Demographic and Social Change in Asia-Pacific Countries and Africa

Demographic and Social Change in Asia and the Pacific

Conflict and Collaboration in Public Health: The Rockefeller Foundation and the Dutch Colonial Government in Indonesia History of Public Health
Terence Hull
Chapter for a book edited by Milton Lewis, U. Sydney.
This chapter presents the story of public health in the Netherlands Indies in the 1930s, where the Rockefeller Foundation and the Dutch government struggled to promote competing concepts of preventive treatment to reduce mortality.

Family Planning in Indonesia
Terence Hull
Chapter of a book edited by John Ross and Warren Robinson. The project documents and describes the way in which family planning policies and programs came into being, were implemented and unfolded in a selected group of countries in Asia, Africa and Latin America. This group is drawn from the first wave of early-adopting Third World countries (Korea, Taiwan, India, Pakistan, Thailand, Indonesia, Malaysia, Singapore, Philippines, Egypt, Ghana, Kenya, Colombia, Chile, Honduras, Jamaica) whose efforts began in 1960-65.

Abortion in Indonesia
Terence Hull and Ninuk Widyantoro (Indonesian Women's Health Foundation, Jakarta)
Chapter for a book edited by Andrea Whittaker. Researchers and activists have worked for two decades to ascertain the scope and nature of the health challenges of induced abortion in Indonesia. Hull and Widyantoro published a key paper on this issue in 1993, with the estimate that there were over 700,000 pregnancy terminations each year. Since that time there have been a number of research projects to determine incidence, and current public debate cites a figure of 2,000,000 abortions per year. In this context the legislature is considering a law to substantially legalize safe medical procedures, and aggressively prosecute unsafe procedures carried out by non-qualified people. This chapter will review the situation to 2007.

Transition to Adulthood in Indonesia
Iwu Utomo (ANU), Terence Hull, Gavin Jones (University of Singapore) and Peter McDonald
The historically largest generation of Indonesian young adults (aged 20-34 years) is now going through a difficult period of transition to adulthood. The difficulty derives from the simultaneous influences of complex social forces including globalization of information, Westernization, traditional and cultural values, Islamic fundamentalism, the spread of democracy, and education and work competition.  The proximate forces of parents’ and extended families’ expectations add to the complexity.  These forces complicate the transitions that young people make through education, employment and family formation. The project undertakes a survey of young people in Jakarta, Bekasi and Tanggerang to investigate how young people cope with these social forces.

Marriage Studies in Asia
Terence Hull, Gavin W. Jones (University of Singapore) and over 40 colleagues across Asia
In 2005 a Workshop at the Asia Research Institute of the National University of Singapore established a Marriage Research Network including centres and individual researchers from across the Asian region. Terence Hull participates in the network both as an advisor to some of the researchers in Indonesia, Singapore and Malaysia, and as the designer of a spreadsheet used to calculate a variety of marriage indices for demographic and social analysis. The spreadsheet is regularly updated and can be found on Hull’s homepage.

Migration of Teachers from Pacific Island Countries
Siew-Ean Khoo, Robyn Iredale, Carmen Voigt-Graf (University of the South Pacific)
This is a Discovery project funded by the ARC for three years. The research objectives are to examine the outmigration of teachers from Pacific Island countries and its human resource implications for those countries. Small surveys of teachers, school principals and students at teachers colleges have been undertaken in Fiji, Cook Islands and Vanuatu to examine the patterns and prospects of teachers' migration and its implications for the education system. Exploratory surveys were also undertaken with Pacific Islander teachers in Australia and New Zealand.

Suicide in the Pacific Islands
Heather Booth
Research on changing patterns of suicide in several Pacific Island populations focuses on youth and gender. New data for Guam and Western Samoa provide added  evidence informing theoretical research.

Family Formation in Fiji
Heather Booth
Methods developed to give unbiased estimates of age at first marriage and age at first birth inform family formation patterns in Fiji by ethnicity and socio-economic status over the period 1986-1996. This research finds large differences in family formation according to women’s education among the Indian population, which is related to gender and cultural factors in an unbalanced marriage market.

The Demography of China

Determinants of Mortality Among the Oldest–old
Zhongwei Zhao and Heather Booth
This study investigates the determinants of changing major causes of death among old people, focussing on seasonality and environmental factors. Two major data sets are used. The first includes detailed health and mortality information of more than 10,000 people aged 80+ (including some 3,000 centenarians) collected by the Chinese Longitudinal Healthy Longevity Survey since 1998. The second dataset consists of more than half million records of deaths at age 65+ in other East Asian populations. Plans are to expand the coverage of this analysis to include Australian data.

Age Reporting Among the Oldest-old
Heather Booth and Zhongwei Zhao
Using CLHLS data on Chinese centenarians, nonagenarians and octogenarians, novel methods have been devised for the examination of age reporting at very old ages, and further research will be undertaken into age reporting and mortality patterns at the oldest ages. Comparison with Australia will increase knowledge of Australian mortality patterns.

Shanghai/China Mortality Project
Zhongwei Zhao
This is a Wellcome Trust funded research project and involved researchers from the Australian National University, University of Cambridge, Fudan University, and Shanghai Municipality Centre for Diseases Control and Prevention. The research team has computerised a large amount of mortality data collected over the period between 1956 and 2001. This project is designed to examine long-term mortality changes in Shanghai, and it particularly focuses on changes in causes of death and mortality patterns and their relationship with a number of socio-economic, demographic and environmental factors.

Hong Kong Mortality Project
Zhongwei Zhao
The project is funded by the Hong Kong government and jointly undertaken by researchers at the Australian National University and Hong Kong University of Science and Technology. It will analyse death records collected in Hong Kong since 1976. The project is similar to the Shanghai mortality study, but it also investigates the relationship between migration and mortality.

Reproductive Health

Gender and Sexual Health in Southeast Asia
Terence Hull, Iwu Utomo (ANU), Romeo Lee (De La Salle University, Manila), N. Dang Anh (Institute of Sociology, Hanoi), Wassana Im-Em (UNFPA, Bangkok) and Muhadjir Darwin (Gadjah Mada University, Yogyakarta)
This project has compiled and reviewed evidence of a variety of sexual behaviours thought to have important implications for male and female reproductive health in Indonesia, Vietnam, Thailand and the Philippines.  These behaviours include use of herbal and medicinal preparations to influence sexual relations, genital cutting (circumcision) of males and females, penis modifications (implants, adornments, injections), and the use of various sexual stimulants and astringents (eg. Tongkat putih in Indonesia).  Analysis of the social context and cultural content of these behaviours were guided by questions about current and potential gender relationships and their impact on reproductive health. This project was the precursor of project 3 on vaginal practices. A book is being prepared about the project results.

Using National Surveys to Uncover and Assess Potentially Harmful Sexual Practices in Southeast Asia
Terence Hull and Iwu Utomo (NCEPH)
This ARC funded project is based in NCEPH. Potentially harmful sexual practices including genital cutting, vaginal drying and penile implants are known to increase susceptibility to sexually transmitted infections, and are likely to shape patterns of gendered interactions disadvantageous to women. These practices have not been adequately documented in Southeast Asia. This project builds on the project 'Gender and Sexual Health in Southeast Asia' to develop standardised methods to assess prevalence of such practices in urban and rural areas and analyse demographic and socio-cultural characteristics of users. Outputs include questionnaire modules to gauge prevalence and characteristics in national health surveys, and analyses presented in journal articles, country monographs and a book.

Gender Dimensions of Vaginal Practices in Four Countries
Terence Hull and Iwu Utomo (NCEPH)
Sponsored by WHO, funded by Ford Foundation, Rockefeller Foundation, ARC and other donors working with the individual country teams. This multi-country study is being carried out in Indonesia, Mozambique, South Africa, and Thailand. Terence Hull is the Coordinator for the Asian studies and has worked on the design and management of the study from the outset. The project will be completed in the course of 2008, but will go on for a new phase dealing with microbicides and HIV.

It has collected and analysed information:

Integrating Gender and Reproductive Health Issues in the Indonesian National School Curricula: Challenges for Moslem Societies
Iwu Utomo (NCEPH), Peter McDonald, Terence Hull, Jamhari Makruf (University of Islam National Jakarta), Tati Hartimah (University of Islam National Jakarta) and Ilmi Idrus (Hassanudin University-South Sulawesi)

Despite new laws on human trafficking, citizenship and domestic violence in Indonesia, development does not yield equal benefits for women and men. An important new consideration is the rise of fundamentalist Islam and its impact on young people and the implementation of Syariah law restricting women's mobility in more than 56 districts in Indonesia. The formal education system provides an excellent opportunity to promote gender equality and reproductive health and rights among the rising generations. Integration of an understanding of gender equality into school curricula would directly address the inequitable values being supported by the conservative forces of fundamentalist religion and patriarchal value systems.

The expected outcome of this research will be gender-sensitive curriculum design materials that can be integrated into the national and local curricula for primary and secondary education.

More information on this study

The Demography of Iran

The Health and Social Consequences of Very Low Fertility and Early Cessation of Childbearing: The Case of Iran
Peter McDonald and M. Jalal Abbasi-Shavazi (University of Tehran)
Funded by the Wellcome Trust.
Fertility in Iran has reached a low level in recent years, and many women will have their last birth in their twenties. This study has addressed three main sets of questions.  First, what are the health implications of very low fertility and the early cessation of childbearing for Iranian women?  What are the appropriate health policies that the agencies responsible for the provision of family planning should employ to deal with this situation?  Second, because female education has risen dramatically in Iran, all of the children of many well-educated women in Iran will be at school by the time that their mothers are in their early thirties. The sets of questions addressed in this regard are: what are the aspirations of young women regarding marriage and parenting, including the timing of marriage and the first birth and the spacing of children?  How do these aspirations relate to their aspirations for education and employment, as well as to their personal values?  What are the social policy implications of an early cessation of childbearing for Iranian women who tend not to be engaged in the formal labour market?  Third, when fertility has reached below-replacement levels, as it has in a number of provinces of Iran, the policy question arises as to whether government family planning programs can be rolled back and, even more controversially, whether the government should be considering pronatalist policies.

Fertility Levels and Differences in the Islamic Republic of Iran
S. Philip Morgan (Duke University), M. Jalal Abbasi-Shavazi (University of Tehran) and Peter McDonald
In contemporary Iran, norms against having many children are observed and are more visible in low fertility regions. Norms against childlessness and one-child families are strong in all regions. As a result, the mean ideal/intended family size is low and the range narrow across provinces. The primary stated reasons for having children of low parities mirror those documented in other non-Muslim societies (i.e., they are for affective not economic reasons). Likewise, consistent with results elsewhere, stated reasons for not having high parity births include the cost of children and the desire to invest more heavily in the schooling of children already born. The project examines whether high Iranian provincial fertility (TFRs well above 2.0) results primarily from unwanted births and whether factors that compete with childbearing will reduce the likelihood that women will realise or exceed their intended family size.