Terence H. Hull

The relation of economic class and fertility: An analysis of some Indonesian data

Summary Many recent fertility studies in developing societies put forward the hypothesis of a negative relation between economic class and fertility. Data showing a positive relationship are frequently dismissed a priori as resulting from the reporting errors of illiterate women. This study draws on data from Indonesias 1971 Census, a 1973 sample survey of fertility and mortality, and an intensive community study in Java, to argue that an observed positive relation between class and fertility is real, and is related to differences in patterns of marital disruption, postpartum abstinence, and fecundity. The positive relation may be reversed in the future as changes in these patterns, and the impact of the national family planning programme, affect the family structure of each class differently. Had the positive relation in this context been attributed offhand to reporting errors, these important socio-economic changes would have been misunderstood, and possibly ignored.

Prevalence, motivations, and adverse effects of vaginal practices in Africa and Asia: Findings from a multicountry household survey

BACKGROUND Women worldwide use various vaginal practices to clean or modify their vulva and vagina. Additional population-level information is needed on prevalence and motivations for these practices, characteristics of users, and their adverse effects. METHODS This was a household survey using multistage cluster sampling in Tete, Mozambique; KwaZulu-Natal, South Africa; Yogyakarta, Indonesia; and Chonburi, Thailand. In 2006-2007, vaginal practices and their motivations were examined using structured interviews with women 18-60 years of age (n=3610). RESULTS Prevalence, frequency, and motivations varied markedly. Two thirds of women in Yogyakarta and Chonburi reported one or more practices. In Yogyakarta, nearly half ingest substances with vaginal effects, and in Chonburi, external washing and application predominate. In Tete, half reported three or four current practices, and a quarter reported five or more practices. Labial elongation was near universal, and 92% of those surveyed cleanse internally. Two thirds in KwaZulu-Natal practiced internal cleansing. Insertion of traditional solid products was rare in Chonburi and Yogyakarta, but one tenth of women in KwaZulu-Natal and nearly two thirds of women in Tete do so. Multivariate analysis of the most common practice in each site showed these were more common among less educated women in Africa and young urban women in Asia. Explicit sexual motivations were frequent in KwaZulu-Natal and Tete, intended for pleasure and maintaining partner commitment. Practices in Chonburi and Yogyakarta were largely motivated by femininity and health. Genital irritation was common at African sites. CONCLUSIONS Vaginal practices are not as rare, exotic, or benign as sometimes assumed. Limited evidence of their biomedical consequences remains a concern; further investigation of their safety and sexual health implications is warranted.

Unintended pregnancy and women's psychological well-being in Indonesia.

Few studies have examined the impact of unintended pregnancy on women in developing countries. This paper examines the impact of unintended pregnancy on Indonesian womens psychological well-being. It is hypothesized that experiencing unintended pregnancy is associated with lower psychological well-being and that use of family planning and small family size are associated with higher levels of psychological well-being. Data are drawn from a 1996 survey of 796 women aged 15-49 from two Indonesian provinces, Lampung and South Sumatra. This article focuses on the 71% of women (n=562) who answered all 41 survey items related to psychological well-being. In cluster analysis, women grouped into three clusters, differentiated by their scores on four scales of well-being established through factor analysis (general negative feelings, satisfaction with relationships, satisfaction with economic/family/personal conditions, and negative feelings regarding domestic issues). Women in cluster 3 were characterized mainly by their high level of psychological well-being. Women in cluster 1 had the lowest level of well-being, and women in cluster 2 were in the middle. Multinomial logistic regression was used to assess jointly the effect of unintended pregnancy, contraceptive use, number of children and other factors on a womans level of psychological well-being. Unintended pregnancy was associated with lower levels of psychological well-being and contraceptive use was associated with higher levels of psychological well-being, while number of children was not associated with level of well-being. Women who had experienced an unintended pregnancy were less likely to be in the high psychosocial well-being cluster versus both the medium and low clusters. In addition, women using contraception were more likely to be classified in the high than in the low or medium well-being clusters.

Induced abortion in Indonesia.

Induced abortion is one of the most difficult sociomedical problems facing the Indonesian government. While well-known in traditional society, the practice was discouraged by all Indonesian religious groups, and forbidden by the Dutch colonial authorities. Although abortion was technically illegal under the criminal code, a judicial interpretation in the early 1970s permitted medical professionals to offer the procedure so long as they were discreet and careful. The numbers of medical abortions carried out in Indonesia rose dramatically, and there was evidence of matching declines in the incidence of morbidity and mortality caused by dangerous illegal procedures. Medical and community groups campaigned for a more liberal abortion law to protect legal practitioners and stamp out illegal traditional practices. Their efforts appeared to bear fruit in the draft Health Law, but when the law was passed by the legislature in late 1992, the issue was again clouded by contradictions and inconsistencies.

Health care utilization, cost burden and coping strategies by disability status: an analysis of the Viet Nam National Health Survey

There is a need for nationally representative information on the affordability of health care by disability status to assist in the design of equitable health systems in developing countries. Using the Viet Nam National Health Survey (2001-2002), this paper analyses health care utilization, cost burden and coping strategies for people with disabilities versus the population at large. The results clearly show that the disabled population are more prone to hospitalization, and spend more on inpatient stays and pharmaceuticals. Households with disabled members are at greater risk of catastrophic health expenditures and debt financing, posing a serious threat to economic welfare.

Resolving contradictions in Indonesian fertility estimates

Abstract Over the last half-century Indonesia has been concerned about excessive population growth. To reduce the levels of fertility the government in 1968 established a national family planning program. In the following three decades fertility levels fell from over five to under three children per woman. In the past decade questions have arisen about the validity and reliability of fertility estimates. Increasingly Indonesias Demographic and Health Surveys (DHS) have reported higher fertility than is recorded in the censuses and other large social sample surveys. In 2007 the discrepancy reached more than half a child on average. This paper reveals one of the major causes of the discrepancy and shows ways to adjust the DHS results to gain more reliable measures. At present Indonesian national fertility is very close to the policy target of replacement levels by the year 2010.

Sexual Pleasure and Wellbeing

ABSTRACT Pleasure may be the key to the successful working of the reproductive systems of humans. However, for all the enjoyment sexual relationships can provide, there are countervailing forces of guilt and disappointment at work on the individual psyche. Religious and social norms enforce limits on sexual expressiveness. These controls are defended as means to protect individuals and their partners from unhappiness due to infidelity. The contrasting balance of potential pleasure on the one hand and deeply felt self-controls on the other gives rise to many problems of sexual health. Couples with discordant expectations about sexual pleasures can find their relationships crumbling. Deeply planted understandings about inappropriate behavior can cause individuals to feel shame or fear when faced with choices about their sexuality and particularly their desires. People unable to achieve desired pleasures due to physical handicaps experience a loss of wellbeing that can be extremely distressing. Simultaneously society struggles to control the individual expression of harmful sexual behavior such as child molestation while protecting the rights of individuals to enjoy personal satisfaction. The recognition and promotion of sexual pleasure as an integral part of wellbeing is one of the most challenging elements on the sexual health agenda. Progress in this area will require extraordinary efforts by professional groups and political leaders to forge a forthright understanding of the meaning of pleasure in peoples lives, and the priority of promoting healthy sexuality as a part of a global health agenda.

DEMOGRAPHIC PERSPECTIVES ON THE FUTURE OF THE INDONESIAN FAMILY

This paper explores some consequences of rapid changes in contraceptive use, fertility and mortality in Indonesia. An examination of demographic trends over four decades reveals a behavioural disjuncture, with implications for diagnoses of social problems arising from changing family structures, and for policy prescriptions to overcome these problems. One important issue not revealed by statistics representing average behaviour is the way in which lower fertility implies a change in the distribution of women between mothers and the childless, and between mothers with very small numbers of children and those who more than reproduce themselves. To the degree that these distributions reflect the emergence of new social roles that are a function of reproductive status, any efforts to prevent fertility from going to the very low levels typical of Europe and many countries of East Asia imply the need to address the core nature of new roles adopted by Indonesian women. Looking to the future of childbearing in Indonesia, the emergence of low fertility seems to be bringing the nation to a crossroads: will increasing numbers of women adopt no-fertility roles that preclude childbearing; or will patterns of near-universal marriage be maintained, with the bulk of women becoming mothers of very small numbers of children? Convincing evidence to answer these questions is likely to emerge only in the next decade, but this paper presents some speculations that suggest the answers may be very surprising to the current generation of policy-makers.

FIRST RESULTS FROM THE 2000 POPULATION CENSUS

This note discusses the preliminary results of the 2000 Population Census, and their implications for population trends. It outlines problems encountered in collecting the census data, some of which arise from census policies and practices, and others from changed circumstances following the crisis and democratisation. It considers issues that will influence the calculation of the final estimates, highlights some surprising aspects of the results, and offers recommendations for future enumerations.

Estimates of Indonesian population numbers: first impressions from the 2010 census

Abstract This note provides a critical perspective on the preliminary results of the 2010 population census, which were announced by President Yudhoyono on 16 August 2010. It explores the concepts of population used and the adjustments made to increase the accuracy of census estimates. The assumptions underlying various official population projections in the last decade produced estimates for mid-2010 that were substantially below the figure of over 237 million persons counted in May. The note argues that, far from reflecting a ‘population explosion’, this is due to the achievement in the 2010 census of greatly increased coverage of people residing in Indonesia on the census date.