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kAtAnYa……

Blog itu katanya tempat ngomel…. nanti lama-lama jadi pinter nulis…..

Masa sih?…. let’s try….. anggap ini omelan saya yg pertama…

Starting from ZERO…….

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Sudah lama rasanya tidak menyentuh blog yang satu ini. Kepulangan ke tanah air paska kuliah di negeri dongeng telah menenggelamkanku dalam pekerjaan yang tidak ada hentinya. Kangen menulis… jadi kangen kuliah…. tapi apa daya… pengabdian pada negeri ini harus ku berikan sebelum merubah status menjadi “Scholarship Seeker” lagi… hehehe…..

PNS yang dihujani banyak pekerjaan mungkin terdengar aneh bagi sebagian besar orang…. apa bener PNS bisa sibuk? bukannya PNS datang jam 10, jalan-jalan ke mall jam 12, dan pulang jam 2 siang? Believe it or not….. itu tidak terjadi di kantor tempat saya bekerja.

Pekerjaan yang paling baru dilakukan adalah PSPK atau sensus “SAPI”. Sapi di sensus?, Gimana nanyanya? Pasti tuh hewan ga bisa jawab … (kalo ada sapi yang bisa jawab, cepat-cepat lari yaa… hehehe). Katanya tujuan kerjaan itu untuk menghitung stok daging sapi dan kerbau untuk persiapan swasembada daging nasional di tahun 2014. … akan tetapi, berita-berita yang berhubungan dengan sapi belakangan ini sangat menggelitik telinga saya…..

Ternyata sapi bisa membuat orang berurusan dengan lembaga yang “sangar”… KPK… Seorang anggota dewan yang TERHORMAT tersandung masalah korupsi pengadaan sapi impor… mungkin ini membuktikan bahwa pangsa pasar sapi sangat menguntungkan…tapi jangan ditiru ya oknum yang satu ini…

Dilain pihak salah satu pejabat kita bilang kalo “Australia masih menganggap kita sebagai pasar sapi yang utama”… hal ini tercetus ketika Australia mendapatkan protes dari warganya yang merupakan pencinta binatang. Mereka melakukan investigasi langsung dan menyatakan bahwa sapi-sapi yang diimpor dari australia, begitu sampai di rumah jagal di Indonesia, disiksa dulu sebelum dibunuh.. (masa sih???). Walhasil pemerintah Australia membatasi eksport sapi ke Indonesia. Mungkin saya yang terlalu naif… tapi melihat perkembangan itu, sepertinya bapak Pejabat itu sangat takut bila pemerintah Australia menghentikan ekspor sapinya ke Indonesia… lahhhh…. katanya mau swasembada sapi… gimana sih…???

Mungkin memang saatnya kita berhenti bergantung pada negara pengekspor sapi (Australia)… bayangkan .. 20 tahun terakhir kita sudah mengimpor 6,5 juta sapi hidup dari Australia….. (Maaf ya negeri paman Cock…. walaupun saya alumni dari negerimu…. Negaraku yang paling utama… hehehe).

Anyway….. saat petugas pendata sapi bingung dengan teori dan cara2 mensensus sapi, Instruktur yang bicara panjang lebar sampai bibir kering, dan panitia yang tidak tidur 2 hari untuk membuat persiapan….. eee…si Sapi dengan nyamannya makan rumput dan memandang dengan lirikan penuh arti ke ruang pelatihan…dan dia cuma bilang…. “Moooooo”…… hehehehe… Selamat mensensus sapi buat rekan-rekan di BPS.

Tag:Sensus Sapi

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Maternal mortality and maternal morbidity form the major parts of women’s health problems in developing countries

8 Sep

Introduction

One of the biggest problems on women’s health in developing countries is maternal mortality. Rosenfield and Maine recognized the problem as “a neglected tragedy”, because it had been the major cause of death among women in reproductive ages (Rosenfield & Maine 1985, cited in McCarthy & Maine 1992, p. 23). WHO has stated that each year, 500,000 women die from complication of pregnancy and childbirth, and the reduction of maternal mortality to three quartes has been stated as one of the millennium development goal (WHO 2005, cited in Kvale, at.al. 2005, p. 141).

Recently several researches and interventions have supported the safe motherhood initiative to reduce the number of maternal mortality (McCarthy & Maine 1992, p. 23). They have addressed the causes which are associated with maternal mortality in several categories. Obstetric, health services, reproductive, socioeconomic and transportation are believed to be the causes of maternal mortality (Maine, at. al. 1987; Royston & Armstrong 1989, cited in McCarthy & Maine 1992, p. 23).

This essay will discuss the factors associated with maternal mortality and maternal morbidity in developing countries and tries to find suggestions to overcome maternal mortality and maternal morbidity, as main problems for maternal health.

Maternal Mortality and Maternal Morbidity in Developing Countries

A woman’s death can be classified as maternal death if that woman was pregnant and experienced “some complication of pregnancy or childbirth, or having a pre-existing health problem that is aggravated by pregnancy” (McCarthy & Maine 1992, p. 24). Maternal mortality is a risk that women must face while pregnant. It is estimated that women who die because complications of pregnancy and childbirth have reached 500,000 persons each year and 99% of these deaths take place in developing countries (WHO 2005, cited in Kvale, et.al. 2005). In developing countries, women have to face 45 times higher risk of dying from pregnancy related complications, compare to women in developed countries (www.rho.org 2005).

The Factors associated with Maternal Mortality and Maternal Morbidity

McCarthy and Maine have introduced a framework for analysing determinants of maternal mortality and morbidity. This framework is the answer the question about model for determinants of maternal mortality. The framework contains three general stages of the process of maternal mortality; distant determinants, intermediate determinants and outcomes. Women’s socioeconomic and cultural status has influenced maternal mortality in the greatest distance. It will affect women’s health status, reproductive, access to health services and health care behaviour (intermediate determinant). Thus, the 4 set of intermediate determinants plus a set of unknown factors will directly influence the outcomes stage (McCarthy & Maine 1992, p. 24).

There is no maternal mortality without pregnancy and pregnancy is the starting point of outcome stages leading to maternal death, which can be classified as direct and indirect obstetric (McCarthy & Maine 1992, p. 25). Direct obstetric, such as complications of pregnancy, delivery, postpartum period, and abortion complication, are the main causes of maternal mortality (WHO 1985, cited in McCarthy & Maine 1992, p. 25).

Another cause of maternal health is haemorrhage. Figure 1 show 25 percent of maternal mortality in the world is caused by haemorrhage. On the other hand, poor hygiene during delivery or of untreated sexually transmitted diseases (STDs) will cause sepsis/infection. Careful attention to clean delivery and detection of STDs during pregnancy can restrain sepsis/infection.

Figure1. Causes of Maternal Deaths: Global Estimates

Source: WHO 1999

In several studies, the distance from health facilities is believed to be one of the causes of maternal mortality (Fortney, et.al. 1985; Walker, et.al. 1985, cited in McCarthy & Maine 1992, p. 27). The access to health services not only the distance but also financial access. In developing countries, financial barriers contribute to high maternal mortality (Ekwempu, et.al. 1990; Omu 1981; WHO 1985, cited in McCarthy & Maine 1992, p. 27). There are issues in women’s health in developing countries which are associated with maternal mortality; “the three phases of delay” (Thaddeus, et.al. 1994, cited in Kvale et.al. 2005, p. 143). The first phase is “failure of a patient to seek appropriate medical care in time”. In developing countries, the awareness about the importance of pregnancy care is less. The second phase is “delay in reaching an adequate health care facility” (Kvale et.al. 2005, p. 143). Low quality of road and bad transport system usually occur in developing countries and it is also the factors which cause maternal mortality. The development of transport system and improvement of road qualities between peripheral areas and health facilities can reduce maternal mortality (WHO 1991, cited in Kvale et.al. 2005, p. 143). The last phase is “delay in receiving adequate health care at the facility, including delay in referral”. In some developing countries, circumstances where there are no adequate health facilities are often take place. These circumstances make people unwilling to spend their money for reaching another health facility if they know that facilities cannot help them (Kvale et.al. 2005, p. 143). It is believed that the improvement in health system is more important than socioeconomic factors for the declining of maternal mortality (Kvale et.al. 2005, p. 143).

In developing countries, the fundamental determinant of maternal mortality is low status and economic status of women. It will limit access of women to education, good nutrition and health services (WHO 1999, p. 15). On the next stage, it will lead to maternal death. Several pregnant women in developing countries who have low level of education seem less likely to understand their health.

Many women in developing countries use traditional birth attendant in delivery. Sometimes, they only assist by family, relatives or even alone. These situations will risk their health. The assistance of health personnel such as doctor or midwife is only used by 53 percent of women in developing countries. WHO estimates that life-threatening complications that require emergency care will be experienced by 15 percent of pregnant women in developing countries (WHO 1999, p.16).

Women’s status is not the only variable which can influence maternal health. Family status is another determinant in maternal health. In developing countries, sometimes woman cannot access health services because she and her family have not sufficient income. More over, women and their families in developing countries ussualy have low education which can influence maternal health. For example, if a husband had low level of education, then he was not understood the important of accessing health facilities for pregnant women and he would not advice his wife to access health services.

Strategies to Reduce Maternal Mortality in Developing Countries

Political commitments from developing country governments are needed to reduce maternal mortality. Families, communities, health systems, and good will from government at any levels can support the program for reducing maternal mortality. The resources can be mobilized and policy decisions can be made if the top level of decision makers has resolved to address maternal mortality (WHO 1999, p. 22). The government must provide appropriate health services, cheap essential drugs and good transportation to facilitate women to access health services. It is almost impossible to reduce maternal mortality if women have difficulties to pay services and essential drugs. The government also have to provide information and elucidation about the important of family planning program and sex education for adolescents, especially for girls. Family planning program is necessary to limit and postpone pregnancy. It is important for a woman to know that she have to face high risk of death when she gives birth for more than 5 times or having parity less than 2 years.

It is believed that the support form individuals and a wide range of groups are needed to address maternal health, because that kind of supports is needed by women in obtaining access to essential health care. In developing countries, many women give birth without a skilled attendant but with their family or a relative. It is important for the government to trained members of community, so that they can recognise danger sign of delivery and able to develop plans for emergency (WHO 1999, p. 25). The communities may organize communication tools, such as radios, telephones and transportation for emergency cases, and even they can provide it with their financial support. On the other hand, it is better for the government to distribute cheap and simple kits to pregnant women for home births (WHO 1999, p. 25). In Developing countries especially in remote areas, several women use traditional birth attendants to help their delivery. Maternal death will occur if a woman uses untrained traditional birth attendants. When health facilities do not available, it is important to provide health training for traditional birth attendants.

Good quality of health services is essential variable to reduce maternal mortality. Moreover, women will be suffered if they found that health service did not provide pre-delivery health care. Maternal death can be avoided if a pregnant woman gradually visited health services in order to have health baby. Health services must provide family planning information, so that women, men, and young people will realise the importance of family planning. The information about risks of maternal death must be informed to women and men. Information such as delaying pregnancy after 2 years and sufficient age for women to pregnant will help them to design their future family. Information about adequate ages for women to pregnant is also important for adolescent girls, so that they realise the risk for them if having pregnancy in their age.

Conclusion

Several researches have address that maternal mortality is the main problem of developing countries. The WHO has stated that maternal mortality is one of the eight millennium development goal, it show that maternal mortality is a main target to be solved. Direct obstetrics have been the main causes of maternal mortality. On the other hand, indirect obstetric such as women’s health status, reproductive status, access to health services, health care behaviour and women’s socioeconomic and cultural are important variables in addressing maternal mortality. Strategic actions must be developed to reduce maternal mortality. Policy actions, such as political commitment from the government are needed to address the problem, while the support of families and communities are also important.

In health sector actions, it is important to provide health training for traditional birth attendants. On the other hand, good quality of health services is essential variable to reduce maternal mortality. Family planning information and information about risks of maternal death will bring people’s understanding about maternal health.

REFERENCES LIST

Kvale, G, Olsen, B.E, Hinderaker, S.G, Ulstein, M and Bergsjo, P. 2005, ‘Maternal Deaths in Developing Countries: A Preventable Tragedy’, Norsk Epidemiology, Vol. 15, No. 2, pp. 141-149, viewed 21 May 2008, < http://www.ub.ntnu.no/journals/norepid/2005-2/052_06_Kvale.pdf>.

McCarthy, J and Maine, D. 1992, ‘A Framework for Analyzing the Determinants of Maternal Mortality’, Population Sudies, Vol. 23, No. 1, pp. 211-226, viewed 20 May 2008, in Jstor Online Academic Research Library, <http://www.jstor.org.ezproxy.flinders.edu.au/stable/pdfplus/1966825.pdf>.

RHO Cervical Cancer. 2005, ‘Overview and Lessons Learned’, Safe Motherhood, viewed 24 May 2008, < http://www.rho.org/html/sm_overview.htm>.

WHO. 1999, ‘Reduction of Maternal Mortality’, A Joint WHO/UNFPA/UNICEF/World Bank Statement, viewed 18 May 2008, < http://www.who.int/reproductive-health/publications/reduction_of_maternal_mortality/e_rmm.pdf >.

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Can, and should child labour be totally abolished?

8 Sep

Introduction

Child labour is a crucial problem, because it engages with economic growth, poverty and cultures. An estimation from International Labour Organisation (ILO) states that almost 246 million children age 5-17 years are engaged in child labour. Then, 171 million of them were dealing with dangerous jobs, such as pesticides and chemicals, while 73 million of them are children under 10 years old. (Unicef 2006, p.46). The larger consumer of child labour is agriculture sector. For example, in Africa, child labour becomes ‘an urban phenomenon’, because child labour is found in large number in farming areas (Canagarajah & Nielsen 1999, p. 1).

Addressing the economic sectors, children often become a victim as cheap worker. They are paid lower then adult worker and do not have bargaining power against the employers. On the other hand, sometimes child workers have to work using pesticides and other chemicals, which harm their health. Similarly, they are loosing opportunities to access education, because their time mostly has been used to work. Consequently, these tragic situations make child labour have low education, ill-health and disability, and also will destroy children’s future, or they even will never know the future because the death risk in child labour.

Child labour

Children in reality have four options. First, they attend school and do not work, as ‘normal’ children. Second, they work and attend school. The third option is neither work nor attends school. And the last option is they work but do not attend school (Maitra & Ray 2000, p. 4). Child labour cases usually happen in the last option, while they have to work and cannot attend school. Children from low family income usually are forces to enter employment world. Children usually have not right to make a decision wether he want to work or not, because the decision maker usually is the household head who allocated the time for all household members (Canagarajah & Nielsen 1999, p. 5).

Addressing the child labour, employers seem to value children as irreplaceable workers because of their ‘nimble fingers’. For example, it is easier for children to make fine, hand-knotted carpets, or pluck jasmine flowers without breaking branches, rather than adult worker. Furthermore, employers prone to believe that child workers are ‘cost-effective labours due to their low salary level’ (Canagarajah & Nielsen 1999, p. 4). The other reasons why employers still hire child workers are less difficult to manage, easier to be ordered and to less complaining, and trustworthy at work (Levison et.al 1996; Anker & Barge 1998, cited in Canagarajah & Nielsen 1999, pp. 4-5). However child labour will influence children’s health and also will cause injury or even death.

Figure 1. Children in Unconditional Worst Forms*

of Child Labour and Exploitation

(thousands; 2000)

Child Labour and Health

Child workers have higher health risks than adult workers. It is caused by ‘physiological and psychological immaturity and the biological process of children’s growth’, which make children easier to injury and make children more sensitive to noise, heat, lead, and radiation (Bequele & Myers 1995; Forastieri 1997; ILO 1998; Fassa et al 2000, cited in O’Donnel, et al 2003, p. 3). Moreover, children have to face other health risks, such as dangerous tools and machines, chemicals from pesticides and infections while working on a farm (O’Donnel, et al 2003, p. 3). The UNICEF (2006, pp. 46-47) also states that children are easier to have illness and injuries than adult because their physical immaturity.

Child workers not only work in agriculture sector, but also in construction and mining. According to UNICEF (2006, p. 47), child workers have higher risks of injury while working in construction and mining, rather than in farming. 25 percent of boy workers and 35 percent of girl workers who work in construction sector, suffer work related injuries and illness, while 16 percent of boy workers and 20 percent of girls workers who work in mining sector, have the same experiences (UNICEF 2006, p. 47). Health problems are not the only consequence of child labour. Children’s education and overall well-being will be influences by child labour.

Child Labour, Education and Children Well-being

It is believed that being poor will increase the children’s probability to work and at the next stage will decline the probability to attend school (Deb & Rosati 2004, p. 15). Parents form poor families cannot afford to send their children to access school and sometimes they have no other options but sending their children to work. In contras, parents think that school attendance is inefficient, because these learning processes at schools are foregone in favour of work (Canagarajah & Nielsen 1999, p. 2). These conditions will create illiterate children. Education will provide children with basic skills, which are needed to find better job and to avoid poverty. Illiterate children will have a weak position in the future employment as an adult (UNICEF 2006, pp. 47-48). Consequently, it will lead them to poverty and will create a similar ‘child labour problem’ for their kids.

In addition, child workers are also vulnerable to physical and psychological harm and sexual abuse. Base on research in El Savador, 66 percent of girl workers experienced physically or psychologically abused and many of them experienced sexual abuse by employers (UNUCEF 2006, p. 51). However, the most important thing is that child labour has lost leisure time as a child. Such information about the effects of child labour have rise the question weather child labour should be totally abolished or not.

Child Labour, Abolished or Not?

The International Labour Organisation (ILO) conventions 138 and 182 define that ‘hazardous work’ is ‘labour that jeopardises the physical, mental or moral well-being of a child’, which is categorised to be abolished (ILO 2002, cited in Rosati & Lyon 2006, p.2). Child labour should be abolished if dealing with dangerous works. However, to totally abolished child labour, is not a good decision. In some cases, children voluntary work to help their poor parents or to earn money for their poor families. If child labour is totally abolished, poor family cannot continue their live. The wise child labour policies are needed to answer these conditions.

Conclusion

Child labour is a complicated problem. In one hand, it has link with economic development processes, but on the other hand, it will affect children’s wellbeing. Children will lose their leisure times and opportunity to access education while working. Unfortunately, their leisure times and education are children basic needs to have better future. Moreover, children will experience ill-health. It also will influence their future health or even they have to face death as the worse risk.

However, it is almost impossible to totally abolished child labour. Sometimes children must help their family by working to earn money, and without that their families cannot continue their live. The policies to manage child labour are needed, so that the risk of child labour could be minimised.

REFERENCES LIST

Canagarajah, S, and Nielsen, H.S. 1999, ‘Child Labor and Schooling in Africa: A Comparative Study’, Social Protection Discussion Paper Series, No. 9916, pp. 1-30, viewed 18 June 2008, <http://siteresources.worldbank.org/SOCIALPROTECTION/Resources/SP-Discussion-papers/Child-Labor-DP/9916.pdf>.

Deb, P, and Rosati, F. 2004, ‘Determinants of Child Labor and School Attendance: The Role of Househould Unobservables, pp. 1-33, viewed 18 June 2008, <http://urban.hunter.cuny.edu/RePEc/htr/papers/household_effects_3.pdf>.

Maitra, P, and Ray, R. 2000, ‘The Joint Estimation of Child Participation in Schooling and Employment: Comparative Evidence from Three Contiments’, pp. 1-39, viewed 18 June 2008, <http://www.utas.edu.au/ecofin/Library/discussion_papers/papers_00/2000-08.pdf>.

O’Donnel, O, Van Doorslaer, E and Rosati, F.C. 2003, ‘Health Effects of Children’s Work: Evidence from Vietnam’, Understanding Children’s Work Project Working Paper Series, pp. 1-32, viewed 18 June 2008, <http://www.ucw-project.org/pdf/publications/standard_child_work_health_final.pdf>.

Rosati, F.C and Lyon, S. 2006, ‘Tackling Child Labour: Policy options for Achieving Sustainable Reductions in Children at Work’, Understanding Children’s Work Project Working Paper Series, pp. 1-11, viewed 18 June 2008, <http://www.ucw-project.org/pdf/publications/standard_policy_primer_25sept2007.pdf>.

UNICEF. 2006, ‘The State of the World’s Children 2006’, pp. 1-146, viewed 18 June 2008, < http://www.unicef.org/sowc06/pdfs/sowc06_fullreport.pdf>.

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What makes it too far to walk for pregnant women to reach a medical/health facility?

8 Sep

Introduction

Maternal mortality had been the major cause of death among women in reproductive ages (Rosenfield & Maine 1985, cited in McCarthy & Maine 1992, p. 23) and the major causes of that is by direct obstetric (WHO 1999, p. 13). However, punctual medical treatment is believed will avoid such death. This essay will point to the causes of delaying to seek a health service by women in developing countries base on the three phases of delay and discuss the factors which influence each phase of delay.

The Three Phases of Delay

Addressing the issues why pregnant women in developing countries often delay to seek health facilities, Thaddeus & Maine introduce ‘The Three Phases of Delay’ as the lens to describe the issues (Thaddeus & Maine 1990, p. 4).

a. Phase 1 Delay

Thaddeus & Maine define phase 1 delay as ‘delay in deciding to seek care on the part of the individual, the family, or both’. Distances, cost and quality of care, are the main factors which is commonly discussed and studied (Thaddeus & Maine 1990, p. 4).

The important role in phase 1 delay is ‘distance’ between the woman’s house and health facility. A study of Southern Iraq shows when the distance to a health care increased 2-4 kilometres, consultation rate per 100 sickness episodes for all health services declined dramatically from 100 to 42. These conditions describe that the decision to reach health facility is influenced by the distance which they have to travel from their house to a health facility (Thaddeus & Maine 1990, p. 9).

The financial cost of treatment is another variable which is important to be consider. A study from Nigeria shows a sharp decrease in obstetric admissions from 7,450 to 5,473 in the period 1983-1985 when the Nigerian government increased fees for prenatal and delivery. Addressing ‘opportunity cost’, a woman in Indonesia, usually decided to visit health facility accompanied by her younger children because nobody else who can look after their kid at home. It will spend additional cost, not only transportation fares, but also the provision of snacks for all (Foster 1977, cited in Thaddeus & Maine 1990, p. 15). These examples describe that if financial cost increase then the eagerness to seek health facility will decrease.

The quality of care is considered to be the important factor in the decision to seek care. The evaluation wether a health facility has a good quality of care is depends on patient’s experience and it will influence their willingness to use the health facility (Thaddeus & Maine 1990, p. 16). In rural area of Kenya, patients for all illness who use government clinic were 19%, while 41% of patients used a mission clinic. It was caused by the successful treated at mission clinic which succeed to treat 87% of their patients (Mwabu 1986, cited in Thaddeus & Maine 1990, p. 16). These evidences show that the patients’ satisfaction with the health outcome influences the decision to seek care. On the other hand, the study in Ecuador shows patients who dissatisfy with the health service received, such as delays in admission and long waiting times, tent to reluctant to use hospital (Finerman 1983, cited in Thaddeus & Maine 1990, pp. 17-18).

Illness factors such as recognition of illness, severity of an illness and aetiology, are also important factors in the decision to seek care. If the patients do not recognise that their illness is disease which may harmful their live, then they will not seek for medical care. In Ethiopia, it was difficult to remind that tapeworm infection which was common in Ethiopia is a disease and it influenced their decision to seek care (Kloos, et.al 1987 cited in Thaddeus & Maine 1990, p. 21). Phase 1 delay creates delays in reaching an adequate health care facility in phase 2.

b. Phase 2 Delay

Phase 2 delay is defined as ‘delay in reaching an adequate health care facility’ (Thaddeus & Maine 1990, p. 4). This phase plays a dual role in the process. First role is a disincentive as discuss in phase 1 delay, which influences people’s decision, and the second role, it describes the time spent in seeking a health facilities. The second role contains physical accessibility factors, such as distribution of health facilities, travel distance, transportation, and death on the way to hospital (Thaddeus & Maine 1990, p. 35).

In developing countries, distribution of health facilities is concentrated in large towns and it plans to serve rural areas (Thaddeus & Maine 1990, p. 36). Unfortunately, it does not function as planned. Conversely, it creates another problem such as travel distance between women and the closest health facility, which may delay people to seek health care. Rural patients in Ethiopia had to walk form 15 to 18 kilometres to reach the nearest medical services (Thaddeus & Maine 1990, p. 38). Lack of transportation and poor quality roads also influence the delay of reaching health facility. In Kenya, the improvement of the main roads decreased travel distance and time to seek a health facility. However, the improved roads which shorted the distance did not demonstrate improvement in using health facility because of other barriers such as cost of treatment limited the advantages of shorter distances (Thaddeus & Maine 1990, pp. 10-11). On the other hand, 65% of people in a rural area in Kenya had to walk to get health facility and 40% of them had to walk for 5 kilometres to reach the closest health service (Thaddeus & Maine 1990, p. 38). Moreover, patients sometimes have to face death on the way to the hospital. The evidence from two mainly rural areas of Turki shows in period 1975-1983, 8% of maternal death occurred on the way to the hospital (Dervisoglu 1985, cited in Thaddeus & Maine 1990, p. 40). Phase 1 delay and phase 2 delay create delays in receiving needed treatment in phase 3.

c. Phase 3 Delay

Phase 3 delay is defined as ‘delay in receiving adequate care at the facility’ (Thaddeus & Maine 1990, p. 4), which includes ill-staffed facilities and ill-equipped facilities. Lack of medical and nursing personnel will lead to delays in patients’ receiving care (Thaddeus & Maine 1990, p. 42). In Lusaka’s UTH, staff delays in taking patients to the operating room were associated with 4 from 80 maternal deaths (Hickey & Kasonde 1977, cited in Thaddeus & Maine 1990, p. 44). Similarly, uncompleted equipment and supplies of essential drugs are also associated with delays in receiving needed treatment. In Vietnam, 20 % of maternal deaths were related to the lack of essential drugs.

Priority Phase of Delay

The ‘Three Phases of Delay’ creates variation impact on different countries. Addressing the priority phase of delay, it depends on the factors which affect utilisation in the country, so that a ‘goodness of fit’ between real conditions and the intervention plans will occur.

Conclusion

In developing countries, most maternal mortality could be avoided by punctual medical treatment. Delay in deciding, reaching and receiving adequate care at the facility become the major factor in maternal mortality in developing countries. However, the ‘Three Phases of Delay’ can be use to create plan to reduce maternal mortality in developing countries.

REFERENCES LIST

McCarty, J and Maine, D. 1992, ‘A Framework for Analyzing the Determinants of Maternal Mortality’, Population Sudies, Vol. 23, No. 1, pp. 211-226, viewed 20 May 2008, in Jstor Online Academic Research Library, <http://www.jstor.org.ezproxy.flinders.edu.au/stable/pdfplus/1966825.pdf>.

Thaddeus, S and Maine, D. 1990, Too Far To Walk: Maternal Mortality Context (Findings from a Multidisciplinary Literature Review), Center for Population and Family Health. Columbia University.

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How does the health of Australian indigenous women compare with that of women in developing countries?

8 Sep

Introduction

According to Australian Bureau of Statistics, 2.5% of the total Australian population (517,200 people) were Indigenous people (ABS 2008 cited in Health Info Net 2008, p. 1). There is no doubt that the health status of Indigenous people is worse than non-Indigenous people. Consequently, Indigenous people have higher death rates than non-Indigenous (Pink & Allbon 2008, p. 151). Addressing indigenous women’s health, they experience high rate of maternal mortality, high fertility rates, high infant deaths, and low expectation of life at birth. However, similar health status also happens in most developing countries, which 500,000 women each year die from complication of pregnancy and childbirth, and the reduction of maternal mortality (WHO 2005, cited in Kvale, at.al. 2005, p. 141).

Indigenous Women’s Health Status

The maternal mortality rate for Indigenous women in 2000-2002 was 45.9 per 100,000. It means maternal mortality rate for Indigenous women was five times higher than maternal mortality rates for non-Indigenous women (aihw 2007, p.2). However, Pink and Allbon believes that incomplete data for indigenous status in death is the cause of high rate of indigenous maternal mortality. (Pink & Allbon 2008, p. 82). Similarly, the Australian Bureau of Statistics (ABS) states that in 1996-2001, the life expectancy at birth for indigenous women was 64.8 years or 17 years less than women in total population (Health Info Net 2008, p. 2). This statistics shows that indigenous women have lower life expectancy at birth than the expectation of 82.0 years for all Australian females in the same period (Fredericks 2007, p. 99).

Furthermore, indigenous women have high infant deaths (12.2 per 1,000 live births) in the period 2001-2005, compared with 4.89 infant deaths per 1,000 live births of non-indigenous women (indexmundi.com). Several causes such as worse conditions in peri-natal period, symptoms, signs and ill-defined conditions, congenital malformations, respiratory diseases, injury and poisoning, and infectious and parasitic diseases, were believed have an important role in the high infant deaths among indigenous women (Pink & Allbon 2008, p. 93). Along the same lines, Indigenous women also experienced higher total fertility rate (2.1) compared to 1.8 of total fertility rate (TFR) for non-indigenous women (ABS 2007, cited in Health Info Net 2008, p. 1).

Table. 1. Expectation of life at birth for Indigenous people and the total population,

Australia and selected States, 1996-2001

Causes of Death among Indigenous Women

According to Fredericks, Indigenous women experience less healthy than non-Indigenous Australian. (Fredericks 2007, p. 98). It is believed that circulatory diseases, injury, diabetes, chronic kidney diseases, external causes of morbidity and mortality, intentional self harm including suicide, assault, neoplasm, and respiratory diseases are the leading causes of death for indigenous women (Fredericks 2007, p. 98). The Australian bureau of Statistics states that 19% of injury which was experienced by indigenous women, were caused by assault and 17% were caused by intentional self-harm including suicide (ABS 2005, cited in Health Info Net 2008, p. 3). Similarly, respiratory diseases after pregnancy were also attributed to causes of death among indigenous women.

Woman Health Status: Australian Indigenous and Developing Countries

Women in developing countries are also experience similar health status to indigenous women, even worse. According to UNFPA, the total fertility rate (TFR) in Indonesia is 2.7 lifetime births per woman. This figure is higher than 2.1 TFR for Australian indigenous women. However, 2.7 lifetime births per woman in Indonesia is the result of 50% decrease in TFR in 1970s (UNFPA n.d). Moreover, maternal mortality ratio (MMR) in Indonesia is currently 230 per 100,000 live births. Even though MMR in Indonesia is higher than 45.9 per 100,000 live births for indigenous women in 2000-2002, it is still lower than MMR for developing countries in general (450 per 100,000 live births). Indonesia has lower infant mortality (38.2 per 1,000 live births), compared to12.2 per 1,000 live births for indigenous. On the other hand, life expectancy at birth for female in Indonesia is 69.5 years, which is higher than life expectancy at birth for indigenous women 65 years (UNFPA n.d).

Conclusion

Indigenous woman’s health status is worse than non-Indigenous woman’s health. Indigenous women experience higher rate of maternal mortality, higher fertility rate, higher infant deaths, and lower expectation of life at birth compared to non-Indigenous woman. However, these conditions are better if compared to developing countries, which experience lower women’s health status.

REFERENCES LIST

Australian Indigenous HealthInfoNet. 2008, ‘Summary of Australian Indigenous health 2008’, pp. 1-8, viewed 25 June 2008, <http://www.healthinfonet.ecu.edu.au/html/html_keyfacts/2008Summary.pdf>

Australian Institute of Health and Welfare. 2007, ‘Maternal Mortality’, pp. 384-387, viewed 25 June 2008, http://www.aihw.gov.au/publications/ihw/atsihpf06r/atsihpf06r-c01-23.pdf

Fredericks, B. 2007, ‘Australian Aboriginal Women’s Health: Reflecting on the Past and Present’, Health and History, Vol. 9, No. 2, pp. 93-113, viewed 25 June 2008, <http://www.historycooperative.org/view.php>

Indexmundi, n.d, ‘Australia Infant mortality rate’, viewed 25 June 2008, <http://www.indexmundi.com/australia/infant_mortality_rate.html>

Kvale, G, Olsen, B.E, Hinderaker, S.G, Ulstein, M and Bergsjo, P. 2005, ‘Maternal Deaths in Developing Countries: A Preventable Tragedy’, Norsk Epidemiology, Vol. 15, No. 2, pp. 141-149, viewed 21 May 2008, <http://www.ub.ntnu.no/journals/norepid/2005-2/052_06_Kvale.pdf>.

Pink, B and Allbon, P. 2008, ‘The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2008’, Australian Bureau of Statistics – Australian Institute of Health and Walfare, p. 1-291, viewed 24 June 2008, <http://www.aihw.gov.au/publications/ihw/hwaatsip08/hwaatsip08.pdf>.

UNFPA, n.d, ‘Overview Indonesia’, viewed 25 June 2008, <http://www.unfpa.org/worldwide/indicator.do?filter=getIndicatorValues>

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Maternal Mortality in Developing Countries: The Unsolved Problem By: Ouceu Satyadipura

8 Sep

I. Introduction

Maternal mortality is one of the biggest problems on women’s health in developing countries. In 1985, Rosenfield and Maine called the problem as “a neglected tragedy”, because maternal mortality had been the major cause of death among women in reproductive ages (Rosenfield & Maine 1985, cited in McCarthy & Maine 1992, p. 23). WHO has predicted that 500,000 women each year die from complication of pregnancy and childbirth, and the reduction of maternal mortality to three quartes has been stated as one of the millennium development goal (WHO 2005, cited in Kvale, at.al. 2005, p. 141).

Recently the safe motherhood initiative, which is supported by researches and interventions to reduce the number of maternal mortality, has been provided by many organisations (McCarthy & Maine 1992, p. 23). Several researches have addressed the causes which are associated with maternal mortality in several categories. Obstetric, health services, reproductive, socioeconomic and transportation are believed to be the causes of maternal mortality (Maine, at. al. 1987; Royston & Armstrong 1989, cited in McCarthy & Maine 1992, p. 23). The others have stressed their focus on the pregnancy complication process and various factors that influence women in delaying to seek medical care (Thaddeus & Maine 1990, cited in McCarthy & Maine 1992, p. 24).

This essay will point to the causes of maternal mortality and maternal morbidity and tries to find suggestions to overcome maternal mortality and maternal morbidity, as main problems for maternal health. The focus on this essay will be on the situation in developing countries where maternal mortality is really high.

II. Maternal Mortality and Maternal Morbidity

There is a big gulf in maternal mortality ratio level between developing and developed countries. According to the World Health Organization (WHO),

“Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes” (World Health Organization 1999, cited in Dyer 2006)”.

A woman’s death can be classified as maternal death if that woman was pregnant and experienced “some complication of pregnancy or childbirth, or having a pre-existing health problem that is aggravated by pregnancy” (McCarthy & Maine 1992, p. 24). Maternal mortality is a risk that women must face while pregnant. Pregnancy should be a joyful moment for a woman, but unfortunately it becomes a dangerous time and threatening situation when a woman has to face complications of pregnancy and childbirth. It is estimated that women who die because complications of pregnancy and childbirth have reached 500,000 persons each year and 99% of these deaths take place in developing countries (WHO 2005, cited in Kvale, et.al. 2005).

Table 1. Women’s Lifetime Risk of Death from Pregnancy, 2000

Region (United Nations regions)	Risk of Death
Africa	1 in 20
Asia	1 in 94
Latin American & Caribbean	1 in 160
Oceania	1 in 83
Europe	1 in 2,400
Less developed regions	1 in 61
More developed regions	1 in 2,800
Worldwide	1 in 74

Source: AbouZahr & Wardlaw 2000

These facts show that women in developing countries have to face 45 times higher risk of dying from pregnancy related complications, compare to women in developed countries (www.rho.org 2005). Table 1 show that 1 in 61 women from developing countries have to encounter the risk of death from pregnancy in the year of 2000. In contras, only 1 in 2,800 women in developed countries have the similar risk.

Table 2. Estimates of MMR, number of maternal deaths, lifetime risk, and range of uncertainty by United Nations MDG regions, 2005

Source: United Nations Population Fund 2004

The UNFPA has estimated that maternal mortality ratio (MMR) in developing countries in 2005 is 450 per 100,000 life birth (Table 2). On the other hand, the Indonesian government in 2006 announced that maternal mortality ratio (MMR) in Indonesia (307 per 100,000 live births) was the highest in Asia. It claimed that the high level of MMR was caused by low education among women, malnutrition, culture, and low effort from government to minimize the number of maternal death (Kompas Newspaper 2006, cited in http://www.situs.kesrepro.info 2006).

Many researchers have considered the factors which is associated with maternal death. Some researchers claim that obstetric, health service, reproductive, socioeconomic, and transportation factors are the causes of maternal death (Maine, et.al. 1987; Royson & Amstrong 1989, cited in McCarthy & Maine 1992, p. 23). On the other hand, other researchers have stated that the causes of maternal death are pregnancy complication and delaying in seek medical services (Thaddeus & Maine 1990, cited in McCarthy & Maine 1992, p. 24). However, they have not developed frameworks for maternal mortality’s determinants. The framework is really important to explain and describe what are the causes of maternal mortality in detail.

III. A Framework for Maternal Mortality

It is important to understand the determinants of maternal mortality. McCarthy and Maine have introduced a framework for analysing determinants of maternal mortality and morbidity.

This framework is the answer the question about model for determinants of maternal mortality. The framework contains three general stages of the process of maternal mortality; distant determinants, intermediate determinants and outcomes. Women’s socioeconomic and cultural status has influenced maternal mortality in the greatest distance. It will affect women’s health status, reproductive, access to health services and health care behaviour (intermediate determinant). Thus, the 4 set of intermediate determinants plus a set of unknown factors will directly influence the outcomes stage (McCarthy & Maine 1992, p. 24).

Figure 1. Framework for Maternal Mortality

Health status

Reproductive status

Access to health services

Health care behaviour/use of health service

Unknown or unpredicted factors

Complication

Death/ disability

Pregnancy

Socioeconomic

cultural factors

Distant determinants

Intermediate determinants

Outcomes

Source: McCarthy & Maine 1992

IV. Causes of Maternal Mortality

A. Outcomes Stage

The major cause of maternal health is haemorrhage. A joint statement from the WHO, UNFPA, UNICEF, and World Bank in 1999 stated that 80 percent of maternal death is caused by direct obstetric (WHO 1999, p. 13).

Figure 2. Causes of Maternal Deaths: Global Estimates

Source: WHO 1999

Figure 2 show 25 percent of maternal mortality in the world is caused by haemorrhage, which is more dangerous when a woman has anaemia. Anaemia will lead to blood loss, and without blood transfusion, drugs to control bleeding, or appropriate saving care, it will lead to death (WHO 1999, p. 13). On the other hand, poor hygiene during delivery or of untreated sexually transmitted diseases (STDs) will cause sepsis/infection. Careful attention to clean delivery and detection of STDs during pregnancy can restrain sepsis/infection. Hypertensive disorders are the third biggest factor (12%) which is associated with maternal death. Obstructed labour is another cause of maternal death and it occurs when malnutrition is endemic (WHO 1999, pp. 13-14)

Table 3. Causes of Maternal Death in 1997-2002 (%)

Morbidity		Africa	Asia	Latin America
Direct Obstetric	Haemorrhage	33.9	30.8	20.8
	Hypertensive disorders	9.1	9.1	25.7
	Obstructed labour	4.1	9.4	13.4
	Sepsis/infection	9.7	11.6	7.7
	Abortion	3.9	5.7	12.0
	Others direct causes	4.9	1.6	3.8
Total Direct Obstetric		65.6	68.2	83.4
Total indirect Obstetric		34.4	31.8	16.6

Source: The WHO 2005

The same pattern has occurred in developing countries. Table 3 shows that in Africa (33.9%), Asia (30.8%) and Latin America (20.8%) in 1997-2002, haemorrhage was the major cause of maternal mortality. In total, more than 65 percent of maternal mortality in developing countries was caused by direct obstetric. It is predicted that every year 20 million unsafe abortion have happened and 90 percent of that abortion is in developing countries (Kvale, et.al. 2005, p. 143).

There are no extensive researches on pregnancy and childbirth related with disability in developing countries. However, it is believed that chronic urinary tract infection, uterine prolapse, and vaginal fistulae responsible for serious disability and these will influence women’s physical and social well-being (Maine, et.al. 1987; Royson & Amstrong 1989, cited in McCarthy & Maine 1992, p. 26).

B. Intermediate Determinants

Women’s health status will influence their surviving from complication during pregnancy. Malaria, hepatitis, anemia, and malnutrition are the leading causes for 25% of maternal deaths in developing countries (McCarthy & Maine 1992, p. 27). These indirect obstetric in some circumstances will set a higher risk of direct complications of pregnancy. For example, malaria will lead pregnant women to anemia, which in the next stage will reduce women’s chance of surviving a haemorrhage (McCarthy & Maine 1992, p. 27). Not only women’s health status but also reproductive health (ages, parity and marital status), can influence maternal mortality.

The classic “J-shaped” relation is known as a strong relation between maternal mortality and reproductive health. The relation describe that very young women, older women, women with no children, and women who have many children, have high risk of maternal mortality. Disability as results from pregnancy and childbirth usually occur in very young age women (McCarthy & Maine 1992, p. 27). On the other hand, unwanted pregnancy is also important determinant of maternal mortality. A woman is likely to have an abortion if she has unwanted pregnancy even if unsafe abortion is the only available procedure, and it will lead to increase high risk of death and disability (Kwast & Liff 1988, cited in McCarthy & Maine 1992, p. 27)

There are issues in women’s health in developing countries which are associated with maternal mortality; “the three phases of delay” (Thaddeus, et.al. 1994, cited in Kvale et.al. 2005, p. 143). The first phase is “failure of a patient to seek appropriate medical care in time”. It is important to give education about the importance of pregnancy care to both men and women (Kvale et.al. 2005, p. 143). This action, hopefully, will reduce maternal mortality. The second phase is “delay in reaching an adequate health care facility” (Kvale et.al. 2005, p. 143). This is often caused by low quality of road and bad transport system. The development of transport system and improvement of road qualities between peripheral areas and health facilities can reduce maternal mortality (WHO 1991, cited in Kvale et.al. 2005, p. 143). The last phase is “delay in receiving adequate health care at the facility, including delay in referral”. The first and second delays are influenced by the third phase. In circumstances where there are no adequate health facilities, people will not spend their money for reaching another health facility if they know that facilities cannot help them (Kvale et.al. 2005, p. 143). It is believed that the improvement in health system is more important than socioeconomic factors for the declining of maternal mortality (Kvale et.al. 2005, p. 143).

It is important for pregnant women to use health services either for prenatal care or care during and after delivery. The use of prenatal care and family planning are the most important proximate determinant of fertility. In developing countries, contraceptive use has replaced the use of traditional methods, which usually harmful for pregnant women (Obuekwe & Marchie).

In some circumstances, unknown or unpredicted factor can lead to maternal mortality. Women who have high education, good income, advance health and reproductive status, and have access to health services, may have serious obstetric complications and it cannot be predicted or explained. Similar to developed countries, in developing countries, this case is also difficult to estimate. In Zaire 1987, a study found that 71 percent cases of obstructed labour happened in women with “no known risk factor” (Kasogo Project Team 1987, cited in McCarthy & Maine 1992, p. 28)

C. Socioeconomic and Cultural Factors

Women’s education level, occupation, and income are associated with their status in family and community. The fundamental determinant of maternal mortality is low status and economic status of women. It will limit access of women to education, good nutrition and health services (WHO 1999, p. 15). On the next stage, it will lead to maternal death. Several pregnant women in developing countries who have high level of education seem more likely to understand their health. It will force them to access health services to make sure that she and her future baby are in health condition.

In developing countries, many women use traditional birth attendant in delivery. Sometimes, they only assist by family, relatives or even alone. The assistance of health personnel such as doctor or midwife is only used by 53 percent of women in developing countries. WHO estimates that life-threatening complications that require emergency care will be experienced by 15 percent of pregnant women in developing countries (WHO 1999, p.16).

Women’s status is not the only variable which can influence maternal health. Family status is another determinant in maternal health. A woman cannot access health services if she and her family have not sufficient income. Education of others is another variable which can influence maternal health. For example, if a husband had low level of education, then he was not understood the important of accessing health facilities for pregnant women and he would not advice his wife to access health services. It will increase the risk of maternal mortality.

V. Strategies to Reduce Maternal Mortality

A. Policy Actions

Coordinated systems and long-term efforts are needed to reduce maternal mortality. Families, communities, health systems, and good will from government at any levels must support the program for reducing maternal mortality. Political commitment from the government is needed. The resources can be mobilized and policy decisions can be made if the top level of decision makers has resolved to address maternal mortality (WHO 1999, p. 22). The government must provide appropriate health services, cheap essential drugs and good transportation to facilitate women to access health services. It is almost impossible to reduce maternal mortality if women have difficulties to pay services and essential drugs. The government also have to provide information and elucidation about the important of family planning program and sex education for adolescents, especially for girls. Family planing program is necessary to limit and postpone pregnancy. It is important for a woman to know that she have to face high risk of death when she gives birth for more than 5 times or having parity less than 2 years. The government must conduct a program to inform about this kind of information.

B. Society and Community Interventions

One of the keys to reduce maternal mortality is the support of families and communities. It is believed that the support form individuals and a wide range of groups are needed to address maternal health, because that kind of supports is needed by women in obtaining access to essential health care. In developing countries, many women give birth without a skilled attendant but with their family or a relative. It is important for the government to trained members of community, so that they can recognise danger sign of delivery and able to develop plans for emergency (WHO 1999, p. 25). The communities may organize communication tools, such as radios, telephones and transportation for emergency cases, and even they can provide it with their financial support. On the other hand, it is better for the government to distribute cheap and simple kits to pregnant women for home births (WHO 1999, p. 25).

In Developing countries especially in remote areas, several women use traditional birth attendants to help their delivery. Maternal death will occur if a woman uses untrained traditional birth attendants. When health facilities do not available, it is important to provide health training for traditional birth attendants.

C. Health Sector Actions

Good quality of health services is essential variable to reduce maternal mortality. Health services must provide family planning information, so that women, men, and young people will realise the importance of family planning. The information about risks of maternal death must be informed to women and men. Information such as delaying pregnancy after 2 years and sufficient age for women to pregnant will help them to design their future family. Information about adequate ages for women to pregnant is also important for adolescent girls, so that they realise the risk for them if having pregnancy in their age. This action in the next stage will reduce the number of abortion.

Maternal health services have to provide counselling and health care for women who have had an abortion (WHO 1999, p. 29). In countries where abortion is legal, it is important to provide the counselling and health care to reduce the chance of complications after abortion. Basic antenatal and postpartum care are important variables (WHO 1999, p. 29). Good health services for women in pregnancy and after delivery are essential. Maternal death can be avoided if a pregnant woman gradually visited health services in order to have health baby. On the other hand, women will be suffered if they found that health service did not provide pre-delivery health care.

VI. Conclusion

REFERENCES LIST

Ibu dan Anak Kespro. 2006, ‘Tertinggi di Asia, Angka Kematian Ibu Melahirkan’, Kesehatan Ibu & Anak, viewed 17 May 2008, <http://situs.kesrepro.info/kia/nov/2006/kia02.htm>.

Obuekwe, I.S and Marchie, C.L. 2000, ‘Family Planning: A Possible Intervention In Maternal Mortality’, Medical women’s International Association, viewed 19 May 2008, <http://mwia.regional.org.au/papers/full/33_flossy1.htm>.

RHO Cervical Cancer. 2005, ‘Overview and Lessons Learned’, Safe Motherhood, viewed 24 May 2008, < http://www.rho.org/html/sm_overview.htm>.

UNFPA. 2004, ‘Maternal Mortality Figures Show Limited Progress in Making Motherhood Safer’, Maternal Mortality Statistics, viewed 19 May 2008, <http://www.unfpa.org/mothers/statistics.htm>.

WHO. 2005, ‘Causes of Maternal Death’, Epidemiology, viewed 18 May 2008, <http://www.who.int/reproductive-health/MNBH/epidemiology.html>.

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The differences of Contemporary Fertility and Mortality Transition in Developed and Developing Countries by: Ouceu Satyadipura

8 Sep

Introduction

The first demographic transition relates to historical declines in mortality and fertility which occurred in some European population from the 1700s onward and still occurs in many developing countries. An older stationary and stable population corresponding with replacement fertility (i.e. just over 2 children on average), zero population growth, and life expectancies higher that 70 years were thought to be the final point for the first demographic transition. Meanwhile the second demographic transition (SDT) does not acknowledge such balance as the final point. The new developments enable sustained sub-replacement fertility, a multitude of living arrangements other than marriage, the disconnection between marriage and procreation, and no stationary population (Lesthaeghe 2007, pp. 2-3).

Figure 1. Model of First and Second Demographic Transition

One of the world main problems is population growth. It is ironic, while most developing countries are having a problem of high fertility level; low fertility and impending population decline become new problems of most developed countries. For instance, the Chinese government has produced one child policy and penalizes economically those who violate the role, in contras, 10,000 francs is offered by the French government to couples having a third and more birth (Westoff 1983, p. 99).

An amazing change was taking place in the population of France in the late 19th century when the declining of the number of children happened as the effect of the voluntary limitation of marital fertility. The phenomenon was called ‘the demographic revolution’ (Van de Kaa 2002). It was assumed that demographic revolution was a reflection of the desire to be upwardly mobile, because having a large family will be an obstruction (Dumont 1890, cited in Van de Kaa 2002, p. 1). After World War II, the term ‘demographic revolution’ was replaced by term ‘demographic transition’ as the result of changes in demographic behaviour, which was considered as main function of progress in society (Kirk 1944, cited in Van de Kaa 2002, p.1).

This essay tries to explain the differences of the contemporary fertility and mortality transitions both in developing and developed countries, and also describe the factors, which influence the differences. Fertility and mortality as the aspect of demographic transitions are the focus of this essay

Fertility and Mortality Transition in Developed Countries

‘Altruistic and individualistic’ are two keywords to describe the norms and attitudes behind the first and second demographic transitions (Van de Kaa, 1987, p. 5). Industrialization, urbanization and secularization were believed to be the indirect determinants of the first transition (Lesthaeghe & Wilson 1978, cited in Van de Kaa, 1987, p. 5). However, socio-economic changes are associated with fertility decline in 1960s and the beginning of 1970s (Caldwell 2006, p. 252).

In the beginning of 1970s, fertility rates decreased sharply in most developed countries. These declining were below the replacement level of 2.1. West Germany and Denmark, for examples, had a low of total fertility rate (1.4), and the similar conditions had happened in all western countries except Ireland and in some Eastern European countries (Westoff 1983, p. 99). The declining of total fertility rate in Europe was started after ‘a brief postwar baby boom’ (Van de Kaa, 1987, p. 19).

There have been many underlying factors which have influence fertility decline, such as vast economic growth, urbanization, the spread of schooling, the changing position of women and increasing economic and globalization, (Caldwell 2006, p. 260). The economic pressures as one of the causes of fertility decline, have change the children value became ‘expensive dependent’ (Westoff 1983, p. 101) and couples tend to postpone or even decided to have no child because of it. However, Aries argues that the declining in fertility is caused by self oriented motives of the parents (Westoff 1983, p. 101).

The most possible cause of fertility decline was ‘secularizing of society’ (Caldwell 1997, p. 806). The erosion of traditional and religious value, the growth of individualism, urbanization, higher education, equality, women’s independence and consumerism ideology are believed to be the main factors of fertility rate decline (Westoff 1983, p. 101). On the other hand, modern contraceptive technology, delayed marriage and legalized abortion also played a substantial role in declining fertility rate (Westoff 1983, p. 101). Sexual revolution has ignored the religious view and has turned sexual activities into more of recreational purpose rather than procreation (Caldwell 1997, p. 806).

In the developed world there were two ways on how the global population growth changed. First of all young people were given the excuse for deferring birth, having small families or having no children or alternatively not marrying. Secondly there were more accessible abortion and sterilization to present effective contraception which support almost certain fertility control (Caldwell 2006, p. 261). Parents’ altruistic and willingness toward their children to spend on their smaller families are the reason for declining fertility on developed countries (Becker 1991 cited in Caldwell 2006, pp. 252-253). Schultz (1986) and Wulf (1982) believe that participation of women in work force in developed countries has risen their educational level, which lead them to reduce infant mortality in 1960-1980 (Caldwell 2006, p. 253).

A mixture of older and new contraceptive methods has controlled the fertility rate in developed countries. Pill, abortion, women’s liberation, women working, consumerism, and inflation, are related to the declining of fertility rate in United Stated (Westoff 1983, p. 100). In developed countries, the advent of the pill has influenced mortality level (Ryder & Westoff 1971, cited in Caldwell 2006, p. 254), and the pills were used to keep the families small (Easterlin 1973, cited in Caldwell 2006, p. 254). In United Stated and Australia, rhythm, withdrawal, and the diaphragm were used by couples to reduce fertility. On the other hand, condom, rhythm, and withdrawal were used in Europe (Caldwell, et.al 1973, cited in Caldwell 2006, p. 257).

In 1965, the discovery of suction abortion, which made the operation simpler and safer, has made abortion more accessible in developed countries (Caldwell 2006, p. 259). Consequently, the effectiveness of contraception and legal abortion has permitted couples to stress on their own development rather than of their children (Aries 1980, cited in Caldwell 2006, p. 254). The Australian studies which held in 1975-1976 shown that: (i) The satisfaction of most young adult in having a fertility control to use as a root in planning their lives; (ii) The mutual agreement of most couple to consider continuous contraception as a normal way of life. Therefore should one wanted to discontinue it then one had to consult the partner; (iii) Most respondents prefer to have a “delayed pregnancy” in order to give time for the partners, specially the wife, to mature or to have finished education and obtained sufficient work experiences (Ruzicka and Caldwell 1977, cited in Caldwell 2006, p. 261). In 1986 when the Australian fertility had dropped below the long term replacement level, a study revealed that most couple planned to get at least two children but due to the consecutive deferral they seemed to have lost the interest in having children (Caldwell et al. 1988, cited in Caldwell 2006, p. 262).

The declining of mortality in Europe was depended on socio-economic development. The main causes of mortality decline in Europe were improvement in public sanitation, nutrition and water supply. In 1700s, life expectancy of all countries was at low level. A French scholar, Henry, had conducted a research on French’s population, and the result shown that life expectancy in France between 1740 and 1749 was only 25 years (Blayo 1975, cited in Vallin 1992, p. 407)

Modern medicine has increased life expectation. A combating diseases and death between Moliere and Pasteur era became a true revolution and has pushed life expectancy into higher level. In spite of the level of economic and social development, the improvement of efficient and cheap techniques of medical treatments has pressed the mortality level. The transfer of health technology is believed to be a factor of the fast decrease of world mortality after World War II (Van de Walle 1985, cited in Vallin 1992, p. 407). The transfer of concept of health technologies has raised life expectancy (Preston 1975, cited in Vallin 1992, p. 413). However, Davis and Omran believed that the result of technological transfer was not sufficient explanation for the rise of life expectancy (Vallin 1992, p. 413).

In 1960s, economic improvement had influenced mortality trend (Stolnitz 1965, cited in Vallin 1992, p. 407) and this argument was strengthened by Demeny (1965) and preston, who stated that there is a strong relationship between evolution of per capita income and mortality (Vallin 1992, p. 408 and p. 413).

Table 1. Income and Mortality in Western Countries 1900-2000

(PCI in 1990 US dollars)

Country	Measure	1900	1950	2000
England & Wales	PCI	4,492	6,939	19,817
England & Wales	IMR	154	30	7
France	PCI	2,876	5,271	20,808
France	IMR	160	52	5
Germany	PCI	2,985	3,881	18,596
Germany	IMR	229	60	5
Sweden	PCI	2,561	6,739	29,321
Sweden	IMR	99	21	5
USA	PCI	4,091	9,561	28,129
USA	IMR	Na	43	7
Australia	PCI	4,013	7,421	21,540
Australia	IMR	100	24	5

Source: Caldwell 2006

In Australia, per capita income rose sharply from US$ 4,013 to US$ 21,540 between 1900 and 2000. On the other hand, IMR declined from 100 to 5 in the same period. The negative relation between per capita income and IMR indicates that high per capita income will press IMR level.

Fertility and Mortality Transition in Developing Countries

Constant fertility declined was unidentified in developing countries before 1960.

In developing countries, contraception and health are associated with fertility decline. In some developing countries, limited access to health services is the cause of low birth control. On the other hand, Abortion is illegal and not being used to limit family size (Caldwell 2006, p.258).

The family planning programs have hastened the process of mortality decline (Caldwell 2006, p. 254). On the other hand, the effectiveness of contraceptive or family planning program is believed to have little influence on mortality decline (Pritchett 1994; Demeny 1979, cited in Caldwell 2006, pp. 254-255). In contras, other authors are believed that contraception and family planning programs become a major causal role in the timing and pace of fertility decline (Tsui & Bogue 1978; Chowdhury 1985; Cleland & Wilson 1987; Robey, et.al 1993; Carty, et.al 1993; Cleland et.al 1994; Potts 1997, cited in Caldwell 2006 p. 255). Contraception methods have success to reduce family size. South Korea and Taiwan were using IUD programs, while India promoted sterilization program which started to males and later to females. The program’s success spread widely. In China, a metal ring (China’s type of IUD) and sterilization were used to reduce family size. On the other hand, Turkey, Thailand, and Indonesia were using IUD and pill programs (Caldwell 2006, p. 259). In 1946-1948, campaign to spray DDT had increased Sri Lanka’s life expectancy from 42 to 54 years (Vallin 1992, p. 407). The rise of living standard in Sri Lanka after World War II has increased its life expectancy (Vallin 1992, p. 410). In 1950’s the research fund for developing contraceptive pill was requested by Pincus considering that it was needed in the developing world. Though at first it was quite expensive for mass use in the developing countries, in the developed countries the pill was available in the early 1960 (Caldwell 2006, p. 259).

In developing countries, birth rates have decreased even without the improvement of living condition factor. New contraceptive technologies and educational power through mass media have been benefited by developing countries in order to reduce fertility rates (Robey, et.al 1993, cited in Caldwell 2006, p. 255). The evidence in Latin America shown that economic adversity and a simultaneous increase in organized family planning activities have caused mass fertility control (Guzman 1994, cited in Caldwell 2006, p. 255).

In the Middle East and North Africa rationalization must be searched in Arab Muslim attitudes toward involvement of Allah’s plans, political tensions and position of women. The Sub-Saharan Africa was among the poor country though no poorer than much of the Asia yet more pronatalist nation than elsewhere as to religious and cultural reasons (Caldwell & Caldwell 1988, cited in Caldwell 2006, p. 261).

Freeing the developing countries from the burden of main parasitic and infectious diseases has become the one World Health Organization’s commitment (Vallin 1992, p. 407). The adopted of modern health technology has caused the rapid mortality decreased in developing countries. Johansson and Mosk believed that there are two catagories of factors in the decline of mortality: the population’s resistance to diseases and ‘the degree to which the population was protected from exposure to infection. Base on Johansson and Mosk research, the progress in education and public health in England and Italy has increased their life expectancy (Vallin 1992, p. 415).

Mother’s educational status also contributes to infant mortality (Mosley, cited in Vallin 1992, p. 429) and this argument is strengthen by Antoinete and Diouf (1987), who states that if the mother is literate, then child mortality is halved. Antoinete and Diouf also argue that the source of water supply does not influence mortality level (Vallin 1992, p. 429). However, Ngouatchou (1987) disagree with Antoinete and Diouf’s argument. Ngouatchou believes that formal education is weak indicator of knowledge of nutrition, which has strong effect on mortality. For example, less educated Bamileke mothers were more likely to vaccinate their children rather than Beti mothers, who have better education (Vallin 1992, pp. 429-430).

Conclusion

The fast decreasing of mortality in developing countries is caused by adopting health technologies, which was founded by developed countries 100 years ago. On the other hand, mortality decline in developed countries was steady and was influenced by its socioeconomic changes. These become the main differences between developed and developing countries in experiencing demographic transition.

In developed countries, demographic transition is influence by vast economic growth, urbanization, higher education, equality, women’s independence, and participation of women in work force. However, secularizing of society has an important role in changing fertility and mortality trend in develop country. There is no doubt that self oriented motives of the parents in developing countries has decreased fertility rate. Similarly, consumerism ideology has forced parents to think twice to have a child, because of economical pressures. Moreover, delayed marriage and legalized abortion has dropped the fertility level in to lower level. If this condition still happens, then most developed countries will face the declining of population which may causes many problems.

In contras, demographic transition in developing countries is mainly caused by contraception methods, health, and family planning programs, even without the improvement of living condition. Contraception such as IUD, sterilization and pill programs has decreased the mortality level in developing countries. However, limited access to health services becomes serious problem for developing countries.

In order to reduce mortality level in developing countries, recent technologies of health should be applied. The governments of developing countries must promote health intervention programs and produce health policies, which can be accepted and tolerate by the socio-cultural factors in order to reduce mortality level. On the other hand, the governments of developed countries have to produce exciting policies to increase fertility level as have been conducted by French and Australian government, which have offered donation to couples who having baby. Otherwise, migration is the only answer for declining population.

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REFERENCES LIST

Caldwell, J. C. 1997, ‘The Global Fertility Transition: The Need for a Unifying Theory’, Population and Development Review, Vol. 23, No. 4, pp. 803-812.

Caldwell, J.C. 2006, ‘Demographic Transition Theory’, Springer Press. Netherland.

Lesthaeghe, R, Neidert, L, and Surkyn, J. 2007, ‘Household Formation and the Second Demographic Transition in Europe and US: Insights from Middle Range Models’, Demographic Paper, pp. 1-53, viewed 5 June 2008, < http://sdt.psc.isr.umich.edu/pubs/online/rl_romantic_unions_paper.pdf >.

Vallin, J. 1992, ‘Theories of Mortality Decline and the African Situation’. In Van de Walle, Etiene, Pison, G, and Sala-Diakanda, M. Mortality and Society in Sub-Saharan Africa, Clarendon Press. Oxford. 1992. pp. 405-437

Van de Kaa, D.J. 1987, ‘Europe’s Second Demographic Transition’. Population Bulletin. Vol. 42, No. 1, pp. 1-57.

Van de Kaa, D.J. 2002, ‘The Idea of a Second Demographic Transition in Industrialized Countries’, Paper presented at the Sixth Welfare Policy Seminar. The National Institute of Population and Social Security, Tokyo. 29 January 2002, viewed 8 June 2008, <http://www.ipss.go.jp/webj-ad/WebJournal.files/population /2003_4/Kaa.pdf>.

Westoff, C.F. 1983, ‘Fertility Decline in the West: Causes and Prospects’, Population and Development Review, Vol. 9, No. 1, pp. 99-104, viewed 7 April 2008, in Jstor Online Academic Research Library, <http://www.jstor.org.ezproxy.flinders.edu.au/stable/pdfplus/1972897.pdf>.

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An Article Review for Ethnic Differences in Fertility and Sex Ratios at Birth in China: Evidence from Xinjiang By Barbara A. Anderson and Brian D. Silver

8 Sep

Anderson, Barbara A. and Silver, Brian D. ‘Ethnic Differences in Fertility and Sex Ratios at Birth in China: Evidence from Xinjiang’, Population Studies, 2 July 1995, Vol. 49, No. 2, pp. 211-226, in Jstor Online Academic Research Library, http://www.jstor.org/stable/2175153. In their article, Anderson and Silver analyse two issues which based on ethnic differences, the factors which determine whether couples with at least one surviving child have an additional child, and sex ratios at birth. It shows how the differences in fertility by ethnic are important as the result of one-child family policy in China. The differences occur because the one-child policy application in the minority ethnics had not been consistently applied. The authors attempt to describe the fertility behaviour of four largest ethnics in Xinjiang Region; Uighurs, Kazakhs, Hui, and Han. In 1990, the Uighurs was the largest ethnic in Xinjiang and numbered 7.1 million people or 47 percent of Xinjiang population. On the other hand, The Han was the second largest population in Xinjiang (38 percent) in 1990 (Anderson & Silver, p. 212).

In Xinjiang, women from all four ethnic have capability to control their fertility and it is proved by high fertility control among those ethnic. However, that condition depends on ‘the sex of surviving children’ (Anderson & Silver, p. 212). For example, women, who have several daughters and have no son, tend to have a son. On the other hand, an eagerness for having girls in certain circumstances is noted by the authors. It means that ‘the sex ratio of previous children’ is one of the factors which influenced the variety models of sex-selective fertility behaviour and the author rejected that ‘masculinity’ as the reason for sex-selective fertility behaviour (Anderson & Silver, p. 225). The Chinese government issued one-child family planning policy in 1980, but the implementation of that policy varied form one ethnic to another. These differences caused variety models of sex-selective fertility behaviour, either in the choice to have another child, or in the sex of newborn babies.

Social background was not an important role in a woman’s decision to have her first child is noted by the authors (Anderson & Silver, p. 218). It is very strange that only age and marital status were believed to be the most important factors of having a first child, while social determinant background was ignored. Social background has played a substantial role in decision to bear the first child. For example, education background plays an important role in the decision to bear the first child. Women who have high education tend to concern about their career or at least thinking how to get a job. They may postpone their marriage and finally will influence their decision to bear her first child.

It is contradict; the authors believed that a woman who has larger number of children or has many sons, then her desire to having another child will decrease (Anderson & Silver, p. 219), but on the other hand the authors realised that a woman has the desire to have a girl after having many boys and no girl (Anderson & Silver, p. 223). Tendency for parents to have balance sex number of children is natural. The authors should have clear position regarding this issue. However, the authors have sharp analysis on the pattern of sex parity of children in each ethnic. The parity sex composition of children is not important for the Uighurs and the Kazakhs, except the parents already had three or more previous children. On the other hand, Hui and Han’s women think that the parity sex of previous children is not important, except they have two or more children (Anderson & Silver, p. 218).

The importance of sex selective abortion has been ignored by the authors, which even judged that sex selective abortion was not important in Xinjiang. Anderson and Silver believe that much infanticide or sex selective abortion of male fetuses in 1989-1990 seems implausible. ‘Adoption-out of excess boys’ is believed as the possible causes of extreme sex ratios in Xinjiang (Anderson & Silver, p. 224). These opinions are weak because sex selective abortion had happened in all regions in China. Under one child policy regime, many parents who borne a child and already had previous child sent their new baby boys to be adopted to other families and most of baby girls were abandoned or killed at birth (Skinner and Yuan, cited in Lubman 2007 p. 1). The Chinese government in the beginning of 1980s had forced to have an abortion and pressured to take sterilization if women have an illegal pregnancy (Hemminki, et.al 2005, p. 4). Statistics show that abortions increased to about 30 percent from 1960 to 1987 in urban China and climbed from almost none to more than 15 percent in rural areas. In 1990, there were 21 million pregnancies and 14 million of it was aborted (Wesley 1995, p. 3). However, forced abortions are rare recently and parents begin to register their hidden children (Hemminki, at.al 2005, p. 4).

‘Masculinity’ as the reason for sex-selective fertility behaviour has been rejected by the authors (Anderson & Silver, p. 225), but in fact ‘masculinity’ had happened in China. In 1980, parents in China sometimes gave their baby girls for adoption if they wanted sons (Wesley 1995, p. 1). Son preference cannot be ignored, because it has economic, social and cultural root in Asian countries. Aging parents expect to live with their sons, so that their adult sons can provide their financial support. From a social and cultural perspective, boys carry on the family name and have ‘a special role’ in family traditions (Wesley 1995, p. 2).

The limited effect of one child family planning policy for Uighurs and Kazakhs is noted by the authors (Anderson & Silver, p. 215). It is almost impossible for Uighurs and Kazakhs to set aside the policy. The policy is an agreement between parents and the Chinese government. Economic rewards such as monthly incentive, free charge for obstetric care, priority in schooling and health care for children, and ‘preferential treatment’ for house and pension applying are offered to parents who agree to have only one child (Hemminki, at.al 2005, p. 3). However, fines will be given if the parent broke the agreement. The fines started at 10-20 percent of a family’s annual income to 2.5 times if the village’s per capita income. (Kaufman 1989, cited in Hemminki, at.al 2005, p. 3).

In conclusion, the one child policy has influenced social and pattern of all ethnic in Xinjiang. The parity sex composition of children is valid in different circumstance for all ethnics. Abortions have happened in China as consequence of one child policy. The increase of sex ratio in China is the effect of sex selective abortion, which is started by fetal screening (Wesley 1995, p. 3). ‘Masculinity’ is one of the reasons for sex selective behaviour. Son preference cannot be ignored. China, such as many Asian countries, has social and cultural perspective about son preference. Sons are family’s new generation which carrying family name and while they were mature; they have a responsibility to take care their parents. It means, ‘if no sons are born then the family dies’ (Wesley 1995, p. 2).

Set aside the judgement about the authors’ opinions, Anderson and Silver have sharp analysis on the pattern of sex parity of children in each ethnic. Their article is well organised and structured, started by explaining the geography and cultural background of ethnic in Xinjiang, followed by providing the data and showing the results, so that the readers can easily read and understand the flow of the article. This article may bring up the readers’ curiosity about the one child policy and its effects on social and demography of China.

REFERENCES LIST

Anderson, B. A and Silver, B.D. 1995, ‘Ethnic Differences in Fertility and Sex Ratios at Birth in China: Evidence from Xinjiang’, Population Sudies, Vol. 49, No. 2, pp. 211-226, viewed 1 May 2008, in Jstor Online Academic Research Library, <http://www.jstor.org/stable/2175153>.

Hemminki, E, Wu, Z, Cao, G and Viisainen, K. 2005, ‘Illegal births and legal abortions-the case of China’, Reproductive Health Review, Vol. 2, No. 5, pp. 1-8, viewed 5 May 2008, <http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1215519 &blobtype=pdf>.

Lubman, S. 2007, ‘Infanticide Detailed in China’, Infanticide, viewed 9 May 2008, <http://www.abortiontv.com/Misc/ChinaAbortions.htm>.

Westley, S.B. 1995, ‘Evidence Mounts for Sex-Selective Abortion in Asia’, Asian-Pasific and Population Policy, No. 34, pp. 1-4, viewed 5 May 2008, < http://www.eastwestcenter.org/fileadmin/stored/pdfs//p&p034.pdf>.

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Article Review-John C. Caldwell’s article “The Global Fertility Transition: The Need for a Unifying Theory”

10 Jul

In this paper I will discuss John C. Caldwell’s article “The Global Fertility Transition: The Need for a Unifying Theory”. Caldwell’s article is about the importance of unifying theory in fertility transition. In particular he argues that there is no two fertility transitions; spontaneous fertility transition in the west which supported by social view, and manmade fertility transition, which is influenced by economic condition (Caldwell 1997, p. 804). He believes that it is necessary to build one unifying theory which bridges these two theories (Caldwell 1997, p. 803). After summarising Caldwell’s main point I will be claiming that unifying theory is a must. It is not the best way to see the fertility transition only in one point of view. We must understand that the fertility transition has been influenced by many factors, such as economic, social, government policies, religions, etc.

Caldwell puts forward the idea that the unifying theory of fertility transition is needed (Caldwell 1997, p. 809). The two theory of fertility transition occurred because the different view among demographers (social and economic views). The domain of economic view is the difference between low level societies, which are from agricultural societies and have low purpose in fertility control, and high level societies, which are from urbanize and educated societies. He believes that the economists have to learn to be more ‘sociologically sophisticated’, because the fact that social factors have influenced many thresholds to choose same pattern which applied in their community, for example, parents usually want to have high quality children, to recognize themselves as high quality parents (Caldwell 1997, pp. 803-804). I agree with his opinion, because people cannot ignore the pattern that exist in they society. On the other hand, Caldwell believes that the demographers, who are used to view the fertility transition in social way, have to realize that the beginning of fertility decline happened in different socioeconomic level and economic reasons also have an important part in the fertility transition (Caldwell 1997, p. 804). I strongly agree with his opinion. We cannot disprove that economic reasons also influenced people opinion about fertility. People realized that they have to limit their fertility because of economic pressures and this reason brought up the manmade fertility transition.

Firstly, he argues that spontaneous fertility in the west was not happened in the same time with the economic view in fertility transition (Caldwell 1997, p. 804). Robert Malthus, in his first essay in 1798 believed that the population growth have a tendency to press on resources. As one of the English classical economics, he claimed that unlimited population growth will bring no benefits. Unfortunately, Malthus also showed his disagreement to contraception which is one of solutions to limit the population. I have the same opinion as Caldwell that Malthus’ concept was irrelevant, afraid of unlimited population on one hand, but also refused contraception on the other hand. However, Caldwell has to understand that in 1700s Malthus’ concept was influenced by Church which condemned contraception as sinful (catholic.com 2004, p. 1).

Secondly, Caldwell realizes that the ‘intellectual battle’ of ideas and opinions about birth control, which happened in the past, preceded the fertility decline in Western at first and in the third world countries (Caldwell 1997, p. 805). He may be right, but other research indicates that the declined fertility in the Western is caused by people opinion that children became ‘expensive dependent’ as the impact of war and the ‘growing independence of women’ was started (Westoff 1983, pp. 99-104)

Next, Caldwell believes that pro birth control won the ‘intellectual battle’ because of secular change, such as changes in women attitude and sexual revolution. Changes in women attitude led them to the freedom to choose wether they want to marry or not, and to have children or not. On the other hand, sexual revolution has ignored the religious view and has turned sexual activities into more of recreational purpose rather than procreation one (Caldwell 1997, p. 806). I think, it is an important and valid point, when women are faced with choices wether to have or not having any children, some of them may choose not having children due to economic reasons or wanting to be independent. Sexual revolution also has changed people opinions about women’s sexual pre marital sex behaviour activities outside marriage, which were widely accepted (isis.aust.com).

Caldwell argues that in several generations, these issues have declined the fertility trend and replaced the economic change and the contraceptive method knowledge as the main issues of fertility decline. In France, fertility transition happened in different way. The declining of fertility happened at revolution and after revolution and the most possible cause was ‘secularizing of society’ (Caldwell 1997, p. 806). I do agree that these issues replaced over economic and social issues as the main issues of fertility transition. Hera Cook, in her book said:

The response to birth control methods in nineteen-century England can only be understand in the context of the shifts taking place in women’s sexual behaviour. … Thus substantial changes in sexual behaviour are revealed by changes in fertility rate… (Cook 2004, pp. 62-63)

The classical economic theory was applied to the developing countries, especially in India. Many of India’s elite educated persons saw that population transition in their country was the problem, similar to the British officials did. Certainly, Hinduism, which is the largest religion in India, has policy to sexual restraint. In 1947, the Population subcommittee of the Congress Party recommended the India’s Government to start a family planning program and finally, the formation of family planning program was announced by Nehru in 1952. The American, Frank Notestein and Princeton’s Office of Population Research took the lead in the post-war to support developing countries’ birth control program. Caldwell claims that these actions were taken by the American because population growth is inevitable and it is only natural that the USA, as the super power country in the west, plays an important role in taking the lead in these actions especially when a competitive atmosphere was detected. The USA has to lead these actions and it will maintain their power in developing countries as consequences of cold war (Caldwell 1997, p. 809).

Caldwell believes demographic pressure, which has changed the fertility transition, was influenced by ideas, ideologies, and organized assistance in Europe in 1800s and in third world countries in 1900s. Moreover, he argues that a unifying theory can embrace all process in fertility transition and can represent the economic and demographic views about fertility transition, and the world will appreciate the search of unifying theory (Caldwell 1997, pp. 809-810).

In conclusion, Caldwell’s article covers several points. Firstly, there are two theories regarding fertility transition, spontaneous fertility transition which supported by social view, and manmade fertility transition, which is influenced by economic condition, and these theories are needed to be unifying. Secondly, ‘intellectual battle’ of ideas and opinions about birth control preceded the fertility decline in Western at first and in the developing countries and third, fertility transition has been influenced by economic, social, government policies, religion, ideas, ideologies, etc. He has good reason why unifying theory is need and gives long explanation about unifying theory, but he did not mention the formula for unifying theory itself. Caldwell’s idea about unifying theory will contribute to the changing of view in fertility transition and will challenge young scientists in demography to find the unifying theory.

REFERENCES LIST

Caldwell, J. C. 1997, ‘The Global Fertility Transition: The Need for a Unifying Theory’, Population and Development Review, Vol. 23, No. 4, pp. 803-812.

Catholic Library, 10 August 2004, Birth Control, viewed 5 April 2008, <http://www.catholic.com/library/Birth_Control.asp>.

Cook, H. 2004, The Long Sexual Revolution: English Women, Sex, and Contraception 1800-1975, Oxford University Press, Oxford.

ISSI Creations, n.d. Writing, viewed 5 April 2008, <http://www.isis.aust.com/stephan/writings/sexuality/revo.htm>.

Westoff, C.F. 1983, ‘Fertility Decline in the West: Causes and Prospects’, Population and Development Review, Vol. 9, No. 1, pp. 99-104.

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