Bruce Caldwell

The construction of adolescence in a changing world: implications for sexuality, reproduction, and marriage.

This article aims to show how the period now known as adolescence came into being and how it was shaped by international economic, institutional, and social influences. It considers premodern societies and argues that traditional culture has shaped contemporary adolescence even more than has global society. Explanations are offered for the enormous differences across the world in adolescent sexuality, reproduction, and marriage. The data are drawn mainly from research programs in Nigeria, Sri Lanka, India, and Bangladesh, and comparisons are made with other countries.

Searching for an optimum solution to the Bangladesh arsenic crisis

Searching for an optimum solution to the Bangladesh arsenic crisis: Thirty years ago Bangladesh experienced very high levels of infant and child mortality, much of it due to water-borne disease in deltaic conditions where surface water was highly polluted. In what appeared to be one of the great public health achievements, 95% of the population were converted to drinking bacteria-free tubewell water from underground aquifers. Recently, it has been shown that perhaps 20% of this water is arsenic contaminated and alternatives to tubewell water have been sought. This paper reports on two national surveys collaboratively carried out in 2000 by the Health Transition Centre, Australian National University and Mitra and Associates, Dhaka: A census of tubewells and a household survey of tubewell use and arseniosis. The study found that the tubewell revolution has been promoted not only by health considerations but also by the demand for a household water facility and the desire by women to reduce workloads associated with using surface water. Because of this, and because the population had absorbed the message about safe tubewell water, it is argued that the movement away from the use of tubewell water should be as limited as possible, even if this means using safe tubewells which are often found in the neighbourhood. To enable such a move the most urgent need is not changing the source of water but comprehensive national water testing providing essential information to households about which wells are safe and which are not.

The effect of arsenic mitigation interventions on disease burden in Bangladesh.

Many interventions have been advocated to mitigate the impact of arsenic contamination of drinking water in Bangladesh. However, there are few data on the true magnitude of arsenic-related disease in Bangladesh nationally. There has also been little consideration given to possible adverse effects of such interventions, in particular, diarrheal disease. The purpose of this study was to estimate and compare the likely impacts of arsenic mitigation interventions on both arsenic-related disease and water-borne infectious disease. We found that arsenic-related disease currently results in 9,136 deaths per year and 174,174 disability-adjusted life years (DALYs; undiscounted) lost per year in those exposed to arsenic concentrations > 50 μg/L. This constitutes 0.3% of the total disease burden in Bangladesh in terms of undiscounted DALYs. We found intervention to be of overall benefit in reducing disease burden in most scenarios examined, but the concomitant increase in water-related infectious disease significantly reduced the potential benefits gained from intervention. A minimum reduction in arsenic-related DALYs of 77% was necessary before intervention achieved any reduction in net disease burden. This is assuming that interventions were provided to those exposed to > 50 μg/L and would concomitantly result in a 20% increase in water-related infectious disease in those without access to adequate sanitation. Intervention appears to be justified for those populations exposed to high levels of arsenic, but it must be based on exposure levels and on the effectiveness of interventions not only in reducing arsenic but in minimizing risk of water-related infections.

Sexual regimes and sexual networking: the risk of an HIV/AIDS epidemic in Bangladesh

Bangladesh adjoins the Asian region with the severest AIDS epidemic and has common borders with two of the most affected areas, the Indian Hill States and northern Burma. There has been disagreement about the danger to Bangladesh, one view citing the likelihood of transmission from neighbouring infected populations and the other claiming that the countrys predominantly Muslim culture protects it. This paper reports on a 1995-1997 research project. Preliminary research was carried out in Dhaka in 1995-1996 which suggested that the poor squatter areas might well sustain an epidemic. The experience also showed that more accurate measures of sexual networking could be obtained from males than females. The 1997 field research reported here investigated 983 males, 52% single and 48% married in Chittagong city and two more rural areas of Chittagong Division in southeast Bangladesh. It was found that around half of all males and probably a somewhat lower proportion of females, experience premarital sexual relations, with males having a lower level of extramarital than premarital relations. The factor heightening Bangladeshs risk of an epidemic is that one-quarter of single males and a significant but lower level of married males have had relations with prostitutes. This is one explanation for quite high levels of STDs in Bangladesh. The factors restricting the chances of a major national epidemic are the small number of premarital sexual episodes per person and the low level of intravenous drug use.

Anthropology and Demography: The Mutual Reinforcement of Speculation and Research [and Comments and Reply]

Most demographic theory attempts to explain changes in fertility and mortality and much of it rests on anthropological assumptions. Yet the scale and quality of the anthropological work designed to establish modify or refute these assumptions have been trivial compared with the need. Where the ideas of demographers have attracted the interest of anthropologists the result has more often been a stimulus to further theorizing than to investigation in the field. A fundamental problem is that demographic and anthropological theory have frequently fed on each other each discipline accepting ideas which emerge from the other less skeptically than it would the ideas of its own members. This paper substantiates this charge with regard to two of a variety of possible themes namely the pre-modern deliberate control of fertility and the related concept of primitive affluence. It goes on to consider the value of existing anthropological work in areas in which the authors are interested as demographers to outline their experience as demographers attempting quasi-anthropological work and to identify areas in which anthropological work is currently most needed for an understanding of demographic change and stability. (EXCERPT)

Factors affecting female age at marriage in South Asia: Contrasts between Sri Lanka and Bangladesh

In contrast to East and South-east Asia, changes in marriage patterns have played a small role in reducing fertility in South Asia. While age at marriage for women has risen, it remains early, with the exception of Sri Lanka, and change has been slow. Except in Sri Lanka, the region has shown few signs that there will be a sizable population that will never marry. South Asias marriage patterns reflect its cultural context and lesser socio-economic change but their precise effect is not simple or always predictable. The paper examines these issues in Bangladesh, where age at marriage is very early, and Sri Lanka, where it is much later. The study areas, Dhaka city and south-western Sri Lanka, are ones of great economic and social change. A particular examination is made of the way in which changes in the arrangement of marriage affect age at marriage.

Pretransitional Population Control and Equilibrium

A persistent theme in much anthropological writing is the concept of the deliberate control of population numbers by hunter-gatherers as a means of achieving moderate family size, adequate nutrition, and constrained adult mortality. An analysis of the mix of theory and field evidence that led to this conclusion finds the case not proven. On the contrary, Malthusian constraints can operate, and probably did operate, to produce a hunter-gatherer society where most adults were reasonably robust and healthy even though child mortality was high and life expectancy short. The absence of population limitation in pre-Neolithic times implies high mortality as well as high fertility, and weakens the argument positing a Neolithic mortality crisis.

A Randomised intervention trial to assess two arsenic mitigation options in Bangladesh

Arsenic groundwater contamination in Bangladesh warrants immediate remediation. This randomised controlled intervention trial was conducted to determine the effectiveness of two possible interventions: dug wells and three-pitcher filters. A total of 640 individuals participated with 218 randomised to the dug well group, 216 to the three-pitcher group and 206 to a control group. Data were collected at baseline and at 1, 6 and 12 months after the intervention. Self reported compliance with dug wells remained below 20% during the entire 12 months of the study. The compliance with the three-pitcher filters decreased after 6 months and became similar to the compliance of the dug well group after 12 months. A substantial decrease in urinary arsenic metabolites occurred only among those who were compliant with dug wells and three-pitcher filter systems after 1 month of intervention as opposed to control participants. However, a persistent reduction in urinary arsenic concentrations was observed only among the dug well users after 12 months of intervention. Our results show that a functional dug well could be offered as a long-term alternative to tube wells, but use of this option is likely to be low, unless appropriate behavioural change measures are taken. Our study also demonstrates that arsenic removal technologies such as three-pitcher filters are an effective option as a short-term measure. The three-pitcher filters that are not adequately maintained are not an effective option for a year. These arsenic removal technologies may be even harmful in the long term if the resultant water quality is not properly monitored.

Effect of price and access on contraceptive use

The Family Planning Program in Bangladesh has been very successful. The contraceptive prevalence rate (CPR) has increased from 13% in 1979 to 49% in 1996. Now that the program has matured and demand for family planning has been created, the Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh is concerned with increasing its financial sustainability. Options to increase financial sustainability include cost sharing and a gradual transition from doorstep to static clinic delivery of contraceptives. Many of these alternatives would involve additional travel time or charges for consumers, and it is important to estimate the effect that these additional prices would have on the use of contraception. The effect of economic constraints, such as cash price and access to services on contraceptive method use, the choice of contraceptive method and provider choice, has been analyzed, taking into account the socioeconomic factors that influence decision-making for individual family members. Two data sources have been used for this analysis: (1) a survey on use of contraception and (2) two baseline surveys of 1993 and 1994 in the two field sites of the MCH-FP Extension Project (Rural) of International Center for Diarrhoeal Disease Research, Bangladesh. No effect of cash prices was found on the probability of use of any contraceptive method, but clients were to a limited extent responsive to price in making choices about contraceptive methods and providers. In addition, couples were less likely to use contraception or choose methods if the travel time to fixed clinics was greater than 30 min.

Below-replacement fertility: Determinants and prospects in South Asia

Although 10 countries and two of China’s special administrative areas, totalling 1,528 million people or 44 per cent of Asia’s total population, are now characterized by fertility rates below long-term replacement levels, no such countries are yet found in South Asia. This paper first examines the characteristics of 12 Asian administrations with very low fertility at various stages of their fertility declines and then compares the findings with the present situation in three South Asian countries, Sri Lanka, India and Bangladesh. This allows a prediction of when the South Asian countries will reach replacement fertility in accord with the trends in two key criteria, the percentage of girls in secondary school and the infant mortality rate. These conclusions are then buttressed for each country by the findings of anthropological demographic research programs in which the authors were involved. The predictions are that all three countries will attain a total fertility rate of 2.1 within the next 30 years and that the UN2000 Revision of the medium population projection is plausible in that regard. However, the authors part company with the UN projection in their assessment that the nature of these societies means that they will all subsequently fall to still lower fertility levels.