Asia-Pacific Population and Policy

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Asia-Pacific Population & Policy was a four-page policy brief, published quarterly from 1987 to 2004, that summarized research on population and reproductive health for policymakers and others concerned with the Asia-Pacific region.

No. 69. HIV/AIDS awareness is improving in China by Chen Shengli, Zhang Shikun, and Sidney B. Westley. April 2004. Behavioral surveys in China suggest substantial risk for the spread of the HIV epidemic. Needle sharing is common among injecting drug users, condom use between sex workers and clients is low, sexually transmitted infections (which increase the likelihood of HIV transmission) are widespread, and there is continuing risk of infection through blood transfusions and other medical procedures. One area of concern for the Chinese government has been the low level of awareness among the general population. Lack of knowledge is often accompanied by continuing risk behavior, limited adoption of preventative measures, and negative attitudes toward people living with HIV and AIDS. This issue of Asia-Pacific Population & Policy discusses a three-year information, education, and communication project conducted by the National Population and Family Planning Commission to improve HIV/AIDS knowledge and attitudes in China.

No. 68. Tackling the HIV/AIDS epidemic in Asia by Tim Brown. January 2004. The HIV epidemic varies widely across Asia. Cambodia, Myanmar, and Thailand have the highest prevalence levels in the region-at around 2 percent of the adult population-followed closely by India. By contrast, Bangladesh, Lao PDR, and the Philippines have some of the lowest HIV rates in the world. China, Indonesia, Nepal, and Vietnam have epidemics in transition, characterized by recent increases in infection levels after an extended period of low prevalence. HIV in Asia is characterized by linked sub-epidemics among three at-risk populations: clients and sex workers (by far the largest group), injecting drug users, and men who have sex with men. When these groups are combined, together with the wives of men who visit sex workers, between 7 and 25 percent of the adult population in Asian countries may be at risk of HIV. While Asian epidemics will almost certainly never rise to the levels seen in Sub-Saharan Africa, prevalence rates for the region as a whole could easily reach 2-5 percent over the next decade if effective prevention programs are not implemented. And if Asia's two largest countries, China and India, reach prevalence levels of only 2–3 percent, they will account for more than half of all infections in the world. Although the potential for expanding HIV epidemics is high, experience in Thailand and Cambodia shows that well-targeted prevention programs can be extremely effective.

No. 67. Child survival and healthcare in developing countries of Asia by Sidney B. Westley. October 2003. An estimated 11 million children in developing countries die each year before reaching their fifth birthday. Findings from 15 Demographic and Health Surveys conducted in Asia between 1990 and 2001 shed light on recent trends in child survival and aspects of healthcare that potentially affect mortality rates. Information on medical care during pregnancy and childbirth, child immunization, treatment of children who are ill, and child nutritional status is presented for Cambodia, Indonesia, the Philippines, and Vietnam in Southeast Asia and Bangladesh, India, Nepal, and Pakistan in South Asia. The three countries with the lowest under-five mortality rates—Vietnam, the Philippines, and Indonesia—rank high in terms of most aspects of child healthcare.

No. 66. Assessing the effects of population change, economic growth, and globalization on income inequality by Jeffrey G. Williamson and Matthew Higgins. July 2003. A recent analysis—covering income-inequality data from 92 countries over four decades—suggests that inequality tends to increase at early stages of economic development and fall at later stages. The most important determinant of inequality is not economic growth, however, but rather changes in population age structure. These population changes occur as mortality and fertility drop during the course of economic and social modernization. This analysis suggests that policies that make health and family planning services widely available will contribute to a reduction in income inequality by lowering mortality and fertility rates.

No. 65. Caring for the elderly and holding down a job: How Are women coping in Japan? by Naohiro Ogawa, Robert D. Retherford, and Yasuhiko Saito. April 2003. Findings from Nihon University’s 1999-2000 Japan Longitudinal Study of Ageing show that more than half of Japanese women who live with an elderly parent or parent-in-law are employed outside the home. Even in households where the elderly family member is very old or seriously disabled, large proportions of women continue to hold down full- or part-time jobs. These finding should be reassuring to Japanese policymakers who are concerned that middle-aged women remain in the labor force while continuing to care for elderly family members at home.

No. 64. Population and globalization by Sumner J. La Croix, Andrew Mason, and Shigeyuki Abe. January 2003. Globalization has both direct and indirect effects on population. Certainly the movement of people around the world has accelerated the spread of diseases such as HIV/AIDS and SARS. More importantly, however, the global spread of public health, medical, and family planning technology has played a key role in worldwide gains in life expectancy and reductions in fertility. Over the past 50 years, support from international donors has been critical in improving life expectancy and reducing fertility through the global spread of modern health and family planning technology. In several Asian countries, these efforts have contributed to unprecedented economic growth. More broadly, international support has been remarkably successful in reducing the gap in fertility and life expectancy between rich and poor countries.

No. 63. Population and environmental challenges in Asia by Vinod Mishra. October 2002. Population growth and economic development contribute to many environmental problems in Asia. These include pressure on land, habitat destruction and loss of biodiversity, water scarcity and water pollution, air pollution, and global warming and climate change. Projections of future resource requirements and environmental stress are worrying, whether the focus is on population numbers alone or on the effects of poorly planned economic development and changing consumption patterns.

No. 62. HIV/AIDS in China: Survey provides guidelines for improving awareness by Chen Sheng Li, Zhang Shi Kun, Mo Li Xia, and Yang Shu Zhang. July 2002. A recent survey conducted by the State Family Planning Commission shows that one-fifth of Chinese adults of reproductive age have not heard of HIV/AIDS. AIDS awareness is much lower in rural areas than in urban areas and is slightly lower among women than among men. Results show that television is an important medium for increasing awareness of HIV/AIDS. In addition to mass media, face-to-face meetings with health and family planning personnel, supported by appropriate information materials, appear to be a promising—and underexploited–avenue for increasing AIDS awareness.

No. 61. Assessing women's well-being in Asia by Sidney B. Westley. April 2002. After centuries of male domination in much of Asia, women's lives are improving with economic development, social modernization, and better access to health and family planning technology. Yet many Asian women still face problems of low status at home and in the workplace.

No. 60. The HIV/AIDS epidemic in Asia by Tim Brown. January 2002. The HIV/AIDS epidemic began relatively late in Asia, and HIV infections have not reached the high levels observed in some other parts of the world. Yet behavioral patterns that increase the risk of HIV transmission—such as unprotected sex and needle sharing—are not uncommon in many Asian societies. Without interventions to modify high-risk behavior, the virus continues to spread, and current infection levels could rise rapidly in many Asian countries.

No. 59. A “snapshot” of populations in Asia by Sidney B. Westley. October 2001. Over the past 50 years, there has been a fundamental shift in population dynamics in Asia. Fueled by economic growth and the diffusion of new ideas and health and family planning technologies, both mortality and fertility have declined in every country of the region. Between 1950 and 2000, life expectancy in East Asia rose from 43 to 72 years, and fertility dropped from more than five to less than two children per woman. The countries of Southeast and South and Central Asia have begun the transition to low mortality and fertility, but most are not as far advanced. Yet even in the less developed countries of the region, death and birth rates have fallen, and population growth rates and structures are changing. This demographic transition has provided favorable conditions for accelerated social and economic development.

No. 58. Surveys show persistence of teenage marriage and childbearing in Indonesia and Nepal by Minja Kim Choe, Shyam Thapa, and Sulistinah Irawati Achmad. July 2001. Recent surveys show that nearly three-quarters of rural women in Nepal and more than half of rural women in Indonesia marry while still in their teens. In both countries, four out of 10 rural women have a child before they reach age 20. Analysis shows that women's education is the only variable consistently associated with later marriage and childbearing. Although the effects of primary education are small, early marriage and childbearing drop steeply among women with junior high or higher education.

No. 57. Does "being connected" reduce the risk of teenage drinking, smoking, and drug use? Survey results from Southeast Asia by Minja Kim Choe. April 2001. Survey findings on drinking, smoking, and drug use in Thailand and the Philippines suggest that young people who feel strongly "connected" to their communities are less likely than others to engage in risk-taking behavior. Factors such as living with parents, staying in school, having plans for college, and being strongly religious are associated with low use of alcohol, cigarettes, and illegal drugs.

No. 56. Although the situation is improving, women and children still face serious health problems in India by Sidney B. Westley and Vinod K. Mishra. January 2001. Although infant and child mortality decreased between 1993 and 1999, 7 percent of all children born in India still die during the first year of life, and 9 percent die before reaching age five. Among the most striking findings from the second National Family Health Survey (NFHS-2) are the high infant mortality rates among children born to teenage mothers and children born within two years of a previous birth. Clearly, efforts to expand the use of temporary contraceptive methods—both to space births and to delay childbearing—could have an important impact on infant mortality. The clear link between maternity-related medical care and infant mortality also reinforces the urgency of ensuring that all pregnant women receive professional care during pregnancy and childbirth. Undernutrition and anemia are widespread among women and children in every state and in nearly every socioeconomic group. The proportion of children age 12–23 months who have been fully immunized against six preventable diseases has risen, but rates still fall well short of universal immunization.

No. 55. New survey measures fertility and family planning trends in India by Sidney B. Westley and Robert D. Retherford. October 2000. According to the second National Family Health Survey (NFHS-2) in India, the total fertility rate in 1998–99 was 2.9 children per woman. Fertility levels vary widely among India's regions and states. Nearly one-half (48 percent) of currently married women are using some contraceptive method. Female sterilization is by far the most popular method, used by 34 percent of all currently married women age 15–49. The use of spacing methods (pills, IUDs, condoms) remains extremely low.

No. 54. Policy options to support Asia's growing elderly population by Sidney B. Westley, Sang-Hyop Lee, and Andrew Mason. July 2000. Effective strategies that foster economic security for the elderly should include, as a priority, policies that increase labor market flexibility and remove barriers faced by older workers. The elimination of gender discrimination in the workplace will allow women—the largest group of elderly—to better prepare for old age. Policies are also needed that favor education and job training, that help families support and care for their elderly relatives, and that provide old-age benefits based on a carefully considered balance between self-funding and resource transfers from younger to older generations. How well countries can provide financial security for their growing elderly populations will also depend, in large part, on the performance of their economies.

No. 53. Population aging raises questions for policymakers by Sang-Hyop Lee and Andrew Mason. April 2000. All across Asia, populations age 65 and above are expected to grow rapidly over the next 50 years, both in terms of absolute numbers and as a proportion of Asian populations as a whole. Within the elderly population, the majority will continue to be women. Expanding proportions will be in the oldest age groups, will have a living spouse, and will have few or no adult children, while shrinking proportions will be in the workforce. These developments present a clear challenge to policymakers. Who will provide Asia's growing elderly population with the health services, financial support, and personal care they will need?

No. 52. A look at poverty in the developing countries of Asia by James C. Knowles. January 2000. The financial crisis of 1997 caused widespread unemployment and loss of income in the developing economies of East and Southeast Asia. Although less affected by the crisis, most countries in South Asia have large numbers of people living in poverty due, in part, to rapid population growth. In absolute terms, more people live below the poverty line in Asia today than in 1995. Asian population groups who suffer from “income poverty” are frequently also disadvantaged in terms of social indicators such as adult literacy, life expectancy at birth, and child malnutrition.

No. 51. Indonesian survey looks at adolescent reproductive health by Sulistinah Irawati Achmad and Sidney B. Westley. October 1999. A recent survey conducted in four provinces of Indonesia found that nearly half of women age 15-24 had already married, and nearly all of young married women had at least one child. Very few young men or women remain in school after marriage. The survey found serious gaps in young people's knowledge of family planning and reproductive health, calling for better family life education in classrooms as well as community programs to help parents discuss sensitive issues with their adolescent children. The survey also found that young people's use of health services has been adversely affected by the recent economic crisis.

No. 50. Thailand copes with HIV/AIDS by Sidney B. Westley. July 1999. Over the past 15 years, Thailand has experienced the worst HIV/AIDS epidemic in Asia. A strong society-wide response has substantially reduced the number of new HIV infections and has mobilized a wide range of resources to care for individuals and families affected by the epidemic. Yet today there is concern that Thailand is relaxing its guard against HIV/AIDS. Young people may be at a particularly high risk from a resurgence of new infections.

No. 49. Nepal survey shows that "family planning saves lives" by Norman Y. Luther, Shyam Thapa, and Sidney B. Westley. April 1999. Results from the 1996 Nepal Family Health Survey show that delaying, spacing, and limiting births can substantially reduce infant and child mortality. Children born to very young mothers, children born after four or more previous births, and children born less than 24 months after a previous birth all suffer particularly high mortality rates. These results suggest that efforts to reduce under-five mortality in Nepal should focus on family planning programs that target young mothers and mothers with large families. Another priority should be programs that promote temporary contraceptive methods for child spacing.

No. 48. A look at Asia's changing youth population by Peter Xenos, Midea Kabamalan, and Sidney B. Westley. January 1999. Over the past 50 years, nearly every country in Asia has experienced a population boom followed by a drop in birth rates. This pattern produces, after about 20 years, a significant increase in the proportion of adolescents and young adults in a population. Unusually large numbers in this age group will lead to unusually large numbers of births, even when fertility rates are low, a phenomenon that demographers have termed "population momentum." In many countries, policies and programs in family planning and reproductive health will have to be redesigned or expanded to meet the needs of this burgeoning population group.

No. 47. Family planning for new mothers in the Philippines by Andrew Kantner and Sidney B. Westley. October 1998. When a mother becomes pregnant too soon after giving birth, she places her own health and that of her children at risk. To reduce this risk, the months right after childbirth are a critical time for women to begin, or to resume, using family planning. A recent survey in the Philippines indicates that only 7 percent of women who visit a health facility for postpartum care accept a family planning method in the first six months after childbirth. Many providers do not have a good understanding of when new mothers should begin using contraception or what methods are appropriate for women who have recently given birth.

No. 46. What's happening to marriage in East Asia? by Sidney B. Westley. July 1998. A trend toward late marriage has brought birth rates in Japan and South Korea to unprecedented low levels. In recent surveys, young people in these countries have expressed more negative attitudes about marriage than young people in the United States, and married people in Japan and South Korea have expressed less satisfaction with their marriages than their American counterparts. Women's views on marriage may be affected by the disproportionate burden of housework reported by married women, even those who work fulltime outside the home. Policymakers might counter attitudes associated with low fertility by making employment conditions more favorable to women who are married.

No. 45. Asia's next challenge: Caring for the elderly by Sidney B. Westley. April 1998. In the more advanced economies of East and Southeast Asia, sharp declines in fertility, combined with rising life expectancies, will eventually produce unprecedented population aging. Just as the numbers of elderly are poised to soar, several factors may reduce the ability or the motivation of Asian families to care for the older generation. Can Asian governments step in? Recent financial crises highlight concerns that governments in the region will not have the resources to assume major responsibility for elderly care. At the same time, there are signs that working people in Asia are saving money to support themselves in their old age. How successful will they be?

No. 44. Women are key players in the economies of East and Southeast Asia by Sidney B. Westley and Andrew Mason. January 1998. As gender differences in economic activity have diminished, Asian women have played an increasingly important role in economic growth. An international study of six East and Southeast Asian economies sheds light on women's changing marriage and childbearing patterns, educational attainment, and labor-force participation over the past 40 years.

No. 43. Population and the Asian economic miracle by Andrew Mason. October 1997. Have slower rates of population growth accelerated economic development in East and Southeast Asia? An international study of six economies in the region points to three important ways in which a decline in childbearing and accompanying improvements in mortality have influenced economic development: through increases in the relative size of the labor force, improvements in education, and higher rates of saving and investment.

No. 42. Survey sheds new light on marriage and sexuality in the Philippines by Peter Xenos. July 1997. According to the 1994 Young Adult Fertility and Sexuality Study (YAFS-II), most of the sexual activity reported by young people in the Philippines takes place within the context of a committed relationship. Such relationships usually pass through a continuum leading to some form of traditional or formally sanctioned marriage. These results suggest that "marital status" is a rather poor basis for deciding whether to provide or withhold family planning and reproductive health services.

No. 41. Change comes slowly for women in rural Bangladesh by Deborah Balk. April 1997. Results from a 1982-89 survey conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh, provide a unique opportunity to explore the changing status of women in rural Bangladesh. Status was measured in terms of physical mobility and authority in household decision making. Results indicate the importance of regional and village-level characteristics in determining women's status. Another finding is that the characteristics associated with women's freedom of movement are not necessarily the same as the characteristics that enhance a woman's decision-making authority within the household. With such complex forces at work, a change in women's status may not lead right away to demographic change.

No. 40. Are young people in the Philippines taking chances with HIV/AIDS? by Deborah Balk, Tim Brown, Grace Cruz, and Lita Domingo. January 1997. A national Young Adult Fertility and Sexuality Study (YAFS-II), conducted in 1994, contributes to the information available on risk factors that could produce a serious HIV/AIDS epidemic among young people in the Philippines. A substantial minority of young men (age 15 to 24) reported premarital and extramarital sexual activity, including visits to commercial sex workers. This activity, combined with extremely low levels of condom use, puts young men at a heightened risk of HIV infection. Young women, who appear to be taking fewer chances, are primarily at risk through the premarital and extramarital activities of their sexual partners.

No. 39. The United States and Japan pursue a common agenda by Sidney B. Westley. October 1996. In 1993, The United States and Japan launched the Common Agenda for Cooperation in Global Perspective. The goal is to apply the combined resources of the world's two largest economies to programs in five areas of global importance. One of these areas is the promotion of health and human development, which includes initiatives in population and HIV/AIDS, children's health, women in development, and emerging and re-emerging infectious diseases. Several cooperative activities in these areas are already in progress.

No. 38. Do family planning programs enhance children's health? by Eric Jensen and Sidney B. Westley. July 1996. The 1993 National Demographic Survey (NDS) in the Philippines provides data on the incidence of childhood diarrhea and acute respiratory infection and on the health care that children receive when they become ill. This information indicates that children who were "unwanted" at the time of conception are more likely to become ill than other children. Children from large families are less likely than other children to receive medical treatment when they become ill. These results confirm the justification for family planning programs based on child health.

No. 37. Who uses reproductive health services in the Philippines (and who doesn't)? by Sidney B. Westley and Andrew Kantner. April 1996. With the release of information from the the 1993 National Demographic Survey (NDS) and the 1993 Safe Motherhood Survey (SMS), researchers in the Philippines can now develop extensive profiles of the frequency, duration, and quality of contact between reproductive health clients and service providers, as well as the characteristics of eligible women who are not currently using reproductive health services. Analysis of NDS and SMS results points to several recommendations for improving health care during pregnancy and childbirth, strengthening postpartum family planning services, extending the range of reproductive health services, and balancing the roles of the public and private sectors.

No. 36. Explaining regional fertility variations in the Philippines by Sidney B. Westley, James A. Palmore, and Robert D. Retherford. January 1996. The recent National Demographic Survey (NDS) in the Philippines revealed wide variations in total fertility rates (TFR) for individual regions--from a low TFR of 2.8 in Manila to a high of 5.9 in Bicol. A detailed analysis of survey results showed that several factors other than contraceptive prevalence influenced levels of fertility. These included age at first marriage, infecundity, and the use of relatively ineffective contraceptive methods. To design effective family planning programs, policymakers need to understand the relative importance of all the factors that contribute to high fertility and how these factors vary at the regional and local levels.

No. 35. The HIV/AIDS epidemic in Thailand: Addressing the impact on children by Tim Brown and Werasit Sittitrai. July-August 1995. In less than a decade, the HIV/AIDS epidemic in Thailand has grown from a handful of infections to a major public health threat. The direct effects on children are already obvious: by the end of 1994, 16,000 HIV-infected children had been born, and tens of thousands of child prostitutes and street children were at risk of infection. By the turn of the century, more than one million Thai children will have at least one HIV-infected parent. This issue of Asia Pacific Population & Policy summarizes a recent report prepared by the Program on AIDS of the Thai Red Cross and the East-West Center's Program on Population. The report takes a critical look at the current situation, estimates the magniture of future problems, and recommends policy responses.

No. 34. Evidence mounts for sex-selective abortion in Asia by Sidney B. Westley. May-June 1995. In Asian societies with a strong preference for sons, there is growing evidence that couples are using ultrasound and other modern methods to identify the sex of unborn fetuses, followed by selective abortion of females. Population statistics in South Korea, China, Taiwan, and some parts of India show a record preponderance of male births, leading to predictions of gender imbalance in future generations. This combination of son preference with modern technology poses a social, economic, and ethical dilemma for policymakers. Governments are responding by severely penalizing the use of fetal screening for sex identification and are trying to address the deep-rooted problem of son preference that underlies the incidence of sex-selective abortion.

No. 33. India's National Family Health Survey provides new information on maternal and child health and AIDS awareness by Sidney B. Westley. March-April 1995. The recently completed National Family Health Survey shows the current status of child immunization, health care during pregnancy and childbirth, infant feeding, and infant, child, and maternal mortality in India.

No. 32. New survey finds fertility decline in India by Sidney B. Westley. January-February 1995. The National Family Health Survey provides information on current fertility rates in India as well as women's fertility preferences, knowledge and use of contraceptives, and sources of family planning services.

No. 31. Apocalypse when? Population growth and food supply in South Asia by Allison Greenspan. December 1994.

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

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

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

No. 27. Changes in fertility patterns can improve child survival in Southeast Asia by Allison Greenspan. December 1993.

No. 26. Family planning's benefits include improved child health and nutrition: New data from Bangladesh by Allison Greenspan. September 1993.

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

No. 24. Determinants of fertility and the unmet need for family planning in Indonesia by Allison Greenspan. March 1993.

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

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

No. 21. Poverty in the Philippines: The impact on family size by Allison Greenspan. June 1992.

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

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

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

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

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

No. 15. How female literacy affects fertility: the case of India edited by Bryant Robey. December 1990.

No. 14. Asia's demographic future: The next 20 years edited by Bryant Robey. September 1990.

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

No. 12. Family size and well-being: Evidence from Thailand edited by Bryant Robey. March 1990.

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

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

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

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

No. 7. Why Thai fertility has fallen: Are there lessons for other countries? edited by Bryant Robey. December 1998.

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

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

No. 4. Community-based contraceptive distribution: A Korean success story edited by Bryant Robey. December 1987.

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

No. 2. Sex preference and fertility: What is the link? edited by Bryant Robey. April 1987.

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