The role of marital sexual abstinence in determining fertility: A study of the Yoruba in Nigeria

Summary Although sexual abstinence has probably been the single most important factor in restricting human fertility, Western researchers have tended to regard it as a phenomenon mostly found outside marriage. The research reported here was carried out amongst the Yoruba, a sub Saharan people, among whom it is more desirable in terms of social stability to practise female sexual abstinence mainly within marriage, rather than outside it. A similar situation is found widely in tropical Africa. Data are reported from five surveys carried out in 1973-75 in the Changing African Family and Nigerian Family Projects. Three types of marital abstinence are shown to have an effect in reducing fertility: post-natal abstinence (often wrongly described as a 'taboo'), terminal abstinence, and abstinence at other times. Female sexual abstinence is not paralleled by an equal practice of male abstinence, and the main reason for abstinence is to preserve long birth intervals and periods of lactation in a society prone to high rates of infant malnutrition and mortality. It is shown that the Index of Proportions Married (I ( m )) is only one of a number of fertility-weighted indices which can be employed to sub-divide the female reproductive span, and that a complete series of indices adding to unity can be constructed. The duration of lactation and abstinence are found to be related but, because abstinence is traditionally of longer duration, lactation amenorrhoea is of little importance in containing fertility. Married women spend less than half their reproductive lives in periods when sexual relations are possible and marital abstinence is between three and four times more important than delayed marriage in restricting fertility. The period of abstinence is shown to be changing and it is probable that it has never been of an agreed length; the concept of 'natural fertility' is examined in this light. The partial substitution of contraception for the abstinence period is analysed, and the possible effect on fertility considered.

Determinants of rural-urban migration in Ghana

Abstract In the 39 years between the 1921 and 1960 censuses, urban population in Ghana multiplied by nine while the population of the whole country only trebled. The major factor in urban growth was rural-urban migration and the reproduction of the migrants. In 1963 a survey consisting of a systematic sample of households in 45 rural centres, randomly chosen in Local Authority Areas selected in accord with the regional rural population distribution, reconstituted the rural population so as to include current migrants in the towns as well as those remaining in rural areas. For analysis 13,748 respondents were divided into 14 categories by ruralurban migration behaviour. At the same time a survey of urban population provided a check on rural-urban migration data. study of the propensity to migrate from rural to urban areas shows that this increases with the closeness of the rural area to a large town, the population size of the rural centre, the economic well-being of the rural household, the number of relatives already in the urban area, the individual's level of education, larger family size and probably lower birth rank, as well as exhibiting specific age and sex patterns. It is shown that only a minor role is played by occupation, conjugal condition and number of dependants. Various interrelations between these factors are discussed, and attention is given to the special importance of education in partially or wholly determining some of the other factors. Census data are used to demonstrate the effect of rural-urban migration in concentrating persons with certain characteristics in the urban areas.

The erosion of the family: A study of the fate of the family in Ghana

Abstract In Ghana, as in other developing countries, it has been held that one cultural element acting towards the maintenance of high fertility has been the awareness that large families do more than small ones to ensure assistance to parents during sickness and especially during old age. The only experience known to the society of the fortunes of those in the latter condition is necessarily that of those who are already old and need such assistance. During 1963-64 a survey of 800 retired persons over 60 years of age was made in Ghana. Respondents of each sex were randomly selected within the urban southern rural and northern rural areas of the country. An examination was made of the effects of mortality and other factors in reducing the amount of possible assistance given by their children below the potential maximum determined by the original level of births. Differentials in fertility by area of present residence were discovered. It was shown that, although the average number of children supporting aged parents is greater in the case of large families, the extent of the assistance is not proportional to original family size, because of differentials in mortality, the chances of survivors reaching adulthood by their parents' old age, and the chances of adult survivors being able or willing to give such assistance. Only families who had between one and four children presented their parents with any considerable risk of receiving no help from their children. It was shown that there are grounds for conflict between the need for maximising assistance by having as many children as possible and by educating as many as possible. It was also shown that there is little evidence that parents consciously make such decisions in order to create an individual 'social welfare' system in that an extension of the state social welfare system would not, according to respondents, do much to change their views about desired family size.

Heart failure, diastolic dysfunction and atrial fibrillation; mechanistic insight of a complex inter-relationship

Atrial fibrillation (AF) and heart failure (HF) commonly coexist, and their co-presence is associated with adverse outcomes relating to thromboembolic events, HF progression, hospitalisation and death. Diastolic dysfunction (DD) is also frequently present in patients with HF and is an independent predictor of hospitalisation and mortality. The presence of DD is a strong predictor of incident AF in patients with HF. In this review, we provide mechanistic insight into pathophysiological processes that frequently promote the occurrence of AF, HF and DD and outline the yin-yang relationship between AF, DD and HF. More recently, invasive studies have also shown that asymptomatic paroxysmal atrial fibrillation (PAF) is a common phenomenon in HF patients. We examine complex inter-relationships between PAF, HF and DD and speculate upon the possible clinical influence of undiagnosed PAF in HF patients.

Evaluation of two different metabolic hypotheses for dichloromethane toxicity using physiologically based pharmacokinetic modeling for in vivo inhalation gas uptake data exposure in female B6C3F1 mice

Dichloromethane (DCM, methylene chloride) is a lipophilic volatile compound readily absorbed and then metabolized to several metabolites that may lead to chronic toxicity in different target organs. Physiologically based pharmacokinetic (PBPK) models are useful tools for calculation of internal and target organ doses of parent compound and metabolites. PBPK models, coupled with in vivo inhalation gas-uptake data, can be useful to estimate total metabolism. Previously, such an approach was used to make predictions regarding the metabolism and to make subsequent inferences of DCM's mode of action for toxicity. However, current evidence warrants re-examination of this approach. The goal of this work was to examine two different hypotheses for DCM metabolism in mice. One hypothesis describes two metabolic pathways: one involving cytochrome P450 2E1 (CYP2E1) and a second glutathione (GSH). The second metabolic hypothesis describes only one pathway mediated by CYP2E1 that includes multiple binding sites. The results of our analysis show that the in vivo gas-uptake data fit both hypotheses well and the traditional analysis of the chamber concentration data is not sufficient to distinguish between them. Gas-uptake data were re-analyzed by construction of a velocity plot as a function of increasing DCM initial concentration. The velocity (slope) analysis revealed that there are two substantially different phases in velocity, one rate for lower exposures and a different rate for higher exposures. The concept of a "metabolic switch," namely that due to conformational changes in the enzyme after one site is occupied - a different metabolic rate is seen - is also consistent with the experimental data. Our analyses raise questions concerning the importance of GSH metabolism for DCM. Recent research results also question the importance of this pathway in the toxicity of DCM. GSH-related DNA adducts were not formed after in vivo DCM exposure in mice and DCM-induced DNA damage has been detected in human lung cultures without GSH metabolism. In summary, a revised/updated metabolic hypothesis for DCM has been examined using in vivo inhalation data in mice combined with PBPK modeling that is consistent with up-to-date models of the active site for CYP2E1 and suggests that this pathway is the major metabolizing pathway for DCM metabolism.

Demographers and the study of mortality: scope, perspectives, and theory

Demographers have for a long time adopted an empirical approach to the study of the levels and trends of mortality, fertility, and population size. They depend for their analyses on data, usually collected until recent times by government and often for other purposes. Modern demography had its origins in Britain in the second half of the seventeenth century. The major focus of demographers has usually been on mortality, although fertility studies predominated in the 1960s and 1970s. Mortality decline in the West only became certain in the late nineteenth century. Until the 1960s the fastest mortality declines were for the young, but an unheralded mortality decline among the old thereafter became important. The world, especially in economically advanced countries, is faced with an increasingly high proportion of old people, explained largely, not by mortality decline, but by fertility decline. Explanations for the mortality transition place different emphases on the role of modern medicine, better nutrition, and behavioral and social change, particularly rising levels of education. Even among the old, at least until 85 years of age, there are wide differentials in mortality by educational level. Analysts have divided the mortality transition into stages: (1) high, pretransitional mortality, (2) early transitional mortality with the decline explained by the conquest of infectious disease, and (3) late transitional mortality largely attributable to degenerative disease. Some have now added stage (4), the reduction or delay in death from degenerative causes. Attempts have been made to effect the convergence of demographic and epidemiological approaches to the analysis of mortality, and they have been more successful in the case of medical demographic than in social demographic approaches.

Fertility trends and prospects in Australia and other industrialised countries

Marital fertility in Australia has been falling, with occasional halts and reversals, for a century. The trend in overall fertility has been rendered more complex by changes in marriage patterns. The original fertility decline may not have been triggered by a mortality decline but instead may have initiated one. The paper analyses the unprecedentedly steep fall in fertility after 1971 and the reversal from the mid-1970s of marriage trends which was so sudden as to wipe out in three years the entire movement towards younger marriage over the preceding thirty years. Fertility and fertility control trends are compared with other industrialised countries, and prospects for future natural increase and immigration are assessed.

Evaluating the health significance of hazardous air pollutants using monitoring data

OBJECTIVE

Though many contaminants are released into the atmosphere, in the US only six air pollutants-ozone, particulate matter, sulfur dioxide, carbon monoxide, nitrogen dioxide, and lead-are closely monitored and carefully assessed for health significance. Other pollutants, even if highly toxic, are neither widely monitored nor routinely assessed at the national level. The goal of this study was to analyze the availability of information needed to characterize the health significance of hazardous air pollutants, focusing on urban areas in California.

METHODS

The authors compared different approaches to identifying which contaminants should be considered hazardous air pollutants of potential health concern; reviewed the availability of toxicity values for these pollutants; and analyzed the usefulness of air monitoring data from California agencies for determining populations risks, by comparing method detection limits with health benchmarks.

RESULTS

Approaches to identifying air contaminants of possible health concern differ. Toxicity values are not available for many hazardous air pollutants, including those identified in the Clean Air Act. In California, monitoring data are available for many, though not all, pollutants of concern. Monitoring methods for several pollutants do not have adequate sensitivity to detect all relevant concentrations.

CONCLUSION

The information necessary to fully assess the health significance of hazardous air pollutants is not currently available.

Evaluating the health significance of hazardous air pollutants using monitoring data

OBJECTIVE

Though many contaminants are released into the atmosphere, in the US only six air pollutants-ozone, particulate matter, sulfur dioxide, carbon monoxide, nitrogen dioxide, and lead-are closely monitored and carefully assessed for health significance. Other pollutants, even if highly toxic, are neither widely monitored nor routinely assessed at the national level. The goal of this study was to analyze the availability of information needed to characterize the health significance of hazardous air pollutants, focusing on urban areas in California.

METHODS

The authors compared different approaches to identifying which contaminants should be considered hazardous air pollutants of potential health concern; reviewed the availability of toxicity values for these pollutants; and analyzed the usefulness of air monitoring data from California agencies for determining populations risks, by comparing method detection limits with health benchmarks.

RESULTS

Approaches to identifying air contaminants of possible health concern differ. Toxicity values are not available for many hazardous air pollutants, including those identified in the Clean Air Act. In California, monitoring data are available for many, though not all, pollutants of concern. Monitoring methods for several pollutants do not have adequate sensitivity to detect all relevant concentrations.

CONCLUSION

The information necessary to fully assess the health significance of hazardous air pollutants is not currently available.

Air toxics and health risks in California: the public health implications of outdoor concentrations

Of the 188 hazardous air pollutants (HAPs) listed in the Clean Air Act, only a handful have information on human health effects, derived primarily from animal and occupational studies. Lack of consistent monitoring data on ambient air toxics makes it difficult to assess the extent of low-level, chronic, ambient exposures to HAPs that could affect human health, and limits attempts to prioritize and evaluate policy initiatives for emissions reduction. Modeled outdoor HAP concentration estimates from the U.S. Environmental Protection Agency's Cumulative Exposure Project were used to characterize the extent of the air toxics problem in California for the base year of 1990. These air toxics concentration estimates were used with chronic toxicity data to estimate cancer and noncancer hazards for individual HAPs and the risks posed by multiple pollutants. Although hazardous air pollutants are ubiquitous in the environment, potential cancer and noncancer health hazards posed by ambient exposures are geographically concentrated in three urbanized areas and in a few rural counties. This analysis estimated a median excess individual cancer risk of 2.7E-4 for all air toxics concentrations and 8600 excess lifetime cancer cases, 70% of which were attributable to four pollutants: polycyclic organic matter, 1,3 butadiene, formaldehyde, and benzene. For noncancer effects, the analysis estimated a total hazard index representing the combined effect of all HAPs considered. Each pollutant contributes to the index a ratio of estimated concentration to reference concentration. The median value of the index across census tracts was 17, due primarily to acrolein and chromium concentration estimates. On average, HAP concentrations and cancer and noncancer health risks originate mostly from area and mobile source emissions, although there are several locations in the state where point sources account for a large portion of estimated concentrations and health risks. Risk estimates from this study can provide guidance for prioritizing research, monitoring, and regulatory intervention activities to reduce potential hazards to the general population. Improved ambient monitoring efforts can help clarify uncertainties inherent in this analysis.

The construction of adolescence in a changing world: implications for sexuality, reproduction, and marriage

This article aims to show how the period now known as adolescence came into being and how it was shaped by international economic, institutional, and social influences. It considers premodern societies and argues that traditional culture has shaped contemporary adolescence even more than has global society. Explanations are offered for the enormous differences across the world in adolescent sexuality, reproduction, and marriage. The data are drawn mainly from research programs in Nigeria, Sri Lanka, India, and Bangladesh, and comparisons are made with other countries.

Application of health information to hazardous air pollutants modeled in EPA's Cumulative Exposure Project

Relatively little is known about the spectrum of health effects, and the scope and level of ambient air concentrations of those pollutants regulated under the Clean Air Act as "hazardous air pollutants". The U.S. Environmental Protection Agency's (USEPA) Cumulative Exposure Project uses currently available emissions inventories, from a variety of source types, and an atmospheric dispersion model to provide estimates of ambient concentrations for 148 hazardous air pollutants (HAPs) in over 60,000 census tracts for the year 1990. This paper uses currently available hazard information for those pollutants and provides a database of potential regulatory threshold concentrations of concern, or "benchmark concentrations," and a methodology for prioritizing and characterizing the quality of the data. In order to demonstrate application of the database and prioritization scheme to outputs from the Cumulative Exposure Project, comparisons were made with the maximum modeled concentration of each individual hazardous air pollutant across the census tracts. Of the 197 benchmark concentrations for cancer and non-cancer (long- and short-term exposures) effects compiled for the study, approximately one half were exceeded with a predominance of exceedance of cancer benchmarks. While the number of benchmark concentrations available to fully characterize potential health effects of these pollutants was limited (approximately 80 percent of HAPs identified as cancer concerns had benchmark concentrations for cancer and 50 percent of all HAPs had non-cancer benchmark concentrations) and there was greater uncertainty in derivation of maximum modeled air concentrations than other levels, the comparison between the two was a useful approach for providing an indication of public health concern from hazardous air pollutants.

Male and female circumcision in Africa from a regional to a specific Nigerian examination

There is a strong relationship between male and female circumcision in traditional thought and, north of the equator, in their practice by ethnic groups. The Southwest Nigeria Study, a 1994-95 survey of 1749 males and 1976 females in Nigeria's Ondo, Oyo and Lagos States, is used to examine contemporary levels of circumcision, reasons for carrying out the practice, and the circumstances of the circumcision operations. These findings are compared with earlier southwest Nigerian and West African studies. The persistence of the practices is confirmed, but rapid change towards their medicalization is also established. Possible links with AIDS are discussed.

Perceived male sexual needs and male sexual behaviour in southwest Nigeria

Part of a research programme studying methods of combating the AIDS epidemic was a survey and accompanying qualitative research focused on attitudes toward male sexuality and male sexual behaviour outside marriage and the extent and success of female attempts to control it. A survey of 1749 males and 1976 females was conducted in urban and rural populations in three states of southwest Nigeria. The majority of the community believes that males are by nature sexually polygynous, although about half the community believes that male sexuality can and should be confined to marriage. These beliefs arise out of the nature of the traditional society and are being changed by new ways of life, education and imported religions. Nevertheless, sufficiently rapid change is unlikely, even if promoted by government, to successfully combat a major AIDS epidemic, and the major strategy should attempt to reduce the rate of transmission, especially in high-risk relationships.

The African AIDS epidemic

In parts of sub-Saharan Africa, nearly 25 percent of the population is HIV-positive as a result of heterosexual transmission of the virus. Could lack of circumcision make men in this region particularly susceptible?

Cell recruitment to the sperm granuloma which follows vasectomy in the rat

Sperm granulomas are chronic inflammatory lesions at sites of extravasation of spermatozoa from the reproductive tract. Using light and transmission electron microscopy, monocytes were identified in the wall of the early granuloma of the vasectomized rat. Some young macrophages contained sperm fragments and scanning electron microscopy showed them to wrap around, and partially engulf, spermatozoa. T-lymphocytes predominated over B-lymphocytes in the granuloma wall, helper cells being more numerous than suppressor/cytotoxic cells. The percentage of lymphocytes of all classes among the cells of the granuloma wall was higher at 3 months than at 3 weeks and 6 months after vasectomy, reflecting the high immunological activity known to occur at this interval after vasectomy in the rat.

The dangerousness of persons with the Othello syndrome

The Othello syndrome, or delusional jealousy, often raises significant forensic issues, particularly dangerousness. Dangerous patients suffering from the Othello delusion may present with hostility ranging from verbal threats to homicidal acts. We present three cases of individuals suffering from Othello syndrome associated with significant hostility and organic mental factors. We analyze these cases along with Othello syndrome cases culled from the recent anglophonic literature, especially in terms of implications for domestic and public safety.

African women's control over their sexuality in an era of AIDS. A study of the Yoruba of Nigeria

Very limited knowledge is available about African women's control over their sexual relations with husbands or other stable partners in situations where there is a high risk of STDs and HIV/AIDS. Such control must be seen as encompassing women's control over their sexuality and reproduction as well as the broader areas over which they can make decisions. The paper examines other research findings in sub-Saharan Africa, and then reports a study carried out by survey and anthropological methodologies among the Yoruba people in Ado-Ekiti, a town in southwestern Nigeria. Because the AIDS epidemic is still at an early stage in Nigeria and because of the relation of STD infection to HIV-transmission, as well as the probability that the behaviour developed for limiting STD transmission will subsequently be employed to limit HIV transmission, the study focused on STDs. Yoruba women have a considerable ability to refuse sexual relations for a limited time, and they are placed at greater risk of STD infection by their ignorance of whether their partner is infected than by a lack of ability to control the situation when STDs have been identified. This ability may be more limited in the case of AIDS because of its longer duration.

Health transition: the cultural, social and behavioural determinants of health in the Third World

The paper defines 'health transition' and outlines the development of recent research programmes. Evidence is reviewed as to the cultural, social and behavioural determinants of health in the Third World, and the extent to which they interact with the provision of health services in reducing mortality. Specific attention is given to the impact on mortality of education, and the historic experience of the now developed countries is compared with contemporary developing countries. Consideration is also given to the role of cultural factors and to radicalism, egalitarianism and the role of women in traditional society as well as fertility control and various forms of deleterious behaviour in contemporary society. The extent to which all these changes are facets of a single social transformation is discussed. Finally, the future of health transition research and its value for planned health interventions are summarized.

Diffusion and focus in sexual networking: identifying partners and partners' partners

This article describes the second stage of a research project on sexual networking that aims to further understanding of the spread of sexually transmitted diseases and HIV/AIDS in Ondo State, Nigeria. A sample of 488 males aged 15-50 were interviewed in depth to ascertain (1) the numbers and characteristics of their sexual partners, (2) the numbers and characteristics of the partners of those partners, and (3) the extent to which these relationships were commercial. In addition, a census was taken of all commercial sex establishments in order to estimate the numbers of their clients. The results show that male (and female) sexual networking is extensive, that in most nonmarital relationships men do not have accurate knowledge of their partners' partners, and that detailed questioning provides a reasonably accurate picture of the number of these relationships that are commercial in nature. The situation revealed was one of sexual diffusion rather than one with a strong focus on commercial sex workers, which fits the model of a slowly increasing HIV/AIDS epidemic rather than an explosive one.

What does the Matlab fertility experience really show?

The family planning program in the Matlab District of Bangladesh has been described in unique detail for more than 25 years and is regarded as a model for equally poor parts of the world. Its experience has been reported as showing the ineffectiveness of contraceptive saturation approaches and the prime importance of program management and especially of the selection of a special type of family planning household visitor, criteria that render family planning programs relatively expensive. This reanalysis of the Matlab experience suggests that there is inadequate evidence from which to judge the record of the saturation experiment and of family planning workers from less highly selected backgrounds. It is also argued here that the role of contraceptive choice and of access to different types of contraceptives, especially injectables, delivered to the door in this society of secluded women has been underestimated, and that too little importance has been attributed to demand in contrast to supply. While it is agreed that the Matlab demonstration has been of central importance in showing that fertility can be reduced in Bangladesh, it is argued that many developing countries can draw on this experience to provide less costly family planning programs with less emphasis on the managerial, top-down approach.

Underreaction to AIDS in Sub-Saharan Africa

In those parts of Sub-Saharan Africa most affected by the HIV/AIDS epidemic both public and private reaction to the seriousness of the epidemic have been less than might have been anticipated. This limited reaction weakens national, community and family responses to the epidemic and also reduces the pressure on international donors to provide adequate support. The paper first examines the reasons for underreaction by governments. These reasons include an assessment that successes will not be easily achieved, a reluctance to give leadership in areas of private sensitivity, an awareness of the fragility of the data base, a persistent feeling that it is a disease of foreign origin with a foreign overreaction to the situation in Africa, and the nature of the disease itself with a long latency period, obscure symptoms and an urban bias. Nevertheless, the paper argues that the more fundamental underreaction, shaping the reactions of governments, is that from the community itself. This arises partly from the demonstration that it is a sexually transmitted disease in societies where the discussion of sexual relations between the generations and the sexes has always been difficult and where new religions have in some societies reinforced older attitudes towards the shame of being discovered to have had illicit relationships. However, the main reasons lie in continuing aspects of the cultures which emphasize the multiple antecedents of misfortune and plural explanations of death, an element of predestination in when death takes place, a concept of good fortune--sometimes arising from or demonstrated by sexual activity--which renders misadventure unlikely, and a courage when facing death which is partly attributable to belief about survival beyond this event.

The impact of family and budget structure on health treatment in Nigeria

Health-treatment decisions, in much of the world, are affected by the family's ability to meet the cost. In West Africa the situation is more complex because husbands and wives typically have separate budgets. This article reports an exploration of the impact on treatment of divided family budgets in Nigeria where health services now charge for prescribed drugs. It was found that most child treatment is paid for by one person only, usually a parent, and that the treatment chosen is decided by the person meeting the cost. Mothers are most likely to pay for minor illnesses but the father's role becomes more important as the cost rises. Because the type, and even fact, of treatment depends on the ability to pay, and because the family is not a unity in these decisions, the health system may have to devise charging procedures that make both parents responsible, possibly with community involvement in securing payment.

What have we learnt about the cultural, social and behavioural determinants of health? From selected readings to the first Health Transition Workshop

The article explores the issue of whether the holding of an international workshop in Canberra in 1989, and the preparation of papers for it, increased our knowledge of the cultural, social and behavioural determinants of health and whether the publication of the proceedings placed new knowledge in the public domain. The approach adopted is to compare those proceedings with a collection of selected readings on the subject made shortly before as part of the same program and also with certain other publications. The conclusions reached are that, in addition to having stimulated interest in the field, the workshop and its proceedings furthered knowledge in at least five important areas: (1) the existence of mortality-prone households; (2) the impact of differing cultural situations of women in terms of individualism on their children's survival; (3) the mechanisms whereby maternal education is translated into child survival; (4) the impact of culture and ethnicity on mortality; and (5) indirect indices of the impact of care. The workshop failed to contribute to substantial advances (or draw attention to the lack of advance) in the following areas: (1) the measurement of Third World morbidity or health; (2) adult health transition; (3) the impact of radicalism or egalitarianism in communities other than Kerala and Sri Lanka on mortality; (4) the impact of lifestyle diseases on Third World mortality; (5) the identification of economically optimum mixes of social change and the provision of health services in reducing mortality and improving health; and (6) the employment of health transition knowledge in the reduction of mortality and the improvement of health.

Sexual networking in the Ekiti district of Nigeria

The confirmation of a significant number of HIV-positive persons and some deaths due to AIDS in Nigeria has rendered more urgent the study of sexual networking, both for an understanding of the risk of HIV transmission and also that of sexually transmitted diseases, which may serve as a vehicle for HIV infection. This article reports on a research project that concentrated initially on developing both small-scale survey and anthropological methodology to a point where reliable information was obtained. The research was carried out in both urban and rural areas of Ekiti, Nigeria, a Yoruba district 150 miles northeast of Lagos. Findings are reported from both the survey of 200 men and 200 women and the supplementary specialized in-depth studies. A high level of premarital and extramarital sexual activity was shown to exist, with higher levels among men than women and in urban than rural areas. Most female extramarital relations in rural areas were occasioned by the need for material or economic assistance and were highest among the younger wives in polygynous marriages. Male extramarital relations were highest in monogamous marriages and were frequently explained by wives' periods of postpartum sexual abstinence. Polygyny and postpartum sexual abstinence were underlying social institutions that explained much of the sexual networking. Reported levels of sexually transmitted disease were high, as were beliefs that these disease could be treated successfully by traditional healers.

Why is health relatively poor on Sri Lanka's tea estates?

The mountainous interior of Sri Lanka is one of the world's great tea-producing areas. The labour force on the tea estates consists of a population which has migrated from Tamil Nadu, in southern India, over the last one hundred years. This migrant population is known as 'Indian Tamils' and is largely drawn from the two largest Harijan castes of agricultural labourers in Tamil Nadu. On the now government owned estates, they have formed a kind of industrial proletariat, living in long estate line housing where each family has one or two rooms. The women, who are the tea pickers, work longer hours than do the men. The Indian Tamils have been characterized by markedly higher mortality than the indigenous population (Sinhalese, Sri Lankan Tamils and Moors). This paper reports a research program which was carried out in 1987 and which employed both anthropological and demographic survey techniques in an attempt to explain these higher mortality levels. The research identified the origins of higher mortality, both in limited access to health provision and in the social characteristics and economic circumstances of the community.

Changing population rates, policies and attitudes in Africa, the Middle East and South Asia

This paper explores the relationship between population growth rates, government policies, and social attitudes in 3 regions: Africa, the Middle East, and South Asia. The comparative success of family planning programs in certain countries of South Asia (most notably India and Sri Lanka) can be partly ascribed to their long tradition of government leadership. In addition, families in those countries have strong incentives to educate their children. On the other hand, in North Africa and the Middle East, high levels of urbanization have had antinatalist effects, which are offset by very low levels of girls' schooling and of female employment outside the home. In Sub-Saharan Africa, high fertility is sustained by the structure of the family, with its tendency to separate reproductive decision-making from responsibility for child-rearing. In addition, governments there have had a comparatively weaker tradition in areas such as family behavior.

Is the Asian family planning program model suited to Africa?

This paper examines four Asian countries where fertility declines between the early 1960s and early 1980s ranged from 29 to 57 percent and contrasts their situations with seven African countries where fertility either remained constant or rose. It is shown that the difference is not explained by the African countries being at an earlier stage of socioeconomic development nor by the failure to provide family planning programs. The explanation is a lack of African demand for limiting family size, the result of family structures and economies quite different from Asia, and of essentially religious attitudes toward fertility that have an impact both on family economics and the acceptability of various forms of fertility control. These attitudes, together with the nature of the African state, mean that governments could not implement the forceful family planning policies that have at times characterized the programs of China, India, and Indonesia.