assessment of the relative contribution of several key proximate determinants to the recent levels and changes in Thai fertility. The results clearly show that increased contraceptive use is the main proximate determinant accounting for Thailands fertility decline. Chapter 6 also focuses on the proximate determinants but is based on qualitative evidence and includes a discussion of evidence pointing to a substantial latent demand for lower fertility even before fertility went down. The relations between societal change and reduced family size are the topic of chapter 7. Chapter 8 focuses on aspects of the Thai culture that are particularly relevant to understanding reproductive behavior and attitudes. Chapter 9 explores the channels through which the means of fertility reduction spread through Thai society. The final chapter summarizes basic arguments regarding the causes and conditions behind Thailands rapid fertility decline.

Infant feeding practices postpartum amenorrhea and contraceptive use in Thailand.

The findings from Thailands 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.

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.

Contraceptive use and fertility in Thailand : results from the 1984 contraceptive prevalence survey

The 3rd national Contraceptive Prevalence Survey of Thailand took place in 1984; a total of 7576 ever married women wre interviewed of which 317 were included in a special sample. The survey indicates an increase in contraceptive prevalence as measured by the % of currently married women aged 15-44 presently using a contraceptive method. The increase nationallly was from 59 to 65% between 1981 and 1984. Increase in female sterilization accounts for 86% of the increase in overall prevalence. This report breaks into 9 chapters: 1) introduction; 2) methodology; 3) fertility; 4) contraceptive awarencess; 5) contraceptive use; 6) contraceptive source unmet need and nonuser profile; 7) infant feeding practices and postpartum amenorrhea; 8) Moslem/Buddhist differentials; and 9) Summary and implications for family planning program. Discusson and tables present the findings: 1) The lowest contraceptive prevalence rate is in the South (50%) the highest in the North and Bangkok (over 70%). 2) Only 2.5% of currently married women aged 15-49 have an unmet need for spacing and only 3.5% have an unmet need for limiting; thus about 450000 of the approximately 7.5 million currently married women under 50 are not being served by the family planning program or by some commerical outlet. 3) The large majority of Thai couples practicing contraception used a government outlet as their most recent source of supply or service. 4) Total fertility at the national level declined from 3.68 to 3.47 between 1981 and 1984. 5) The modal number of children desired among women married less than 5 years is 2. 6) For Moslems overall prevalence is only about 1/2 as high as among Buddhists but language region and religion each exert an independent influence on prevalence within these groups. 7) Fertility levels and preferences differ considerably between Moslems and Buddhists: marital fertility is over 70% higher for Moslems. 8) Generally only a small proportion of Buddhists indicated that they believed that any contraceptive method was against their religion; Moslems were far more likely to express religious opposition but less toward temporary than toward permanent methods of contraception.

Breastfeeding in Thailand: data from the 1981 contraceptive prevalence survey.

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 babys 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.

Thailand's reproductive revolution: an update.

A comparison of the results of the 1981 Contraceptive Prevalence Survey with those of a similar survey carried out in 1978-1979 shows that the proportion of currently married Thai women who are practicing contraception has continued to rise and is now approaching 60%. Nearly all segments of Thai society have participated in this increase; rural/urban and educational differentials are modest and even among rural women with fewer than 4 years of education more than half report that they are currently using contraceptives. Important regional differences remain however; southern Thailand particularly lags behind the other regions. Increases in contraceptive prevalence have resulted largely from greater use of female sterilization and to a lesser extent from increased use of injectable contraceptives. The pill remains the method most commonly employed but by 1981 it was only slightly more popular than female sterilization. Pill users represent slightly more than 33% of all women using contraceptives; sterilized women constitute slightly less than 33%. Government outlets of the Ministry of Public Health are by far the most important suppliers of contraceptive services. Fertility rates among currently married women in the year prior to the survey were slightly higher among 1981 respondents than among those interviewed in 1978-1979. However the proportion of respondents reporting that they were currently pregnant declined between surveys; the average length of the interval since a womens last live birth increased. Both of these findings suggest that Thai fertility may have actually declined between surveys and that regional fertility differences are diminishing. The average expected family size has decreased to 3.3 children. Among women married less than 5 years only 2.4 children are wanted. A 2-child family appears to represent a lower limit on any further decline in fertility that might occur in the immediate future. Family size preferences vary with the sex distribution of children already born. (authors modified) (summaries in ENG FRE)