Asia-Pacific Population & Policy (1987-)

This series of four-page policy briefs summarizes research on population and reproductive health for policymakers and others concerned with the Asia-Pacific region. Funding is provided by the David and Lucille Packard foundation.

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No 62. HIV/AIDS in China: Survey Provides Guidelines for Improving Awareness, by Chen Sheng Li, Zhang Shi Kun, Mo Li Xia, and Yang Shu Zhang. July 2002.

A recent survey conducted by the State Family Planning Commission shows that one-fifth of Chinese adults of reproductive age have not heard of HIV/AIDS. AIDS awareness is much lower in rural areas than in urban areas and is slightly lower among women than among men. Results show that television is an important medium for increasing awareness of HIV/AIDS. In addition to mass media, face-to-face meetings with health and family planning personnel, supported by appropriate information materials, appear to be a promising—and underexploited–avenue for increasing AIDS awareness.

No. 61. Assessing Women's Well-Being in Asia, by Sidney B. Westley. April 2002.

After centuries of male domination in much of Asia, women's lives are improving with economic development, social modernization, and better access to health and family planning technology. Yet many Asian women still face problems of low status at home and in the workplace.

No. 60. The HIV/AIDS Epidemic in Asia, by Tim Brown. January 2002.

The HIV/AIDS epidemic began relatively late in Asia, and HIV infections have not reached the high levels observed in some other parts of the world. Yet behavioral patterns that increase the risk of HIV transmission—such as unprotected sex and needle sharing—are not uncommon in many Asian societies. Without interventions to modify high-risk behavior, the virus continues to spread, and current infection levels could rise rapidly in many Asian countries.

No. 59. A “Snapshot” of Populations in Asia, by Sidney B. Westley. October 2001.

Over the past 50 years, there has been a fundamental shift in population dynamics in Asia. Fueled by economic growth and the diffusion of new ideas and health and family planning technologies, both mortality and fertility have declined in every country of the region. Between 1950 and 2000, life expectancy in East Asia rose from 43 to 72 years, and fertility dropped from more than five to less than two children per woman. The countries of Southeast and South and Central Asia have begun the transition to low mortality and fertility, but most are not as far advanced. Yet even in the less developed countries of the region, death and birth rates have fallen, and population growth rates and structures are changing. This demographic transition has provided favorable conditions for accelerated social and economic development.

No. 58. Surveys Show Persistence of Teenage Marriage and Childbearing in Indonesia and Nepal, by Minja Kim Choe, Shyam Thapa, and Sulistinah Irawati Achmad. July 2001.

Recent surveys show that nearly three-quarters of rural women in Nepal and more than half of rural women in Indonesia marry while still in their teens. In both countries, four out of 10 rural women have a child before they reach age 20. Analysis shows that women's education is the only variable consistently associated with later marriage and childbearing. Although the effects of primary education are small, early marriage and childbearing drop steeply among women with junior high or higher education.

No. 57. Does "Being Connected" Reduce the Risk of Teenage Drinking, Smoking, and Drug Use? Survey Results from Southeast Asia, by Minja Kim Choe. April 2001.

Survey findings on drinking, smokiing, and drug use in Thailand and the Philippines suggest that young people who feel strongly "connected" to their communities are less likely than others to engage in risk-taking behavior. Factors such as living with parents, staying in school, having plans for college, and being strongly religious are associated with low use of alcohol, cigarettes, and illegal drugs.

No. 56. Although the Situation is Improving, Women and Children Still Face Serious Health Problems in India, by Sidney B. Westley and Vinod K. Mishra. January 2001.

Although infant and child mortality decreased between 1993 and 1999, 7 percent of all children born in India still die during the first year of life, and 9 percent die before reaching age five. Among the most striking findings from the second National Family Health Survey (NFHS-2) are the high infant mortality rates among children born to teenage mothers and children born within two years of a previous birth. Clearly, efforts to expand the use of temporary contraceptive methods—both to space births and to delay childbearing—could have an important impact on infant mortality. The clear link between maternity-related medical care and infant mortality also reinforces the urgency of ensuring that all pregnant women receive professional care during pregnancy and childbirth. Undernutrition and anemia are widespread among women and children in every state and in nearly every socioeconomic group. The proportion of children age 12–23 months who have been fully immunized against six preventable diseases has risen, but rates still fall well short of universal immunization.

No. 55. New Survey Measures Fertility and Family Planning Trends in India, by Sidney B. Westley and Robert D. Retherford. October 2000.

According to the second National Family Health Survey (NFHS-2) in India, the total fertility rate in 1998–99 was 2.9 children per woman. Fertility levels vary widely among India's regions and states. Nearly one-half (48 percent) of currently married women are using some contraceptive method. Female sterilization is by far the most popular method, used by 34 percent of all currently married women age 15–49. The use of spacing methods (pills, IUDs, condoms) remains extremely low.

No. 54. Policy Options to Support Asia's Growing Elderly Population, by Sidney B. Westley, Sang-Hyop Lee, and Andrew Mason. July 2000.

Effective strategies that foster economic security for the elderly should include, as a priority, policies that increase labor market flexibility and remove barriers faced by older workers. The elimination of gender discrimination in the workplace will allow women—the largest group of elderly—to better prepare for old age. Policies are also needed that favor education and job training, that help families support and care for their elderly relatives, and that provide old-age benefits based on a carefully considered balance between self-funding and resource transfers from younger to older generations. How well countries can provide financial security for their growing elderly populations will also depend, in large part, on the performance of their economies.

No. 53. Population Aging Raises Questions for Policymakers, by Sang-Hyop Lee and Andrew Mason. April 2000.

All across Asia, populations age 65 and above are expected to grow rapidly over the next 50 years, both in terms of absolute numbers and as a proportion of Asian populations as a whole. Within the elderly population, the majority will continue to be women. Expanding proportions will be in the oldest age groups, will have a living spouse, and will have few or no adult children, while shrinking proportions will be in the workforce. These developments present a clear challenge to policymakers. Who will provide Asia's growing elderly population with the health services, financial support, and personal care  they will need?

The financial crisis of 1997 caused widespread unemployment and loss of income in the developing economies of East and Southeast Asia. Although less affected by the crisis, most countries in South Asia have large numbers of people living in poverty due, in part, to rapid population growth. In absolute terms, more people live below the poverty line in Asia today than in 1995. Asian population groups who suffer from “income poverty” are frequently also disadvantaged in terms of social indicators such as adult literacy, life expectancy at birth, and child malnutrition.

A recent survey conducted in four provinces of Indonesia found that nearly half of women age 15-24 had already married, and nearly all of young married women had at least one child. Very few young men or women remain in school after marriage. The survey found serious gaps in young people's knowledge of family planning and reproductive health, calling for better family life education in classrooms as well as community programs to help parents discuss sensitive issues with their adolescent children. The survey also found that young people's use of health services has been adversely affected by the recent economic crisis.

Over the past 15 years, Thailand has experienced the worst HIV/AIDS epidemic in Asia. A strong society-wide response has substantially reduced the number of new HIV infections and has mobilized a wide range of resources to care for individuals and families affected by the epidemic. Yet today there is concern that Thailand is relaxing its guard against HIV/AIDS. Young people may be at a particularly high risk from a resurgence of new infections.

Results from the 1996 Nepal Family Health Survey show that delaying, spacing, and limiting births can substantially reduce infant and child mortality. Children born to very young mothers, children born after four or more previous births, and children born less than 24 months after a previous birth all suffer particularly high mortality rates. These results suggest that efforts to reduce under-five mortality in Nepal should focus on family planning programs that target young mothers and mothers with large families. Another priority should be programs that promote temporary contraceptive methods for child spacing.

Over the past 50 years, nearly every country in Asia has experienced a population boom followed by a drop in birth rates. This pattern produces, after about 20 years, a significant increase in the proportion of adolescents and young adults in a population. Unusually large numbers in this age group will lead to unusually large numbers of births, even when fertility rates are low, a phenomenon that demographers have termed "population momentum." In many countries, policies and programs in family planning and reproductive health will have to be redesigned or expanded to meet the needs of this burgeoning population group.

When a mother becomes pregnant too soon after giving birth, she places her own health and that of her children at risk. To reduce this risk, the months right after childbirth are a critical time for women to begin, or to resume, using family planning. A recent survey in the Philippines indicates that only 7 percent of women who visit a health facility for postpartum care accept a family planning method in the first six months after childbirth. Many providers do not have a good understanding of when new mothers should begin using contraception or what methods are appropriate for women who have recently given birth.

A trend toward late marriage has brought birth rates in Japan and South Korea to unprecedented low levels. In recent surveys, young people in these countries have expressed more negative attitudes about marriage than young people in the United States, and married people in Japan and South Korea have expressed less satisfaction with their marriages than their American counterparts. Women's views on marriage may be affected by the disproportionate burden of housework reported by married women, even those who work fulltime outside the home. Policymakers might counter attitudes associated with low fertility by making employment conditions more favorable to women who are married.

In the more advanced economies of East and Southeast Asia, sharp declines in fertility, combined with rising life expectancies, will eventually produce unprecedented population aging. Just as the numbers of elderly are poised to soar, several factors may reduce the ability or the motivation of Asian families to care for the older generation. Can Asian governments step in? Recent financial crises highlight concerns that governments in the region will not have the resources to assume major responsibility for elderly care. At the same time, there are signs that working people in Asia are saving money to support themselves in their old age. How successful will they be?

As gender differences in economic activity have diminished, Asian women have played an increasingly important role in economic growth. An international study of six East and Southeast Asian economies sheds light on women's changing marriage and childbearing patterns, educational attainment, and labor-force participation over the past 40 years.

Have slower rates of population growth accelerated economic development in East and Southeast Asia? An international study of six economies in the region points to three important ways in which a decline in childbearing and accompanying improvements in mortality have influenced economic development: through increases in the relative size of the labor force, improvements in education, and higher rates of saving and investment.

According to the 1994 Young Adult Fertility and Sexuality Study (YAFS-II), most of the sexual activity reported by young people in the Philippines takes place within the context of a committed relationship. Such relationships usually pass through a continuum leading to some form of traditional or formally sanctioned marriage. These results suggest that "marital status" is a rather poor basis for deciding whether to provide or withhold family planning and reproductive health services.

Results from a 1982-89 survey conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh, provide a unique opportunity to explore the changing status of women in rural Bangladesh. Status was measured in terms of physical mobility and authority in household decision making. Results indicate the importance of regional and village-level characteristics in determining women's status. Another finding is that the characteristics associated with women's freedom of movement are not necessarily the same as the characteristics that enhance a woman's decision-making authority within the household. With such complex forces at work, a change in women's status may not lead right away to demographic change.

A national Young Adult Fertility and Sexuality Study (YAFS-II), conducted in 1994, contributes to the information available on risk factors that could produce a serious HIV/AIDS epidemic among young people in the Philippines. A substantial minority of young men (age 15 to 24) reported premarital and extramarital sexual activity, including visits to commercial sex workers. This activity, combined with extremely low levels of condom use, puts young men at a heightened risk of HIV infection. Young women, who appear to be taking fewer chances, are primarily at risk through the premarital and extramarital activities of their sexual partners.

In 1993, The United States and Japan launched the Common Agenda for Cooperation in Global Perspective. The goal is to apply the combined resources of the world's two largest economies to programs in five areas of global impportance. One of these areas is the promotion of health and human development, which includes initiatives in population and HIV/AIDS, children's health, women in development, and emerging and re-emerging infectious diseases. Several cooperative activities in these areas are already in progress.

The 1993 National Demographic Survey (NDS) in the Philippines provides data on the incidence of childhood diarrhea and acute respiratory infection and on the health care that children receive when they become ill. This information indicates that children who were "unwanted" at the time of conception are more likely to become ill than other children. Children from large families are less likely than other children to receive medical treatment when they become ill. These results confirm the justification for family planning programs based on child health.

With the release of information from the the 1993 National Demographic Survey (NDS) and the 1993 Safe Motherhood Survey (SMS), researchers in the Philippines can now develop extensive profiles of the frequency, duration, and quality of contact between reproductive health clients and service providers, as well as the characteristics of eligible women who are not currently using reproductive health services. Analysis of NDS and SMS results points to several recommendations for improving health care during pregnancy and childbirth, strengthening postpartum family planning services, extending the range of reproductive health services, and balancing the roles of the public and private sectors.

The recent National Demographic Survey (NDS) in the Philippines revealed wide variations in total fertility rates (TFR) for individual regions--from a low TFR of 2.8 in Manila to a high of 5.9 in Bicol. A detailed analysis of survey results showed that several factors other than contraceptive prevalence influenced levels of fertility. These included age at first marriage, infecundity, and the use of relatively ineffective contraceptive methods. To design effective family planning programs, policymakers need to understand the relative importance of all the factors that contribute to high fertility and how these factors vary at the regional and local levels.

In less than a decade, the HIV/AIDS epidemic in Thailand has grown from a handful of infections to a major public health threat. The direct effects on children are already obvious: by the end of 1994, 16,000 HIV-infected children had been born, and tens of thousands of child prostitutes and street children were at risk of infection. By the turn of the century, more than one million Thai children will have at least one HIV-infected parent. This issue of Asia Pacific Population & Policy summarizes a recent report prepared by the Program on AIDS of the Thai Red Cross and the East-West Center's Program on Population. The report takes a critical look at the current situation, estimates the magniture of future problems, and recommends policy responses.

In Asian societies with a strong preference for sons, there is growing evidence that couples are using ultrasound and other modern methods to identify the sex of unborn fetuses, followed by selective abortion of females. Population statistics in South Korea, China, Taiwan, and some parts of India show a record preponderance of male births, leading to predictions of gender imbalance in future generations. This combination of son preference with modern technology poses a social, economic, and ethical dillema for policymakers. Governments are responding by severely penalizing the use of fetal screening for sex identification and are trying to address the deep-rooted problem of son preference that underlies the incidence of sex-selective abortion.

The recently completed National Family Health Survey shows the current status of child immunization, health care during pregnancy and childbirth, infant feeding, and infant, child, and maternal mortality in India.

The National Family Health Survey provides information on current fertility rates in India as well as women's fertility preferences, knowledge and use of contraceptives, and sources of family planning services.

Earlier issues are available in print only.

No. 30. After the demographic transition: Policy responses to low fertility in four Asian countries by Allison Greenspan. September 1994.

No. 29. Does low fertility call for new policies in some Asian countries? by Allison Greenspan. June 1994.

No. 28. Culture influences demographic behavior: Evidence from India by Allison Greenspan. March 1994.

No. 27. Changes in fertility patterns can improve child survival in Southeast Asia by Allison Greenspan. December 1993. (Out of print: photocopies available on request)

No. 26. Family planning's benefits include improved child health and nutrition: New data from Bangladesh by Allison Greenspan. September 1993. (Out of print: photocopies available on request)

No. 25. Shifts in household demographics herald economic changes for Thailand by Allison Greenspan. June 1993. (Limited quantity)

No. 24. Determinants of fertility and the unmet need for family planning in Indonesia by Allison Greenspan. March 1993. (Out of print: photocopies available on request)

No. 23. Effects of education on reproductive behavior: Lessons from Pakistan by Allison Greenspan. December 1992.

No. 22. Age at marriage is rising for Asian women and men, according to new data by Allison Greenspan. September 1992.

No. 21. Poverty in the Philippines: The impact on family size by Allison Greenspan. June 1992. (Out of print: photocopies available on request)

No. 20. Fertility decline in Bangladesh: An emerging family planning success story edited by Anne Stewart. March 1992.

No. 19. Adding choice to the contraceptive mix: Lessons from Indonesia by Allison Greenspan. December 1991.

No. 18. Five levels of family planning progress: Lessons from Thailand edited by Bryant Robey. September 1991. (Limited quantity)

No. 17. Pakistan's population growth: The need for action edited by Bryant Robey. June 1991. (Limited quantity)

No. 16. Economic development and fertility decline: Lessons from Asia's newly industrialized countries edited by Bryant Robey. March 1991.

No. 15. How female literacy affects fertility: the case of India edited by Bryant Robey. December 1990. (Out of print: photocopies available on request)

No. 14. Asia's demographic future: The next 20 years edited by Bryant Robey. September 1990. (Out of print: photocopies available on request)

No. 13. The Matlab project: Family planning success in Bangladesh edited by Bryant Robey. June 1990.

No. 12. Family size and well-being: Evidence from Thailand edited by Bryant Robey. March 1990. (Out of print: photocopies available on request)

No. 11. Falling fertility in Indonesia: Success in national family planning edited by Bryant Robey. December 1989.

No. 10. Adolescent sexuality in Asia: New focus for population policy edited by Bryant Robey. September 1989.

No. 9. Policies for fertility reduction: Focus on Asia edited by Bryant Robey. June 1989.

No. 8. Costs and benefits of children: Implications for population policy edited by Bryant Robey. March 1989. (Limited quantity)

No. 7. Why Thai fertility has fallen: Are there lessons for other countries? edited by Bryant Robey. December 1998. (Out of print: photocopies available on request)

No. 6. How development programs can affect fertility: The case of Bangladesh edited by Bryant Robey. September 1988. (Limited quantity)

No. 5. Choosing a contraceptive method: Why does it matter? edited by Bryant Robey. April 1988. (Limited quantity)

No. 4. Community-based contraceptive distribution: A Korean success story edited by Bryant Robey. December 1987. (Out of print: photocopies available on request)

No. 3. How rapid decline in fertility speeds economic development: Evidence from Asia edited by Bryant Robey. September 1987. (Limited quantity)

No. 2. Sex preference and fertility: What is the link? edited by Bryant Robey. April 1987. (Out of print: photocopies available on request)

No. 1. Curbing population growth: Lessons from India edited by David Ellis. January 1987. 

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